It’s strange to stick to this same title, “without noticeable masculinizing changes,” because lately, I have started to aim for masculinizing changes. But it still fits because nothing of note has changed yet. About 6 weeks ago, I doubled my dose. I’d like to see my face change shape, and I’d like my voice to drop. Ultimately, I’d like for strangers to gender me as “male,” as the default, instead of “female.” At least more than half of the time. As of now it’s maybe 10% of the time. We’ll see. So far all I’ve noticed is more acne… Oh, also some beginnings of a “happy trail,” which I’ve always hoped to have!
So I’ve jumped from 1 pump of 1.62% to 2 pumps. I might even go up to 3 pumps just to see. Alternately, I might stop all together, just to see. I have my whole life to be on testosterone or not be on testosterone, and now that I’m finally starting to feel more mentally stable again, I’m just kind of really curious.
Here are some other posts from this series, to fill in more information:
As of now, I feel more sure about other transitional steps than I ever have before. I just can’t seem to get there yet. I feel sure about legally changing my name and about top surgery. And I can imagine some first steps. I just can’t wrap my head around implementing them. A part of me feels like this attitude is a hold-over from feeling so unstable for so long. Not a good time to pursue permanent changes. Just wait for more forward momentum to kick in naturally. A part of me wonders if I should just push myself to get the ball rolling, and positive feelings about it will follow. Right now, I just feel scared. And I guess I’ll sit with that. I don’t think it will last forever. I reached a tipping point with testosterone. (That one, in my mind, felt comparatively easy, I guess!) There’s no reason I won’t reach that point with other changes. I don’t want to force it.
The newest change is that my mom told extended family about my new name (super grateful to her), and people (almost everyone) were using it at a recent family gathering. This felt really validating and also alarming(?) I guess would be the word? I have to say that I’m still alarmed by my new name. It still feels like, “is that me?” I definitely still feel like I have to change it, and if I were to go by a new name, that would be it. There is no better name. But I guess ultimately I feel like, why couldn’t the name I’m used to just have worked out. (I’m super slow to warm up to change – if it’s not obvious.) This tells me that it’s not quite time to pursue legally changing my name. There will be a time – it’s just not yet.
To conclude, here are some face shots:
Today marks 2 years! I bring this up each time I do one of these posts, because it’s that important: although I haven’t changed much on the outside, my internal world feels significantly different, and that’s why I stay on it. I don’t have any changes to report, but these back-posts say a lot:
I may be changing my tune. I might increase my dose in order to look more masculine/androgynous. I just don’t know yet. Just wait and see. For now though, here’s some pictures of my face; I don’t think I look different over time. Maybe slightly rounder face?
To celebrate this milestone, I figured I’d post an (edited) email reply I sent an internet friend. They asked, essentially, how I finally made the decision to start testosterone. They were wondering if I felt a hormonal imbalance prior to starting T. I said,
I was in the hospital for 4 nights (5 days) a little over a month ago, for psychiatric reasons. Although this was a very trying time and I was in an extremely vulnerable head-space, I was mostly treated with respect and dignity (as much as seemed possible, given the conditions). In terms of my trans-status, I was treated with respect and dignity across the board.
While in the Emergency / Admittance Area, my family and friends present must have spoken behind-the-scenes, on my behalf about the fact that I am transgender, because I didn’t mention it at all at that point. My friend later told me the intake leader (don’t know his exact title) told her that he has a transgender son.
Also my partner later told me there was signage throughout the hospital about their non-discrimination policies. I found this to be accurate in the way they run things. Everything was by schedule and protocol, no special treatment and in general no immediate response to a want (like, “can I get a pencil?” “Can I get a snack” elicited a quicker response.) At times, I found the ways they were doing things to be confusing, and I wasn’t explicitly told how things are run (when mealtimes are, when med times are, what is allowed and not allowed, etc.) I just picked up that information as I went along, as best I could. Not sure why that kind of stuff was never conveyed to me, but it all did make sense in terms of treating everyone fairly.
I got the sense that not every staff member got the memo about male pronouns, but the more “important” positions definitely did, and they took the lead on that when conversing with other staff members. For example, one of the team leaders asked an overnight staff person to “open the shower area for him,” and that staff member said, “What?” and looked confused. The team leader just repeated herself and no problem arose.
I was in an extremely fuzzy, drug induced state the first 24 hours of my stay. As I started to pull out of that and notice my surroundings, I picked up on certain things. If you woke up early enough to make it to the morning meeting at 8am, you could get non-decaffeinated coffee and also information about the day! I was surprised how few people came to the meeting (it felt like one of the highlights of each day.)
On the first day I was capable of making it to the meeting, I was still very much in my head and not at all with it. An out-of-character-for-me event happened. I interrupted the team leader 1 minute into the meeting. I stood up and went to the front of the room. I said I’m new here and introduced myself. I said I’m transgender and could everyone use male pronouns? (If only all comings-out could be this easy!!!!! I feel really proud of myself for this one.) Another patient asked excitedly, “What’s transgender? That means you were born a girl, right?” He seemed ready to continue conversing at length, but another staff member made attempts to derail him and get the meeting back on track, which worked immediately. I wasn’t done with my spiel yet though. I concluded with, “And there are no knives allowed – I heard that early on!” before sitting back down.
I also chatted with another patient about my transgender identity at one point.
The first day I was there, I did not have access to Androgel, but that seemed part of protocol – it takes time to clear personal belongings including prescriptions, maybe? I did not yet have my street clothes or reading material or slippers either. The second day, the nurse brought my Androgel and seemingly played dumb with how to apply it and how much. I told her I apply 1-2 pumps daily (I apply 1 pump, but my prescription states 1-2 pumps). I told her it’s supposed to be applied to your upper arms, but I do my thighs. I told her I have to go into my bathroom (in private) to apply the gel, and she waited for me. The other times she came with it, she referred to it as a spray and also as a patch. She was vague about my dosing. She let me do my thing and then hand it back to her. Although this all felt confusing, I think it was an attempt to convey, “this is your thing and we trust that you will take care of it. We don’t care what you are doing in this regard.” It felt validating.
Although the hospital was far from a pleasant experience, and I would say there were a couple of instances while I was in the emergency department in which I was treated as less than a person with dignity, in terms of my trans-status, they got it right, every step of the way.
I’ve been using Androgel, daily, for over a year and a half now. And I’m just now getting a full understanding about how the prescription & insurance industrial complex works as it relates to me continuing to get what I need. Here are a few experiences that, each taken separately, are small, but as a collection of anecdotes, are kinda mind-boggling:
– My first doctor initially tried to sway me toward a different product, Fortesta, telling me I could save big, and handed me a discount card I could activate. I went through all the hoops only to learn I was not eligible because I am not male. When I came back to him with this, he changed my prescription to Androgel without further discussion.
– Although I made clear to him that I was aiming to be on a very low dose, and see what happens from there (like 1-2 pumps), he wrote the script out as 4-6 pumps daily. This led me to be able to get 2 bottles at one time for $25. This amount lasted me for 4 months. At $6.25 per month, I wasn’t about to speak up about the inaccuracy!
– The prescription wording has changed over time (and between two doctors), and I’ve felt confused as to how that equates to how much I’m getting and how much I’m paying. I’ve paid $25 for 2 bottles together, $50 for two bottles together, and even $50 for only one bottle at one point. I guess I assumed it fluctuated in price. I thought I was paying per bottle.
– I’m not paying per bottle. I’m paying per month. My payment, I finally found out, should be $25 per month (not too bad!), but somehow I’ve continued to avoid even having to pay that much. I also have been able to store some bottles in reserves (which helps me feel much more secure since most of my visits to the pharmacy have led to some sort of questioning, calling of my doctor office, etc. Not for anything personally about me, but because of how the script was written out.)
Basically, while talking to my insurance company (using the pharmacy’s phone) last week, I learned that all that matters is how the script is written. Testosterone is a controlled substance. I always have to pick up the prescription at my doctor’s office and show a picture ID. I can never get a refill (although my doctor has tried!) If the doctor writes the dose out as 1-2 pumps per day, the higher amount is factored in. If it’s 4-6 pumps, it’s 6 pumps, even if I’m only actually using one. No one seems concerned about whether the amount correlates to what I’m doing. I can get a 30 day supply, a 60 day supply, or a 90 day supply. I’d prefer the 90 day because it means I don’t have to go as frequently. But if it’s entered as a 30 day supply, it’s 1/3 of the price. And no one actually seems concerned with whether that translates into how frequently I go to the pharmacy. Interestingly, I could pay a whole lot more to get the amount I use, or I could pay a whole lot less to get more than the amount I use. I don’t understand this logic, but I do finally understand this system.
When I was told I’d be paying $50 for one bottle and would have to come back in 2 months with a new prescription, for my 2nd bottle (due to the wording of the script) last week, I argued with that. The pharmacist got me on the phone with my insurance (which led to me finally grasping how this works). I realized the only way around it was to get the script re-written by my doctor.
I asked the pharmacist if I could get a discount card for Androgel. This is called “The Restoration Program.” Due to my experience with the Fortesta discount card, I wasn’t holding my breath. The pharmacist got me started and then handed the phone to me to complete the activation process with an Androgel representative. He was friendly and smooth. I was asked a lot of questions: name, address, email, phone number, etc. I was asked if I’ve read all the terms and conditions. Since I had just been handed the booklet with mass amounts of fine print 2 minutes prior, I just said, “yes.” I was then asked, “Are you MALE?” He said the word, “male,” in such a harsh, abrasive tone; all customer-serviceness left his voice. I paused for a good long while. Repeated the question back to him. Said, “No.” Said, “I’m not legally male; if there is any other criteria under which someone could be male, I’m interested in that.” But his helpfulness was long gone. I felt mildly humiliated; he just kept grinding it in that he could do nothing further for me.
My jaded brain (during a conversation with my partner’s jaded brain, haha) decided that men are rewarded for using Androgel because the company is trying to promote a specific type of patient for their product. Rugged, middle-aged, robust and vigorous. Masculine. Diagnosed with low testosterone, just needing a boost. Just take a look at the pics of men on their website:
I am nothing like the men on the website. However, I am just as worthy of being eligible for a discount program! I would call it “The Re-imagination Program.” Testosterone has certainly aided me in re-imagining who I am and what I can do / who I can become.
I told the pharmacist I wasn’t eligible. He acted surprised, but my jaded brain decided he already knew. The next day, I called my doctor’s office; asked for the prescription to be written the way it had previously been written. Got a call back that it was all set; ready for pick-up. Picked up the prescription, went back to the pharmacy, got my 3 month supply for $50. Anticipating more hassles in the future…
I got a doctor last February so that I could get on testosterone. He has been fulfilling that need, but I am realizing that I want a doctor to also fill other roles. For example, I’m sick right now (I’m slowly realizing maybe I have
the flu a really bad cold.), but there’s really no way I would go to my doctor about that, or something like it. I would avoid my doctor unless it were really an emergency, or unless I need more testosterone (which, not having testosterone would totally feel like an emergency!). And I’m starting to find myself wanting a doctor who A) is nice, B) will answer my questions C) will spend an adequate amount of time with me. I’m pretty sure that’s not too much to ask.
I do not like having to have a doctor. If if weren’t for the T, I probably would continue not having a doctor. I have not really had a doctor since I was 18 and under. I’ve gone to some health centers, and I’ve had psychiatrists, but I’m pretty turned off to the whole thing. My therapist has slowly been convincing me that I could find someone I connect with and could go to for medical concerns as I age. I understand how this might be beneficial. She’s even in the process of looking into someone who is trans-knowledgeable for me, and I’d be super grateful if it works out.
I got referred to my current doctor by a therapist I wasn’t really liking. But I went to him because he apparently treats trans* people. There are a couple of good things about him. Mainly, he doesn’t seem to give a fuck. This has worked in my favor in some ways. He’s leaving it totally up to me how much Androgel I wanna take, basically. He doesn’t care that I don’t want to physically transition or that I don’t identify as FTM, exactly. On the first prescription he wrote me, he checked off both the boxes for M and F. I liked that a lot! (But the pharmacy did not, and basically every trip to the pharmacy has resulted in calls back to his office, issues with the way he wrote something out, etc.) He first tried to get me on a different topical testosterone which would be an amazing deal, like ridiculously low monthly costs. The fine print, however, stated this was only for men 18+, and he failed to catch that, resulting in more hassles at the pharmacy. Currently, he’s writing the script in such a vague way (dosage-wise) that I’m getting a really good deal (Like $6.25 per month) and I’m able to stockpile a supply (which I don’t think he knows about). But, again, it caused issues at the pharmacy.
I would trade all that in (my thriftbrain is not in control of me!) in order to go to someone I could talk to and who would answer my questions. My doctor is gruff and impatient, he apparently has no time for me (visits have been 97% waiting, 3% face-time), and he seems to want to place blame on me for his lack of caring and follow through. For example, I know I should care about my blood tests, but I don’t. So I don’t take the initiative in making sure I get them done at regular intervals. Should I? I’m pretty sure that’s his job. When I was most recently there he asked when my last blood-work was done, and I said I didn’t know. He glanced at my chart and said, “April?!! You have to get these done every couple of months!” I just shrugged and said, “I don’t know these things!” I felt as exasperated as he seemed. It may not be totally fair, but his attitude dictates my attitude, essentially. If I had a doctor who seemed to genuinely want my blood-work and to then talk to me about it, I’m pretty sure I would be motivated to get the blood work done. It’s pretty simple. It’s kinda how a doctor-patient relationship works.
Especially if the patient isn’t a big fan of doctors to begin with. I’m ready to be convinced they can actually be OK.