[flamesabers]

So, how do you do go about having the conversation?  Just say I'm a guy but want breasts?  Maybe it's the environment I've been in for the last 25 years, but I figure that's bound to raise eyebrows more than being transgender.

That's a very good question. 

For me, I booked my first HRT appointment through the Planned Parenthood website, so it wasn't like I had to explain myself to someone over the phone initially. Once I saw a doctor, she asked some questions to establish my health history. Eventually the doctor's question about HRT came up (since that was the purpose of my visit), and I explained I'm transgender and I want to transition.

As far as I know, with the informed consent model, the doctor will prescribe you HRT so long as 

• You don't have any physical health risks that might be exacerbated by HRT
  
• You understand the risks/changes of being on HRT
  

Assuming you meet both criteria, you should get an HRT prescription. With communicating your intentions with the doctor, perhaps you could focus on more on wanting your own breasts (and less about being a guy)? Ideally your doctor won't be judgmental or skeptical of you. With me, I didn't feel like I was being put on trial or anything, it was just an opportunity to explain to the doctor what I wanted to get out of being on HRT.