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.