The week before the appointment I kept flip-flopping. When I walked in, I didn’t know if I was going to bring it up again. I didn’t know if my new Nurse Practitioner even remembered that was why I came in a year ago, when I had my intake with her predecessor, but, right after she asked me how I was feeling, she asked me if I wanted a prescription. I squeaked out “Yes.” She said my blood work looked good, my cholesterol was down, and if I chose to use hormones she’d monitor my progress and work with me.
She took out the Informed Consent form, and quickly ran down the risks: increased cholesterol, increased number of red blood cells, acne, and increased risk of heart disease, high blood pressure, stroke, and liver inflammation. Then she read me the irreversible body changes: deepening of voice, facial and body hair, fat redistribution, and male pattern baldness.
I signed, she signed, and another Callen-Lorde staff member signed as the witness. It took less than two minutes. She asked me if I wanted to set up a follow-up, and I told her that I wanted to wait a while before I started, if I started, and that I’d set something up when I had a plan.
Before I left, I asked her if she had other clients who took low-dose testosterone and how they fared on it. She said that everyone was different, but that it was not uncommon to start on a 1/2 packet (12.5mg) and wait and see what happens and how it feels. The gel is slower and less of a shock to the system than injection. It is matter of personal preference, but she hadn’t worked with anyone who regretted starting.
As often as I’ve read about the risks, I was surprised at how jarring it was to hear them said out loud. I’ve read a lot about testosterone, and rationally I know what I am getting myself into. Hearing the word “stroke” shook me up. I believe in informed consent. I believe that it is the patient’s responsibility to be their own expert. I don’t want anyone else to determine whether I am a good candidate for taking testosterone. I don’t want anyone else to question whether I am trans enough, or whether someone who isn’t interested in a full binary transition should be allowed to start testosterone at all.
I signed the form. I understand the health risks, but I don’t have a good sense of the probability of each risk, or how low-dose affects the probability of each risk, or how my age affects the probability of each risk. I signed the form the same way I click Accept every time Apple upgrades my iOS. I signed with the assumption that if I do start testosterone, and I get regular blood work, then my NP can catch anything before it gets out of hand. I didn’t read the fine print. I hope I don’t have to.
I can’t clearly articulate why I’m thinking about taking testosterone or exactly what I want to get out of it. I know I don’t want to transition to male, but I want to blur the line. I don’t know if I would feel better on low-dose testosterone. I don’t know how my body, hair-line, and voice would respond to it.
When I came home, I put the testosterone in a drawer. I felt a little giddy. Relieved. I was tempted to break out a packet and put some on, but I hadn’t even told Donna, my partner, what happened. The light’s turned green, the engine’s running, but my foot’s still on the brake, and I don’t know if I want to ease off the pedal.
Notes: This set of guidelines from UCSF is one of the few that specifies a protocol for starting non-binary low-dose testosterone. UCSF recommends between 12.5mg and 25mg of daily topical gel to start (or 20mg/week injected). The common starting protocol for trans men is 50mg/week by injection, working up to 100mg/week.
This list of “Things They Didn’t Put on Your Informed Consent Sheet” was written by a trans man after his first year on T and provides more food for thought.