Better Living Through Chemistry, Part 1
This has been quite a couple of weeks, with family emergencies followed by a round of Covid, and just as I was starting to have some energy again, SCOTUS did their thing. If you’re wondering why there’s a sudden explosion of trans memoir out there, it’s not because we feel safe doing it. Quite the opposite; it’s because we’re determined that our stories are told by us, and hoping that they are remembered. My apologies, then, if this isn’t edited to my usual standard.
I was in a hurry.
In the process of losing my decades-long denial, I was pretty cognizant of what it had cost me. I was also quite aware of its role in keeping me alive.
Just as I was now determined to live as my real self, I didn’t think I’d be able to live much longer in the disguise I had so carefully crafted, even one as ineffectual as I later discovered it had been.
Does that make sense?
I had convinced myself at age twelve that if anyone found out I wasn’t a boy it would be fatal. Now, at forty-three, I was even more convinced that if I had to try and present myself as one for much longer, that would be fatal. Hey, if you’re a boy, good on you. Be a good one, and be happy in it.
I am simply not one. Pretending to be had been a soul-killing grind, every day. It took hard work and study. Studying humans in their natural environments to learn how men moved, and talked to each other. Studying scholarly works on “male greeting behavior” among humans and other primates. Learning how to say, “How’ya doin’?” when encountering a strange male at the gas pump without raising suspicion that I was not One of Them.
As a student of holistic health, I knew that this process of gender transition was going to be complicated. Not only was this going to involve the psychomotor, cognitive, and affective domains within me- body, mind, and spirit, if you will, there were obviously relationships, professional ramifications, legal complications, and even an extralegal organization created to control trans lives to deal with. That last I’ll get to in another piece.
What I wanted as soon as possible was to be on hormone therapy. Taking all of the above into account, I knew that getting access to those meds was a process that was going to take months, at least, even if all went well. I had made my goal clear when introducing myself the first time I attended my therapist’s gender group in early April 1999. Sandra, another attendee, immediately spoke up: “One thing you need to remember about hormones, is that they work.” I didn’t really know what she meant, at the time, but I soon met transfolk whose response to hormone therapy was rapid, and dramatic. Linda, for example, whose conservative timeline for coming out of work got disrupted when she quickly sprouted a pair of DD’s, and there wasn’t much she could do to disguise them.
It was a chance I was more than willing to take. I was still pretty much convinced that my life was going to follow what was the standard trans narrative of the day: I’d lose my family-of-origin, my marriage, most of my friends, my job as a school nurse, and likely my entire career. So, I was determined to transition as quickly as possible and get on with my life. I had made the decision in late December that I was going to be a live transsexual, not a dead one, and speed was necessary.
When I was very early in the coming-out process back in January, I had sat down with Catherine, a Nurse Practitioner who did the women’s health clinic every Friday at the boarding school where I was working. Among other things, Catherine (who was part of the inspiration for my middle name), asked, “So, who are you going to get to do your hormone therapy?”
“Amy,” meaning the school health center’s Medical Director, and really, one of the smartest people and best doctors I’ve ever met.
“How are you going to do that?”
“Easy. You’re going to ask her if she’s willing to manage hormone therapy for a transsexual woman, and when she asks who it is, you’re going to say that you’ll only tell her if she says ‘yes.’”
“Well then, Ms. Machiavelli!”
And in the end, that’s how it worked. It turned out I wasn’t Amy’s first trans patient, anyway. When a bit less than the minimum amount of time had passed, and I’d been reasonably well-behaved at my therapy appointments, Nancy signaled that she was open to my starting hormones. I made an appointment with Amy, who I’d already had a couple of long conversations with by that time. The formal, approved process didn’t just mandate a waiting period, it required a letter from a PhD-level psychologist (or a psychiatrist), and a corroborating document from a second, master’s-level-or-above provider as well. When I explained this to Amy, her eyebrows-raised look in response conveyed that she clearly felt this was unnecessary bullshit, as only a Harvard-educated physician’s eyebrows can. She asked for Nancy’s phone number, they had a brief conversation, and that was that. I was cleared. And ready. And excited.
In prescribing for another patient, Amy had already done research into the standard hormone therapy for a transsexual woman, and still had the copy at home of the journal where she’d found it.. She left it on the desk for me at work, without, of course, mentioning to anyone else why; the article in question wasn’t listed on the cover. We were all in the habit of sharing articles anyway, so it didn’t elicit any questions among the other staff. I read it, and emailed Amy to say that it was what I’d come up with as well. I always loved to say we got my treatment out of a magazine. Yeah, it was a high-class medical journal, but still. Lots and lots of trans women were sent to endocrinologists by their Primary Care Providers who would look wise, stroke their beards portentously, and write for exactly the same medications and doses spelled out in that article. Those were in turn, the exact same medications and doses that had been in use since the 1970s, and are still widely used today. I can’t think of any other course of treatment, in any area of medicine, that has been unchanged (and unresearched!) in that length of time. Thankfully, due to the efforts of a few courageous individuals, that is changing.
At our appointment- by now it was late May- Amy wrote prescriptions for 2mg estradiol, PO twice a day, plus 100mg spironolactone, PO, twice a day. I sat there holding those little pieces of paper, almost unbelieving. “Okay,” said Amy, looking into my eyes; “So, when do you want to start?”
I looked at the clock. “Well, it’s 10 O’clock now. I figure, ten minutes to Wal-Mart, twenty for the pharmacy to fill the scripts, and I’ll ask for a glass of water. . .”
“Okay, I get it,” she said, laughing. “You want to start right away. Are you going to start one med first, and wait a few days?”
“No. I can’t wait. I’m just going to take them both right away.”
A bare ten minutes later, I handed my prescriptions to the pharmacist, and was ready for his reaction when he looked down and read what he was holding as he walked away from the counter. No surprise, he stopped dead, whirled around and looked at me, aghast; I gave him my prettiest smile. He slumped, turned around again, and went into the back. I wasn’t expecting any trouble, but it was probably a good thing that I hadn’t heard from some other transfolk who’d been refused, even shouted at by pharmacists. As an outpatient nurse who spent a lot of her time on the phone with pharmacists, I wasn’t about to tolerate any bad behavior anyway. It was pretty normal to call in a prescription for an antibiotic and tell the patient to ask for a glass of water and take a dose right then, so I felt comfortable asking for one when they handed me the prescription bottles a few minutes later. The pharmacist stood there wide-eyed while I popped the caps off and shook one of each into my hand; when I tossed them into my mouth and followed with a big gulp of water, he fled.
I was on my way.