09/16/2026
I'm really doing my best, but I ran some analytics on my average patient email message.
2,406 words 13,083 characters
This is a 5 page single spaced essay.
I'm really sorry, but I literally cannot do this anymore. Not due to a lack of wanting to do it, I am trying, but there are simply not enough hours in the day or spoons left in my body to work this hard.
I'm currently trying to see enough patients to keep this practice afloat while we pay the absurd "trans tax" that is malpractice and legal costs that allow us to remain the literally last standing bastion for trans teens in the midwest. If we shut down, they can just take a short walk over to Philadelphia which is the next closest location.
I have just repeatedly worked myself into collapsing health over the past 2 years in an effort to not bend the knee as there was simply no other way to do it. I keep hoping that posts like this will change the dynamic of how patients message me, that people will care or understand my reality, but what instead happens is I get an email that says the following
PatientName
Subject: Deprioritize this, I know you are crazy busy and massively overwhelmed trying to care for all of us.
Message: 5 page essay on the nature of gender dysphoria and 27 questions about whether or not they are a "true transgender" or some other absolutely esoteric nonsense, or basically asking me to be an emergency therapist via text, or be a specialist in a specialty I'm not a specialist in, or to explain to them in great detail all the molecular biochemistry behind exactly why I am going to be doing the treatment I am doing for PFS/PSSD of which I routinely post about on my subreddit for the benefit of the patients (10,000+ unique people per DAY and 5 million plus pageviews per year at this point)I will never ever see but whom don't have a Dr. Powers to give a s**t about them.
But because they poured their heart out or had these super important questions and need me to explain exactly why I replicate an Estrone to Estradiol ratio of 3:1 to 5:1 throughout early transition, I answer them. Because I feel like it is my duty to do so. I owe them that, because I agreed to be their doctor.
But in reality, there are not enough hours in the day. I worked an entire day of patient care today, and I've been at email messages for the past 4 hours, and I have 61 more that have come in since. I literally cannot answer them fast enough.
And no, they can't just "make appointments" as these people are seeking care for incredibly rare things such that they fly in for a single visit, and I manage their incredibly rare thing remotely as there is no other legal way for me do to this.
There is no alternative to me. If you have some incredibly rare genetic mutation that made you trans and is screwing up your transition results, there is not another doctor on earth who can go through your genome, analyze it, find the glitch, and figure out a workaround by giving you some esoteric estrogen-like molecule to resume things for you. 20 years of PFS and PSSD research went by with zero meaningful clinical improvement. I decided to do for them what I did for my trans patients and solved the mechanism of these incredibly bizarre and previously "psychogenic" conditions which now have real genetic markers and anomalous lab test patterns that 20 years of formal researchers couldn't manage to figure out. Now, my patients are getting better, and talking about it online, which just makes the demand even more astronomical.
They cannot go anywhere else. They have no other option. They cannot just "make an appointment" as they have to email.
Please, I am begging you, this is my last attempt to try and rationalize with my patients about this stuff. If I cannot get this under control by the end of this year, I'm simply just not going to do it anymore. At all. I cannot sustain this, it is not humanly possible. I will cut DPC down to a tiny fraction of what it is now and charge vastly more, because the only other option is to boot hundreds of trans teenagers who also have ZERO other place to go besides my clinic and I refuse to do that.
You want to "Save trans kids" then please god have some mercy on me with these patient messages. I am not an AI, I am too autistic to not feel a deep commitment to answer every obscure question, and I am just literally one guy doing his best on 3 rare medical conditions. If this doesn't improve soon, I am throwing in the towel on this as I physically and mentally cannot sustain it any longer.
- Dr Powers
PS: Literally, as an example of the absurdity of my situation, in the 10 minutes it took me to write this, I got 5 more emails. One is attached below (censored) from someone getting frustrated that the email they sent sunday afternoon is not yet replied to, as there are yet about 30 more emails from over the weekend to get to before reaching theirs.
The worst is when patients literally get mad, reply to their own email, bumping their thread to the end of the line because they just made it the most recent email in my inbox, then after days, flip out they weren't answered after sending 4 emails over 4 days. I love that.
Why am I behind on answering weekend emails? Because I didn't spend 8 hours working on emails on Saturday and Sunday like always, because I was prepping and hosting a charity event in my clinic parking lot to try and raise funds for the most indigent and desperate people that come to our clinic, and help prevent their homelessness every brutal Michigan winter that comes. So because I did that, people are upset that the email they sent didn't get an instant reply like always.
I'm sorry, I cannot do this anymore, I just can't.
