After the Oncologist, Before the Injections


I talked to my oncologist, and…

the good doc said my previous diagnosis poses no additional risk!  It seems I had an adenoscarcoma, and those cancers don’t respond to testosterone.  So, she has no problem with me going on testosterone.

Aaaannd, most female reproductive system cancers are responsive to estrogen, and so, testosterone might actually help me avoid future cancer issues.  There is no science to back up this claim, just some educated assumptions, but at least I know my previous diagnosis doesn’t put me at an additional risk.

Are you fucking kidding me?  Hilarious.

In retrospect, it appears my body produced just enough cancer to put a hysterectomy on the table, but not enough to make me sick in any other way.  It chose to make the kind of cancer that would get the uterus out of my body, but allow me to explore testosterone later in life.  In fact, after my hysto, the surgeon said my body had created a polyp around the cancer, as a way to cut off blood flow to it and to keep it from metastasizing.

The doctor I talked to at Howard Brown said he often sees elevated levels of testosterone in trans guys, pre-HRT, and said of it, “the body knows what it wants.”  I believe this is my body knowing what it wants. My body knows an estrogen-based hormonal system is wrong for it, and a testosterone-based system is right.  It knew I had to get that uterus out, and it apparently also knew I needed it out via a means by which insurance would pay.  My body is super smart.

Before getting ahold of my oncologist, I was bummed.  I spent a few days moping around, feeling like a misfit, like I might not get to fully realize what I believe to be my true gender identity. But that sadness was very reassuring to me.  It made me realize how important hormone therapy is to me.  When I felt my chance to take testosterone was being taken away from me I felt an emptiness that can only be described as depression.  You can’t learn a bunch of stuff about yourself only to be turned away at the penultimate page and be told that’s the end of the story.  I needed to see this through.

I feel pretty sure taking T is the right decision.

Pretty sure?  Yeah, pretty sure.  I am still changing my body’s chemistry in a substantial and foundational way.  There are not any long-term studies out on the health risks of doing this.   But, I am certain I am male, have always seen myself as male, and want to present as male.

I am a little concerned about the unknowns–but that’s life, right?  I don’t mean to sound flippant about this very serious choice, but I do want to be level-headed here: with any major health decision, there is bodily risk, and this is a bodily risk that will be closely monitored by the health professional I have in place.  I have a loving and supportive partner, a therapist I have been working with for over three years, a solid oncologist and a gender specialist who has been in the field for over 13 years.  I feel prepared and supported.

I will minimize my risks: I will continue to eat well, and tighten up my diet a bit (cheating on dairy occasionally, my terrible sweet tooth…I’m looking at you guys), I will continue to exercise (and maybe up the time I am at the gym from 3-5 times a week to a consistent 5 days, with some slightly longer sessions when I can fit them in [up to an hour from 40 minutes, ideally]).  And I will be in contact with my doctors should any red flags appear.

And between all that, I will try to fit in some good times.

My next step is a gender advocate appointment at HB.  I am on the waiting list for an appointment in January.  After that is the final appointment with the doc to go over my blood test results and get my first injection.  So in time for Valentine’s day, I should be well on my way to a deeper voice, bigger muscles, and male pattern baldness.


Be nice to yourselves,
Your Pal Eli

After My Howard Brown Appointment

Last week was my doctor’s appointment with the folks at Howard Brown.  The doctor was great, he answered all my questions and was really friendly.  In fact, the whole staff there was very knowledgable and approachable.  All around, if you are in the Chicagoland area, and are looking for gender-related care, Howard Brown is the place to go.

In total, K and I spent about an hour there, while the doctor and I reviewed my health history and talked through all my questions.

I was told that yes, cholesterol and blood pressure and red blood cell count are all negatively affected by testosterone, but the degree to which they are affected varies person to person.  I was told that there are no long-term studies on the affects of HRT for trans folks, and that we just manage the levels and monitor our health as close as we can, and that there doesn’t seem to be any serious complications for most folks in good health.

It was also made clear my energy level and sex drive will go through the roof. 😉

I was reassured that if I went the injectable testosterone route, I would circumvent most of the problems testosterone can cause with my liver, as it goes directly into the blood stream in that case, and is not metabolized through the liver.

On an insurance note: I learned that (at least in IL) if your legal gender is male, insurance companies have to pay for your HRT.  So the lesson here, boys, is to get your gender marker changed before starting HRT (if you can) to save quite a bit of money.

All in all, I was looking to be a good candidate for HRT: a healthy, well-informed adult.

And then, we had to talk about the cancer.

Seems testosterone can put one at an elevated risk for uterine, cervical, and ovarian cancer, if you happen to be the kind of dude that has those organs.  So when I told him I already had uterine cancer, he was concerned.  He would prefer I talk to my oncologist and get her opinion about the risks associated with me in particular and testosterone.

It was deflating, for sure, and I am bracing myself for the seemingly inevitable conversation with my oncologist that will end something like this: “Well, Eli, since I can’t say for certain that testosterone won’t give you ovarian cancer, I can’t tell you to go ahead and start HRT.”


The thing is, with this informed consent model that Howard Brown works under, I don’t think I need anyone’s consent except my own, after I have gone through the steps HB requires in their program.

The problem: I am not going to risk cancer, again, for testosterone.  I choose life of any kind over the most fully realized kind.  I may not ever get to be the man on the outside I feel like on the inside, but I would rather be a dude on the inside and a girl on the outside than a dead dude.  This choice makes me profoundly sad.

I think my brush with cancer was environmentally based, meaning, cancer doesn’t run in my family, and I was taking horrible care of myself at the time.  I think I ran my immune system into the ground with the drinking and smoking and bad eating habits and gave myself cancer.  Now I don’t drink or smoke, I eat very well, and I am at the gym regularly.  I think any cancer testosterone could drum up now, my immune system could readily handle in the early stages.  I think that, but I don’t know it for sure.

And so, pending my oncologist’s approval, I swing between looking forward to starting testosterone, and mourning the lost opportunity to start testosterone.  I was hesitant before, nervous about what changing my gender could do to my body and my brain, and so I thought now was not the right time for me to go on it, if ever.  But now that I know I might not be able to go on it at all not because of my choice, but because of a previous illness, I am deeply saddened by the idea of not going on testosterone.  That sadness speaks to me, it has shown me how right testosterone feels to me, or how right the direction of HRT feels to me.

I am going to make an appointment tomorrow for part two of Howard Brown’s program, where I will meet with a gender specialist and outline my transition plans.  I will also make an appointment with my oncologist.  I am going to see this process through, to whatever end it arrives.

To close on a good note: the doctor also gave me the forms I need to change my name legally, and the number to trans legal aid to help me fill out and file the forms, and to get it done for free. Sweet.

Be nice to yourselves,
Your Pal Eli