Providing HRT shouldn't be specialty care. It's not really that complicated. A primary care provider can get the necessary info in like an hour of reading.
Unless you have an unusual endocrine situation, anyone who says it's particularly challenging either is misinformed or has a gatekeepy agenda.
Heck, trans people have been doing it DIY using grey market pharmacies for ages.
What most (US) providers do:
-stick you on a low to medium dose of oral/sublingual estradiol and spironolactone, usually one after the other (better to start with e though).
-check liver function
-iterate dose based on tested hormone levels and how you subjectively feel
-if you can't get where you want on sublingual estradiol, switch you to patches or injections
-give progesterone if you specifically ask for it.
@starkatt my initial doctor didn't do sublingual, interestingly, and wouldn't give me progesterone
