I wanted to write this up before I forget any of the finer details. As I’ve mentioned before, I tend to take my mental health very seriously. With the amount of stressors that I have experienced in the last 2 years, I’m not ashamed to say that depression has been a problem. When you also consider that one of my best friends committed suicide about 10 months ago after losing his battle with depression, it becomes even more important to me.
Over the last year, I’ve been working with my family doctor and my psychologist to find a balance. My GP has tried adjusting my dosages, as well as trying different drugs, to no avail. Both at separate times suggested that I see a psychiatrist that had more specific knowledge on psychotropics. I was recommended to a center that was staffed with both nurse practitioners and doctors of psychiatry. I called and set up an appointment for this past Thursday.
As I normally do when visiting a new doctor, I downloaded their intake paperwork completed it a couple days prior to the appointment. Nevertheless, I arrived about 13 minutes early for my 10:15 appointment. I signed in at the front desk and took a seat. The first thing I noticed was how busy the place was. The building being a repurposed house didn’t have a large waiting room and it was full. Additionally, some of the people waiting had restaurant style pagers.
10:15 came and went as I amused myself on the internet as usual. As 10:30 came, I called my
manager to let him know that I would be coming in later due to a doctor’s appointment. At 10:38, I finally got up and went back to the window to see if they had forgotten about me. She motioned towards the check-in book.
“I signed in at 10:03. The sticker I signed has been peeled off”, I replied.
With no apology or explanation, she took my paperwork and a copy of my ID, then provided me with a pager of my own. I sat across from a mother and daughter, who were waiting for a 10AM appointment. She was finally paged at 10:52. In less than 5 minutes, her appointment was over. I’m thinking, “Seriously? SERIOUSLY?” in my best Meredith Grey voice.
About that time, I get called and simultaneously vibrated as my table for four is ready.. Oh wait, this is a mental health office, not Texas Roadhouse. So I meet my new person. His name is, well, we’ll call him Steve. So Steve invites me into his office. The first thing I notice is that it’s like my office at home. A mess. Stuff everywhere. Which, I can’t cast stones in glass houses, but hey! I don’t see patients in my office. We just play video games and post passive aggressive tweets. I digress.
He introduces himself, and we’re exchanging pleasantries. He mentions that there’s an Addison in his family, but that Addison is a boy. I told him that a hundred years ago, Addison was primarily a masculine name, but in recent decades has become more popular as a woman’s name. I also mentioned that I had a non-binary/agender friend and their name is Addison as well. This is where things started to go sideways.
“What is non-binary?” he asks.
At first I think he’s joking. Then as I look at his face, I can actually see the puzzled look on his face. It’s the same face my seven year old makes when I explain something technical. It’s not dramatically different than my dogs cocking their heads to one side when you say, “Who’s a good dog?”
I explained that there are people who don’t identify with either male or female, that there are people who are fluid between genders and then some, like my friend, who are agender. They don’t identify as any gender. I got the feeling that, maybe.. I was his first trans patient. Somehow, it feels slightly unfair that this guy brings in at least $75-100 an hour, but I have to educate him on things that he could find on google.
Next, Steve starts with a brief history. I give him the broad strokes, my laundry list of medications. What we’ve tried, etc. I always like when a professional asks me, “Why such a low dose of X?” To which I’m thinking, “Uh, IDK. That’s what the doctor told me to take???”
Anyway, he asks about family history. I tell him what I know, in terms of mental health. Then we go into alcoholism and addiction. I explain about my father and his sobriety up until his passing. He pushes deeper about the rest of the family.
“Well, I was raised catholic, so that should give you an idea”, I quipped.
He doesn’t get the joke and continues to push on it. I explain that if you go AA’s “Twelve Questions Only You Can Answer” page, many of my family members would have fallen on the spectrum at some point in their lives.
Finally, moving on, I’m asked about any past surgeries. Mind you, all of this was listed on my intake paperwork. I tell him that I had GRS in May and then Breast Augmentation in November. That I had my wisdom teeth out about 16-17 years ago but other than that, no other significant medical interventions.
I explain that I’m having a number of issues aside from just typical depression. My problem list:
- Trouble concentrating
- Issues staying on task
- Constant exhaustion, lethargy, and malaise.
- Nervous Anxiety
- Clenching my jaw subconsciously when I’m awake.
Then we take, what feels like, a drastic course change back to Transtown™. First is a question that’s so hard for a trans person to answer, at least in the first couple years.
“Are you still,” motioning with his hands towards his crotch, “…. um… male down there?”
I shot him the kind of look that only a mother would give to her kids when they’re out of line and replied, “I was never male.”
As he stumbled over his words and tried to make a coherent sentence, I asked if it was medically relevant to my mental health? Mind you, if he had read my intake paperwork, or had any familiarity with trans patients, he’d have know without asking. He said it was, because some of the drugs have sexual side effects, including erectile dysfunction.
And once again, I had to come back to Trans 101 and explain that a decent percentage of trans women who are post-op or non-op have issues with getting or maintaining an erection. Because of the use of anti-androgens, such as Spironolactone, our testosterone levels are typically lower than the average cis woman. I explained that mine were normally somewhere in the 8-12 range, on a scale of 8-55 for cis women, cis men having a much higher range from ~300-1000 (ng/dL).
I went on to explain that there was a much better way to ask those questions to a trans person. I suggested, “Do you still have a penis?” Or even better “Do you still have testicles?”
From that point on, I pretty much checked out on this dude. Especially when he started to show me facebook pictures of his sister’s lesbian wedding on his phone. Because, you know I’m a lesbian, so we must all lesbian together. Or something.
In the end, he had two cardboard boxes of some drug called “Trintellix” of which he rummaged through and gave me two sample bottles. He basically claimed it to be the best stuff on the planet and that a number of his patients had seen improvements in 1-3 days. Which is odd, because my understanding of SSRI’s is that they usually take a couple weeks to build up a normal level in your system. He wants to see me back in two weeks.
Sorry, I think I’ll skip it.