Looks like it's been a while since I posted here so it's time for an update. My previously unaccepting wife has now come around to accepting that my transition is inevitable, for the better, and will start soon. A couple weeks ago I was offered by my PCP at the VA to start HRT. However, I pay a co-pay there and have great private insurance so my private insurance PCP (separate from that at the VA) has referred me to an endocrinologist who I will meet with this Friday. Hopefully, that will go smoothly and I will be able to start HRT with my private insurance (which does cover it with no co-pay if prescribed in 90 day fills). If there is any slow walking of starting HRT through this endocrinologist I will just message my VA PCP to start HRT through the VA (co-pay is $5/month per prescription).
Next up is an appointment with a urologist to revisit scheduling an orchiectomy. I have a separate diagnosis regarding chronic testicular pain so hope this will help fast track this now that I will be on HRT and the orchiectomy would also remove the need for taking spironolactone.
Then in August I have an appointment to consult on vulvoplasty (minimal depth vaginoplasty). I hope to go this route as soon as insurance approves (most likely after 1 year of HRT). I already have met with psychologist and have letters lined up through him and his colleague.
I'm excited about finally getting this journey started after all the years of delay.