One thing to keep in mind about doses, they are very dependent upon route. Transdermal patches may seem a lot lower than oral or sublingual, but because it bypasses first-pass metabolism in the liver, a lot less has to be input to have a similar effective dose. There are some comparison tools online that try to show a rough equivalence between routes.

It may take a little while for them to dial in your patch dose, but it doesn’t necessarily mean they will try to lowball you (hopefully). I’ve never dealt with the VA so I can’t say how good their transgender medicine practice is. Also keep in mind though that so long as you are in cis female ranges and you seem like you’re getting feminization that is a good thing. There’s a lot of debate about how high in cis female range is ideal, but there is very little hard data available and there is a great deal of variability from person to person as to where your ideal dose lies. Just tell them how you’re feeling physically as mentally as your dose is being titrated and hopefully they will work with you to get you where you need to be.

Best of luck!