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  • Writer's picturetatebholden

Starting Testosterone, Health Concerns, and Contraception

Three days on T and 7 lbs down since coming out about three weeks ago.

I’m going to talk a lot about various medical procedures, conditions, treatments, side effects, etc. in an effort to inform my family and friends and help provide educational material to those who are interested in transitioning. I’m sorry if this post gets a little dry, but there are a lot of medical conditions and concerns you need to come to terms with before you transition.

I had my first appointment with Planned Parenthood yesterday (9/7/18). I was an absolute nervous wreck. I was worried the trans specialist would think I wasn’t trans enough or that I would have to go even longer trying to pass. Back in the day, I guess when transgender was still considered a mental illness, people would have to live as their perceived gender for a whole year and be evaluated all along by a psychiatrist. That’s gotta be really hard if you don’t easily pass without surgery and hormones. But apparently that’s not how things work anymore. I even took out my nose ring worrying that it was too feminine. But that appointment went quite well. She was very easy to talk to and could tell that I had done A LOT of research on the topic. She was understanding and listened to everything I said. I got the feeling by the end of it that it was more or less an information sharing session and less an audition. I didn’t feel like I was being tested or grilled. We went over the effects of the hormone, as was required, and I signed my consent form. Whew. It was over. Sort of.

For the next hour I got to worry about the next appointment, the one that would assess my health to see if I was formidable enough to take the stuff. (If you don’t want to hear about my medical history, skip to the next paragraph.) I was scared that my history of high blood pressure, alcoholism and obesity, and family history of the same plus diabetes and heart problems would make me a poor candidate. Testosterone can raise red blood cell counts putting a person at risk for blood clots, stroke, and heart disease. It also increases the risk for diabetes, high cholesterol, and can (very rarely) impact the liver. Other than those effects, which are essentially the effects of being a man, there are really no contraindications. Fortunately, my blood pressure is only a little elevated and I take a pill to keep it under control. If I lost a few rolls and chins it wouldn’t be a problem. My drinking is waning as of late, and my liver, according to blood work from last month, is fine. I’m only kinda obese according to my BMI, but I eat fairly healthy and get more than adequate physical activity because of my landscaping job. I’ve never shown any signs of having diabetes or high cholesterol. As far as the red blood cell count is concerned, they’ll be monitoring that every three months, or more if needed. I don’t know what the treatment is for it but I was assured it’s manageable. Leeches perhaps. I’ll talk about the other, more desirable, effects in a later post.

I passed. I got a prescription. I chose injectable over patch or cream because it’s cheaper, less work, and I only have to do it once a week. I was also highly advised, and I think this is good advice that everyone should heed, to get tested. Apparently you can have and STI and never know, but it could be damaging an internal organ. I’ve never been tested because I’ve only ever been with two people in my whole life (apply halo here), and no one was ever symptomatic. But, IT ONLY TAKES ONCE. So I’ll get tested at my next appointment, and you should, too.

I was also advised to be on some form of contraception, whether an implant, pill, or condoms. If I were to get pregnant while taking testosterone, especially during the first trimester, it would have very negative effects on the fetus. One is that it may develop an intersex appearance. It is harder to become pregnant while on testosterone, but not impossible. And there have been transmen who stop injections when they are ready to start a family, and carry the child themselves. I, however, do not know that I could handle that experience, psychologically.

I’m terrified of hormonal birth control because it has less than desirable side effects like driving up blood pressure, impacting your libido, etc. It also increases the risk for breast cancer and stroke. Especially at my age. I’ve been on it before; it’s often prescribed as a treatment for PCOS. And it’s amazing that we have it at our disposal. For someone who is healthier than I am, it could be the right fit. I’m also afraid of diaphragms. I’ll be honest, I’m not too familiar with the size, shape, or location of my cervix, so the idea of sticking something up in there that doesn’t have a rip cord worries me. What if I lose it and have to go to a doctor and tell them that, yeah, I was doing the dirty deed, making the beast with two backs, and my diaphragm is now floating around in a tear in the space time continuum. I simply don’t trust the efficacy of sponges and jellies. There’s just too much floating around, too messy. I don’t want to have my tubes tied because it’s a pretty invasive surgery that would take me out of work. And I don’t want my husband to feel like he has to have a vasectomy. That wouldn’t be fair considering that in about five years I plan to have my uterus and ovaries extracted (to prevent the risk of cervical, endometrial, and ovarian cancer, and increased risks due to the fact that I have PCOS and will be experiencing amenorrhea from the testosterone). And finally, condoms suck. They take away some sensation for the guy, are EXPENSIVE, and just get in the way. So what options do I have left. Apparently there are some. Depo provera, a copper IUD, and progesterone-only birth control pills. They all offer differing levels of protection, and some still raise the risk of breast cancer, minimally. However, I plan to have my tata’s sucked out in less than a year, so I’m not too worried about that. At my next appointment I’ll make my decision and let you all know which one I went with.

Ok, back to the testosterone...So I ran my prescription around the corner to Walgreens. Again I was worried. I had just read a news story about a woman who had gone to Walgreens to get medication to help her abort her DECEASED baby and was refused by the pharmacist. How horrible is that!? I also heard a story of a transwoman who went to CVS to get her hormones and was refused. Fortunately I had no problem. My script didn’t phase the pharmacy tech in the least, and he entered some special code to get me a discount. He’s probably use to it with Planned Parenthood being right there. And the pharmacist handed it to me like it was pepto bismol.

I trotted back to PP feeling like I was carrying a package of pure gold in my hand, and nervously, awkwardly, announced to the receptionist that I was back and ready to learn how to inject. I opted for the subcutaneous method instead of intramuscular. It was a no brainer. The subcutaneous shot goes in a fatty area, uses a smaller needle, doesn’t hurt as much, and is released more steadily helping to avoid hormone withdrawal towards the end of the week. The intramuscular method is the total opposite.

Finally. It was done. I had jumped through all the hoops and finished. And because of Planned Parenthood, it was easy, painless, empowering, and hella lot cheaper than I had anticipated.

My insurance company explicitly says that they don’t cover treatment for ANYTHING related to being homosexual or transgender. That’s why I’ve started a Go Fund Me. I had heard horror stories of people paying as much as $700 a month for testosterone. And what about the out of pocket expense for an endocrinologist? But the nice ladies at PP figured out that my insurance can be “encouraged” to pay for my visits and lab work, though not for the prescription and needles. The physician informed me, though, that people who do pay for T using their insurance often end up paying MORE than someone who pays out of pocket. In some states, where gag clauses still exist, the pharmacist doesn’t have to tell you which way is cheaper. Fortunately, the Senate has voted to ban these gag clauses.

So, what did it cost? Not much:

$40 copay for the visit because of my insurance

$0 for the lab work because of my insurance

$40 for a three months supply of testosterone from Walgreens (though as I progress that will only cover me for two months)

$7 for a three months supply of needles from Planned Parenthood

If you want to learn more about contraception and other sex ed topics, Erica Moen does a great webcomic, backed by Planned Parenthood, that talks about this stuff in a fun and relatable way.

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