I always went the informed consent route, which made things super easy. The doc tells you a bit about what effects you might potentially have from the meds, they have you sign some papers, and get your blood drawn to check your baseline levels and make sure you don't have anything wacky going on. If you're lucky, you might head out the door with a prescription. If you're unlucky, you'll be asked to come back after results or maybe just given low dose spiro to start.

The biggest difference is what meds you're given. Most docs I've been to have preferred estradiol pills and spironolactone. Pills are annoying (have to absorb them, not swallow, 2-3 times a day) and spiro fuckin sucks. If you can avoid spiro by either taking a different t-blocker or doing monotherapy, you can save yourself some hassle. Unless you or your partner is into omorashi - then spiro is great!

Some docs prefer patches. Patches are neat, but a little weird to keep on while showering. They come as either nice tiny discreet transparent films, or awful big bulky irritating patches that are the worst thing ever.

Injections are fucking dope if you are okay with needles. Idk if they give them to people starting hormones, but it's nice not needing a t-blocker, and instead just jabbing yourself in the thigh once a week. Eventually adding progesterone properly administered supposedly helps with booba. Anecdotally, I do prog and have nice ones.

I started on the good patches + spiro about 12 years ago, moved to the bad patches when I lost my insurance, did pills+spiro for many years, switched to cyproterone as a t-blocker (much better t-blocker, may cause brain tumors), and finally EV injections + progesterone, so I feel like I have a pretty decent grasp of different estrogen delivery methods.