So, about this time last year.. I was done with my first endo visit. Having started therapy and coming out in December, I had been waiting for this appointment for some time. When I started therapy, I wasn’t sure exactly how things worked. So by the end of my second appointment, I told my psychologist that I wanted to start hormones. The following week, we started working on the formal referral letter which took two more sessions to complete.
When we completed the letter, she suggested two different doctors. The first was Dr. Winters’ at University of Louisville Physicians. She said that they had the least amount of waiting time, but had heard that his bedside manner wasn’t the best. If I had questions, I should have them written down because he normally was in and out very quickly. As I’m the type of person that does her research on her own, I usually don’t have many questions… so this seemed ok. She also mentioned Dr. Pookay, who had the better rapport, but much longer wait time to get in.
With that in mind, and my history of not wanting to wait for anything once I’ve made a decision, I chose Winters. Thus sealing my fate! At the end of that session, she called over to Dr. Winters’ office and setup the appointment for me. This was January 13th, 2015. My appointment was for 8 AM on February 6th. She gave me a post-it note with the details on it, faxed over my referral letter and gave me a copy to keep.
This appointment was to be a defining point in my life. I was so excited that I might be able to get started on hormones. I tried to set expectations that I probably would not get a prescription on my first visit due to blood work and other factors, but IT WAS ALL HAPPENING!!! I was finally going to be myself after thinking about it for so many years.
As I was not out yet at work, or to many people other than family and friends, I was still presenting as male day to day. I had to work that day, so I was dressed fairly typical for myself at that time. That day it was skinny jeans, a woman’s t-shirt and Chuck Taylors. The real reason that I didn’t look feminine didn’t have anything to do with my clothes. The real reason was the same reason I was sitting there. Testosterone.
After the barrage of paperwork and vital statistics, I was finally placed into an exam room. Even before I saw Winters, I saw another doctor that was doing her fellowship with Dr. Winters. Keep that in mind… He’s responsible for shaping the minds of other doctors.
So she comes in does the initial introduction, checks the data on the chart. She has me change into a gown. When she comes back, she checked my thyroid and glands and did an overall exam. She asked for permission to lift my gown and examine my genitals. I complied. She commented on my attire, the fact that I didn’t shave my pubic area, the hair on my arms and other things. The line of questioning was very presumptive that these things are what all women do. The CISnormative checklist. At one point, she asked if I had a primary care physician and I said no, giving some sort of “I should probably take better care of myself” admission. She replied that she understood, that her husband never wanted to go to the doctor either. So, apparently me and her husband are alike in one regard?
After that awkwardness was over, she left and came back with Dr. Winters. He went through most of the same things that she did, feeling my thyroid and general poking and prodding. Then he did something totally unexpected. He lifted my gown and started doing an examination of my testicles. With his bare hand. Without a glove. I was so frozen with shock, awe and equal measures of dysphoria that I couldn’t even voice a protest of what was happening.
Feeling fully sated that he had sexually assaulted someone that wouldn’t ever press charges, he moved into the line of inappropriate questions. He asked a lot of the same things that the fellow had asked. A lot of things that were in the referral letter. He asked if my family was on-board for “all this.” Just a lot of probing. He seemed more interested in playing psychologist than endocrinologist. Maybe trans people are his way of escaping the monotony of diabetes and underactive thyroids…. like a little vacation.
Interestingly, he seemed most interested in my childhood and more specifically my relationship with my father. I could tell that he was trying to come up with a causation theory. My first response was “Well, he’s dead, so we get along pretty good!” He didn’t really like this answer and probed deeper. He wanted to know what kind of activities that we did together when I was a child and other things. It was very bizarre. I kept thinking, “THIS IS NOT YOUR JOB, DUDE.” He went so far as to say that we could proceed with starting hormones (pending bloodwork), left the room… and then came back to ask more questions about my paternal relationship.
With that done, I had blood work drawn. Now my bloodwork came back the next day and he called me to let me know that I had extremely high triglycerides. I didn’t know how my lipids had impacts on hormones, but he said that he wanted me to come back for a glucose tollerence test. Honestly confused at this point, I asked him if there was a concern about diabetes.
“I wouldn’t do it if I didn’t think there was a concern”, he replied with a tone of righteous indignation.
Right there, I stopped him. I said, I’m not asking these questions to argue. I’m asking you because I’m totally ignorant of how diabetes and cholesterol impact each other. You could actually hear him relax and he explained that the concern was that estrogen can cause your triglycerides to increase, which can cause pancreatitis. He prescribed me Lipitor and told me to come back for the glucose test.
The glucose test came back as insulin resistant, but not diabetes. I thought this was a good thing. He disagreed. He wanted me to diet and take the Lipitor for a couple months before he would start me on hormones. I was so upset. I felt so hopeless. I countered with an argument that if a post menopausal woman on estrogen replacement presented with high triglycerides, he wouldn’t stop her hormone treatment until her cholesterol lowered itself. That both could be treated side-by-side. He actually agreed with me on the first part. He said he wouldn’t take hormones away in that situation. But he still wouldn’t give me hormones. Preferential treatment for cisgender versus transgender people.
I tried to impress upon him that he was messing with my mental health and that the here and now was more important than the possibility of diabetes or heart problems further down the line. Furthermore, that I wasn’t sure I could wait any longer and that I might be forced to go DIY. He refused to do anything to help me.
Devastated, I tried to find anywhere within a 3 hour driving radius that would prescribe on an informed consent basis. I had my letter. I knew the risks. The closest places that I could find were in Atlanta or Chicago. Nothing reasonably nearby. I considered ordering hormones over the internet, but dealing with customs and illegal prescriptions seemed risky, not to mention considerably more expensive without my insurance coverage. I sat in a parking lot in my truck crying. It was a fairly dark moment for me.
While all of this was happening, I was relaying it back to my psychologist. I went ahead and had her book me an appointment with Dr. Poorkay at Norton. However, he couldn’t get me in until April. So, I kept my appointment with Winters and double booked to ensure I got what I needed. I also changed my diet and tried to do what the doctor wanted, so he’d have less of a reason to say no.
By the time I went back for bloodwork on the 13th of March, my weight had dropped 14 lbs and my triglycerides had gone down by 138 points. I also had an office appointment with him that day. Honestly, I’m not sure why we were meeting, since the lab work wouldn’t be back until the next week. In any event, since he had told me that I wasn’t feminine enough on my previous visit, I had gone out and bought my first proper girl outfit. So I showed up in a dress, leggings and boots. He walked into the room and looked me up and down, elevator eyes style and said “Good for you.”
On the 18th of March, He called me back again and said that he was going to send over a prescription for Estradiol. However it was a low dose and he refused to give me a testosterone blocker. This is typical, from what I’ve heard from others who’ve seen him. I pressed him on this issue and his claim was that if we added that now, my body would produce excess testosterone and it would be counter-productive. I cited the protocol recommended by University of California, San Francisco – Center of Excellence for Transgender Health and he said they were wrong. I decided it wasn’t a battle worth fighting, as I had my first appointment with Dr. Poorkay on April 6th.
When I called to cancel my follow-up appointments with Dr. Winters’ office, they asked if I would like to re-schedule. When I said no, they didn’t even ask why. The tone seemed to acknowledge that this was not an uncommon occurrence.
When I went to Poorkay and I explained the dosage that Winters had prescribed and his first reply was “Why would he do that? That won’t do anything.” Indeed. He doubled my dose of estrogen, added progesterone and the testosterone blocker. You know what didn’t happen? My testosterone spiking. In fact, 3 months later at my follow-up, my total free testosterone was 9. Normal female range for adults is 8-55. So there.
