3 months on testosterone

Today marks 3 months on T-injections.  My prescription is for 50ml / week, but I’ll admit I was using more than that for the first 6 weeks.  I’ve been doing 50 regularly for the last 6 weeks though, leading up to my blood test, because I really do want to see where the levels are, at that amount.  I have an appointment on Thursday with the endocrinologist to discuss this.  I’m going to ask to be put on a higher dose.  Which I may or may not bump myself up to.  I… just really like to stockpile testosterone and to have some personal control over it.

Changes have been occurring at a comfortable pace.  I’ve gained maybe 8 pounds, mostly in my abs, shoulders, and pecs.  I get more dark hairs on my chin and upper lip, which just means I gotta use the tweezers more often!  My voice definitely dropped within the last month – I’d say that is the most noticeable thing.  And I have mixed feelings about that, because it is such a permanent thing.  But, so far I’d say I’m getting used to it and will probably ultimately be happy about it.

We went to Easter Sunday at my Aunt’s, and it was the first time I’d seen my relatives since these changes have occurred.  I felt a little self-conscious, because they do know I’m trans and that I changed my name and some of them know about my top surgery.  But I haven’t said I am on testosterone.  And I’m not gonna.  It will just be.

Being out at work has been going super well.  Everyone is consistent with “Kameron.”  The “he/she,” “Mr.” etc is all over the place, which is overall fine by me because my gender is all over the place, and at least everyone knows that I said, “Kameron/he/Mx.”

Other than that, it’s been pretty low key.  It’s certainly not as big a deal in my head as getting on Androgel, 4 years ago, was.  I imagine I’ll be on the injections for a few more months at this point.  And then on and off of them, sporadically, for the rest of my life.  Probably.

I came up with a new term in my head, today, to describe my gender.  I’m definitely not “mannish,” but I do think that I am “male-ish.”

Here’s my face:  Other than not being able to get the lighting right, I think that my cheeks and neck have filled out a bit…

before injections

 

 

3 months on injections

Oh, also, I almost forgot!  I barely got my period this month – it was way late, and it was sooooo light, at that.  That was awesome.  It kinda freaks me out that that’s all it takes, and there are no health consequences(?) for the cessation of menses.  But, I guess it’s relatively normal, like with birth control and stuff…

Also, yesterday at work, we were using swing machines, which is uncommon (extra work over break).  And they require a lot of upper body strength.  I’d normally be sore after that, but today?  Not sore!


Emotions and taking testosterone

Lately, I’ve felt an increased breadth of emotionality, and I’ve been wanting to embrace that and document it.  At this point, I’ve been on injections for about 2 months.  I’d say I could first recognize this about a month ago – I saw the film, Moonlight, and I felt choked up / on the verge of tears a couple of times.  This was no small event:  I haven’t cried or even come close for a very very long time.

About two years ago, I was seriously depressed for a year.  It’s definitely different for everyone, but whenever I’ve been depressed in that way, I do not cry.  I don’t have any emotional experiences, really, other than fear and panic and deadened mental capabilities.  And physical pain, but not in the way where I want to cry.  Then, after about a year of trying different meds, I got on one that I actually like, for the first time ever.  It helps me sleep.  It helps me not think in obsessive ways.  It helps me absorb new information and changes and take those things in stride.  I’ve had some serious high notes, in this past year.  This drug has actually helped with that, perplexingly.  I’ve also had a couple of anxiety attacks, but they were extremely few and far between, and related to stressful times.

But I had not felt sad, or any of those nuanced pallets / ranges within the emotion called “sadness.”  Until I started (again) on testosterone – which is kinda interesting because the more likely narrative is “once I started T, I couldn’t cry anymore.”  I have yet to actually cry, but the sensation is there, and I welcome it.

Today, I was listening to a podcast, and I felt overwhelmed with emotion.  Like I said, this has been so rare, that I embraced it.  It was “This American Life,” the episode called, “Ask the Grown Ups.”  Tig Notaro was giving some advice to a teenage girl who’s mom had recently passed away.  It was so moving that the world around me changed, temporarily.

Also, I’ve recently been seeking out music that I listened to while I was depressed, 2 years ago.  (There’s not much at all to uncover because I listened to so little music.  It’s basically 2 albums by Royksopp, something by The Notwist, and, probably a couple more I could track down if I really wanted to dig…)  It’s been… interesting.  There have also been big changes in my life lately, mostly at work, that has triggered some images of violence to flash before my eyes.  I’m all too familiar with this, and in the scheme of things, it’s been super mild.  But, yeah, haven’t experienced that in a very long time.  Instead of acting on it or obsessing on it though, I just came home, took my pills, and went to bed early.  I feel sooooo grateful that that’s all I have to do.  And then the next day it is not too bad.  What???!!!  It’s true!

So, essentially what I’m saying is that I have felt some intense emotions over the past couple of years, but very rarely did that involve any form of sadness.  Which, is pretty bizarre if I think about it.  And that’s been due to depression and medication.  And then, this higher dose of T opens back up a world I have not been able to access.  It includes nostalgia and emotional connectedness and feelings associated with the weather and isolation and the season and the environment, etc. etc.

As long as I’m not continuously bawling my eyes out, it’s all good.

If you’re interested in this topic, I also wrote these posts:
Depression and taking testosterone
Depression and taking testosterone pt. 2


1 month on testosterone

I’ve been injecting 50mg per week.  OK, not exactly true – after the first 2 weeks, I increased it to 80mg, because I felt like it.  Similarly, when I was on Androgel, I wasn’t great at sticking with the script.  Not sure why, but I have a guess that it’s because I wanna exert control over this area of my life.  It just doesn’t really seem like a big deal in terms of consequences, and it makes me feel better…

Even with the higher dose (Just for perspective – 50 is moderately low and is a common starting dose.  100 is also a common starting dose, so I’m not doing anything way out there), I really have very little to report, which feels like a bummer to me – I was expecting more!

(Just a note:  This post is a little confusing because I have “started T” twice now.  When I say Androgel, I’m talking about 4 years ago.  And when I say injections, that means what I’m currently doing.)

When I started Androgel (very very low dose), it was like, WHOA!  It felt like night and day, within the first couple days.  Here’s what I reported 5 months in, if you’re curious:  5 months on T without physical changes.  (This, unfortunately. is my earliest account, because I hadn’t started the blog until I was 5 months in!)

I guess I expected it to be like that, only tenfold, because my dose is now definitely not very very low.  Honestly, I don’t know how to compare the two doses, since they are administered so differently.  I tried to find info online about this, and could not find a single thing.  If anyone has something on this, such as, “____mg of inject-able T = ____mg of Androgel,” please let me know!  I’m pretty sure there’s no straightforward way to calculate this because, for example, everyone absorbs topical substances differently…

Anyway, I am experiencing these shifts, in little ways, again…  A little bit hungrier, a little bit of a higher sex-drive, a lot of “warm and fuzzy,” etc.

but this time around, I’m paying a lot more attention to physical changes (in a way where I want them, not in a way that I’m being hyper-vigilant about them not happening, like the first time around with the Androgel).  And so far, nothing!  Maybe just the slightest shift in voice.  Oh well, no big deal.  I can be patient.

I think what’s going on is, when I started Androgel, I had nothing to compare that to.  All the sensations I was experiencing were vast improvements over what I had going on, previously.  It truly was seeing the world and myself in a brand new way.  Decreased anxiety was mind-blowing because I’d never felt that – the ability to take a deep breath and really feel it?  Whoa.  Actually sensing my body as present/grounded, and not half-dissociated 24/7?  Incredible!

And it’s more like now, I’ve been free of anxiety for a long time at this point, due to a psychotropic drug that I never want to stop taking.  And the warm and fuzzy and the heightened sex drive?  I’m glad to see a return of these sensations (for sure!!!), but it’s more like, “Oh, right, I like this,” as opposed to, “Wow, I have never experienced this before and it is the best thing ever!”

That’s all I got so far!


Starting T injections, tomorrow

Over the summer, I decided I wanted to try injections, short-term.  In September, I started working toward making that happen.  It has taken this long, because it took a very long time to even make an appointment.

Why is it so hard to make an appointment?

Once I got in, though, things progressed super quickly.  A lot faster than I envisioned.

I had an appointment with an endocrinologist on January 10th.  It went super well.  I recall going to therapy a couple of times this past May, and talking about my plans for going on T injections.  I told my therapist that I wasn’t sure what to tell the endo; I might resort to white lying just so I could be guaranteed access.  You know, feign being into being binary and things that I am not.  She replied, “Why would you do that?”  She was being fairly forceful too – like, please, give people some credit!  I replied, almost yelling, “Because it wasn’t all that long ago that you couldn’t be somewhere in the middle, there were such strict guidelines about how to transition.  I don’t know who is where, within that thinking!”  We continued discussing until I was convinced, and agreed to proceed in an authentic way.

I hadn’t forgotten that.  When talking with the endo, I was nothing but honest.  I will say though:  A) it helps that I am 35 years old, which means I have been an adult for a while now.  B) it helps that I have legally changed my name.  C) it helps that I’ve had top surgery.  D) it helps that I have a support network.

I still hear plenty of stories about people being denied or being put on hold or having to jump through hoops they don’t want to go through, etc.  It is a reality.

This endo was super open though.  She seemed to have a checklist, basically of questions to go through.  They were all fine, until she got to my childhood.  “How did you feel as a child?  Did you feel like something was wrong?  Who were your playmates?”  I cut her off and said, while smiling, “I find these questions interesting, but I don’t see how they are pertinent to the here-and-now.”  She replied that, well, for some people… and trailed off.  And then we changed directions.  It was awesome.

She told me that the next step is bloodwork, then she will prescribe the T.  Then I go pick it up and come back and learn how to inject myself, from a nurse practitioner.  I figured all this could take around a month.  I got the bloodwork done the next day.  I got a message that the endo filled the prescription 6 days later.  I got a call that the pharmacy will have it in stock the next day (today).  Then I got a call from the endo’s office saying we could schedule an appointment tomorrow at 8am.  Whoa.  Whirlwind!  After all the time and effort it took to make the appointment in the first place, this was so super speedy and efficient.

Am I ready?  I’m not sure!  Like, I am definitely ready because it’s something I’ve planned on and talked about for a long time now.  And because it is a big part of my ultimate goal, which is to present in such a way that people really cannot tell whether I am male or female.

But to enter that space is super scary.  I’m generally viewed as female, and it feels safe.  I use women’s public restrooms, I am legally female, and I am not viewed as threatening / I don’t feel threatened.  That could change.  I’m not sure where I will feel most comfortable – I guess going on T-injections is one of the ways of finding that out.

This definitely feels different from the time I started Androgel, which was 4 years ago.  At that time, I was soooo excited.  And once I started, the excitement only increased.  BUT, at the same time, I was hyper-vigilant about not physically changing; I didn’t feel comfortable with that at all at the time.  When my voice sounded only the slightest bit different, I freaked and lowered the dose even more.  And I hit a sweet spot, where I stayed for almost 3 years.

That sweet spot has shifted, and I’m not sure where it is now!  And I’m not all that excited about it either!  Who knows, I may hate it and stop after 2 or 3 shots.  Or I may end up loving it more than I anticipated, and staying on it long-term.  My guess is I’ll want to stay on for 6-8 months or so.  …Let’s see if I’m right!


Guest post – Kale (one year later)

About a year ago, I featured the story of an internet friend, here:  Guest post – Kale

We lost touch for a while, but as the year came to a close, I wanted to see where they were at, transition-wise and otherwise.  We corresponded for a bit, and they sent this update:

Hi! My name is Kale and I wrote a guest blog post for Kameron over a year ago when I first started taking testosterone. I live, mostly, in Newfoundland, where it’s cold and grey a lot of the year. I suppose it goes without saying that a lot has changed for me in the past year. I’m writing this today after making a monumental change to my appearance and expression of self this very morning. After five years of having them I decided to cut off my dreadlocks. I know some of you might be thinking “what does that have to do with taking testosterone or being transmasculine?” Well, I believe that all the choices we make about our bodies, not just the big ones like taking hormones or having surgery, impact our experience of self enormously. And though I hate to think on my dreads in a negative way I know they were a kind of crutch for me for a long time. If you think about it dreads are very gender neutral. Whether a man or a woman has dreads it doesn’t matter; the dreads will more or less look the same. And certainly once my dreads were long enough they obscured my neck, my slender feminine neck.

image1Well after a year it seems my neck isn’t as slender as it once was. In fact a lot of things about my body are very different. It amazes me how I can feel so much the same and so very different all at the same time. On the one hand the differences feel right to me, feel like the me I always expected to be, and I know that makes a huge difference. On the other hand I know there is so much about me that is the same, the integral parts of me that will never change, no matter what. I think a lot of folks, myself included, fear changes that will alter who they perceive themselves to be. It’s a legitimate fear but I don’t think it’s grounded in any reality. I know that I am the same person I’ve always been except now I feel closer to that person and so much happier. I should say that I identify with being transmasculine but do not feel comfortable with many labels. Every label I’ve ever tried on did not fit well enough to make me feel comfortable with it. Right now I like to say that I do not feel like a man or a woman. I feel like myself and that person has masculine and feminine traits.

Generally I feel more attuned to my masculine side and that was a huge factor in my choosing HRT. Being read as female, therefore feminine only, made me feel very unlike myself. I could not live that way feeling like no one saw me for who I was. A year later my voice is pretty low and I have the faintest line of hair over my upper lip. My veins pop out of my forearms and my pecs and shoulders have muscles they never had before. Strangers almost always think I’m a man. This is my new reality. It generally feels good to me but it’s not perfect. I’m not a man. I don’t really want to consistently be thought of as one. I take what I can get though because in this society being seen as neither a man nor a woman is a pretty unrealistic goal. I feel closer to my masculine side so being read as a man is less difficult than being read as a woman.

The other huge reason I chose HRT was my association with my genitals and my experiences of sex. For whatever reason I am cursed with the desire to have male genitalia. It fucking sucks. I cannot imagine having bottom surgery despite the fact that I really would rather male genitalia. I’m so not ready to even entertain that idea and I don’t know if that will ever change. I wasn’t entirely sure what testosterone would do for my relationship with my genitals but it certainly seemed worth trying. This was hands down the best choice of my life. I can’t express how thankful I am that I had the ability to make this choice. Before HRT I often could not derive sexual pleasure from my junk; it just didn’t feel like it was a part of me. That feeling was exasperating. I felt incredible guilt because I loved my partner but I could not enjoy sex with them. I don’t know how to describe the difference in my genitals other than it feels like what I imagine having male genitalia feels like. I have experienced some clitoral growth but it’s so much more than that. The difference is mind blowing, truly, and I wish I could find the words to express what it actually feels like but I can’t seem to. I hate to use the cliche but it’s so accurate; my body feels like my body now.

Despite all the ways I am so thankful for testosterone, I don’t like to put excessive emphasis on HRT. It was right for me in that moment in time. It’s not necessarily the right choice for everyone. And certainly I don’t think HRT is the only thing that’s helped me with my sense of self. If I want to I can think about my dreads negatively, as being a crutch. Or I can think about them positively, as being a big part of how I expressed myself authentically. Having dreadlocks and using HRT are both choices I made to feel closer to the person I feel inside. There’s so many ways that we can learn to be happy in our own bodies and the only thing that matters is that; each individual person’s happiness. I am so happy I found the courage to choose HRT but there are still days I look in the mirror and wonder who I am, what I think I’m doing. They’re less often, definitely, but they’re still there. This life is a journey, happiness is a journey and there’s no end until you’re dead. I wish I could say HRT made me completely whole and happy and yay now my days of feeling dysphoria and sadness are over! But it’s just not true. Happiness is not something you attain once and that’s it; it’s something you have to always work for. My intent in saying all this is to remind folks of certain realities. And I need to remember them as much as anyone. Life is hard. Go easy on yourself. Love yourself, no matter what you may feel sometimes. If there’s one thing I’ve taken out of this last year and all my experiences with my changing body it’s this.

____________________________

I like how Kale starts this piece with hair-related changes, and then gets more into it from there.  I also use my hairstyle to obscure my slender feminine neck!  What are some things you do to help feel more congruent with your gender identity?

If you’d like to write a guest post, please go for it!  You can just click on “ask me something” at the top of the page…


Why is it so hard to make an appointment?

I made a decision that I’d like to get on testosterone injections, temporarily.  I’ve thought on-and-off about it for a while, and I think the idea solidified over the summer, like, once I’m back to normal after recovering from surgery, I’m going to look into it.  Unfortunately I knew I couldn’t just get this from my Primary Care Physician – she had been OK with maintaining my androgel dosage, but not comfortable with changing / increasing anything.

On September 26, I called the local LGBTQ+ health clinic and explained what I’m looking for.  They said they could get me in on January 25th.  I said, OK set the appointment, but in my head, I was thinking, this is a ridiculous amount of time to wait.  (And, I know, I know, relatively speaking, it’s not at all, especially looking at it from a global perspective.  But, if I think I can do better than that, why not try?)

From there, I looked up endocrinologists in my area and what types of care they covered.  I found one that hypothetically seemed like a good fit, and I posted about it on the local transmen Facebook page.  I got one comment that yeah, she and her staff are good, and a few more comments agreeing with the inefficiency of the clinic.  In terms of vetting, that seemed good enough.

clockcalendarI called her office on September 27th and was told I’ll need a referral from my Primary Care Physician, and then once that’s in, I should hear back within a week.  I called my PCP’s office, and they said they’d send that over right away.  I then waited 10 days before calling.  I was told the referral didn’t get received, huh, not sure, can you have them send it again?  Got that done, this time with a confirmation plus I got a copy, and waited another few days.  I got a call from my PCP’s office, saying that the endo needs an additional referral, from a psychiatrist.  GATEKEEPING at its finest.  I would have been super pissed, and probably would have stopped trying to go this route, if it weren’t for the fact that I actually do have a psychiatrist right now.  So although I hate that I had to do it, it wasn’t actually much of a hassle.

I emailed my psychiatrist (she was already aware that I was pursuing this), summarized the nature of the referral from my PCP, and asked her to also write a letter.  I said that including pertinent information, like the fact that I’ve been on a low dose before, that I’ve had top surgery, and/or that I identify as non-binary would be great.  She replied that she could write the dates she’s seen my, my diagnosis (meaning my mental health diagnosis), medications she prescribes, and mental stability status.  “OK?”

I replied, “OK that’d be great, thanks.”  Guess I didn’t want to argue or push it.

I then waited another 8 days (by this point, it was Oct. 25th, a whole month later and I still hadn’t secured an appt.) and called the endo’s office again.  I was given a wishy-washy answer by the administrative assistant.  That the endo is still in the process of finding more information, and she is currently booking out till January – they can get me in for January 10th.  But at the same time, she can put me on a waiting list to get me in sooner.  I asked, if I were to call and check my status, would that help me “jump the line”? (I didn’t actually use this phrase.)  She implied that sure, that could help.

At this point, I took a step back and thought about what’s happening.  So far, the endo got a referral from my PCP, and that didn’t include any history of care:  just Female to Male transgender person (F64.1), chronic.  In addition, they got information from a psychiatrist that I am bipolar, that I have been seeing her for 9 months, and that I’ve been stable during that time (relatively, this is such a short amount of time; it’s kind of implying that the rest of my “bipolar disorder” time is a wildcard.)  I don’t want to get too paranoid, but this collection of information is not working for me at all.  That plus the fact that it’s straight up inaccurate.

Feeling like the system is working against me, I decided to pull from my bag of tricks and email my therapist.  If there’s anything that could help this stalemate, it’d be her.  I relayed this whole series of events and asked her if she could also write a referral, actually filling in the background information.  She replied in 10 MINUTES – such a refreshing change! and said crazy that this is so hard, and sure she’d write a letter, and is there anything else I’d want to make sure she includes?

So she’s writing a letter.  My intent is, essentially, that this is not a new diagnosis, coming out of nowhere.  That I’ve already been on T in the past, I’ve had top surgery, I’m in the process of legally changing my name, etc.  So, this should be a continuation of ongoing care (timely, please!).  I’m not starting from square one here.  I imagine this endo has access of my medical records (?? not sure how that works), so if she looked into it, she’d find this stuff.  I’m just having my therapist bring it to the forefront, which will hopefully change something?

Because, I feel like if it went the other way – my doctor sending the referral first on my behalf, instead of me going backwards to get this stuff covered, I would have been given an appointment within a more reasonable window.  Not sure if that’d be true or not – there could be dozens of reasons outside of my control – maybe she’s just really busy.  But, I gotta try…

Blah.


3 months after top surgery / 6 weeks back on T

Physically, I feel 100%, and I’ve felt that good for the past month – like in terms of lifting, stretching, and moving my body.  Aesthetically, I’m still not happy, but I’m starting to get used to / feel OK (for now!) with how things look (I’m sure I’ll be looking at revisions down the road, but I’m not going to worry about that right now.)  Sensation-wise, I’m a little worried, but I know it’s still early on.  My nipples are still numb, and it feels numb/tender within about an inch radius around both nipples.  I’m looking into making some gotu kola oil to massage into the tissue; apparently that’s supposed to help with nerve damage.  Better late than never, right?

I have my 3 month follow-up appointment with the physician’s assistant on Tuesday, via Skype, and I’m not really looking forward to that…

It’ll be fine…

Otherwise, I’m super happy.  I’m so happy to be wearing what I want to wear and also of walking around the house without a shirt on (which I did do, previously, but not as much, and not while my spouse was around.)  A couple of weeks ago, I wrote to a friend, “I did not expect to feel much different other than a cerebral satisfaction regarding being able to wear anything from now on.  But it’s more of a gut- level confidence:  I feel like my posture is different; I walk differently, I carry myself differently.  This is what makes it all worth it.”  That pretty much sums it up.

Also, I’ve been using 2 pumps of Androgel, daily, for 6 weeks now, without any doctor supervision.  I just had some extra bottles laying around, and I felt like starting again (after being off of it for… 6 months?)  I contacted my local LGBTQ clinic via email (which is new for me – previously I’d been getting Androgel from a doctor who was reluctant to be a part of my trans-related health) but after more than a week, I haven’t gotten a response.  So, I plan to call soon.  I’m thinking about trying injections, short term.  I think I’ve gotten about as far as the gel will bring me, and I STILL want to look and sound slightly more masculine.  Like, enough so, so that people are confused, or at least they’re hesitant to actually say “ladies.”  So sick of the “ladies.”  It happened again today.  Blah.

 


(Would have been) 3 years on testosterone

Three years ago today, I took a huge leap, not at all sure this was what I wanted to be doing, but fully positive I needed to try just to find out.  Even though I’m not currently on T, this date is still a really big deal for me.

When I started, I felt, almost immediately. that this was the right decision, and that I could have benefited from testosterone way sooner, if I hadn’t been so unsure I could just take a low-dose to see what it felt like.  Those first few weeks, I wrote a lot in my journal, things to the effect of:  “feel hungrier, more energized, had to get up at 5AM because I was doing overtime [Saturday morning].  Buzzed through the 8-hour area, as if I didn’t lose any sleep and am in fact on speed.  Floated through the rest of the day in a cozy, mellow cocoon.”

About 4 months later, I stopped writing just privately, and decided to start this blog!
First post:  low-dose testosterone for the rest of my life

At the time, I thought about testosterone and it’s effects all the time.  I was hyper-aware of any physical changes (mostly not wanting anything to change) and also my internal states.  It’s impossible to inhabit that way of being, long-term, of course, and other life events happened, causing roller-coaster-like mental states.  And I started to wonder what testosterone was doing for me anymore.

I had been treating testosterone like a psychotropic drug, in my mind.  And, in a way, it kind of is (a naturally occurring one).  I wasn’t on any medications, and I kind of saw it as the solution to my mental health issues.  Until it wasn’t.  (But it did feel like it was for quite a while.)

When I did go back on medications (a little over a year ago), the purpose of taking testosterone started to feel like it was getting diluted.  And the reason to stay on it became, “I need to keep as much as I can the same, right now, so that I can stabilize” rather than, “Testosterone is stabilizing me.”

Right around the end of December, I finally switched to a medication that seemed to be working (maybe for the first time ever, for me).  And right around that same time, I decided to stop taking testosterone.  Was the timing coincidental?  No.  It felt like I found a substitute, actually.  And I’m still feeling really really good.

I’m still undecided about how much more masculine I would like to look and sound, and if I would want to use testosterone to get me there.  It’d be awesome if I could pick and choose… (probably most trans-people wish this).  I would pick a moderately lower voice, a little more muscle mass, and a higher sex-drive.  I would toss the facial hair and balding, the acne, the feeling too hot, and the other body hair.

This will probably be my last update in this series “___ years on testosterone without noticeable masculinizing changes,” since I’m not currently on testosterone.  It doesn’t make sense!  Most definitely I’ll start it right back up if I decide to go back on.  And I imagine, where I am right now, that my reasons will be different.  Less of, “what would testosterone feel like?,” and more of “how much do I want my body to change?”

From my experience, I kind of feel like, if you’re on the fence about hormones, and you’re not sure about how you feel, gender-wise, it’s worth a try (if you can get access).  It might take you to a new place on your journey.  It might jump-start something inside you.  It did for me.  Or, on the other hand, it could help you rule something out.  I know someone who was unsure about starting estrogen, but they kept obsessing over it.  Once they went through the steps, and had the estrogen on hand, they suddenly strongly felt they did not want to continue to pursue that path (after taking only one day’s worth of the hormone.)  So, either way, you may learn something about yourself…

Here are some past posts in this series, for reference:
Five months on T
One year on T
Two years on T
Two point seven-five years on T (Two weeks off)


GID: exclusion for top surgery coverage

When I started moving forward with the process of getting top surgery, I did so with the assumption that I would be paying in full out of pocket.  My therapist had looked into coverage a while back, for me, and told me it was not covered.  Still, though, times are changing, and I had a sliver of hope that my insurance plan might have been updated.  In my state, government funded health care now fully covers transgender related treatment and surgeries.  Maybe mine would, by now, too?

Yesterday, I was on the phone with a customer service person for over an hour.  At first it seemed promising.  I gave her the category number – F64.1 (gender identity disorder in adolescents and adults) and the code for the surgery type – 19304.  She said, “Double mastectomy?” and I said, “Yes.”  She then proceeded to try to find out whether the surgeon was in network or out of network.  She told me that if she’s in network, I would be paying a total of $70.  If she was out of network, I would be paying a $750 deductible, and 80% would be covered beyond that.  I started to get my hopes up – either of those would be awesome! – but also remain skeptical.  The customer service rep made calls to my surgeons office, to the surgical center, and to some other places.  She determined in the end that it would be out of network.

At that point, I said, “OK, I just want to make sure you’re doing this through the category of gender identity disorder?  It is a gender-related surgery.”  She responded, with a blankness in her voice, “That’s an exclusion under your policy.”  I replied, as my heart sank a little, “OK so nothing will be covered.  So it doesn’t matter whether she’s in network or out of network?”  “Correct.”

I was mad that she overlooked the category I gave her, as a first piece of information, and moved forward as if there would be coverage, only to let me down.  And that once I made it clear, she didn’t have anything more to say to me that might be helpful.

I asked her about the appeals process.  She said I would pay for and get the surgery, the office would submit the claim, the claim would be denied, and then I could work toward getting some reimbursement.

I brought her attention to a 7 page document that is called Medical Policy, Subject:  Gender Reassignment Surgery.  It lists criteria that need to be met in order for a surgery to be deemed “medically appropriate.”  I asked her what this was, and what would happen if I gathered enough information to move ahead with this.  I told her it was difficult to understand exactly what I was reading.  She said she was reading along with me, and that yes, these policies are confusing.  She then put me on hold again, and when she came back, she completely derailed that conversation – she steered me back toward the exclusions.  She added that not only was the procedure excluded on the basis of gender identity disorder, it was doubly excluded because it falls under “cosmetic surgery.”  The conversation was basically over at that point.  I stayed on the line to complete a survey about the call, and I gave her good ratings because she was way more helpful (making multiple phone calls on my behalf) than I was expecting.

I keep going back to this medical policy document.  I don’t know for sure, but I have this feeling that it’s the loophole for filing a grievance.  That if I can prove it’s medically necessary, I have a shot at getting at least partial coverage.

However, the criteria are so extremely binary in nature.  Some examples

The patient has completed a minimum of 12 months of successful continuous full time real life experience in their new gender, with no returning to their original gender, including one or more of the following:
1. Maintain part or full time employment; or
2. Function as a student in an academic setting; or
3.Function in a community based volunteer activity
And:

The patient has undergone a minimum of 12 months of continuous hormonal therapy (unless contraindicated)
I would have to have two letters from licensed health professionals, one of them being from a psychiatrist or psychologist (that part would be easy).  If one could be from a psychologist, and the other from a psychiatrist, I just might be able to put something together (with a little stretching of the facts…)  If one has to be from a doctor or other medical health related person, I may be out of luck…
I’ve had close to 3 continuouos years of HRT (although I am not currently on HRT, and I did not move into the opposite gender).  I’ve had 10?  12?  years of continuous real life experience, although it has not been full time.  It has been in my “new gender” even though that has not been the “opposite gender.”  There is nothing in there about having to legally change your gender or name (good).
I’m not sure how to proceed exactly – all I know is that it’s going to be worth a shot…

A full year later / making major changes

Right around this time of day one year ago, I was just getting out of the hospital.  I remember the out-take process was long / we had to wait on meeting with certain people first.  I was so antsy to go, that once we finished something at the front console, I went to open the door to leave.  I didn’t think about the fact that you had to be buzzed out!  Oh yeah, no coming and going as we please – I forgot…

I got coffee at a snack bar on the way out, and we went home.  I was super up and psyched to be out of there.  It wasn’t till later that I got depressed.  For a full year, more or less.

Within the past month, I’ve made some major changes that are impacting my mental health.  I currently feel better than my baseline.  We’ll see if this lasts.

I changed medications:  I had been on Geodon, Wellbutrin, and Klonopin (for sleeping).  I didn’t think the drugs were doing anything; I still felt shitty, and in December, it was getting worse again.  I was having vague suicidal thoughts and was having trouble making it through my daily routine.  I talked about this in therapy, and my therapist asked if I would talk to my new psychiatrist about it.  I said, “Yeah, but what can she do?  What else is there to try?”  It seemed hopeless – I’ve been on so many drugs, and overall nothing had ever worked out long-term.  My therapist just said that she might have some ideas.  So at my next appointment, I did talk to her, and she suggested switching off of the Geodon onto something else.  She listed a few, told me about what they work best for and what side effects accompany them, and left it up to me to pick one, basically.  I said Seroquel, but I couldn’t really tell you why.  I didn’t have much faith.  I did the tapering off /ramping up thing, and surprisingly, right when I hit a certain dose of the Seroquel, my day got way way better.  And then the next day.  And the next.  And now it’s been 23 straight days where I have felt free of crippling anxiety and vague suicidal thoughts.  I feel present in my body, and I am looking forward to simple things that make my day more interesting / better.  Like listening to a radio show, or going to get a bagel, or just, anything that previously would not have brought me any extra joy.  I’m kind of floored by this.  I’ve never had this experience with a drug before.  We’ll see if it lasts…

I went off testosterone:  I had been increasing my dose for a while, but it was a fine line between looking for more masculinizing changes and worrying about my hairline receding.  (It had started to.)  I found myself obsessing about my hairline and feeling negatively about testosterone.  I felt stuck and stressed.  Eventually, I decided, why don’t I just go off it for now and stop all the worrying.  I have my whole life to figure out if I want to look more masculine or not – it doesn’t have to happen right now.  So I stopped, and I felt better.  I worried I might hate feeling colder or having less energy or having more aches and pains or experiencing a drop in mood.  But none of those things happened.  I haven’t been looking for anything to be different, and as a result (partly) nothing feels different.  (I’ve been reading this book about expectations and beliefs and how much our judgement gets clouded – maybe testosterone hadn’t been doing much for me if I hadn’t been looking at what I thought it was doing.  This is convoluted, and of course there’s more to it – it’s a powerful hormone! – but so far, so good.)

I stopped going to therapy:  I have been going to therapy consistently for 4 years.  Much of that time was weekly, sometimes we scaled back to every 2 or 3 weeks.  The past few times recently, I didn’t know what we were doing / didn’t know what to talk about / we were going in circles.  All of a sudden, it occurred to me that maybe I didn’t need to go.  And instead of that thought freaking me out, it settled in and felt right.  So on Tuesday, I talked to my therapist about it, and she said it sounded like a great idea.  We wrapped some things up for now, with little fanfare, and she made sure the door was open if I ever want to go back.  I imagine I probably will, but for now, I had just been spinning my wheels, and it feels good to put an end to that.  Maybe I can focus more on other areas of my life…

Considering how unstable I’ve been for a long time, these are some pretty huge changes.  And I am finally starting to look forward to what’s ahead!