I went in there expecting to have to fight. I even had a plan if I needed to walk out. See, I’ve never had good results for long when I went to the VA for health issues. I was leery about reaching out to the LGBT Care Clinic to begin with. I was leery about going in to meet the counselor who was supposed to decide if I was “trans enough” for HRT. I was even leery about going to group therapy.
But, every step, that trepidation turned out to be unwarranted. The director of the clinic was kind and warm (and his email signature specified his pronouns . . . very progressive for VA, I thought). My counselor was amazingly sweet and supportive, complimentary of the steps I’d taken on my own “already”, and told me just a few minutes into the appointment that there was no doubt that my decision to start HRT was clearly right for me. Even Group was OK, with yet more bright and obviously compassionate care providers facilitating.
But, today . . . today I was meeting my prescriber. Today I was meeting the woman who held my fate in her hands, as the gateway between me and that sweet, sweet estrogen.
You may not know, but transgender hormone therapy is kind of a mess, academically speaking. Heck, it’s only been in the last 5 years or so that it’s been widely accepted as “safe”. There’s almost no meaningful research, what has been done is tainted by poor methods or out-of-date protocols, and there’s no real push to do anything about it. If you want an education in female “cross-sex” HRT, you’ve got to weed through tons of poorly documented anecdotal evidence, fight through mountains of prejudice, and hope like hell the person on the other side of the prescription pad has done the same. Or is at least willing to listen.
I’ve done that research. I’ve found the work of the few people actually working to refine the protocols. And I found some less than well known information compiled mostly by one man out of Detroit, who is so passionate about this that he keeps his entire catalog of research in an updated PowerPoint on his Facebook for care providers and patients alike; the same PowerPoint he uses to present at conferences every chance he gets, when he’s not treating his thousands of patients actively in transition. I want to do it his way. His way is to use the body’s natural feedback loop to trick it into shutting down testosterone production with high consistent levels of estradiol (A form of estrogen most commonly used in hormone therapy) WITHOUT having to resort to anti-androgen compounds (or “blockers”). His protocol relies on injections of estrogen, to skip “first pass” liver processing (hard on the liver, and reduces the efficacy of the estradiol). Most protocols rely on blockers to squash testosterone levels, and use barely significant levels of estrogen administered under the tongue to encourage feminization. His method has lower risks, lower side effects, and most importantly, shockingly better results.
And so I went in today expecting to have to defend his position as my own. I don’t know how much time I have (for those of you joining us already in progress, I have terminal heart failure), so I want to be as aggressive as possible. I’ve been on sublingual E- it’s impossible not to swallow some of it, and every microdot that goes through my digestive system is lost opportunity. F that. Gimme the good shit, Doc, and gimme a lot of it. Now.
And she did. Injections? No prob. Skipping the blockers? Of course, that works just fine. High levels of serum E? Well, she’s a little leery of the upper end of his range, but she’s willing to shoot for the low end AND she’s willing to read his research.
She’s also willing to write any and all letters I need for changing my birth certificate and getting an orchiectomy.
I don’t think I’ve ever said this before, but . . . things went really well at the VA today.