Transfem

honestly same, I have needle phobia, e.g. I nearly pass out when getting blood drawn and I wasn't sure I would ever be able to actually mentally put a needle into my body.

But I learned ways to make it work - I inject subcutaneously instead of IM, so I use tiny needles that usually cause no pain at all. I learned a ton of different tricks to make injecting mentally doable for me and to reduce chances of passing out, and safe in case I do pass out. (Let me know if you want me to share those with you, I have a whole write-up about it.)

I won't lie - it was difficult for me at first. But it also got much easier than I ever thought it would, and now it's pretty much trivial.

I still decided injecting was worth it compared to other methods, and I stand by that in my results. I have had better feminization than trans women I know IRL who started HRT around the same time who just use pills.

My endo agrees that pills are a terrible way to take estrogen, she points out that they cause massive spikes and dips throughout the day rather than maintaining a steady blood level. Also, like 80% of the estrogen is eliminated by the liver and doesn't get into the blood-stream, so it's just inefficient and an unnecessary tax on your liver (though I don't think bioidentical oral estrogen is particularly risky, either).

EDIT: if not pills or injections, transdermal is an option, but I consider it a better option post surgery, since I found I needed higher doses when I still had testes. In the U.S. you generally have to be on HRT for a year before they'll do an orchiectomy (I wanted one immediately, but was gatekept for a year, and I got an orchi ASAP - literally within weeks of my 1 year HRT anniversary, highly recommend it - was great).

Bicalutamide didn't work for me as an anti-androgen, I suspect because it has weak impact on the central nervous system and wasn't blocking biochemical dysphoria in my brain, which was the main reason I personally was on HRT.

I never tried spiro but didn't even want to try, it's a very weak anti-androgen and has side effects and some risks, I just never thought it was a good idea when monotherapy was an option, which is easier with injections and not as feasible or reliable with transdermal routes (patches, gel).

There's also gel and patches. Take your pick :3

Yeah, I'm only going to be on the insurance plan for about a year more at most, so it's not like it's going to be forever. For primary care? I think the last time I visited a primary physician was like 12 years ago when I was 12. Haven't really needed to and haven't gotten sick aside from the occasional cold.

I do plan on moving eventually as well, I'll have to relocate for this job, but that could be in a few months or take up to a year, government being government. I have friends who are trans and they are also looking at moving.