25 #2
“Shannon, you would be done in about six to nine months without a doubt.”
“OK, I am making a statement right now. I do not want testosterone in any form, on any level, now or in the future.”
Dr. Anna replied, “I expected that decision, but understand I had to give you, Shannon, the choice.”
Carmine reached over, took my hand, and squeezed so hard I thought it was going to break. Shannon had just silently voted.
Dr. Anna said that and smiled at the two of us, and then turned to my mother and said, “Mom? It is not your decision, as she is twenty-one, but your opinion?”
“No, no, no, no no. I do not want to lose my youngest daughter to some monster that they are not and never wanted to be. If my son were desperate to be a man, then yes, but that is not what I think is best for my child and her partner. No. Please, Shannon, as they say, just say no to drugs, OK,
to testosterone anyway.”
Dr. Anna continued, “I think we are all on the same page there, and for the record, remember I said that this was being recorded? This is why I gave the option, and Shannon refused. That fulfills that legal responsibility for due diligence for the patient.”
“And just so that you all know, in New York, that is a requirement imposed by the laws in this state; I had to tell you all of your options even if I do not believe that they are right for you. You had to have made an informed decision, which, Shannon, you just did.”
“Now, Shannon, three choices: first, do nothing and see what happens, but we already know what will happen, just not all that fast. Second, try a moderate path and have a combination of male and female hormones in your system, some feminization, but constant monitoring for the rest of your life,
trying to find a moving balance. It will move as you age; that is normal. Or door number three, stop the testosterone production in your body and undergo full gender-level feminization with estrogen and a complete replacement. That requires low-level oversight and has the lowest risk.
It will stop the aging that is happening, allow your bones and organs to heal, and, for the record, your external skin is an organ that will respond to estrogen, and it will prolong your ability to work as a model.”
Mom stepped up and asked, “The bad effects of the third choice?”
“It will affect her ability to have children and institute a full female puberty in her. Her partner, that I assume is going to be Carmine, will not be able to have heterosexual intercourse with Shannon, and that is a major complaint for some couples”
I asked, “How long before the ability to produce sperm do I have?”
“Six to nine months most likely, perhaps longer. But that also depends on how effectively we attack the production of testosterone. And that has to be stopped to be safe.”
“How do we do that?”
“Medications, estrogen in high enough dosages, and there are other drugs that are semi-reversible for the first six to nine months, or subsequently with the removal of the testicles.”
Mom asked, “Which would you suggest for Shannon?”
“Testosterone blocker for three to six months to allow time to be positive; this is the path Shannon wants, and that will complete Shannon’s living one year full-time as a female, and that is a requirement that she lives as a woman and can earn a living as a woman.”
That caused a massive round of laughter; the good doctor damn well knew what I was doing for a living and what I was making.
“Understand that there are two issues here; the first is intersexuality, and that we are addressing. But there is also the protocol for transgender, and we might as well address that regardless of the long-term decisions. Because at this point it is secondary, but if we are there,
let’s cross that bridge and get those requirements over with. You, Shannon, do not have to have SRS, but you do have to comply with protocols to have SRS in the future. Why not do both if there is no additional burden on you?”
“And I would recommend at some time in the future that the testicles at least be removed, and that would legally constitute a sex change in the eyes of the law.”
“And then I give her a daily prescription for her replacement hormones that can be a monthly shot, a weekly shot, a patch, or pills. Your choice; they all work.”
“Now, most of the girls I see want the monthly shot because it jumpstarts puberty, but do you need that? I can see that you already have implants, I believe, and believe me, no one alive would guess that you are not female just by looking at you, so jump-starting is really optional.”
Carmine spoke again; she had been mostly quiet with this discussion.
“Shannon love, I vote that you go for it. We are already going to save the sperm, and that is the only reason I see to keep parts that are harming you. I love your body now, but I would love your female body at least as much, and maybe more,
since I would know that you would be healthy for our kids and me. That’s my vote, girlfriend; that is my vote.”
Dr. Anna looked at my mother and asked, “Mom? Opinions?”
“Shannon, my son is no longer with us. Long live my daughter. I love her as much or more than my son, and Shannon, if you do not do this, then you are not going to barrel race one of my horses. I will not allow you to risk your body to brittle bones and racing.”
Dr. Anna then asked, “What is this, Shannon races?”
“Shannon does a rodeo race called Barrel racing, and it is a very technical and difficult riding event that puts her at very high risk of being thrown from the horse, not a violent throw as you old-timers think of a bucking horse,
but a riding throw where she exceeded her ability to hold on during a mad ride around barrels in a ring that is timed.”
“And she does this now?”
“I am supposed to race in two weeks, I am afraid.”
“Then I want to start calcium and estrogen today. And with that, I suggest that you go full untriturated dosage to protect your bones as fast as possible.”
“Dr. Anna, how long does Shannon have before she is out of risk from osteoarthritis?”
“Well, she is safe now, but the calcium levels are low, and we know that in say two to three years, she will most likely be dealing with broken bones if she were thrown from a horse. Now? Maybe ten to twenty percent greater risk of a break than Carmine would face.”
“Hey, I am not crazed like my girlfriend; I do not ride eight-hundred-pound behemoths; I will not ever watch her ride barrels if I can avoid it.”
“Shannon, do you need time? A few hours away over lunch? Or a couple of days?”
“No, I have decided. I want the big girl hormones. Can I do the sperm save before we stop the testosterone?”
“I give you two weeks, then I want you on a blocker, OK? That is my max if I give you a starter shot today, and I want to do that because of your riding, and then a heavy dose until we bring your bone density up to what it should be, and then we will taper off a bit.”
And with that, I did a short physical exam; nothing unexpected was found.
Endocrinology is test-dependent, not exam-dependent, but the doctor needed to see that I was male physically for the State of New York to satisfy state requirements.
What she is giving me could be lethal to a natal female.
But I have already read the numbers, and the doses are as she stated: high-end but typical for a transgender woman starting transitioning.
And also, as she said, we can moderate the dose once we clear up the issues that the intersexuality has caused.
I had one more question: “Dr. Anna, I have to ask, are you treating me as an intersex patient or as a transgender patient?”
“Shannon, good question. The transitioned path is suitable for an intersex patient, but you selected a path that is only appropriate for someone diagnosed as transgender, male to female, so you are officially diagnosed as a transgender woman,
or as we used to call girls like you when I started this field, you are a transsexual woman.”
“Oh.”
I had to ask, didn’t I?