Best Doctor’s Appointment Ever

OK, reader, I have a lot of good news to share. Are you ready for all this positivity and progress and victory? If not, this probably is not the post for you, and you should keep scrolling through dank memes and cat videos and reposts of clever tweets.

I saw a doctor I’ve seen once before at Family Care Health Center in St Louis today. I went in there with like a 10-item agenda. I was prepared to have to argue with the new doc about my treatment and to fight with her about what is and isn’t true, but she is an amazing listener, and even better, she actually did the research she was saying she would do after our last session in November. I did my research, too, so we both came prepared to meet minds and make informed decisions. I think she is a resident instead of a full MD, but I will follow her to whatever practice she goes to after this one because of this awesomeness. So the good news here is that I lucked into having a curious, listening, collaborative, and informed doctor, finally, after so many ignorant, authoritative, self-important ones.

We’re just getting started with the good news here though.

1) She upped the dose of my depression medication, so I don’t have to pay out of pocket to see a psychiatrist for that! Huzzah!

2) She gave me the OK to start estrogen injections NEXT MONTH! This is so great, as I’ve been seeking a doctor since 2017 to give me the clear and to monitor me while I start it. It’s double great because the sublingual estrogen I’ve been taking is part of the reason I had my gall bladder removed, and sublingual E can lead to liver damage, so this is not just a move toward healthy HRT–it’s a way to stop my current HRT from further damaging my organs. Technically she gave me the ok to start them today (!), but I said we should wait a month to do smarter science because of item 3.

3) She gave me the OK to up my progesterone IMMEDIATELY. She read some stuff recently that says progesterone functions as a testosterone blocker (!) which is like SUCH A BONUS to its already awesome effects of filling out my breasts and acting as a mood stabilizer and interacting with estrogen to keep me from getting all sorts of other health problems.

4) Based on the last round of labs I did in November, I WAS RIGHT in suspecting that my testosterone had climbed back up out of the female range. I’m at 91 ng/dl Tnow, which is 41 ng/dl too high to be considered in the female range. I WAS RIGHT THIS WHOLE TIME THAT MY HORMONES WERE MESSED EVEN THOUGH MY LAST DOC SAID THEY WERE IN A GOOD SPOT. Now we know precisely how messed they were, and which kind of mess, and my inner sense of “something is off here” has been validated.

5) She referred me to a local dermatologist to get a cyst I’ve have on my face since 2013 removed!

6) She wrote me the letter I’ve needed for my passport IN LIKE FIVE MINUTES DURING THE APPOINTMENT. She also commented that the language in it was offensive to her, and that this entire process seemed unnecessarily discriminatory for me to have to go through, and that it didn’t make sense since like obvi I’m a woman obvi I’ve been transitioning for five years now, and she even understood that transition is a process and that standards of completion are different for everybody (some folks want surgery and some don’t, some folks want HRT and some don’t, etc), so why are the feds asking for this letter anyway whatever here give me a few minutes. Basically my doctor is a bamf and an ally and hopefully I’ve finished this passport process because I’m mailing out the letter tomorrow morning.

7) She’s giving me access to the clinic’s psychology services so I can see a therapist and psychiatrist through them, which will be covered by their local insurance program, so I won’t have to pay for therapy, and said they are happy to refer me somewhere else if they can’t meet my needs there! So, that whole process of finding a county mental health clinic with sliding scale fees and trans-accepting providers I was trying and failing to do after I left the psych hospital is moot now. Someone from the clinic is contacting me tomorrow to set up an intake appointment for ASAP.

8) She said she is interested in the science I am reading about HRT things she hasn’t heard of, and asked me to bring her what I’ve been reading so she can integrate it into her practice and so we can both make informed decisions regarding my care through her. Was mostly referring to why we want progesterone levels to be in the luteal phase range, and evidence for why sublingual E messes with the liver and gall bladder. THIS IS HUGE. She trusts me enough to do my own research. She doesn’t think I’m crazy, incompetent, ignorant, or deceptive, like so many of my prior providers have. I’m valid. She sees me. She listens. She trusts. We are collaborating. I love it.

9) She renewed my scrip for the anti anxiety medication I have been taking that helps me sleep and helps me leave the house! She even upped the dose, and gave me license to drop it back to the current dose if I don’t tolerate it well. Again with the trust. Feels so good.

10) She told me there is current research saying the proton-pulse inhibitor I’ve been taking since surgery to help with my digestion (Zantac) can be difficult to stop if I take it for a few months (I plan to take it all year until my guts even out from surgery) because it can produce acid bounceback after stopping it, so we switched to Ranitidine, which either isn’t a PPI and/or doesn’t have a documented history of producing bounceback after cessation. BONUS.

11) I went in there with a laundry list of stuff I needed to discuss and we covered all of it. In short, I’m getting what I’ve known I needed regarding my progesterone, my estrogen, my testosterone, my whole HRT regimen, the hormone imbalance and the accompanying dysphoria that I’ve been carrying since I stopped spiro over a year ago and have been unable to meaningfully address through no fault of my own. I’m getting the followup care I was supposed to be getting after my stay in the psychiatric hospital but couldn’t because I’ve been homeless and moving around too much after surgery to access facilities due to residency requirements I couldn’t establish. I’m getting my meds renewed and adjusted. I have access to therapy again. I’m taking care of issues I’ve been carrying for years. I’m finally finishing (fingers crossed) my passport application. This session addressed SO MUCH. It was so necessary. I left it feeling like a huge burden had left my body.

TLDR: I just had the best doc’s appointment ever and I’m looking forward to another with this person next month. But mostly I’m stoked to have forward motion again regarding my healing. It’s possible. Healing is still possible. Even in St Louis.

Wish me all the luck!


Leaving KC

Life Update: I (hopefully) start hormone injections with a doctor I trust in St. Louis next month. As it could take months of labs to test my levels regularly and to learn how to do injections safely and reliably on myself, I will be moving back in with my mother in St Louis.
The irony of re-entering what last year was a life-threatening living environment, so that this year I can address my hormone deficiency in order to save my life (or at the very least remove the barriers living with a hormone deficiency erects before my efforts to build a livable life, dispel its constant debuffs) is not lost on me. Given my means, this is the only realistic solution I can access at the moment. So, I go to St. Louis and live with my mother again while adjusting my hormone levels. Once hormones are set and my vitality is back, I plan the next move. I don’t have the means to get my stuff back to St Louis either, so KC friends are holding on to my belongings while I get my health in order.
Depending on how the hair removal Groupons shuffle out, I may or may not be travelling back and forth from Kansas City once a month in order to do hair removal while being based in St Louis.
Voice lessons start next week with money from the fundraiser. Thank you to everyone who gave!
I’m realizing now that I never should have gone to Kansas City after my arrest. Had I not had the trauma of my arrest to deal with on top of everything else I brought here with me, maybe I’d be looking at a different reality rn. Maybe I would have been able to find work, even with my hormone deficiency and beard and man voice and the insecurities and unmanageable anxiety and real safety issues those bring.

All the planning and fundraising I did in February and March was done under the pretense that KC would be a healthy escape from my mother’s, a place with more opportunity, where I had more community, where the city offered better trans resources, where my place of residence afforded me many potential places of employment within walking distance. That was all before my arrest the weekend before I was supposed to rent the moving van, which I couldn’t rent due to my arrest, and which should have been a sign to call off the move. Friends I spoke with encouraged me to go through with the move anyway, but I should have listened to the part of me that was curled up in a ball screaming hoarse at the void every night, should have known myself better, should have listened to my instinct to withdraw and focus on caring for myself rather than my urge to take on all these new burdens as I had planned to, to buckle down and muscle up and and power through and all that.

I was so eager to gtfo my mother’s that even though I was traumatized from having to deal with law enforcement and from being back in the legal system in the same college town I fled almost a decade ago, I saw a shiny way out of my immediate circumstances and I took it, hoping things would go as I had planned before this new factor rose up and shadowed everything like a DOOM MONOLITH.

The problem was, that monolith followed me to KC. And dealing with it on top of everything else I brought took the three month buffer of not paying rent my landlady had offered me so I could have an easier time finding work and getting settled in this new city, and turned them into 3 months of dealing with escalating trauma and escalating legal consequences and escalating legal fees I couldn’t afford and didn’t know how to pay and the escalating health consequences of carrying that in a foreign city while you’re supposed to be taking on the other burdens of building a life.

This trip became one of encountering my limits and understanding what is and is not possible to power through. I had hoped it would be a trip of putting down roots and finding sources of money to get out from under my maxed credit cards (which are now in collections) and my private student loan (currently in default) and my health problems (which my new fundraiser is finally helping me address, thank you so much).

I know now that the grad school Z who can head an organization planning and hosting and running an interdisciplinary conference, be second in command running a literary magazine and managing a pool of readers and coming up with fundraising strategies and doing layout on final proofs, write her thesis, research her transness, apply to further graduate school, move twice in one school year, and come out to her family all at once…that Z is gone. Or sleeping. Or on hiatus. Maybe not forever, but for now, she needs more rest and more care than she used to, and can’t do all the things at once like she used to.
This is how I understand why I am moving back in with my mother again, after this false start, after doing all this work to get away from that place, after literally a lifetime of putting distance between me and St Louis first by travelling to the middle of nowhere for undergrad, then to the desert for grad school part 1 where I finally felt safe enough to come out, then to the further possible coast for grad school part 2 where I finally felt courageous enough and sure enough of myself to start transitioning, then to LA to try…actually what I was trying in KC (professionalizing while recovering from trauma, which didn’t work there either) then to Knoxville as a way out, then to StL to relearn I couldn’t exist there, then to Knoxville to professionalize (again abortively due to trauma) then back to StL, then to KC to try professionalizing-under-trauma abortively again, just for shits this time I suppose. 
I have learned my lesson. One cannot professionalize when one’s health is in the gutter. So I am addressing what I can with what I have. But I want this to be the last fucking time I return with my head hung low to this accursed city that sucks you in like a singularity and just won’t let go.
Still, this is what I can do for now, so it is what I am doing. Back to St Louis, to heal. I suppose it’s different this time in that I am aware of all this while returning, but it feels so goddam the same already that it is difficult–but not impossible–to have real hope that I can do what I need to do there–HEAL. I need to heal. Hormones, you come first. Voice, you come next. Beard, you’re next-next.
Still, I did a lot of work to heal while in KC. Thanks to the Kansas City Anti-Violence project hooking me up with therapy, thanks to my therapist for being a fucking badass and exactly whom I needed, thanks to KCAVP again helping me get ID, and thanks to both of them for helping me become able to feed myself through food stamps and access to pantries.
KC was not a complete wash. I reconnected with the friends I have here. I healed, I learned how else to heal, learned other angles of healing. I obtained ID, I obtained access to food, and I obtained vital self-knowledge that I NEED to put my health first in all things, or else this cycle of abortive and expensive attempts at professionalizing will continue.
Health comes first. 
If you can, consider giving to my fundraiser. It will help me get my hormones to liveable levels, finish hair removal on my face, and feminize my voice so that internally my body becomes easier to live in, and so that externally I can pass better in public. All of this will long-term help me be a healthier human and one day be able to support myself again. Thank you for anything you can give.

Cursory Hormones Research

Doing more research about hormones. Apparently, both E and T regulate/impact seratonin response, so either being low can result in depression. My E has been low since last October, when I stopped taking the antiandrogen that kept my T down but almost killed me. I was already depressed then, and I’ve been climbing out of another gutter since I got arrested in March, but what’s important here is that MY E HAS BEEN LOW SINCE LAST OCTOBER AND THAT CAN RESULT IN DEPRESSION.
I made addressing my known hormone deficiency a lower priority when I was arrested because I ran out of money and staying out of prison (by paying the requisite legal fees to avoid violation the orders of my probation) took priority over almost everything else. Pmuch I couldn’t afford to address it, and I figured it was better to live with E deficiency and stay out of jail than go to ail and risk not getting hormones at all. I still can’t afford to fix this. Endorinologists cost hundreds per visit, but this new knowledge necessitates action. Gonna ask the new doc in StL about switching to injections to try to get my E up, even tho I won’t be able to see them much because I’m in KC so often these days. There’s also a Planned Parenthood a few miles from my house I’ve been pointed to–maybe I can do it there.
I’d love to take pills forever, but oral estrogen damages your liver over time, and taking them sublingually isn’t very realistic–the pills need to be absorbed through the mouth tissue over a period of about thirty minutes and mine are usually gone/swallowed/dripping down my throat around five.
Also I have a rather severe needle phobia that I plan to get over either before or during my first injection.
Also have I mentioned how much I hate transitioning.

TLDR: girl can’t get a break.

The Times on Antidepressant Withdrawal

Glad this issue is getting some attention, from the press and from the scientific community.

I have friends who have gone through monstrous withdrawal experiences from these drugs. I have friends whose lives the drugs have dramatically improved.

Antidepressants have: done nothing to improve my life; improved my life; exacted significant tolls upon my life in exchange for improving it; wrecked my body without improving my life; asked me to weigh their benefits against their costs; led me to stop and restart and change dosage and change meds and abandon them and thank the gods for them over the last decade and a half; been prescribed in informed-sounding ways; been prescribed with serious discussion of withdrawal; been prescribed as if a lighthearted jaunt through a casino; been prescribed as if methodically combing a troubleshooting guide; led me to avoid them for the better part of a decade; made me functional enough to complete graduate school despite not feeling enough like myself to enjoy as much of the experience as I thought I would; made me functional enough to complete my first and last year of full-time college teaching though I didn’t enjoy that experience much either.

There is nothing redeeming or good about depression. I’m glad science has given us antidepressants–sometimes they help. Sometimes they save lives. Sometimes they repair people. Sometimes they make the unbearable more bearable and life more livable.

I have serious problems with how antidepressants are prescribed so often right now that it seems as if our culture would rather medicate away how guts-crushingly shitty everything is than to do the work of fixing the large-scale social problems that make so many people depressed, hopeless, suicidal, and unable to imagine surviving another day.

This is not everyone’s story. There are many depressions, many flavors, many sources, many treatments.

I’m glad we are, culturally, starting to look at the back end of depression and antidepressants, to try and make this thing–treatment, product, drug, addiction, boon, burden, mess–that already asks so much of people one day ask less.