Rationing Health Care

As you know, I’m an American living in the UK and I’ve had a few health issues and have dealt with the NHS some. But I want to talk about how my mom got sick a few years ago.
She had been having a few problems and went to her GP for help, but the GP didn’t correctly figure out what the problem was. A week or so later, when she was suddenly partly paralyzed, my dad took her to the hospital, where first they thought she had a stroke and later they diagnosed her with a brain tumor. There was a national holiday, which delayed things for a bit, and then she had emergency brain surgery.
After the surgery, she needed to talk to some specialists about followup care and so had to wait to get on their calendars, despite needing care fairly immediately. They were on summer holidays. It took so long to see them that time was running out to actually start treatment.
Everything I’ve described so far could have happened in any first world country. The next part of it is uniquely American.
If you have a brain tumor, there is a very typical path through treating it. First surgery, then radiation + chemotherapy. Almost everyone does those things. But when it came time to start radiation, my mom’s insurance said no. That would not have happened under the NHS. The NHS would have covered it and she would have been able to start radiation within a reasonable time frame. Instead, my dad had to have a lawyer write a letter to the insurance company. While at the same time trying to cope with his wife having terrible cancer. So he approached Stanford Hospital to see if he could just pay cash. They said no. That also would not have happened in the UK. If my mom had been in the UK, she might have lived longer than the few weeks it took her to die, after she finally started radiation too late.
When I hear of people talking about how having national health in the states would cause delays in treatment or rationing of care, I wonder what planet they’re on. I’ve read that insurance companies spend 30% of their budget looking for ways to say no. In the UK, the NHS just follows standard treatment models. The doctor prescribes a treatment and the patient gets it. There is not an accountant involved in this process.
I have waited to see specialists in England. Sometimes months. But my issues are not life threatening. And I can see a GP usually the next day. In the US, I’ve been told I had to wait several weeks for a normal checkup. When I tried to get a gyno exam, the waiting list for that was six months. For a normal checkup. The NHS is faster and more efficient.
And, in the UK, if I decided for some reason that I wanted to see a private doctor or I wanted a prescription that they weren’t too keen to pay for (like the topical form of testosterone, for example) or I just thought it would be faster to go private, I could do that. Unlike my dad and Stanford Hospital, which only knew how to deal with insurance companies.
The US has the most expensive health care in the world. Per person, we pay more than anybody else in the world for our health system, which ranks at the very bottom of the first world. We pay twice as much as the NHS costs and we’re not getting better treatment, we’re getting worse.
So if the proposal for health reform in the States was to put in an American NHS, I say go for it. They’ve done fine by me and most everyone I know here. People in the UK don’t need to declare bankruptcy to pay medical bills. They’re astounded that we do. It’s responsible for half of all bankruptcies in the US. Here, like none. When people are hit by a car or something, they’re worried about getting better and getting back to work to pay their regular bills, not how they’re going to pay their medical bills. And we’re already paying twice as much as Brits for our system.
But just about everybody I know in the states has had some sort of issue with medical bills or insurance or something. Paying well over a hundred dollars just for a normal doctor visit or having to wait forever or being declined. Can we all take a moment and share those stories. Because the “rationing” fears I’m hearing from the states seem to be describing the present, not some dystopian future.
The NHS exists to keep people healthy. Private companies exist to turn a short term profit. Which do you think sounds more trustworthy?

NHS Mental Health Trust Shrink

In order to ration care treat trans patients, the NHS wants shrinks to be involved. Specifically, you can’t get a referral to an endocrinologist without a psychiatrist. Also, importantly, nobody wants to pay for anything unless you jump through all the proper hoops like a trained circus dog. So this morning I arose bright and early to go see a shrink.
The letter informing me of my appointment told me to go to the Queen Elizabeth Psychiatric Hospital (QEPH), which is right by school. It always struck me as highly convient, having the mental hospital right next to the Uni. I also often wonder how the queen feels about having a mental hospital named after her? There must be a great number of strange things named after her. The Queen Elizabeth Car Park. The Queen Elizabeth Strip Mall. The Queen Elizabeth Home for Rabid Puppies. Does she get any say in it? “Oh, thank you for the kind offer, but I was really holding out for a suspension bridge?” (Or can there be multiple Queen Elizabeth Bridges? Would that be too confusing? Could there be both the Queen Elizabeth Bridge and the Queen Elizabeth Suspension Bridge?) I mean, personally, I wouldn’t be picky, but I have many fewer people asking to use my name for their construction projects. Nevertheless, I think I would balk at a mental hospital. What are you trying to say?
Most Brits probably have odd ideas about America. I think they imagine the shootout at the OK Corral as being highly symbolic of the country as a whole, which is not an entirely unfair assessment. Similarly, I have various stereotypes floating around in my head about the UK, many of which come from Victorian novels. High school English classes typically spend one year on American Literature and then one year on British literature. The Victorian era seems to have been a golden age of writing in England. Or, at the very least, it’s the one most enshrined in American highschools. Costume dramas made by the BBC are also a major cultural import into the states. We all imagine a dark, smoky gray London with a polluted fog overhead, women in petticoats, Dickensonian beggars, murderers left and right (with Sherlock Holmes or Miss Marple on their tail) and hulking brick asylums, filled with suffering upperclass women who can’t accept their station in life. Women who want to read too much. Women who want to be men.
Fortunately, I have managed to avoid being committed. I woke at an extremely early hour and managed to spill every drop of my morning coffee on the floor before I left for my appointment, alas and woe. The QEPH is in a typical largish medical building. They have automatic doors, which, unlike mental health centers in the Netherlands, are actually automatic. The reception was separated only by a normal counter, again, unlike the Netherlands which was behind glass. Maybe they think I’m crazy, but at least they don’t think I’m dangerous. That was nice.
The doctor asked me when I first knew I might be trans. I should have a set answer for this by now. I should write out my official narrative and post it to my blog. Then, when somebody decides that I need to see a shrink, I can just give them the link. I don’t fucking know when I first had gender issues, ok? sheesh. I really don’t want to draw any kind of line anywhere. I don’t want to validate all the homophobic bullshit I used to be subjected to. I don’t don’t want invalidate decisions of other butch women not to transition. When did I cease just being a butch woman? When I started taking hormones and told people to call me he. Not before. It happened then.
Lack of coffee, up early in the morning, strident (formerly) lesbian feminist, so very very american. I must have seemed a bit like Hillary Clinton. But, you know, if she were a bloke. I was confused by the questions and gave confusing answers. I’m pretty sure I annoyed the doctor. Nevertheless, I have successfully jumped through this hoop.
He explained that there were evaluations and waiting lists and whatnot. We don’t just give out hormones on demand to people who ask for them, he explained. Why the hell not? What terrible harm would befall the commonwealth is trans people had easy access to transition? None!
Alas, this is just one hoop. This doctor is not a gender specialist. I’m to keep seeing him while I wait to see the one specialist for the region. Who is not in Birmingham. The second largest city in the UK has no gender clinic. The waiting list is apparently months long. In the mean time, I can keep taking T – and I can keep paying for it.
I am so very, very, very glad I started on hormones while I was back in the states. Sure, we’re all cowboys and it’s the wild west and all, but that’s not all bad. The social worker in San Francisco explained that the city had no vested interest in saying no to trans people. What purpose would it serve? The city pays for it’s residents to get this service if they want and need it, like the NHS pays for Brits (and foreign students). And San Francisco found it was coming out ahead when it got rid of all its hoops. People who come in for hormones also get the other health services that they need. Happier people tend to take better care of themselves and are healthier. Does it save tax money to say no to trans people? No, quite the opposite.
I left my heart in San Francisco. Sometimes, I think it’s the only place in the world where anything makes any sense.
I felt good about myself when I left QEPH. I got through this round. I was treated more or less like a normal person. When I got back outside to the bike parking, somebody had left a nice, new, red mountain bike leaning on my bike. With no lock on it at all. You’d have to be crazy to leave that bike out unlocked like that! . . . oh right . . . I wish my issues weren’t treated as mental health issues.


If you’re wondering about that photo shoot magazine business, well, they haven’t paid me yet, so I’m going to wait to mock them. But I got my T shot finally on Monday (and I feel so much better).
On Monday, I showed up to my doctor’s surgery and after asking the receptionist if I could speak with a nurse, I asked her if, as a favor, she could please change me from “Miss Celeste” in the NHS system to “Mr.” They have to use my legal name, fine. But titles aren’t legal. And every time I got something addressed to “Miss Celeste” I felt like they had tied a pink bow around my neck. “Mr” would help. A lot.
The receptionist looked at her computer. “Is your real name ‘Celeste’?”
“uh. yeah.”
“Are you from the states? Are you American?”
“yes . . .”
“Oh! Well, over here ‘Celeste’ is usually a girls name! That’s probably what’s caused the confusion.”
I did not start laughing. I said, “My mom was a big Johnny Cash fan.” Which is true, but I wasn’t exactly a boy named Sue. I went to sit down and out of the corner of my eye, I saw the receptionist get more and more confused looking until she went into the back. And then my name came up.
The surgery has a sort of an announcement system. “Would so-and-so please go to room 15?” I couldn’t tell if they said “Miss Hutchins” or “Les Hutchins” or what. They pronounce “Les” like “Lez”, not like “less.” And “Liz” is also a name, which sounds very very much like Les. It’s confusing. But my last name was clear, so I went to the room.
The nurse showed me how to open the ampoules. They’re made entirely of glass. You have to snap them open and be careful not to cut yourself. But they snap cleanly. She told me not to worry about bits of glass getting into the T. I asked her if she could just do the shot for me, since she’d opened the container.
She agreed and I asked for it in my bum. It’s a good idea to rotate injection sites, because of scar tissue and whatnot. Since I use my legs, I thought I’d ask her to do someplace that I can’t reach. She was anxious that I not lower my trousers in front of the window, but then she just pushed the needle in. No gloves. No hand washing for her. No antiseptics for me. Not even a quick jab with the needle. It just went right through my unsterilized skin. I’m surprised the British aren’t ultra-cautious about this, like they are about everything else Is it just her? I guess I don’t need to be too paranoid about that part then.
I asked if I could just have a few needles instead of buying a hundred, so she gave me some (yay) and then asked me how I dispose of them after using them. I explained that I put the cover back over them and put them back in the little plastic pouch they came in, so nobody would get stabbed, and threw them away. “Oh no, you’ll go to hell for that!” she said.
My friend has a joke he loves: There are Jews in hell for eating bacon. There are Catholics in hell for eating steak on Good Friday. And there are Anglicans in hell for eating the meat course with the salad fork.
I won’t go to hell for being all kinds of queer, I’ll go to hell for not following proper safety protocol with used sharps. She told me I need a sharps container and wrote me a prescription to get one from the pharmacy. When I saw the name on the scrip, I knew my conversation with the receptionist had not been in vain. It’s written for “Miss Les.”

Feeling Sleepy

When last I posed about my adventures with the NHS, I had just gotten a prescription from a completely uncertain doctor. She had no idea if she’d written me the right amount of the right type of T nor whether or not I should have to pay for it. She didn’t even know what kind of needles I would need. She went to ask a nurse but couldn’t find one. She promised me a referral to an endocrinologist, so that somebody with experience could be checking on things. I agreed this was for the best.
If I had stayed in the states, I would have 10 weeks of testosterone left on my initial prescription, so as long as I’m getting an equivalent amount to what I was first prescribed, it’s ok that nobody has checked up on me yet. And I went asking around on the internet and the doctor had, indeed, given me an equivalent amount. So I took my prescription note to the chemist (British word for “pharmacy”) to get it filled, the day before I was due for my shot. They had to order it.
I find injecting to be stressful as hell, so I didn’t actually hurry to pick it up the next day. I arrived on Friday, a day late, to get my T. The pharmacist gave me 3 ampoules and 30 needles! But they were insulin needles. They only held 1 CC and the needle part was about half the length needed for intramuscular injections. And, I mean, I like to have spare needles, so I can practice on oranges a few times before I stab myself, but ten per shot is a little excessive. Ten per shot of totally the wrong needle is beyond useless. The pharmacist (chemist?) said he could order 2 CC needles for me . . . in a case of 100 for £20. That’s a fairly major investment on my part, not just economically. If I stay on the same kind of T, instead of switching to the once every three week formulation most frequently used by European ftms, that’s enough needles to last me 4 years. If I practice with an orange every time, that’s 2 years worth of needles. I was kind of hoping to switch from injecting to some other form, like a patch or implant or whatever. That’s a hell of a lot of needles. He promised to order them. They would arrive on Saturday. Two days late for my shot.
I got home and found I had one needle left from before. yay. Obviously, I’d prefer to have an extra (one time I took the cover off of a needle and promptly gouged into my thumb. So much for that needle.), but if I only have one, then I only have one. I watched a youtube video about how to DIY it, just to double check that I’m doing it right (more or less, I’m fine) and I put on some Steve Reich phasing music to feel happy and relaxed. I did the prep. Wash my hands. Figure out where I’m going to stab myself (left leg). Clean it. Clean the top of the ampoule before . . wha? What’s this? It’s made entirely of hard plastic. Where do I stab it? How do I get the T out of this thing?
I looked at the clock. 17:15. I looked at the web page for my Doctor’s Surgery (British word for “office”). Oh christ, they’re closed until Monday morning.
I was already a day late.
I don’t know how to describe what this feels like. People who have taken the pill or whatever can probably relate, on some level, since they’re messing around with their hormones also. The goal of the T dose taken by an FTM is to cause masculinization, but also to overwhelm his ovaries so they just give up. It’s early menopause. Which is fine, because he’s got new artificial hormones to keep him going. It’s better living through chemistry! Except that’s only as good as the pipeline coming to you.
When I started T, I still had a fair amount of anxiety, so I’d never typed the name of my drug into google. I thought reading the information might freak me out, since, you know, I got freaked out kind of easily. Oh my god, this is the most sought after steroid for weightlifters. There are body builders who take more every day than I take in two weeks. Well, I guess I don’t need to worry about dying of an overdose or something. They all report the same effect I did. More energy. More stamina. Easier to make muscles. All this physical energy and strength.
Missing a dose for several days, though, isn’t just going back to baselines levels. My baselines hormone levels have been shut down. It’s going to zero. Not only am I below the normal male range, I’m below the normal female range. I’m at nothing. I feel like. I don’t know. I want to take a nap. A really really long nap.
I feel like I’m underwater, somehow. You know how it sounds when you’ve got your head underwater and somebody’s shouting at you? You can hear it, but it sounds strange and distorted and barely understandable. I feel like that sounds.
I can get through a few days of this with tea (caffeine is a little like T. (if only there was T tea)) and chocolate. In Harry Potter, you recover from dementors by eating chocolate. It sort of revives you from having stared into the abyss. That’s the most true part of those books. But, now, I dunno. I got nothing. I don’t want to eat. I don’t want to walk around. I don’t want to make music. I don’t want to make tea. I don’t want to eat the chocolate sitting by my bed. I just want to sleep. And not, like, with a longing, just like a default. It’s like staring in the abyss, but the nothing staring back at you isn’t infinitely horrifying in it’s emptiness. It’s not horrifying at all. It’s like the abyss is made up of shuffle board courts and corporate team meetings and sandwiches made of wonder bread and waiting rooms and BBC Gardening shows. It’s not dread, it’s complete numbness. The mummy’s curse causes dread. But being a mummy is all white bandages and laying in a box and nothing ever happening, just a really long nap.
A half hour goes by and I haven’t even noticed. I could stare at the wall for days.
Of course, some part of my body has noticed this state of affairs and is rousing itself to action. It’s kicking at my ovaries telling them to wake the hell up and do something about this. I really don’t want them to wake up. stay asleep. Stay asleep. It’s only another day. I’d rather be a eunuch.
Is it bad for me to oscillate like this? How the hell should I know? Probably it’s not good. It doesn’t seem like it could be. When I made a list of pros and cons, this possibility was at the top of the con column. I’m tethered to doctors and prescriptions and chemists and needles and and and. Not that being anxious all the time constituted total freedom.
I don’t want to sound like I’m complaining. I’ll get through this. I don’t regret my decision. Not that I have the energy for regret.
I want to go abroad this summer for a few weeks. I don’t see how I can work that out and my prescription at the same time. Especially since the referral that came was for a shrink. I have to jump through some hoops in May and probably June. There must be a way, obviously. I’m sure I’ll work it out. And it’s not like I don’t have a fuckload of options. When I go to play a gig in the states in July, there’s 10 weeks of T I’ve still got prescribed to me. I’d rather not have to fork over the $$ for it, but I know it’s there if I get stuck.

I got a prescription

I woke up at an ungodly early hour to phone the doctor’s office to ask for an appointment. And they had one, to which I arrived about 5 minutes late. Mornings are not a good time of day for me. I felt sheepish for being late and also pissed off from the day before. But if the desk clerk recognized me, she gave no indication of it. It’s amazing something could give me so much angst, but be not even worthy of recognition the next day.
The doctor started everything off by asking me about a note on my gender in my file. So I guess the clerk the day before had tried to be accommodating or whatever. The hardest part about culture shock is that things can really seem like fights or conflicts when they’re not.
And it quickly became apparent that I actually am the only ftm going there. The doctor was looking through the NHS prescription database and a little book trying to figure out what prescription to give me. I kind of want my doctors to know more than I do about this stuff, not less.
In the end, she gave me a prescription that I’m going to double check, since she wasn’t certain it was equivalent. It’s a private prescription. The UK has a really bullshit system where some things are private and some are public. So the NHS paid for my visit this morning. They’ll pay for the needles. She wasn’t sure if they would cover the T. It turns out to be pretty expensive. 33£ / per shot. So I’ll be paying about £100 for my next 3 shots. Yikes.
What’s fucked up about this is that a NHS doctor is totally empowered to prescribe it and I’m totally empowered to go get it. But they don’t want to pay for it. Or might not. I don’t have a shrink letter saying I should transition, which is required documentation. But I arrived in the midst of my transition, so they might be willing to pay because I followed the rules in my home country.
I didn’t ask if I could start jumping through hoops here in order to get coverage. Because the doctor let slip that they require two years of therapy. Two fucking years!
I don’t know what the writers of these rules imagine, but in my admittedly limited experience, people realize they’re trans on their own. Then they try to ignore / resist it, usually, because it’s kind of a pain in the ass and has the tiniest bit of a stigma attached. I’m under the impression that most people wait until they’re at their wits end before they even think of broaching the subject with a doctor.
So they take people, adults, who are at their wits ends, who have held off as long as they can, who probably have really terrible anxiety, and they spend two years trying to talk them out of it? What could some fucking doctor say that I hadn’t thought of myself? Have you considered that maybe you’re just a butch lesbian? Gee, what a crazy idea. And all the while scrutinizing you, trying to figure out if you’re trans enough. You better double check that your shirts button on the correct side before you go in. Maybe it’s not like this. I don’t know. I’ve never done it. But two fucking years, what could they possibly doing during all that time? Do the writers of said rules imagine that people impulsively transition? Do they think everybody would do it? Are they struggling to hold themselves in abeyance? Do they have conversations about “thank god for the rules or who knows what genitals I might have woken up to after that last office party!”
But if I can get it privately, it means they’re not protecting themselves from transitioning in a haphazard manner. They’re protecting poor people. In the US, the unemployment rate among transgender people is alarmingly high. 50% of mtfs lose their jobs – regardless of class or job. I imagine the situation here is similar. So if you want to skip your two years, you better have inherited wealth and a tolerant family who won’t cut you off. The National Health isn’t a privilege, it’s a right. If some MP is trying to entice trans people to go outside the system and forgo their rights, well, there’s a word for that: “Discrimination.”
Again, they must imagine we’re out on a lark.
So maybe it would be worth it to go and talk to a shrink, as long as I don’t have to put things off while doing it. If I get a letter for my last few months here, then that’s a few months of not having to pay so damn much out of pocket. Also, note that the shots are the cheap way of doing things and I really want to find a less stabby delivery method. England is taking a lot of my money. I’m not asking for more than I’m paying in.

I arrived 8 or 9 minutes late

Ok, I wasn’t exactly on top of things. So I waited until I was about to run out of T to call. What do I do if they say no? And then I waited to come in with my passport. How long am I willing to go off of T? And I arrived a few minutes late for my appointment. How many months am I willing to wait again?
I showed up before the cutoff time, but I wasn’t fully registered with the office for some reason because they needed to see my passport. Which I had with me when I came to register initially, but which they hadn’t asked to see then. The front desk woman scolded me. I’ll have to make another appointment. She was the same person who took my registration originally. Who acted uncomfortable when I asked if the doctor could refill my T prescription or if I would be referred out of office. What is the process in this country? “I don’t know. You need to talk to the doctor.” This is the closest office to the school. Could I really be the only transitioning student in my entire university?
She took my passport and disappeared into the back room for several minutes. I chatted a bit with the other, friendlier woman behind the counter. “Maybe you should try to make afternoon appointments,” she wisely suggested. Finally, her more dour colleague returned and handed me my passport. “I’ve had to register you as a female.” she said, as if I had been trying to pull something. I shrugged. I know I still require pelvic exams and whatnot. “Fair enough.” I said. She was annoyed. “You tried to put down both.” What I put down was “ftm.” Can somebody in a doctors office really not know what ftm means? There are thousands of students at my uni. Percentage wise, trans people are only a few per thousand, but there should be a half a dozen of us at the very least. “Ftm” is not both, it’s a specific designation relating to what health services that I require and the identity I need respected. No, I did not just put on my paperwork “I am a freaky person trying to make your life difficult” but thanks for treating me that way.
She went on, still dour. “You’ll have to re-book. We have nothing for the next week. Call up every morning at 8:45 to see if we have anything for that day.” Oh shit. “Ok” I said. What the hell else am I going to say? The other, friendlier desk person finished her phone call and suddenly noticed I was leaving. “Wait, do you want to schedule a new appointment?” she called after me. I looked back questioningly. Her dour colleague answered, “No, I’ve just told her to call in the mornings.”
Is the doctor going to be like this too? Is it the whole office? Is it just this one person? Can I find another office? When I run out of T on thursday, when will I be able to get more? Am I going to be able to get an appointment in the next two weeks? Are they going to make me go get a therapist letter? Will I have to wait to get on the calendar of an endocrinologist? Is there a way to scam more T without going through the proper legal channels?
But, I have to be fair. I’m prepared to concede that it’s my fault that I was turned away from the doctor’s office this morning. They phoned me a week ago to say that they needed to see my passport and I didn’t bring it until I arrived a few minutes late this morning. (I did try to bring it on Good Friday, but they were closed until this morning.)
I have no love for the medical profession. I can recall every single time that a doctor treated me like a full person. It works out to about five of them. Maybe 6. I want to go on to make a claim about how I’m in a special class in this regard and how the very job description of a doctor is a promotion of normativity in bodies – to force them to conform to a state we call “health,” (which is a system that can work well for the promotion of well-being in already normative bodies and uses of said bodies). I want to say that doctors abhor queers because queerness – a non-normative use of the body – is uncomfortably close to ill health. It’s something to be diagnosed, treated and stamped out. But, alas, I don’t think I’m in a special class. The perfect patient is one who is already well, already normal. If you can’t or won’t have the ideal weight, if you won’t conform in that regard, then you’ve already spurred part of what the doctor is offering you. If you don’t want this part of the normativity, why should ze offer you any of it? I’ve seen how doctors treated my mom while she was dying. I overheard them, years earlier, driving her towards an eating disorder while they obsessed about her weight. I’ve heard the stories of people with disabilities. I’m not special. If your doctor treats you like a full person, then you are the one in the special class. Everybody else here is just somehow refusing doctor’s orders. Not skinny. Not physically able. Not young. Not physically male. Abnormal and untreatably so.
Forced by circumstance, they’re willing to concede very specific circumstances in which one may escape portions of normativity, in exchange for more fully conforming to other ones. There’s a set drama that is required to unfold in the treatment of transsexuality. It usually starts with a GP and then is referred on from there. Sometimes, like in the US, GPs will prescribe hormones. If their office allows it. If they feel like it. They might just say it’s against policy when it’s not and then act really uncomfortable and shoo you out. If your GP won’t do it, if you are less fortunate that I was, you get sent through a set of people who are supposed to talk you out of it. It’s a really lovely system. I hope to see it more widely introduced. “Oh, um, well, what makes you so certain you need eyeglasses? Have you always had trouble seeing? How do you know this isn’t just a phase? Sorry, if you were serious about needing glasses, you wouldn’t have arrived dressed that way.”
I’ve had enough doctors act visibly repulsed by my sexual orientation and gender non-conformity that I’m still surprised when they treat me like a person. It’s not what I expect. If I need to come in to get a hormone prescription refill in a new country, of course they’re going to look for a reason to say no. And what then? What do I do then?


It has recently been exposed that drug companies have been aware for quite some time that drugs like zoloft have no effect on mild to moderate depression. It performs the same as a placebo. Well . . . that explains a lot. I wish I could say I was shocked, but I’m not. I took it for weeks before it started “helping” and then it only helped very slowly, while I still endured panic attacks and ate many many antacids in a single day for weeks and weeks. And it explains why I didn’t really start feeling ok until I started to transition.
Several months ago, I read that the pharmacy where I got my Zoloft had a markup on it of, like, 900%. I should have paid around $100- $150, but instead I paid a thousand. For the first bottle. I had to pay for three different American doctors to get the drugs coming. And doctors are the only thing in America that’s not cheap. And I had to keep up with this in Europe and go see doctors there and pay for prescriptions there. Basically, the medical industry made thousands of dollars off of me and gave me something with all the many benefits of a placebo. I should have just taken St. John’s Wort.
Because while Zoloft helps as much as a placebo, it has all the downsides of a real drug. It didn’t do much for my panic attacks, but it did alter my brain chemistry. But not in a way that helped me. It made me stupid and gave me nothing in return. Now, it’s giving me the many joys of withdrawl. Because that part is real. The part where your risk of suicide goes way up and the part where you feel like shit if you miss a dose or change your dose. So thousands of dollars plus shitty health effects. . ..
I mean, I guess there’s a silver lining. I felt like I really needed help and they gave me fake pills. So it was me that made me better. I did it. Hooray for me.
I hadn’t “needed” the pills since I started to transition. So I started cutting my dose. I figured that if I noticed a change for the worse, I could start again. But I haven’t noticed a change at all. Except for a week or so of crappy withdrawl at every decrease.
I don’t want to blame my doctors. They didn’t know. They didn’t exactly send me off to talk therapy. Well, the Netherlands very generously put me on an 8 month long waiting list, so it’s not like I got no kind of support of any kind while I was freaking out. But the drug companies knew and suppressed the data. And the pharmacy didn’t know that the drugs they were selling me were crap, but they sure as hell knew how much they were charging me. (And they knew that people don’t go around comparison shopping for drugs they think they really need because they’re in a crisis).
I want my fucking money back. I want a letter of apology. I want some fucking therapy. I want a drug company executive to come to my door and personally say ze’s sorry. Then I want hir to slowly learn to deal with the side effects of taking the drug as ze ramps up to the max dose and slowly combat the withdrawl symptoms as ze cuts back to zero. And then I want to kick hir in the shins several times for good measure. And I think every other deceived person should get the same – to kick an executive in the shins.
I was sick. They took my money and gave me shit while I was sick. I want somebody to go to jail. It’s not like they just charged me a lot for a sugar pill. They charged me a lot for a pill that causes an alarmingly high percentage of takers to become suicidal. They charged me a lot for something that made me feel sicker. They charged me a lot and I was patient while I waited and waited and waited to get a “high” enough dose and feel ok – and during that time, that’s all I had. Well, that and my very very patient girl friend. And my chiropractor. She claimed she could cure me by pressing on the sides of my head, but at least I knew that was bullshit.
Anyway, I took the last pill of it I’m ever going to take two nights ago – because the withdrawl of cutting it down by half when I got here had worn off an acceptable amount. And if anybody comes to me with a class action lawsuit thingee, I’m so onboard.

And . . . I finally injected

Yesterday morning, I biked over to my friendly neighborhood doctor’s office and asked t speak with a nurse there. The desk person seemed to think this was kind of a weird request. It’s pretty normal in Holland, at least. I waited a very short period of time which I spent conversing with an overly-friendly patient who told me my sweater was “pretty.” umm
I had brought with me my vial of T, some needles and my aborted needle from the night before, still with most of a dose in it. I explained I had gotten freaked out, that T had leaked everywhere, that I thought I was going to stab something vital, etc.
She told me to throw away the needle with a partial dose left in it and just start over, injecting the full amount. Some of the T might have gotten to the right place, but it probably didn’t and the old needle tip would be blunted from re-use and the dose in it might not be sterile anymore. So just start over.
Then she assured me that there wasn’t much danger involved with this kind of shot. If I stab way too deep, I might hit my bone (ack), but that doesn’t happen to people unless they’re really, really, really skinny. And even if you hit your bone, it causes pain, but it doesn’t actually hurt anything. It’s also possible to hit a blood vessel, but the risk there is just pain and bruising, not anything serious or life threatening.
She told me to jab it in quickly, rather than push it in slowly (“Just like that scene in Pulp Fiction“) and to practice by stabbing oranges. Then she looked at my needles and told me I might be happier with a BIGGER gauge. T is really thick and obviously my problem would not be with the actual stabbing but with the squeezing the syringe. She offered to get me bigger needles. I declined. (Ack! No! Are you crazy??!) And she gave me some pamphlets on how to do it.
I asked if she could just give me the shot. I was still feeling kind of freaked from the drama the night before and also, since I was a day overdue for my shot and the previous week’s had partially leaked away, I was kind of in a weird space. I was really grumpy and weird. My body was thinking, “What the hell? Where’s all my hormones? Should I start making some? How am I supposed to regulate mood without hormones?” I was hoping she could just do it and I could return to normal. She was taken aback when I suggested it and went to ask if the head doctor would let her. The head doctor said no, as I didn’t get the prescription from their clinic.
I complained saying that I had tried to get it from their clinic, but the doctor I talked to said they didn’t do that there. The nurse was even more surprised. “We most certainly DO do that here! What doctor said that? Was it Dr. Z?” It was some white guy, I said. “It was Dr. Z, then.” She went to discuss it further with the head doctor. I still didn’t get my shot form her, but at least the guy who told me they wouldn’t do it and acted kind of freaked by my request those weeks ago, at least he’s getting in trouble. The nurse offered to set me up an appointment at the clinic there, so close to my house, so I could get them managing my health again. I said no. I don’t have more money to throw at doctors right now. The blood tests alone cost more than $1000. I can’t afford to repeat them. When I need a new prescription, if I’m not in England, I’ll go there. But otherwise, no.
The more I think about my experience with Dr. Z, the more annoyed I get. He was a dick, but not openly hostile. Still, he refused me treatment because of prejudice. And what’s alarming is that I know this will be a constant for the foreseeable future. I was reading recently about a trans guy who died of ovarian cancer. He caught it in time. It was treatable. Doctor after doctor refused to treat him. They thought it would harm their social standing to provide life-saving treatment to a freak. I mean, this is Berkeley, I shouldn’t have that problem, right? Meh. Maybe I should get all the female-specific parts of my anatomy removed pre-emptively? There’s differing opinions on whether FTMs on hormones are more likely to get ovarian cancer. They’re way more likely to die of it, though. Lesbians are also more likely to die of ovarian cancer, cervical cancer, etc. Because doctors can be discriminating assholes. I still have lingering negativity towards the medical profession based on the experiences I had with them as a young dyke. Being FTM is that all over again. Being out as FTM now is a whole lot like it was for me to be out as a dyke 15 years ago.
After the doctor, I went to wrestle with Jean’s wifi network. (the network won the match, alas) and then I went home to discover that Cola had coincidentally bought a whole bunch of oranges. I explained my plans to stab them with hypodermic needles. “Well, they are blood oranges.” she said.
I held one in my hand, ready to stab. What if I missed and gouged up my hand!? I put it between my knees. Too much danger! I found a narrow-mouthed cup and put it in the top of that. Stab. Stab. This isn’t so bad. Then I had an idea and poured some compari into the cup and drew it up into the needle. I stabbed the orange again and injected the compari into it. I turned the organe and repeated the process. but I quit when compari started leaking out all the puncture holes. Ok, I can do this. Also, compari injected blood orange is a tasty treat.
So, finally, at bed time, I prepped everything to get ready to inject and pulled the protective cover off the end of the needle – and promptly slipped and stabbed the tip of my thumb. Ouch! It went in deep, until it hit something hard and stopped. I cursed and bled. Augh!
I re-washed and re-prepped and pulled out another needle. This was #4. I suddenly understood why I had gotten a prescription for 25 needles and was relieved that I had taken a few “extra”. I pulled the T into the needle, got the bubbles out and then sat with the needle poised over my leg. “Just jab it. Just like the orange” I instructed myself . . . and then sat there for 20 minutes trying to remember to breathe, but not hyperventilate. Finally, I made the jabbing motion but decided to abort at the last second. Too late! My leg was bleeding. Damn it. About 20 minutes later and a third or fourth re-swabbing of my leg later, I jabbed in the needle. And it was remarkably like stabbing the orange. Sort of a rind and then a softer under-layer. I slowly pushed the plunger down, probably scraping up my leg muscle as my hands shook.
All in all, it worked out for the best. I have a hard time psyching myself up to jab, so the previous two times I had a needle in my leg, I had pushed it in slowly and not far enough and had leaking. But after talking to the nurse and stabbing an orange, I think I should have much less trouble next time. While the emotional barrier to jabbing is high, once it’s jabbed, it’s much less emotionally intense than pushing in slowly.
There’s now a whole collection of used hypodermic needles in the trashcans of my house. (I always put the safety cover back over the needles.) And there’s the compari one on my coffee table. I’m pondering whether I should keep it to further fortify fruit Can one purchase duller fruit needles that wouldn’t be tempting to a junkie or dangerous to a klutz but still be able to pierce an orange or watermellon and up the alcohol content? Also, how the hell do people come to be IV drug users? My gods.
I woke up this morning feeling much more normal. No more putting off injections to the last second or the next day.

I don’t want to be whiny, but

. . . but since I cut my zoloft dose in half a few days ago, I’m starting to experience negative emotions like a normal person. Er, yeah, only minor headaches from withdrawl, so that’s good. And in other health-related news – (I used to think that getting sent to hell would mean spending an eternity at a dinner party where the person next to you described all the minutiae of their health concerns in great detail. I hope my blog isn’t too much like that.) I went to SF yesterday to learn to give myself my own needle sticks. I was thinking maybe I could just look it up on wikipedia and try it that way. I mean, how hard can it be? Yeah. so the nurse showed me how to do it, but I didn’t do it myself at all. Actually, I was kind of freaking out when she jabbed me with the needle. She seems to think it will take me a few months before I’ll be able to do it. Alas and woe. Not only is it a pain to get in to the clinic, but I’m paying out of pocket for getting somebody to prick me.

In case you’re wondering how to give yourself an injection into a muscle . . . first wash your hands. Then swab off the top of the bottle containing the injectables. Draw some air into the needle. Stab the bottle with the needle. Push the air out into the bottle. Draw back (a lot) to suck the sesame oil into the needle. Stare at the needle as the oil slowly trickles in. Push up on the needle until the black plunger is even with the 1 ml line (or with whatever line you need). Flick at the needle to get out big air bubbles (these aren’t such a big deal when you’re trying not to hit a vein). Take the needle out of the bottle. Fine the “belly” of the target muscle. If you’re covered with freckles and moles, you can use these for navigation. Clean the spot with rubbing alcohol. Relax the muscle. No, really. Try exhaling. Relax it. Really. They tell me this is possible. Hold the needle perpendicular to the skin to be stabbed. Relax, damn it. Jab yourself. Stay relaxed (ha ha ha). Slowly push extremely thick oil out and into your muscle. When you push the plunger all the way down, the needle will suddenly (and somewhat painfully) retract. Put on a bandaid.
Yeah, so as soon as the needle stabbed me, I clenched up like a mofo. This is undesirable because it means that I won’t absorb as much and because it really smarts today. The needle starts tearing up my poor muscle when it’s all clenched. Ouch. Once every two weeks isn’t all that often. This isn’t overly traumatic or time consuming. Using the jell would probably be more hassle. But, alas, this is annoying.
Anyway, I went out for lunch today with an old friend. And when he asked “what’s new?” I took a deep breath and said, “not much, how about you?”
October 11th is National Coming out Day. Once, in the 90’s, I played a concert with the LGBT marching band on that day and the conductor gave a rousing speech about how everybody should come out. It was such a big deal in the 90’s! You don’t even know. But at some point, I just sort of, well, stopped. I haven’t come out in ages. I mean, it’s one of the advantages of being visibly queer. I can mention my girlfriend once and folks look at my wardrobe and then we all rely on common sense. So I’m not in the habit of coming out.
I got my haircut last night and I worked up the courage to tell my hair dresser and she squealed her delighted support. (I love San Francisco.) And then, I was at a bar after wussing out on my injection and I told a guy I know and he said, “really? That’s awesome!” (again, I love San Francisco.) And, I mean, it’s a big deal, but it’s cool and stuff. Like, I dunno, coming out always seemed so serious, like some sort of civic duty. I guess I could say to folks, “hey, I got a new girlfriend! She’s awesome!” and that might be coming out. And that’s more what this is like. So I get all worked up and don’t want to come out because it’s intimidating, when it should be more like having an awesome new girlfriend. But, alas, I’m still intimidated.
I called my brother today and asked if him if he was keeping up with this blog. Yep, he is. (Hi Paul.) On the one hand, it’s kind of impersonal, but on the other hand, it’s a really awkward conversation. Traditionally, people send letters, but that seems to dramatic. This is the 21st century. I think most folks might tend more towards being surprised than shocked. Writing a letter makes it seem more shocking and scandalous than merely surprising. Anyway, my brother was really cool, which is what I hoped for.
And I called my dad today and . . . we debated whether or not waterboarding is torture. And then my head exploded. I’m going to tell my dad in person. (My brother said, “doesn’t he read your blog too?” Um, I don’t think so?) Then I can hear his theory on the difference between the left and the right in America. He seems to be very pleased with the theory and wants to disclose it in person. It has something to do with evolutionary theory.
I still have no mail form my letting agent. I’m starting to suspect that I won’t be able to get on my booked flight back to England, since I still don’t have everything I need to apply for a visa and it’s less than a week form xmas.
It’s been raining like crazy and apparently, my building had construction defects related to the water proofing. So we just started getting those fixed, like, the day I got back here. This is not the best timing to be peeling the skin off the building, since it’s actually raining a lot. Predictably, it started leaking a couple of days ago. Today, the leak was fixed. And then it started raining again and now there’s more leaking. The water has punched a hole in the ceiling, which is dripping in earnest. And the plasterboard of the wall is getting all messed up.
Oh, yeah and when I tried to install Mac OS X 10.5, it said I had a bad master boot record and refused to mount my hard drive and then some files disappeared when I rebooted in 10.4 and I fear my hard drive might be dying again.
And xmas shopping? Barely started.
So yeah, my home, which I own, is leaking. I have to come out to my dad. And all of my friends who don’t read this blog. (BTW, if you’re reading this, you should feel empowered to tell people. I mean, I should probably tell my dad myself and also my godmother, but friends and acquaintances can gossip to their heart’s delight – just as if I had an awesome new girlfriend.) The conversation with my brother went really well, but was still stressful just to have it. I have to be able to stab myself in the leg while keeping it relaxed and have pain from failing to be relaxed last night. My immigration status is still in disarray. My computer’s broke (maybe), and I don’t know what to get you for xmas. And I wanted to whine a bit about these things: *whine* ok, thanks.
Um, on a more positive note, I had my second shot. There was a blog several months ago called “The Man Project” where the writer gave herself a dose of T and chronicled what the two weeks were like. My experience was very similar to hers. After two weeks, your body is still treating it like a one time fluke. The first sign of non-flukiness is zits. I started getting them in earnest on Sunday or Monday. (I know I said my voice was lower. One of my friends says the lower pitch is in my normal range for when I’m relaxed. So it’s only a sign of happiness, which is nice of it’s own right.) I’m all, like, happy to have zits. I bet the novelty of that won’t last overly long! Ha ha ha ha!

Shot in the butt

The closer the date got, the more my nervousness dropped away. Some kind email helped, as did supportive friends and forming a sort of game plan for disclosure.
Still, I was nervous when I got to the doctor office. I had a sort of a mini-physical. Apparently, I haven’t been eating enough vegetables and it’s caused my body Ph to change in undesirable, bacteria-friendly ways. Or it could be stress. I declined anti-fungal meds (don’t ask), vowing to eat more brussel sprouts. It’s pathetic, though, that when I lived in England, I ate more vegetables than I’ve been eating in California.
Everything checked out alright, so I got a scrip. I asked for androgel, but apparently it’s expensive and requires very large quantities. The doctor recommended a once-every-two-week shot. I didn’t argue much or insist. I’m concerned about how long I’m going to want to continue having to inject myself. I hate taking a zoloft pill every night and that’s just a pill. But on the other hand, this is only once every two weeks and gel would have been at least once a day and in large quantities and danger of accidentally giving it to others when snuggling with them.
I felt happy and freaked out at the same time, as I went to a pharmacy to fill my new scrip. They told me to come back in half an hour, so I went to a restaurant and got a plate of steamed vegetables. Because I’m supposed to eat more of them. And I went back to find a snafu at the pharmacy because the doctor wrote tomorrow’s date. I recalled fondly all the insane things one can get over-the-counter in France and here they have to page rather than fill something 4 hours in advance of the written date.
Stuff in hand, I went back to the doc, where they were about to close, so I didn’t learn how to self-inject, but instead, got a shot in the ass administered by a nurse.
I feel kind of giddy. Also my ass hurts. Maybe. Or I could be imagining it. Also, I think my voice is kind of scratchy. Except I know I’m imagining that. On the BART train back to Bezerkeley, I suggested going on a run around the Aquatic Park tomorrow morning and Nicole looked at me like I’d lost my mind. It’s impossible to separate expectations from reality so early on. I’ve had folks (ok, one person) ask me to keep a regular update of whatever tiny thing might be going on related to this. I might do it for a while, at least until some novelty wears off.