by Jessica Soukoup
My phone rang. It was an endocrinologist's office calling to set up a time for me to come in.
Confused, I logged into the health portal for my primary care doctor’s office. I knew I had a series of tests the previous week. However, she never called and so I assumed nothing was wrong.
My heart leapt as I read the message from my doctor. The note said I had osteoporosis and everything suddenly fell into place.
I had gone to a health and wellness fair and while there, some salesperson had tested my bone density on my ankle with a device. The device said I had osteopenia, the precursor for osteoporosis but I didn’t lend it much credence as I assumed it was part of the sales tool. After all, my testosterone level was 650 - high normal for my age and biology. I had a lifetime of workouts and fitness and healthy eating. I was not at risk for osteoporosis. Nevertheless, I mentioned it to my doctor when I saw her and she scheduled me for a bone density scan. I did so at the same time as another test.
This meant that I could go to the endocrinologist and receive estrogen - Hormone Replacement Therapy (HRT) - as treatment for my osteoporosis. This avoided an insurance exclusion designed to block the transition of transgender people.
Now with that obstacle overcome, I had to figure out if this endocrinologist was affirming of transgender people. A quick facebook post solved that problem. In addition to reports from several of my trans friends who received HRT through this office, one of my cisgender best friends had followed my request a few years earlier and asked their doctor if they were trans affirming. I had made this request in an effort to encourage doctors to get necessary training as there is such a shortage of trained doctors. The doctor I was referred to happened to be the doctor she was seeing. So, in addition to the information from facebook, I my friend had a personal conversation with the doctor to fall back on.
I remember sitting in the waiting room before my first meeting with her. My stomach was all in knots. I was so excited. I had been reading about HRT for years as I tried to navigate the systems in order to get it as well as evaluate my own personal needs and concerns.
When I finally got in to see her. She was lovely. She spent two hours with me going over my whole health history, options for treating my osteoporosis and very carefully reviewing the informed consent document for cross sex hormone replacement therapy. She wrote me up prescriptions, I made my follow up appointment where she would train me to give myself the injections and I went on my way. I was so happy.
That happiness did not last.
I knew some pharmacists would refuse to write prescriptions. I had a 10 year relationship with mine and so I hoped it would be ok. Turns out she was willing to fill the prescription but she didn’t stock it and it was on backorder. She placed it on order but as the date of my appointment approached, there was no estrogen to be found. She searched and searched and could not find a place to get some. The night before my appointment, I took matters into my own hands. I knew so many trans women in town. Somebody must know where to get it.
As I messaged around, I found that these shortages happen far too often and many trans women maintain a few extra vials in order to not go through menopause every time there is a shortage. I received multiple offers for a loner vial but we eventually located a CVS up in Austin that had a vial. I drove there from San Marcos after work and waited in line for more than 90 minutes to get it filled. In celebration, I went to my trans friend’s house and we had a celebratory glass of wine or two before I headed back home.
Off to the endocrinologist I went. I frankly didn’t need to go for this appointment. She had asked me to come in so she could teach me how to do a shot. In addition to my pharmacist, who out of frustration for not being able to fill my estrogen order had carefully trained me what to do, I had already watched a number of YouTube video tutorials and read several articles on it all. Thank goodness I had. The syringes that were prescribed with the estrogen were too large for my dose and so I had to ask the pharmacist to get me smaller syringes.
Regardless, I showed up in my endocrinologists office and took my required training and gave myself my first injection. As I sat there listening to the training and carefully reviewing with my doctor the procedure, I beamed. I can’t remember ever having been that happy. Finally, I would take the steps to bring my body into alignment with my internal vision of self. This step promised to allow me to look at the reflection in the mirror and instead of looking away and trying not to think about the reflection that stared back at me, but maybe, just maybe I would begin to see myself.
Alas, my journey was not over though. Weeks passed and injection after injection left me increasingly depressed.
Every three months, I would meet with my endocrinologist and she would adjust my hormone levels. The problem was, she was limited by a hormone protocol developed using hormones derived from horse urine rather than the bio-identical ones of today.
After 9 months, I had enough. I complained on social media of my challenges and a doctor who I had become connected to via some trans related activism suggest I come and see her. She made some minor changes to my protocol and it was like a light turned on inside me.
Not only did my depression clear but, it was like a heavy wet blanket that had been laying on top of my emotions for my entire life suddenly lifted. I began to blush for the first time in my life and it was fascinating feeling my cheeks get hot. I smiled. I laughed. I cried. And, I loved it all. It felt right. I felt right.
On top of that, my body responded. For the first 9 months of HRT, I had no breast growth. In the year since, I have gone from nothing to large C, small D breasts. My skin is soft and sensitive. And, finally, for the first time in my life, as I look in the mirror, I have begun to see myself reflected back.
