The VA Hospital Roadblock Still Stands

I am sitting here in a deli eating lunch across the street from the Denver VA hospital. I’m frustrated that I can’t get online. But, I’m furious that I’ve been denied female hormones because I don’t cross dress.

When I first sought hormones, the Veterans Administration, and more specifically, the endocrinology department at the VA had a policy that prevented the prescription of cross gender hormones until the patient was living full time. This policy was incredibly backwards. How can one even contemplate living full time or even part time without seeing some physical changes the cross gender hormones provide. So, I continued speaking with my private practice therapist and worked both with her and a private practice doctor to get a prescription to estrogen and spironolactone to block testosterone. Blood was taken. Blood pressure results were written down. I spoke with the doctor. And she wrote a script. I stayed on that prescription until it became a financial burden to continue getting my blood drawn on a frequent basis. It should also be noted that my zoloft medication was not yet generic. So, I had to pay $80 a month just for that.

When I could no longer afford to do things the legitimate way, I turned to the internet. And that’s what I’ve been doing for at least the last two years. Since then, I’ve come a long way. My social anxiety is barely noticeable. My depression is non-existant. I’ve come to personal acceptance with my gender issues. I’ve been attending transgender support group meetings on a very regular basis every week. I’ve found a community. I’ve come out to friends and family.

Recently, I was told by a friend that getting hormones the right way is cheaper than getting them online now. This friend also told me that the VA had changed their policies regarding hormone treatment of transgender people. Up until this time, I had only been using the VA for mental health visits. I didn’t have a primary care doctor. I needed one to get the hormones I needed. I made the appointment. I spoke with my new doctor. He didn’t express any desire to stand in my way. He just needed to see the results from a blood test. I did that. A letter from the VA arrived shortly after the test, explaining my blood test results. My blood pressure was high. It always has been. There is a history of high blood pressure in my family. But, some of it is diet. I’ve been working on that. Along with riding my bike often, I consider myself in the best shape I’ve been in in a very long time. But, I continue to work on things.

My appointment with endocrinology finally arrived this morning. I took the day off from work. A job I can barely afford to do anyway. I’m spending way too much money on gas to keep doing this for much longer. Anyway, I arrived where I needed to be 15 minutes before my appointment. I was feeling good. PTSD counseling, while stressful, is going well. My blood pressure was taken. 150 over 90. High. But, much, much lower than it used to be. I returned to my seat in the waiting room watching doctors come out to the lobby calling in people who had appointments scheduled before mine. I really hoped that when it came my turn, that a woman came out. I feel a little tense speaking with men about my gender dysphoria.

When my name was finally called, it was a man speaking. Grrr. Ok. If this is how it’s going to happen, so be it. I’m feeling good. I can do this. I followed him back through the maze of hallways into a small room. I put my backpack down and sat across from what turned out to be a very nice man who told me he was a Resident. I hesitated for a brief second before looking at him in the eye and said that I’m transgender. He was very nice and professional. He told me he would be doing the initial meeting and would go get the regular doctor when we were finished. He looked through my records on paper and on the computer. He asked about my medical history. He asked me how long I had felt like I was transgender. I told him sinceI was 5 years old. He asked what changes I’ve noticed since being on hormones. I told him softer skin, some breast growth and a general peace of mind I haven’t experienced before. Everything was going well. I even had my current medications on stand by ready to show him. At the end, he asked me if I had any questions. I usually don’t. But, I didn’t really understand how this whole thing would work. He told me that my primary care doctor is the one who would be doing the prescribing. Endocrinology would be just making sure that my current health wouldn’t be impacted in a negative way by the prescription of estrogen and spironolactone. I then said “So, no prescriptions today?” He responded with “Well, that decision will have to be up to my boss who we’ll be speaking with you shortly. But, I don’t see why not.” He then went to go get her.

He left the door open. And while waiting, I saw the man who took my blood a couple of months ago. I thought about getting his attention. But, I wasn’t sure he would remember me. And he looked rather busy. After a few minutes, an Asian woman named Dr. Cecilia Wang came in with the aforementioned Resident I was speaking with before. We shook hands, she closed the door and pulled up a chair in front of me next to the resident. Her first words had absolutely nothing to do with my physical health. She said “What can you tell me about being transgender?” I sat there confused for a second. Was she asking for a clinical explanation? Or was she asking for me to explain my personal experience. She wanted my experience. While I am usually shy about speaking about it, I felt a little more comfortable. So, like I told the Resident, I explained that I had felt this way since I was about 5 years old. I said that I’ve always felt uncomfortable in my skin. Things got much worse during puberty. I’ve been shy and withdrawn due to my gender dysphoria. But, I’ve been doing much better over the last couple of years since getting help from the mental health department and finding a home away from home at The GLBT Center. She nodded. She had a small look of concern on her face.

“We provide treatment for actually a large number of transgender patients here. What concerns me is that you don’t live as a woman.”

Me: “I wasn’t aware that that was a prerequisite anymore. Also, I’ve shied away from that because of a few incidents I’m currently working on.”

Her: “Well, it’s not technically a requirement. But, we do hesitate in approving the prescription of cross gender hormones to people who are not living any part of their life in the opposite sex.”

Me: “Do all the transgender patients you see here live full time?”

Her: “Most do. At least part time.”

At this point, I looked away shaking my head. I should have seen this coming. She then turned to my blood pressure. She asked the Resident to take my blood pressure once more. He did. The results came back as 160 over 100. Slightly elevated from the test taken when I first arrived. Gee, I wonder why? While the resident was taking my blood pressure, she sat in his seat and looked over my file on the computer. I watched her randomly look at passages from mental health.

Once she had the results of my second blood pressure, she explained that it was extremely high. I asked her if that was really surprising both considering my anxiety and the fact that I’m not hearing an opinion I agree with. She ignored that and started talking about the health risks of prescribing estrogen while having a normal level of testosterone in my system. I pointed out that that’s what the spironolactone was for. She agreed. But, moved the topic of the conversation back to my blood pressure. She wanted to get me on blood pressure medication before agreeing to put me on hormones. She then left me with the Resident so he could arrange to have the medication sent to my house.

Before she left, I asked her for her name. She held out the badge hanging around her neck and said “Sure. It’s Wang.” Knowing Wang is a common name, I got her first name, Cecilia. The resident could see that I was upset. When she left, he offered an apology and said that probably wasn’t what I was expecting. I told him no. No, I wasn’t expecting or hoping for that kind of treatment. In hindsight, I’m disappointed with myself for not putting up more of a fight. I can hear my friend Shannon’s voice in my head about being one’s own advocate. I’m also remembering another friend’s disgust about the VA’s treatment of transgender patients. I told the resident that I would be reporting my experience to the patient advocate’s office. And I’m finding that I want to write a letter to the Secretary of Veteran’s Affairs as well.

But, first I need to get some lunch and write this blog post. I feel better since writing it. Also, I hope that by posting this online, other transgender patients at the VA can try to avoid Dr. Cecilia Wang in the endocrinology department. She clearly sees herself as a gate keeper. And I find that utterly disgusting.

Dr. Cecilia Wang, if you weren’t googable before. You certainly are now.

 

PTSD Session #4

I didn’t write about PTSD session #3. I meant too. But, honestly, it wasn’t very noteworthy. She read some things about PTSD and the treatment I’m there for and had me record it to listen to later. Then she showed me a breathing exercise I can do on my own.

Leading up to session #4, I thought this would be where I had to talk about what happened to me. In the last week, I had been having nightmares about the incident. I kept waking up in two different places. One I had remembered. And the other, I’m not sure is real. I remember the officer touching my breast and asking me if I liked it. I can’t get the way his hand moved as he touched me out of my head. I would also wake up after he whispered something in my ear. But, I don’t remember that happening.

I was more than a little nervous as I walked into this weeks meeting.

But, we started as we did the week prior. She read about things and had me record it on my phone so that I could listen to them again at a later date. Then we watched a movie. It was a VA made video featuring a woman who had survived being knocked out and raped in a parking lot years prior when she was on active duty. It was a real woman who had suffered a very real attack. Not an actress. The purpose of the video was to demonstrate a little more of the process and to show a real life success story. At the end of the video, she is able to talk about her attack as if it was told to her by someone else. She’s a very brave woman.

After the session I threw up a message on Path saying something about how it being a hard session. It was. But, that didn’t start until the video started. In the beginning of the video, some words (perhaps a title) showed on the screen. I don’t remember the first two words. But, the third and fourth were “sexual assault”. It was the word “sexual” where my eyes narrowed in on. Suddenly, it felt like someone had a firm grip on each one of my lungs. I couldn’t look at the screen. I felt like I had to get out of there. But, I stayed.

Afterward, my counselor looked at me and asked what I thought of the video. She could tell something was bothering me. I didn’t know how to verbalize it. I couldn’t look her in the eye most of the rest of the session. So, I looked out the window, concentrating on a certain part of a building off in the distance. I tried to explain what was going on. Well, that’s not entirely true. At first, I tried to change the subject. I said it was a good video. But, she wasn’t having any of that. She kept me on target.

I explained that I wasn’t sure what was going on with me when I saw the word “sexual” on the screen. It was next to the word assault. I said that, although true for the lady in the video. I didn’t see how it paralled with my incident. I explained that sex didn’t have a part in my life at all. Up until recently, I saw myself as asexual and I lived with that most of my life. But, she explained that, although only knowing the basic frameworks of my incident, said that it was a sexual assault. She even used the word molestation.

I’m going to stop here. I’m having a hard time continuing. I’m tired. And I’ve already spoken about this with a friend. So, perhaps I should set this aside. I’m not sure if or when I’m going to post this.

Spring Cleaning

As my self confidence improves of late, I’ve been looking into some boxes stored since the relationship with the ex broke up. In these not so mini time capsules, I’m finding artifacts no longer needed. But, things I wasn’t ready to get rid of.

After we broke up, I took my things and initially put them in my grandparent’s basement. Over time, I moved some of them to my parent’s crawl space. But, as my depression and anxiety worsened, I let them sit. My life had fallen apart. All I wanted to do was hide.

Now that I’m in a much better place, I’m looking back at these boxes and finding that it’s really beyond time to go through them and fill some trash bags. I have the use of a truck this summer. So, the timing is right to do this. Once a week, I’ve been stopping at my parent’s house on Fridays before heading home from work to grab at least one box. This week, I grabbed three. And then over the course of the weekend, I go through them.

When life was falling apart around me, I just found some boxes and put my stuff in them. I wasn’t my normal organized self. It was an extremely emotional time. I had failed at a relationship with a woman. I had failed at being a father figure. I was a failure. And I didn’t know where my life was heading. So, I through my stuff in boxes and moved them less than a mile and then hid myself away until I could figure things out.

Doing this has been a very cathartic experience. Each box holds some very emotional memories. But, not everything is worth keeping. It feels good to get rid of things that I no longer need or want. Most of it is garbage. There’s a lot of paperwork. A ton of computer cables of various types (if you need a cable, I guarantee I have what you need).

It’s hard not to laugh as I go through each box. I’m often shaking my head and laughing a little. A utility bill from 2003. A piece of this or that. It’s really very random. I filled three trash bags this weekend. And there are only two boxes left at my parent’s basement crawlspace. And those are filled with cooking pans and dishes I don’t have a need or have the space for right now. So, they can stay put until I have my own place.

Oh. I almost forgot. When the relationship was ending, I came out to her. After she came down from being shocked and we talked about it, she ran upstairs and gave me a bunch of clothes she no longer wanted. I took them and put them all in a duffel bag that ended up with everything else. I had completely forgotten about it until recently. So, this past weekend, I got up the nerve to haul it up and throw it in the back of the truck. I was actually a little nervous walking past my mom and step dad, as if they knew what was in it. Old habits die hard. It wasn’t the first thing I went through this weekend. But, I did eventually find the courage.

What I found was good and bad. There were several pairs of jeans and denim shorts I can use. And some t-shirts that will probably fit me. There were other things in there that either won’t fit me or things I don’t like or want. So, there might be a few things I can take to the thrift store in my neighborhood. There were two dresses as well. Going through this bag gave me an excuse to reorganize my closet. My male clothes are now on the left side. And my female clothes are on the right. Both hanging up and on the shelf above the clothes rod. It’s a good start. When I decide that I’m ready to tackle clothing.

Encouraging Words From the Edge

The other day, while chatting with a good friend, I said that I hope I’ll have enough guts to move on with my life without having a life threatening disease or event get me out of the funk that I’m currently in.

You see, I get encouragement from all sorts of people from all different backgrounds. But, the most encouragement seems to come from people from two different backgrounds. Either they’ve reached an age where they see mortality as a real thing. Or they’ve had a life threatening disease like cancer that made them realize that they should live life to it’s fullest now while they still can.

Now, I recognize that my description of my current mental state as “a funk” isn’t really very descriptive. And it’s also a little misleading. I just feel like I’m in a funk most of the time. I know what is keeping me moving forward. It’s this constant fear that I’m going to be beat up or killed if I show the world my real self. I’m in the process of facing these fears. And I hope that by the time fall rolls around, that these fears won’t be in my way as much as they are now.

At the same time, it’s very interesting to get so much encouragement from a friend who has survived breast cancer. Or being pulled aside at the end of group by an older trans friend who is in her 60′s and no longer cares what the world thinks of her to have her tell me that she’ll go shopping with me anytime. It almost, and I stress almost, makes me want to be stricken by a life threatening condition to make me realize that this life is short and I won’t get a second chance at it.

A Fair For Jobs

Today in Denver is the second annual Transgender Job Fair. I’m thinking of all my trans friends and the organizers. I’ll be keeping my ear close to the social media grapevine to hear how things go.

Nope. Not gonna be there. Yes, it would be a great time to find another job. Goodness knows I don’t want my current job to be my career. But, there are several reasons why I won’t be attending this years event. I have several things going on in my life. The most obvious is that I’m nowhere near presenting full or even part time in female mode. But, the most important reason is that job hunting and interviewing are somewhat stressful things. And right now, I’m in the middle of PTSD counseling. Which is a massive time suck and a ball of stress in it’s own weight class.

There will be another one in October and hopefully one or two next year. So, we’ll see where my life is then.

This years event, will again be at the GLBT Center in downtown Denver. Courtney, the Center’s Transgender Programs Coordinator has done a wonderful job preparing for it. Apparently last year’s job fair was very well attended (but not well RSVP’d). I saw the list of the employers who have committed to being there. It’s quite impressive. I don’t remember all of them. But, some big names included Hewlitt Packard and some local, state and federal governments.

Good luck friends. I’m keeping my fingers crossed for you all from a safe distance.

PTSD Counseling Episode #2

As I sat in traffic this afternoon, my mind was elsewhere. I was looking at the grassy side of the onramp on the other side of the freeway. But, my mind was searching for a question. What exactly did she ask me that brought a tear to my eye?

This afternoon was meeting #2 for PTSD counseling. We haven’t really started yet. She wanted to ask me some more questions. She wanted to make sure that my diagnosis of PTSD was accurate. Since the incidents that impacted my life took place so long ago, my natural anxiety has mixed in with any anxiety brought on by the incidents.

As much as I think what happened back then impacted my life, if she came to the conclusion that it wasn’t PTSD and I would be better off getting better treatment for my social anxiety, I’d be okay with that. If this won’t help me, why should I waste my time?

She asked similar questions as she had the week prior. But, this time she narrowed her focus to one incident in particular. She used the incident with the highway patrolmen as a starting point and asked several questions about how I’ve been dealing with my life since that incident. I could answer most questions. But, not all of them. The distance in time since the incident blurs with the anxiety I was born with. By rephrasing and drilling down, we were able to answer each question.

She told me that if we proceed, I’m many steps in front of where others usually start. I’ve recognized my own anxiety and have been fighting against it for some time. She told me I have a very good understanding of where I’m currently at. And I want to move forward with my life.

Earlier in the session, and in our previous meeting, I had mentioned that I couldn’t understand how other trans people leave the house and don’t get assaulted. I explained that, since spending more time with trans friends, the gulf between my intellectual understanding and the long standing fear that someone will kill me if I leave the house in girl mode was widening. I’m having a hard time reconciling these two realities.

I explained that if I look back in retrospect to the time before those two incidents, I was very naive. I felt that I had a better understanding of the real world than my trans friends do. I know how nasty it can be. I felt that my trans friends were being reckless in their behavior. The next thought that very nearly fell out of my mouth stunned me. I was able to stop it in time. Just barely, though. I felt like I was choking on a very bitter meal. Did I really believe what I was really going to say? I looked out the window. Then closed my eyes and shook my head. I swallowed hard. I took a deep breathe, opened my tearful eyes and looked at my counselor in the eye.

“I almost said that I was glad that it had happened.”

Session #3 is next week.

PTSD Therapy Episode 1: Introductions

I may not end up writing about every appointment. But, since this was the first one I’d like to pat myself on the back a little for actually showing up.

With this new job, I thought I wasn’t going to be able to get this done this summer. But, my main therapist at the VA was able to find an expert in prolonged exposure PTSD therapy who was able to work around my schedule. I just had to find a way to get there. She was able to meet me at 4:30pm for 90 minutes. My day usually ends at 4:30pm. But, if I can get things done early, there’s no problem cutting out early. I was able to find a way to do that this week. But, it may become hard to do so every week over the next 12 weeks. At the end of the meeting, we spoke about it. I told her I really needed this and was willing to find a way to make it work. But, there may be days when I could be up to 15 minutes late. I explained my schedule and that it may be unavoidable with my current job. She said she could make it work if it was only the occasional 15 minutes late. That made me feel better. I’ll do my best. But, I needed to know that she could work with me if I had difficulties.

Walking into her office was less of an issue than I expected. I’m fairly familiar with the VA hospital. But, it’s the first time I’ve seen it so empty. The place really dies at the end of the day. As I got off the elevator, I remembered that I needed her office number that I didn’t write down. I quickly took the touch out of my pocket and pulled up Google Voice. As I was listening to her message, a young lady walked up and asked if I needed help finding something. I would have accepted her invitation if I could remember the ladies name who I was there to see. But, I thanked her anyway.

I accidentally walked past her office and doubled back when I noticed my error. She came out and asked if I was who she was expecting. I introduced myself. It wasn’t hard walking in. But, then I noticed her very cluttered office. She had paperwork stacked up in various spots. There were books on shelves. I have this annoying habit of not being able to relax in a new environment until I have everything memorized. I tried to ignore it so it didn’t interrupt the conversation. But, I told her about so she would be aware.

This meeting was meant as a get to know each other kind of thing. She told me about herself. Where she went to school and how long she had been with the VA and in what capacity. She then, wanted to get to know me. She told me she had read some information my main therapist had sent her. I suspected that she already was aware of my gender dysphoria. But, I also knew that I would have to actually say it outloud for it to be brought up.

I was able to broach it fairly well. Well, I couldn’t look her in the eye when actually saying the dreaded “T” word. This happened quite frequently. When I actually said “I had a gender problem.”, she didn’t say anything other than “Yes, (counselor) did include that in her notes). But, she also didn’t break out a Bible. She didn’t squirm in her seat. She didn’t break out a knife and ritually cut me up into pieces. This whole thing about society becoming more accepting is very odd.

She also asked me to speak in generalities about the incidents that bothered me. I brought up the two that bother me the most. The incident with the grocery workers and the incident with the California Highway Patrol. Both were hard to talk about. I guess writing about something is easier than actually having to say it.

She took notes while we spoke. And she was able to put me at ease while we talked. And later, she reminded me that I had said that I had used the words “shame” and “embarrassment” while speaking about these incidents. I spoke about how I felt like it was my fault.

I asked her if she could provide more details about what would happen later on. I explained that I needed to know to help better understand and feel more at ease before these sessions start. She explained that part of it will involve speaking about the incident as if it’s happening right then and there. She noticed my iPod Touch as I entered and told me that we’ll be using that so that I can record and listen to those sessions later on. There will be homework. Besides listening to myself recount the incident, I’ll also have to spend progressively more time in areas I constantly avoid. Hence the term “prolonged exposure”.

There was a time not to long ago, when I would have avoided this kind of therapy like a curse. About 5 years ago, when the idea of PTSD counseling was brought up with my private practice therapist, I actually stood up and walked around the room. It wasn’t until I was made aware of it, did I realize I had put my chair in between she and I. I didn’t like this idea at all back then. I wasn’t ready to confront it.

I first started seeing a therapist when the relationship with the girlfriend was falling apart. At the time, I knew on some level that I was depressed. But, since I had been depressed since birth, I didn’t know how depressed I actually was. When the words “social anxiety” were first introduced to me, I had to go look it up. Thankfully, we were able to find one medication that helped both symptoms. I dove in full bore in an effort to conquer my social anxiety. I didn’t think the two incidents we spoke of today were that big of a problem. After all, I had accepted that I did something stupid. Live and learn. Never do that again.

But, as time passed over the last couple of years, I’ve noticed that as the social anxiety has started to ebb, something else was left behind. Whenever a trans friend mentioned going out in female mode, I quickly balked. I couldn’t imagine doing such a thing. No matter what solution to help manage my fear was brought up, I dug in my heels. I wouldn’t go out with a group. I wouldn’t go get my makeup done in public. I wouldn’t dress up in the privacy of a friend’s house. I wouldn’t even show up in male mode to group meetings and change in the restroom. NO WAY!

In my mind, I imagine people hiding around every corner just waiting for me to accept my punishment. I know, intellectually that this is absurd. But, I can’t help it. No matter what I do to push myself past this, I can’t do it. It’s too heavy. So, I’m doing the responsible thing. I’m getting help.

By the time the meeting ended, I was a little more relaxed. It was a nice meeting. I trust her and find her very competant and professional. I’m oddly looking forward to it.

Sidenote: On my way out, an employee of the VA was standing at a table speaking to a woman who was walking by. He caught my eye like a smart salesman. He said he was giving away books. Apparently, there is an organization that is giving away a selection of books throughout the year that are picked by librarians. I didn’t recognize the title (And I can’t tell you now, because I accidentally left it in the car). Both the lady and I were a little stunned and taken aback that there was a person standing in front of us giving something away for free. I looked at the book for any tale tell sign of it being a piece of religious propaganda. I didn’t see anything. The guy pawning off these free as in books books said it sounded like an excellent way of giving back to his community. I figured that if I didn’t like it, I could simply give it someone else. And if it turned out to be of a religious nature, it could keep me warm when I eventually go camping. I’ll let you know what becomes of it.