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Anyway, Dr. Anna sees a lot of the fashion industry.
Now, if you are going to be a model, you are not going to eat well.
I, along with Angel, have a metabolism that does not care how much we eat; we simply do not gain weight.
Claire does not have that problem. Claire lives in a gym trying to lose the weight she gained spending time with Angel and myself.
Carmine, well, is not a big girl, but she is larger boned than I am and just more solid, and she does watch her weight.
But for Angel and myself? Neither of us has ever been able to gain weight.
And I do not need Dr. Anna’s most common medical skills used by models, dealing with weight and hormonal issues associated with weight issues.
But I have other issues that need to be addressed.
When we were shown into her office, Dr. Anna, as she asked us to call her, had my records out, including the last four sets of blood work stretching back about eight months or so since I started modeling.
Ellen required a baseline so that when I ended up in this office, Dr. Anna had somewhere to start.
All models have similar issues; we are all too damn thin if you want the truth.
Ellen does this; she requires medical exams and constant blood work for her models because she is aware that her models are on the limits diet-wise.
I am going to be brutal here: the camera, all cameras, hate fat.
They search it out, they find it, and they make it the focus of every photo ever taken.
So, as a model, you hate fat also. And thus you do not eat well.
Only healthy models get photographed. Make sense now?
And after introductions and Dr. Anna taking a few more minutes to look things over, she finally looked up and smiled.
“OK, and since I follow fashion, I know who Shannon is, and the photos are fantastic, but in person, love, you just blew me away. There is nothing, absolutely nothing that I can see that gives your birth sex away. Your gender is female on every level.
But I know that is only partially why you are here.”
“So, the elephant sitting on my desk is, what are you, and what does that all mean? And I understand fiancée and mother, both concerned and want the truth along with the patient. With and only with Shannon’s written permission, I will speak in front of you.”
Dr. Anna handed me a one-page form that allowed her to discuss my medical issues and care with those in the room, specifically Mom and Carmine. I signed instantly. Not an issue, but I was glad that she was that careful.
“Now, I am not going to beat around the bush here, ladies. Shannon is a bit intersex. Now about that. Intersex is not all the same. Two individuals with the same intersex conditions, and there may be hundreds, we are constantly finding new conditions and combining separate conditions under one type,
may have totally different outcomes from the same intersex condition as named. So no one really knows the limits of the intersex world.”
“But Shannon, from everything I see, is intersex XY, or genetically normal, but has an androgen insensitivity. Now, not a total insensitivity, but a very mild partial insensitivity. Most likely, those date back to issues during pregnancy, Mom, that you had zero control over.
It was just one of those things or God’s will, whichever works for you.”
“This androgen insensitivity means that her male puberty really never happened. I will need to do a full physical exam, but I can tell ninety percent of what I need to know from the blood work. All I need to know is two things: what are the hormonal levels in the patient,
and is the patient doing anything that would influence those hormonal levels?”
“And the records show that there is nothing that we know of that would influence hormonal levels to this degree. And the hormonal levels found in four tests are very low testosterone and moderate estrogen. The body can and does turn testosterone into estrogen.
As the body needs a sex hormone to function, the absence of adequate testosterone or the inability to fully utilize testosterone causes the body to convert testosterone into estrogen.”
“Now, how important is this? Well, the human body is designed to have either testosterone or estrogen in it. And when we are young, the levels are high, very high. That causes several things to happen. One is puberty, and the second is strengthening certain parts of the body. As we age,
the importance of the levels of hormones decreases, and our body begins to age and fail, and eventually, well, we all die at some point from something. All of that is normal and fine. But when we are young, and those hormones are not there at the levels they need to be at, then the body, in essence,
ages faster than it is supposed to.”
“Shannon, do you understand what I am saying?”
“I think you are saying that I never had a full puberty because my hormones were too low and that my body is aging faster than it should, right?”
“Yes and no, correct for what we can observe, but it is not so much that your body is not making enough testosterone, but that your body can not use the testosterone that it is making, and that is the insensitivity. It can and does make it, but since it can not use it,
it is changing it into estrogen that it can use. And it has to have one or the other.”
My mother then spoke up and asked, “Dr. Anna, what are the aging risks that Shannon will face if she does nothing?”
“Good question. The first is that her bones will lose mass, as will her muscles. She will eventually reach a place where she will have trouble doing the things that she wants when the muscles start decaying, just like an older person, and she will develop osteoporosis,
the loss of calcium in the bones. Those are the primary concerns, but also with time, her internal organs will begin to age, and her skin will prematurely age, and that includes her hair.”
My mother, being the mother that she is, then asked, “Dr., how long before you see this happening?”
“Elise, I see it happening already. The bone scans I asked to have done show a less-than-healthy density that can be corrected in the short term if we take calcium, but that is in the short term.”
“And more importantly, I already see some indications of liver and kidney diseases associated with aging.”
“And ladies, calcium is not going to help that. However, all of this is reversible if we give Shannon enough hormones to satisfy her body.”
I had to ask, “Doctor, are you talking testosterone or estrogen?”
“Either way, if we increase the testosterone levels, your body will need far more than it currently is producing to resolve the issue. The reason is that your body is only able to use a portion of the testosterone available.
So we have to overdose with testosterone in order to have enough that your body uses it. Still, you will have to deal with all of the side effects of steroidal abuse, including anger, massive muscle bulk, body hair, and baldness if it runs in your family. Your voice will change,
and your sexual preferences will change. Basically every part of you will become hypo-masculinized to some degree. Now, we do not know how much, and we would try to regulate the amount of testosterone that we give her.
But her looks will radically change within six months to achieve the level that her body needs.”
There was a silence in the room.
“Shannon, if you were a normal male, you would leave my office on testosterone, having your first shot before you left this building, and getting a shot about once a week for the remainder of your life.”
“But Shannon, you are not the normal male. Remember, I said that your body needs either estrogen or testosterone, and they are very similar and in the body fulfill the same functions outside of the sexual aspects. Estrogen will be more effective than testosterone,
and we would be giving a far smaller dose.”
Mom again asked what was needed. “How large a dose and what effects?”
“Elise, we titrate the dose to what her body needs, and again, we do not know that without starting the process and observing the results. We could balance her body’s need for a sex hormone to the minimum without causing too much interruption in her life.
She should stay about where she is and not really undergo a full female puberty. This is hard to do and interactive, as in many blood tests, two to three times a week at the beginning and then at least once a week after that.”
I had to ask, “Is that my only option then?”
“No, we can give you a full dose of estrogen, stop the production of testosterone, and simply replace your hormones. The issue is balancing both. If we remove the male, then we remove the issue. We just replace the male with the female, and we already know your body will accept that.”
Mom asked, “How soon does she have to make a decision?”
And Dr. Anna responded, “Well, how much damage is she willing to tolerate?”
Carmine then spoke. “OK, I have a vested interest here; I am like the girlfriend. Now, I really do not want to be with a hyper male, and Dr. Anna, my mother worked the bar in a gay club in Pittsburgh. I grew up in that world, and I know what T does to the male body when taken in excess.
I saw many gay men go down that route, and I do not want that. Shannon, if you have to do this, the testosterone, then I do not know if I could stay with the person you probably would become. I watched way too many men do this, and I saw what happened to them.”
“Carmine is correct; in the gay male culture, there is a story of testosterone overuse, and it is a major issue in some communities, in the bodybuilding world also. Some call this steroids, but understand that testosterone is a steroid,
and every issue you have ever heard about steroids occurs with testosterone. I do not think that Shannon would go that far, but it is a possibility, and a strong one at that. And Shannon, those effects would be permanent once they occurred; you could not walk them back.
That type of body restructuring is a one-way street.”
I had to respond, “And that would kill my modeling career, correct?”