What led to the Best Christmas Present Ever!

This is the story of what happened in the 6 months after the Don’t Give Up story. (That’s here — https://christinepenn.medium.com/dont-give-up-206cb9cf5883)

It took a couple of months to find a gender therapist. My insurance company did not have any listings for “gender” therapists (they didn’t support anything related to transitioning gender at the time), so all they could give me was a list of “therapists”. Without any other better resources, I started calling the official sounding ones that had a doctorate degree…nothing. I then moved into the list of LCSWs (Licensed Clinical Social Worker) and started to find a little success, although most were dealing with divorces and their fallout (children). I was attempting to find a woman (someone I thought would be more empathetic) but ran out of them quickly. I was working on my last page of men and was about to give up hope, when I finally found one. Not ideal I thought but decided to check him out.

He ended up being a really good guy, challenging me with things I would have never thought of. In one of our first meetings, he asked if I would feel comfortable enough to put on a tutu and dance around in the front yard. I told him no way at the time, because I would feel way too embarrassed. Today, I would have no problem doing exactly that…as it's all about feeling comfortable with yourself and not caring about what others think. And that’s the way most things went; feeling like I was in the Karate Kid training program. Not knowing or understanding at the time why you were doing things…and then later finding out why and understanding them completely. (Wax on, wax off…)

Separately, after a 15-year hiatus, I returned to the support group I had once attended before (Renaissance of the Lehigh Valley — or just Ren for short). There was no one there left from my prior visits, except for an interesting one I didn’t really expect and found out about later. Several people there had started shortly after I left and knew some of the people I remembered from my prior visits. Unfortunately, the president at that time, had long since passed. Made me feel bad that I was not there for her when she was nothing but nice to me and had welcomed me with open arms. The interesting one was about someone who was a college student (at the time). She was observing the group as part of her studies and was now a gender therapist, had published several books, and was pretty well known in the community. (I would mention this to her later when I ran into her at her latest book signing…that I knew her when :) )

These were early times in my transition, so I was not attending anything dressed. I had barely been out in public before, and I wasn’t ready to start that until later. I was upfront with my therapist and told him that I was way past the emotional stuff. I came out 15 years prior in several emotional psychologist sessions. And, I had just come from an almost suicide attempt. I knew what I was and what I needed to do. I was on a mission to transition, and I was there to get my letter to be able to start that. But he could see my nervousness about the process and needed to dig in deeper before he’d be willing to write that recommendation. He was serious about following the process and I needed to check off all of his dots first. He also made it clear that he was dying to meet Christine, and sort of required it.

Being that it was so hard to find him, I started looking for an endocrinologist to line up well even before I had my recommendation letter. This turned out to be good, because it would take several months to find one. My primary refused to prescribe them, simply because I already had other endocrine system problems as it was…and he felt I needed a specialist to manage any changes to it. (He was right!) When I came out to him, he yelled at me! He had told me that I should have disclosed being transgender before. It would have helped in the diagnosis of my thyroid condition…as those things (and other conditions) are pretty common in transgender people. He did order my first hormone level test…which came back a bit interesting. My testosterone levels came back low and had me wondering how long they were like that. The testing levels would be needed for the endocrinologist, so it helped to save a little bit of time. My doctor stated that I qualified for a testosterone booster (something big at that time) …and I stated that it was not really the direction I was heading. He said he figured that, and we laughed.

My mother is becoming overwhelmed with how fast I am proceeding and insists that she have a conversation with my therapist. I speak to him about it and arrange for the three of us to meet one night. After some introductions I am asked to leave them alone. I found out a week later what they talked about. Apparently, she thought that he was doing a bad job. He was supposed to be talking me out of transitioning, prescribing things like testosterone boosters or something, to convince me to stay a man…. when he seemed to be supporting my wish to transition instead. She did not like what he told her in reply, so she goes on a mission to attempt to stop me herself…but I am ignoring her. I knew where that leads too…as I had realized a while ago that my best interests and hers were no longer in alignment.

Just like the therapist search, endocrinology is going just about as well. I decide to play a ruse on the next office I called. I want to see if the problem is what I am coming to see them about — transition related HRT. So, I call, am truthful, and the response I get is that the office is not accepting any new patients right now and that they are sorry. I then call back the next day and ask to see them about just my thyroid. Today, they have no problem accepting a new patient!

Not that it mattered a dam bit, I now had proof of a form of medical discrimination. They were not the only office, but I found out that they simply did not want transgender people in their waiting room! This particular one was actually advertising HRT treatments! But apparently, that option was only for women wanting to eliminate menopause symptoms, not for transition related treatments. Today this is much less of a problem, as we now have websites, where we can go to find affirming doctors, therapists, and other medical necessities.

I finally found a doctor who would take me. By this time, it was beginning of October, but the first appointment they have is 12/24/2015. Wow, almost three months later; I take it! I was told that I must show up with my recommendation letter in hand, otherwise they would cancel the appointment. (I got my letter about 2 weeks after this.)

In the meanwhile, I showed up in femme, as requested, to one of my therapist appointments. It was likely pure coincidence, but the waiting room that day was packed. I was particularly enamored with a little girl and her mother. She stared inquisitively at me when I walked in, then quickly went about her business playing with a toy. A gentleman came in and sat beside me, but never said a word and barely looked around. My therapist was noticeably late to come out to get me. I never asked, but it wouldn’t surprise me if he was observing me from another room. Most days I went there, there was never a soul in the waiting room. Why this particular day? I sat there wondering if I was just clocked by a child. Everything must have been Ok, as no one said a word. Shortly after, my therapist wrote me the letter I needed. I was set and ready and could not wait for the months to go by to have that endo appointment.

It was pretty clear that my family was not too supportive of the path that I was about to take. At the time, I was out to them but no one else. Rumors had already started to fly across the family. I was starting to venture out more in public in safe places (LGBTQ bars and resorts). It was the beginning of dual life I would grow to later hate. Nail polish on, taken off. Make up on, make up off. It all depended on where I was going and who I was going to see.

I attended a Christmas party on a Saturday night with some girl friends at Rainbow Mountain; I had a blast. The following day, I attended what would end up being the last ever family Christmas party on my mom’s side of the family. I didn’t know it at the time, but when I attended, I was under a microscope. I think they all thought that I would show up in whatever garb, but I decided not to do that. Being that I showed up in my male garb at the time, nothing was said but the normal pleasantries. However, a couple of days after, a shit storm started.

On my way to the endocrinologist office, I got a text message from my brother asking if I had really worn eye makeup to that Christmas Party (he didn’t attend that year). I told him no, and where did he hear that? From my cousin, who insisted I had on makeup, including mascara. I was like seriously? Then a message comes in from my mother, stating something similar stemming from my aunt. I didn’t have time to deal with this…and I go into my appointment and try to ignore my phone blowing up with all the accusatory messages going back and forth about the party.

My first endocrinology appointment

My name is called, and I am led back by an assistant to an examination room. Someone comes in and takes all my vitals. She states the doctor will be in soon. He’s an older gentleman and it seems like he is out of breath all the time. He sits down with his computer and pauses for a minute, as it seems like he is reviewing something. He requests my recommendation letter for the record, reads it, and then asked me to tell him my story of how I came about to be seeing him. So, I explain to him about when I first knew at 4 years old, and how that came about. How I struggled with it and found some relief in acting out my feelings by dressing up. How that became a regular occurrence that continued even to this very day. I described how I got caught with clothes at 12 and how I was willing to come out then, but the conversation didn’t go well.

He interrupts me and lets me know why it took so long to get that first appointment. The doctor had requested my complete medical records from birth. He tells me that it's pretty rare that transgender people don’t have other symptoms going on and he wanted to see if I had experienced any.

So far, my story was similar to what he has heard before, but he had found something in my medical record that he needed to ask me about. He says, it looks like you went in for a physical when you were 16, but the appointment was cut short. What had happened? I explained that when the doctor was listening to my heart, it sort of skipped a beat and he heard it. The appointment was immediately ended, and I was told that I needed to go up to a hospital to have an MRI done on my heart. They needed to see what was going on with it. He then asked what was the outcome of that? I went through all sorts of testing and was eventually diagnosed with mitral valve prolapse; and what I had felt (and the doctor heard that day) was a valve flutter. They put me on a caffeine restricted diet and other things in an attempt to get to it occur less often, as it was happening very frequently back then. I was told things like that when if I went to the dentist from that point forward, it was now necessary to take a pill to kill any bacteria if introduced into the blood stream. My condition was very suspectable to those types of problems. He says OK, I did see that in your record. I asked if that was going to be a problem and he told me no.

He then states that my doctor at that the visit wrote in the notes that puberty seemed to be delayed on me and a question mark. Did he ask me anything about it? I said no, it was never mentioned, but it was something I was very much aware of at that time. He then thought out loud….and wondered…. but it doesn’t look like there was ever any follow up on it. He asked what was going on with me at the time? I spent an awful lot of time after that appointment seeing a cardiologist for a while, as they were trying to figure out what was aggravating my heart condition so much. I’m not sure they actually ever really figured it out. That went on for a couple of years and by the time I saw my primary doctor again, I was almost 18 years old. Somewhere between 17 1/2 and 18, male puberty finally kicked in for me. So, I am not sure there was anything to really follow up on. He then asked…and the heart condition? Around the same time puberty kicked in, my heart issues also pretty much subsided and eventually I stopped seeing the cardiologist as there were no longer any pressing issues but only some concern about longer term maintenance checkups to worry about.

It was a very weird time for me. I had felt like I had female parts inside of me and it seemed like they were turning on for a time. I was experiencing crushes on boys and growing every year at an extremely fast rate. At 11, I was pretty much an average size kid in school, but by 12/13 I was already accelerating to the taller side of that class and would eventually become one of the tallest. My growth finally stopped when male puberty started to kick in at 17 1/2 — 18. That whole time in between my heart was fluttering a lot. By the time I finally stopped, I reached my current height of 6'5". At the time, I only weighed about 150 lbs. I was growing so fast during these years that I couldn’t put on any weight to save my life; I was real bean pole. However, that had an advantage as I looked like a very skinny girl in appearance early on and was regularly passing as female in public. I went to public school in 9th and 10th grade which enabled me to grow my hair long, which really helped with passing (and I loved it).

(See my Acme lady story, as this is how my life was going at this period of time — https://christinepenn.medium.com/to-the-acme-lady-im-sorry-and-thank-you-a88f0eccaab1)

It really helped me get through that period, but also made me stand out. When I finally masculinized, it was depressing to me. I was really hoping that biology was going to save me, particularly since my attempt to come out previously to my parents had failed. But biology ended up failing me too in the long run (per say). There was another change that came with puberty finally kicking in. It was that my attraction to boys diminished and flipped over to girls. However, while my attraction changed, it had no effect on my identity. My identity never really changed, but it did make it easier to fake living as a boy as a result of the changes. But the whole thing came with more complications and left me a bit confused and questioning about who I really was again. When I got to college, I was back trying to be the best man I could be and did all sorts of masculine things to trying to prove that. Like joining a fraternity and being sort of a jock in intramural sports. This then moved along to marriage and kids, etc.

(Note — much later in life I would find out what was really going on in my teens and it's a real shame that that comment written on my chart at 16 was not actually followed up on to find what the cause was. All of these symptoms and problems I was experiencing at the time were very much related. Although it was the first time, it was not the last time where they focused more on the side effect problems and not the root cause.)

He said very interesting….and then brought up my thyroid condition and asks about that. I told him that my primary had already yelled at me for that one, as it went undiagnosed for a long time (well over a year and a half). It caused me to gain over a 100lbs in the process. Early on it was complicated that I was working on quitting smoking at the time, so they ignored the weight gain for the first 50 pounds or so. My heart also started acting up again (so I was actively seeing a cardiologist again), I was diagnosed with sleep apnea, and my joints were killing me. There was a lot of focus put on these side effects before getting to the root cause. It was actually the cardiologist that figured it out, after we had a conversation. He was at his wits end trying to figure out what was going on and asked me about my weekend. I had explained to him that I had ridden my bike a little over 80 miles over the weekend. When he asked how much weight I lost, I told him I hadn’t, and that I had actually gained 5 lbs. If I hadn’t ridden the bike, I probably would have likely gained 20 lbs. I explained that I could slow down the weight gain with my activities, but I couldn’t reverse it. He then added the test that diagnosed me to my next round of blood tests, and it was off the chart.

I had explained that I didn’t know about any relationship there to being transgender, and I also didn’t know until after I was diagnosed that it actually runs in my family. However, it only runs on the female side and since I was “male”, they never told me about it. As far as anyone knew, it had never occurred with any male in the family, and I was the first. (I’m not so sure that that is still not true….)

I had told him that this was not first time I considered transition. I have had mini meltdowns several times before, and actually came out prior in my 30’s and was on my way for about 6 months. Family had stepped in to stop me from pursuing transition by reminding me of my obligations that I had made to my wife and kids, to be the father/man to them. My mother laid down a particularly powerful guilt trip that hit me to the core. She had stated that if I was truly a woman, then I would know how we put everyone else’s life before our own. So, if I was really a woman, then I would stay a man for my wife and kids. I understood that thinking and took the advice to heart. It was what put that earlier transition on hold for another 15 years (now).

I then explained what was different this time around. My marriage had sort of fallen apart (related/unrelated?) and the kids were now grown. I felt I had lived up to my obligations here. With that, I wasn’t sure I could endure transition but didn’t feel I could go on any longer faking a male life. I seriously considered suicide 6 months prior. I had felt my prior attempts had been like negotiations that didn’t go well for me. I decided if I was going to do it this time around, it was going to be a declaration not a negotiation. I was no longer listening to the advice of others because I knew where that lead. I had to do what I knew was to be true in my heart. And to the core, that has never changed since day one. The suicide attempt helped to put my life into perspective, and although people say it all the time, I really felt that I reached the point where it is transition or die. However, I wondered if I lost the opportunity to transition when I didn’t as a child, in my twenties and early 30’s. I wasn’t even sure how well transition would work now (late 40's), but it was really my only option at this point. (Telling that part, I think was risky to my case…but it was true!)

This is a summary of the things we were talking about, and the appointment had gone on for about 3 hours at this point. I was impressed with his tenacity, his thoroughness, and inquisitiveness. This interrogation was not anything that I was expecting. I was beginning to wonder if he thought I was crazy.

He asked if was continuing to see the therapist, and I confirmed that I was. With that, he told me that he was going to give me the scripts for the HRT medication. We went over what each drug was and what the intention was. Basically, estrogen and spironolactone as a testosterone suppressor. He explained that even though my testosterone was low, with the introduction of higher levels of estrogen it would likely spike up before coming back down. He was a little worried about my blood pressure medication and it was likely it would need to be adjusted. He gave me an order for another set of full blood work. He told me I would need to have it taken before the next appointment and he wanted to see me back in 3 months to be re-evaluated.

I left feeling elated getting the scripts and wondered if every appointment in the future was going to be this intense. I wasn’t sure I can live through this if every appointment was going to go like this one. I also left feeling pissed that my doctor didn’t say anything at that appointment about what he observed when I was 16. That could have been a life changer for me. I had no idea he noticed…but it sort of made sense that he did. I was certainly wondering what was going on at the time.

I left the appointment having to go back and deal more with the crappy text messages as best I could in the parking lot. Between the appointment and the messages, I felt a bit of an emotional wreck.

I stopped at my local pharmacy to get the prescriptions filled on the way home. The pharmacist was extremely reluctant to fill them. They had a private consultation set up for me at pick up where they repeatedly stressed what the drugs were for and did, I realize what they could do to me. I repeatedly told them that I knew exactly what they were for and if they really thought that I had not seriously considered the consequences. I was not expecting this interaction at all and the funny looks I was getting from them. It left me feeling more than weird. I felt like as if they might as well have announced it over the loudspeaker to the whole store. I didn’t care…. they met me on the wrong day to try to talk me out of anything; particularly after dealing with those earlier text messages.

(Future visits to the same pharmacy would elicit similar reactions in the future and I am sure they were talking about me when I wasn’t there. I’m pretty sure I was their first every transgender person ever at that particular store…)

So, on Christmas morning 2015 I started taking my new pills as a Christmas present to myself. The day after, I would start to feel sick (morning sickness — a reaction to the higher level of estrogen) and 5 days later I would end up in the hospital due to dehydration after a bike ride caused by the hormones. (My kidneys had shutdown.)
Despite the rough start, I still consider it to be the ultimate Christmas present ever. Why? Because it was all about starting what I had dreamed about my entire life. I was taking control of my own life and no longer cared what people thought about it. It was what I needed to do to live…not what others wanted me to do or how they thought I should live. It was amazingly freeing, and I don’t regret it one bit.
Although we spend a lot of time caring about others this time a year, don’t forget to also care for yourself as well!
Merry Christmas 🎄🎅🎄

Note — Between the Gender Therapist and Endocrinologist a diagnosis of “Gender Dysphoria” was officially added to my medical record towards the end of 2015. My health insurance at the time did not cover anything related to that. So, all my medical expenses from 2016 to 2018 were completely covered out of pocket. They could no longer distinguish between transition related care and normal care. This caused a lot of problems for me during this time, mostly because my required blood work was constantly being canceled due to the lack of insurance coverage. These problems were not resolved until finally in 2018, support for some transgender related care was added to my health plan. However, I continue to run into problems to this day with insurance.