If you are transsexual, at some point you become aware that you no longer have a choice and must do something about it. Some talk privately to their family doctors and some of these doctors are compassionate enough to quietly put them on estrogens. I had known for years of my own increasing need for estrogens but was absolutely terrified of approaching a doctor about it. I avoided medical professionals to the extent I was able and was well aware that an entry of gender disorder on my medical records would, at the very least, make future health insurance extremely hard to get. I am self employed and thus totally at the mercy of those insurance companies and they have no mercy.
When I discovered the internet transgendered community I was in for an even greater shock. I was told of the HBIGDA standards of care, standards that required me to undergo psychotherapy before I would be allowed hormone replacement therapy (HRT). I had for most of my life sought out and devoured every word I could find about transsexuality. I had run across and read the books by Stoller, Money and the granddaddy of transsexualism, Harry Benjamin. Nothing had prepared me for the SoC. This was particularly distressing because I had reached the same conclusion as Dr. Benjamin, that I was born this way, that it was a matter of brain chemistry and a female wired neurological brain and body and that I quite simply was going to need those estrogens in order to continue functioning. All the recent studies done on sexual dimorphism in the brain and brain structures are pointing in this direction. It's just about established fact now. My needs were medical, not psychological. The dilemma is that this is a "hidden" condition to the medical community and the causes and treatments of our condition are left in the hands of a psychological community that refuses or simply won't search out these facts. They continue to treat our condition as a psychological one rather than a medical one and it is in their continued financial best interest to do so.
I held off as long as I could. I self medicated with herbal estrogens. The results only reinforced my conclusions. I did function much better on estrogens. The time came when I knew that the safety of my own health dictated the real thing and so I reluctantly subjected myself to therapy. I was extremely lucky and found a excellent, knowledgeable therapist. Unfortunately she was new to the area in terms of dealing with a transsexual client and thus did not have connections to the other support locally. I quietly searched for and was given the name of a doctor who had been prescribing estrogens for transsexuals and after getting my "letter" started HRT. By the time I had gotten that far I had read quite a bit about HRT for transsexuals and was subscribed to a email list for hormone use. I knew what I wanted and what would be safest for me. That's not what I got. What I got was Premarin. My doctor wanted to slowly bring my estrogens up, this is sound medical practice and I agreed. I had stopped taking the herbal estrogens and started on a low dose of Premarin. It proved to be too low a dose and many of my GID symptoms returned along with the additional peri-menopausal ones I suspected I'd get. I waited it out and the dosage was increased to a less subclinical dose after first adding an extremely low dose of anti-androgen that I practically had to beg for and don't think I would have gotten if it hadn't also been a diuretic. I found out the these lower dosages were the norm for my doctor and so recently decided to search out additional medical resources both for myself and others like me.
I have found myself in a unique position. I had slowly, with the aid of various transgendered online resources, began to rid myself of the guilt and shame of my transsexuality. I was not afraid to be "out" as a transsexual and thus started to find myself in a leadership role in the local transgendered community. This wasn't something I wanted as much as I seemed to be one of the few willing to speak out. Because of this I was willing to contact the various medical referral networks, out myself and inquire about health care for transsexuals. Was I in for a shock!
No one had any idea where to send me. The consensus seemed to be that "no doctor would deny you treatment because of being transsexual" and therefore I shouldn't have a problem. I was finally referred to a young resident at one of the OSU community medical centers. She is quite nice, but she has no idea or training for treating the special needs of transsexual patients. She and a colleague are willing to learn. They asked about the same resources I did and were told that the doctor I was seeing before was "the" doctor for transsexual HRT. She was unwilling to renew my Premarin prescription. For a transitioned pre-operative transsexual who has been on HRT, estrogen is essential, not optional. I simply will not function well without and can look forward to full menopause if denied it. I was essentially told I must return to the doctor I had started to question. Withholding estrogen from someone in my condition is on an ethical par with withholding insulin from a diabetic. It might not kill them quickly, but it will cause unneeded suffering and a possible shortening of life.
The problem is that we are very much invisible people. Our closets and fears mean we don't speak out and we can safely be ignored by the medical profession except on a limited and case by case basis with the exception of a "ghettoized" care available from a single willing doctor. This must change. We are every bit as deserving of decent, compassionate medical treatment as any one else. Our medical needs, while unique, are not difficult to take care of. The information is available both on the internet and in several books. The members of our community who are medical doctors are willing to consult via phone and e-mail. There is simply no reason for us to put up with substandard care. Transsexual HRT is not brain surgery, it requires only a relatively small effort for a doctor to get up to speed on the subject once the resources are in hand. Estrogens are in the least abused category of prescription drugs and yet my young resident friend was told she could not prescribe them without special training to a genetic male, training that is unavailable to her!
We can no longer afford to stand by and let the medical establishment ignore us. The cost is far to high. Already untold numbers of transsexuals commit suicide under the twin pressures of shame of their condition and a starvation of their brains for a simple available medication...estrogen. Insurance companies must no longer be allowed to write blanket exclusions for all treatment of gender disorder as they do now. The total cost of treatments for transsexuality from initial therapy through surgery are far less than those for a single bypass surgery. There simply aren't enough of us to amount to more than a mere drop in the bucket of health care costs yet they are free to write us off and even deny us further coverage out of what must be transphobia. Our struggle for civil rights must include the right to decent medical care
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