In my experience I had to self advocate, I told them I'd self medicated 2 years before. And I also told them what doses I was taking and such. They seemed pretty clueless but I would hope that it is a bit better now. (I was also going through the NHS at the time, and I had one of the worst experiences going through their "system") But I do hope you get someone nice and with some previous knowledge..

When I went (virtual PP appointment in Texas), they only really brought up sprio and E and asked which I was interested in. I wasn't interested in SERMs, so I didn't ask, but they didn't bring it up either, so no clue how much they knew about them or how they'd feel about prescribing them.

This depends on where you live and whether or not it's an actual gender clinic or it's a stuff-christians-dont-liie clinic (planned parenthood). But they probably won't know that much about hrt, and probably have never prescribed SERMs for that purpose. I would research what drugs are available in your area (ie it's hard to get cypro in the US), what drugs you want, and what a reasonable dose is before you go. Yeah, it sucks that the doctor can't tell you what you need, but such is trans medicine.