Reason for Visit?

LOW-DOSE-TESTOSTERONE-RISKSOn the part of the form that said “Reason for visit?” I wrote “discuss high cholesterol and the potential health risks of starting testosterone”. The Cardiologist listened to my heart with a stethoscope, took an EKG, looked at my blood work, asked me some questions about my exercise and diet, and asked about the circumstances of my parents’ deaths. I walked out with a prescription for low dose Atorvastatin (20mg once a week to lower my cholesterol) and a follow-up appointment in May.

He also gave me the green light for going on testosterone. He said that if I thought I’d be overall happier and healthier on testosterone then I should start taking it and we’d watch and manage my cholesterol. I should be ecstatic; my cholesterol was the only medical obstacle to starting testosterone. Instead, it sent me into another confused tailspin.

I talked to my Nurse Practitioner at Callen-Lorde. She offered to write me a prescription for testosterone and I told her I wanted to wait. She said to call her when I was ready. My next appointment isn’t until September.

Putting off taking taking testosterone feels different than saying “I’ve decided not to go on it.” Even if the outcome is the same. When I think about never going on testosterone, I get very sad. Crying sad. Raging at the unfairness sad.

It lets loose all of my childhood denial. I’m not really a girl, I can’t really be a girl, there has got to be a fix for this, I’m really a boy, and someday I’m going to turn into one. Somewhere in there I still have hope, even though nothing short of a time travel machine can turn me back into a boy. Starting testosterone won’t do it; it will make me look and sound like a man.

My reasons for wanting to start are straight forward. If I don’t try it then I will never know if it is the right thing for me to do. If I don’t like it, I can stop and call it quits. I want it to lower my voice. I want it to make people stop Ma’aming me. I want it to nudge me along.

My reasons for refraining are also simple. I might not like how I masculinize. Donna might not like how I masculinize. I will have a lot of explaining to do as I change, and I’m not sure what to say about it.

begin-early-shave-yourselfThe rest is complicated. I am afraid of too much too fast.

I like my face. I don’t know how it will change. When I look at trans men’s before and after pictures, I don’t always prefer the after picture. Some guys lose their softness and their youthfulness.

I’m not keen on growing a lot of body or facial hair. I don’t want to go bald. I’m already hairy, and the men in my family are hairy. Except on the top of their head.

I’m afraid of gaining weight and bulking up. It took a lot of effort for me to get my weight down to where it is and I don’t want to get husky again. I’m afraid of busting out of the custom-made shirts I bought after I had top-surgery.

I have not found any research on the recommended dosage for post menopausal administration of testosterone or for low dose testosterone. Callen-Lorde follows the Endocrine Society’s guidelines (start with biweekly injections of .5cc (100mg) of 200mg/ml testosterone and increase to 1.0 cc biweekly). This is also the document used by WPATH. It does not take age or estrogen levels into account. If I started, I would start somewhat lower, and probably with Androgel.

I do not know how to get past the sadness and the anger. I do not know if the pain of not being a boy translates into desiring to be a man, or to be seen as a man. I’m content being seen as non-binary, but no one sees me that way. Testosterone is an effective way to change that. Testosterone will not turn me into a man anymore than estrogen made me into a woman. Meanwhile, I’m staying in the middle.

Notes: This post by Dr. Cary Gabriel Costello, from his blog TransFusion, critiques biological and hormonal essentialism in the trans community. He also has a good analysis on why trans men “pass” more easily than trans women, and it doesn’t have anything to do with height or shoulder width.

16 thoughts on “Reason for Visit?

    1. Jamie Ray Post author

      I’m waiting for the magic moment when I flip the coin and I’m only disappointed when one side comes up. But the green light is good. I don’t think I’m doing myself any harm at this point in waiting, and at least I’ve (over)thought it out.

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    1. Jamie Ray Post author

      Thanks. I’ve never had this kind of hesitation about anything in my life before. Makes me feel like I’ve become one of those middle age people who doesn’t like anything to change – but then I remind myself that I managed a legal name change and top surgery. Much easier decisions for me to make. I’m wary of drugs and doctors, and the concept of being on something “forever”.

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  1. ottomaggic

    There is a dude named Ryan Cassata, a musician. He decided not to take T and rocks it just fine. I respect people who do what fits them and not what some in the community say is the right or wrong way, if ya get what I mean. I wish you peace. Take care.

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    1. Jamie Ray Post author

      Thanks for reading and commenting! I’ve watched Ryan Cassata’s videos and listened to his music – he is definitely doing it his way and not the “transgender 1-2-3” way. I know you can be trans and not go on testosterone, but there is a part of me that still believes that if I was really serious about this I would at least go on low dose and give it a try. It is a harsh double-standard because I would reassure anyone else that they do not need to go on T to prove to me that they are trans.

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  2. halitentwo

    Oh man, I am SO on the same page as you are! I wish there was a definitive answer. I wish I could see the results before they are not reversible (like baldness). I also feel the rage and the sadness, the disappointment of the raw deal and the inability to go back and change it from the beginning. While the outside appearance isn’t always my preference (when I look at the before and after photos), I am very curious about the inner effects of T that I read about – the calmer, more clear sense of self and rightness, the decreased anxiety. That’s the draw for me.
    As hard as it sometimes is, I appreciate journeying with you.

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  3. Widdershins

    Give yourself time … there’ll come that moment when you you’ll KNOW … until then treat yourself to something yummy, (foodish or otherwise) because you’ve sweated blood to reach this place. Celebrate it. 🙂

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    1. Jamie Ray Post author

      I get almost to the “know” point and then I back off. And every time I back off I end up buying myself something very butch to make up for it. So I’ve got a very nice dark gray chambray shirt coming in the mail…

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  4. mostcurious

    I feel like this too. I’m not quite as old as you, but I am solidly middle aged now. As I let go more and more of “the person I think I ‘should’ be” and try to be “the person I actually am,” I’m coming up against these same questions. I had kind of a brain spiral about them last weekend and I ended up with the idea that I am definitely, completely nonbinary/agender. The person in my head has no gender and thinks gender is a nonsensical way to be dividing people, and is continually surprised that the rest of the world doesn’t feel this way. However, because I am not Ruler of the Universe and cannot dictate that we all stop trying to divide people by gender; from a day-to-day casual social interaction perspective, it would be more ‘right’ for me to be seen as ‘sir’ rather than ‘ma’am.’ It’s not completely right, because my hang ups are more cultural than anything, but every step I take towards that goal so far has been a positive change for me. I think I’m about to take the “have the conversation about T with a doctor” step in the next month, and I’m trying to see that as another small step in the direction of casually socially male, which I can back out if things are changing too quickly or ends up feeling “wrong” to me. I can make that decision one dose of testosterone at a time as I go. ALL THAT TL;DR: Good luck. Thanks for documenting your experience.

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    1. Jamie Ray Post author

      Thank you for your comment and I’m sorry for the delay in responding.
      Sir is definitely preferrable to Ma’am – but I’m not sure about all of the interpersonal issues that come up with transition (specifically including my partner’s reaction), and the potential baldness factor (I’m vain about my hair).
      In a perfect world, I’d definitely try it out and see how it feels. Meanwhile, I muddle through.

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  5. booker

    I am a 34 year old butch on T. I don’t identify as a man but I am read that way in the world 99% of the time. I share(d) many of the hesitations about trying T that you are talking about. I love many things about T but I have gone on and off of it for six months at a time and eventually settled on a pretty low dose (.3cc every two weeks). One of the major factors I have had a hard time with was getting very bald very quickly. I realized I should have thought more about the fact that all the men on both sides of my family are hairy-bodied and bald on top. I don’t think that I would mind being bald if I truly felt like a binary man in all parts of my being but while I am navigating the world as a gender non-conforming/trans/butch in my intimate circles it feels like a lot to be bald so fast. I don’t know what to tell you except that it’s a mixed bag. I don’t regret it because I knew it was something I needed to try to be at peace but I think it is just as much a mixed bag as being pre-T. Best of luck.

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    1. Jamie Ray Post author

      Sorry that it took me so long to respond to your comment – it rings very true. There is no perfect solution in this society – my perfect solution (see me as I am) requires a lot of social change – and yes, any solution right now is going to be a mixed bag.
      I’m also so used to managing my dysphoria, and working around it, that I take a certain level of discomfort for granted – and I don’t know if it is necessary to ratchet it down further (and if T would do that for me). Top surgery was a real eye opener in terms of how much better I felt and still feel.

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  6. micah

    I was at the exact same place for a long time: doctor was giving me the prescription, but I needed to wait. Even after I tried it, it took maybe one or two years for me to finally be “ok” with everything.

    Sidenote: although I’m no doctor, “.5cc (100mg) of 200mg/ml testosterone” is starting to be considered a full dose by some doctors, and is probably enough for most people. I think the “full” double dose is way too much at the beginning. I take half of that (.25cc), and I still have my ovaries. Since you are post-menopausal, I would suggest starting even lower. When you start or… if you start 😉

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    1. Jamie Ray Post author

      The much delayed plan was/is to start with Androgel and see how I felt and how quickly/slowly things progressed. I also like the concept of a daily application to keep hormone levels on an even keel. At the same time, I know I am an impatient person who likes to see results, so I can picture myself shifting to SubQ to speed things up.
      On a side note, I have a friend who is into medical marijuana and there are tons of different types of weed you can use to get the effects you want, however, we still have one basic form of T (I want the one that gives you a Tenor voice but a full head of hair).

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