Dr. Miller and the Floppy Receptionist: A Hormonal Love Story

Comfortable?  Good.  This is going to take a minute to get the full picture:

This past Wednesday I had an appointment with Dr. Miller, endocrinologist.  I came across his name on a trans resource website for folks in or near Chicago.  I wanted to have some reassurance he would actually talk to a trans person, as not all endocrinologists treat folks like me.  So, I googled “trans friendly endocrinologists in Chicago” and came across this rather colorful website, and there I found Dr. Miller’s name and contact information.

I made an appointment with him for a consult, and double checked with the receptionist that he served the transgendered population.  Her accent was rather thick, so thick* that I questioned the doctor’s decision to make her the first voice potential clients would encounter.  I wondered what kind of a doctor would hire a receptionist for whom english didn’t seem to be a second language, but rather a fourth or fifth, one whose importance seemed to be somewhere down the line behind rude hand gestures and pig latin.

K went with me on Wednesday, and when we entered the tiny office on Michigan Avenue, a thoroughfare that is know for its trendiness and contemporary sensibilities, a street in Chicago synonymous for the very best of the best, I felt like I had left the world I knew and trusted as reality and stood below a dingy awning in one of the streets in Empire of the Sun.  Dr. Miller’s office was in the only building on that stretch that hadn’t been remodeled since the 70’s.   There were far too many mirrors in the hallways, floor to ceiling, for the comfort of Mies van der Rohe.  There were too many floor to ceiling mirrors for the comfort of a porn director.

Oh, but then we got to the actual office.

I am going to play a game with you now, one I play with my students, but we will modify it since you are reading this, not hearing it as they would.

I am going to give you a description, and I want you, after reading this, to close your eyes and imagine it.

OK?

Here we go.

The office: small as a prison cell, a huge mirror behind the receptionist desk so overwhelming that for the first 20 minutes I thought there was another room and desk behind her, until she turned around and the chair in the mirror turned in time and revealed her face to me.  Objects in our immediate space: a full kimono hung in display fashion over a running indoor fountain so loud no one on this earthly plane would find it relaxing.  Stacks of appointment books and paperwork crowd the receptionist, who is using a Dell computer.  It might as well been a telegraph machine.  There is a Viagra clock on the wall. There is a row of five chairs for visitors, K and I take the two closest to the door (which has a buzzer for one to be buzzed in to the office), and a particularly-antsy woman in her 50s sits, or bolts out of, or jitters on, the chair closest to the doorway with no door on it (this door-hole leads presumably to the examining rooms, or maybe some other mismatched shit like an antique roadshow or a fat lady in a tube top).  Something was distinctively Lynchian about that office: nothing was particularly menacing about the atmosphere, but I couldn’t imagine anything else in the place of all this weird stuff.  And the receptionist?  A mousy girl of Asian decent, wearing all clothes that were too big for her: a billowy silk-ish shirt**, some kind of MC Hammer pants, and shoes whose heels hit the ground with a thud every step she took.

We get our first glace of the good doctor 20 minutes into our wait: he is very thin, elderly man thin.  He is wearing a white button up dress shirt and grey dress pants that were too big around for his frail frame but the right length, so what do you do?  You wear billowy clothes too when you’re frail but still man-tall.  Oh yeah, and he is also wearing a beige leather multi-compartment fanny pack.  No shit.

45 minutes into the wait, the jittery woman goes into the secret hallway, comes out soon after that, and it’s our turn.  I am giddy with nerves, partly because I am going to talk to a doctor about the pros and cons of hormone replacement therapy, but now, and mostly, I am nervous because I find Dr. Miller to be potentially insane.  In the creative writing biz, he has the appearance of what I would refer to as “an unreliable narrator.”

He leads us to a small examination room, where there is still a patient’s file on the examination table, Joseph so-and -so***, and it occurs to me that the jittery woman who just left must have been born Joseph.  She was waiting for her shot.  Indeed, we lurk among the cisgendered people, because I would have never guessed that woman to have not been female her whole life.   I thought she was a drug addict, not a trans woman.

Dr. Miller comes back into the room, shut the door behind himself, clears his throat.  He says to no one in particular, and while looking at the floor, “That last patient got on my last damn nerve, and when I get mad I yell, and when I yell I lose my voice, and that’s why I sound the way I do now.  (Another pause, another cleared throat.) Then he looks around the room and says, “You sure you wanna be here?”  And he gives a sidelong glance at me and a slow smile spreads across his face.

I warm to him immediately.

There is a pause, and then he finally looks at me directly and says, “So, what is it exactly you think I can do for you today?”

And I say, “Well, I’m trans and I see a lot of information about hormone therapy on the internet, but I wanted to talk directly to a doctor about the pros and cons of it.”

And he says, “There’s a lot of bullshit on the internet.”

He gets no argument there.

And then he takes another long pause, and tells me a story about when he first started practicing medicine, how he wanted to publish a controversial paper, the topic of which he alluded to but never fully revealed, and that the medical community never warmed to that idea.  I think he was trying to get across the point that treating transgendered patients with hormone therapy is now a controversial course of action, but, well, he thinks it’s the right one, so fuck what the establishment has to say.  There was a lot of cussing coming out of him at this appointment.  It didn’t feel inflammatory to me, just conversational and sincere.

I asked him about the link between the hormones that ovaries produce and heart health (more bullshit, according to Miller, “women don’t die from heart disease like men do,” and science attributes it to the ovaries, but he finds this a dubious claim, or I am translating it as such.)

I asked him about the potential for damage to my liver (“No no no, there is no damage to the liver because I do a blood test every three months to insure your testosterone stays within the acceptable levels, not too low, not too high, and if it shoots outside of those levels we adjust accordingly.”)

He said, “I’m fucking 83 years old and I can’t do this shit forever; I’m going to die someday.  But I do enjoy my work, and so I will keep doing it for now.”

He said, “I don’t know where the spirit comes from, whether it’s God or nature or what, but if you follow your spirit, and you try to be a man with a male spirit, or a woman with a female spirit, you will have an easier life, it doesn’t matter what body you are born into.”

He told me I would (potentially) get very hairy.  He told me I would get more aggressive, and my sex drive would increase.  He told me God is a woman.  He told me not to worry about acting like a man, not to fall prey to the stereotype, and that if I thought about more than fucking, eating, and the score of last night’s game, that it doesn’t make me less of a man.

I don’t know if he will be my endocrinologist.  But I certainly appreciated his perspective.

This may all read like a bit of an about-face to many of my readers.  I have spent more than one entry writing about the reasons I didn’t want to go on T.  But there also, in those same entries, have been outlined the reasons I would like to go on T.  So here I am: I want to go on hormone therapy, I want someday to pass as male, to be rounded to boy for good.  I am more male than female, and I think the part of me that feels female is the part that was put there because of my genitals at birth, not because I have some bond or link with feeling feminine.  Truth be told, when I think about being female I feel deeply uncomfortable, and I have always felt deeply uncomfortable being thought of as female.  I have tried, very hard (3 decades worth in fact) to be happy enough with checking that F.  But I can’t keep lying to myself just because I am used to it, because it is easier, because it is easier for the people around me.

So, I am going to go see one more endocrinologist, and if I have a similar chat with him, that the risks are minimal, that there is no record of trans folks dying in large swaths strictly from HRT, well, then my mind is made up.  I do want to spend some time, however, saying good-bye to the comforts of femininity.  It might have been a house too pink, but it was home for 34 years, and I want to give it some proper farewell and respect before I move out.

At this point, I would love to hear from you guys on T: what do your daily/weekly/monthly regiments look like; how has T changed your life (aside from the physical and emotional changes) in a practical way?

Be nice to yourselves,
Your Pal Eli

*This isn’t some veiled racism on my part.  Her trouble with english was so pervasive she was having a hard time understanding the numbers I was saying over the phone, and was confusing many of the letters of my name with other letters.

**K points out to me that in many Asian cultures the flow-y too big look is fashionable.  So, perhaps, her clothes were not too big for her, but rather she was being fashionable in a way that this guy just didn’t get.

***All names are changed to protect the innocent, but the file did indeed have a male first name on it, and a birth year that would have matched the approximate age of the woman in that waiting room.

8 thoughts on “Dr. Miller and the Floppy Receptionist: A Hormonal Love Story

  1. Hey Eli,
    I just moved up to 75 mg / 2 weeks from 50 mg / 2 weeks. I’ve been taking low-dose T for about five and a half months now, and have only had one shot on 75mg instead of 50. That’s only 25mg/wk, whereas many trans* guys start with a much higher dose, 100mg/wk or more (shotgunning). From what I’ve experienced and heard from other people taking this approach, beginning at a low dose helps to prevent any emotional or physiological shocks (aggression, giant appetite, etc.) and although changes happen more gradually, there are benefits. One’s vocal cords are less likely to get pinched, which helps with voice passing; hair growth happens more congruously with fat redistribution, so facial hair doesn’t pop up overnight, before one’s face has had time to masculinize; and more gradual muscle gain produces less strain on tendons and ligaments, which grow more slowly than muscle. All in all, it’s been pretty easy to adjust to low-dose changes because they’re gradual.

    I don’t think that’s really what you were asking, but I thought it was worth mentioning given that the standard practice is shotgunning, and low-dose information can be hard to find.

    Since starting T, my major changes are feeling more confident, and being able to focus on other areas of my life. I’ve experienced mood stabilization and masculinizing physical changes, but these things happen without my thinking about them—and that’s the key. Now that my physical transition is en route, I don’t have to devote so much mental energy to it. My mind is freed up for my relationships, my career, fighting oppression, and other things of worth to me. There’s a tremendous sense of empowerment that I’ve felt through physically transitioning, also. My decision to start T was entirely mine in a way that other decisions in my life haven’t been. So, because I chose to start T completely on my own, I know I’m capable of making other decisions completely on my own, and I feel pretty liberated. Then, spreading awareness of trans* issues is easier with passing privilege. It’s kind of screwed up, but I’ve found that cisgendered people listen to other perceived cis people about trans* issues with more open minds than they listen to trans* people about the same subjects. I like being out, but sometimes donning the cis cloak can help promote awareness and understanding.

    Those are some practical changes I’ve experienced in a nutshell. I hope you find peace in your journey, whatever it may be.
    -T

    • Tristan,

      Thanks so much for your response. I am sorry it has taken me a few days to respond, but I wanted to give this comment proper attention.

      Your comments on starting low dose, and the specifics of the pros of that approach, are deeply appreciated. I didn’t have any idea about the specifics on what that approach could offer me, and I am so glad to have heard that from you. I want very much to go slowly, in order to get the best potential results in the long term, and to be as gentle to my body as I can.

      And this bit: “Now that my physical transition is en route, I don’t have to devote so much mental energy to it. My mind is freed up for my relationships, my career, fighting oppression, and other things of worth to me. There’s a tremendous sense of empowerment that I’ve felt through physically transitioning, also.” This was so interesting to me. I never thought of that; and I look forward very much to the positive psychological influence T can have, the space being in the right body can give me psychically. My therapist and I have talked about the mitigation of the long term anxiety I have struggled with most of my life. Of course T will not solve all my problems, but I feel very confident that it can have a positive effect on the stress I feel from living in this body, and being viewed as female by most of society.

      Thank you again, so much, for your comments, they were very helpful.

      Please, come back anytime. 🙂

      -Eli

  2. OK. Right. Deep breath. Now I know I’m in a whole other place and things are probably dealt with differently ‘n’ all, but T is T is T, so…

    For my first five months (I’ve been on T for four months and three weeks now), I was on 250 mg monthly shots of testosterone enanthate, and at three months I had the routine blood tests (peak and trough testosterone and liver function). First off, there was a six-week delay with the second lot of results, but the first lot showed that my testosterone level was 20 when the range it should be is 8-12, and my liver function was too high, but only slightly, so for the last of my shots, I was told to do them every five weeks, even though for most people it goes the other way and they have to do them more frequently. But anyway. Now I’m having trouble getting hold of a new prescription because my doctors are being morons, and I may be off T for a while until they get their act together (sigh), but there have been changes.

    And here they come.

    This doctor bloke is right. (And, by the way, I like him already.) You will get hairy, your sex drive will increase, and aggression is probably much more subjective, but I sure as hell am. The men in my family aren’t very hairy, but now I’m overtaking the lot of them; I wasn’t really all that bothered about body hair, but am much more pleased at its presence than I thought I’d be. My voice broke after one month and nine days on T, and it now sounds male and it was my first change and it is glorious and I am still very excited that my voice is Right With A Capital R now so I’m going on about it because I can. I’m asexual, and have never had much of a sex drive, but a few months on T, out of nowhere, there it was. Skyrocketing from a baseline of zero. Very odd. You will get crazy hungry for the first few months too, but it levels off pretty quick – or at least, it did in my case. I can’t cry. At all. And I seem to do Angry, Furious, Raging, and Borderline Psychotic Pissed more than anything else now. But angry makes me more proactive than sad, so I’m all for seeing the positives… I’ve been told that my face has changed, but I haven’t really noticed. And fat redistribution is happening, slowly. Muscle growth is happening much faster.

    And the answer to your actual question (the above is to illustrate what’s actually happened so that I can follow on; I wasn’t just blathering… well, I was, but…):

    Confidence. I’m still a giant social phobe, without question, but I talk now. Aloud. Where people can hear me. And I actually enjoy doing it. I have even been known to spout things in lectures occasionally. And obviously, the Big One: passing. I passed to a certain degree before I started transitioning, but now the voice has made a massive difference and I’m passing much more, especially when I’ve had longer-term interactions with people who don’t know I’m trans (lots of posty updates on that to come), whereas pre-T it was only people in passing who assumed I was male. And I’m actually beginning to get used to myself rather than question or insult, you know? I’m coming into my actual self, and somehow everything else is easier. It made a hell of a lot more difference than I even thought it would.

    And when my Shiny Specialist asked me about negative effects at my three-month follow-up appointment, what did I say? None. (Since then, the acne’s starting to cause problems, but still, that’s about it.)

    Also, YES ME TOO, in response to everything in your post. Because I said so.
    And a final note… I love the title of this post. It reigns all. So there.

    I really will shut up now. (You can tell I’ve missed posting, can’t you…?) 😉

    -JC

    • J.C.,

      Buddy, I am so jealous of your svelte British frame; I bet you look like some rad skinny English dude. So, congrats, and fuck you. 🙂

      And how proud am I of you for your new social abilities! Huzzah! I look forward to hearing more about how T affects your social interactions, for better or worse.

      I’m French, so I imagine I will have lots of hair in my future, and while the tempers run high in my family, it’s mostly due to alcohol, not genetics (although the alcoholism could be genetic, or maybe it’s just us being French in America), and so while I think I have some attitude adjusting in my future, I don’t think it will be indicative of my character as male.

      I have to say, I secretly hope for a little stubble, and a little deeper voice, and some more muscle. But really, I know T is no miracle worker, so I remind myself everyday I will grow no taller, and likely my voice will get only the slightest bit deeper. I didn’t have too much acne the first time around, and I am hoping to go slowly, low-dose, and so I am cautiously optimistic that I will skirt around that nasty business for the most part during this puberty too.

      We will see.

      I miss you. Big time. Good to “read” your voice.

      Your brash American pal,
      Eli

  3. Hey Eli,

    Although I haven’t been taking hormones for very long (6 weeks). I too took a long time and talked with a few doctors before starting hormones. My plan was to approach is slowly and gradually. The first 5 weeks I did an injection of 25mg a week. Now I’m on 40 mg for the next 2 months. Then, we’ll decide to either maintain or go up. I agree with your commenter above that is allows your body to gradually get used to changing from an E based system to a T based system. I’ve had changes, but they come in all a little bit at a time.

    My day-to-day changes so far have been, more energy, feeling more confident, less high-strung more even, and definitely more energy. I spend less time focusing on what things could be and working towards continuing developing my athleticism and professional aspirations. I’m better able to handle larger amounts of responsibility without freaking out. Work, grad school, wedding planning, life… Some negative things have been that at times I have too much energy, but I just need to make sure I stick with my exercise routine. Overall I feel like I’m starting to fit into my body the way my brain has seen it. I’m more social and willing to explore different social interactions.

    Hope this helps. Definitely feel free to email me if you have any other questions.

    -A

    • A,

      Thanks so much for your comments. I am looking forward to (potentially) more energy and feeling less high strung, as those are two areas I definitely feel my hormones work against me.

      When you wrote, “Some negative things have been that at times I have too much energy, but I just need to make sure I stick with my exercise routine. Overall I feel like I’m starting to fit into my body the way my brain has seen it. I’m more social and willing to explore different social interactions,” I found that really interesting and encouraging, really, because I want to spend more time at the gym, and I am currently pretty socially anxious, and so some confidence there would be pretty great.

      I know everyone has different reactions to T, but it is so rad to read about some reactions (some positive reactions) that hadn’t even occurred to me.

      Thanks for all your comments, and feel free to leave anything else you feel like sharing!

      -Eli

  4. Pingback: Retrospect | My Life Without Tits

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