Doctor, Doctor

Remember that time I went to the gyno, and I looked like a man?

My gynecologist’s office is out in the suburban area of Morrow and Montgomery, which is about a 20 minute drive from the center of Cincinnati, where I live.
I was a little nervous. It was my first visit since I started T. I wondered how male I looked, or if I just looked androgynous. I glanced at my reflection in the glass door. I felt I could pass for a girl… a really androgynous girl….

I walked into the waiting room. The place was empty except for one woman. She looked up at me, and then quickly back at her magazine. I was used to the other patients being a little thrown off by my appearance. They were almost all suburbanites, and from what I can tell, suburbanites seem to be used to their own people, their own world, and they act as if nothing exists outside of it. I might as well have been an alien with a space suit on.
I went up to the window and looked in at the two receptionists boxed inside. The younger of the two tired not to stare at me. I didn’t take it personally. After all, I did have a fuchsia faux-hawk, and my nails were painted two different colors. That and, I looked like some androgynous middle-sex.
The receptionist asked me my name. I paused. I knew my medical chart was under my birth name, but JAC was written in quotes next to it. I wasn’t sure what I was listed under. I decided.
“JAC Stringer.” I said, hoping if nothing else, the last name would be a clue.
“Ok. Here for Dr. Phelep, right?”
I relaxed a little. “Yep.”
I busied myself in the basket of lollipops and waited to update my information. I could feel eyes on me. Suddenly rush hour hit the waiting room and a rush of normative, suburbanite-looking women swarmed the room. I filled out forms as I listened to the foreign conversation of two women, a man, and their teen daughter who where sitting behind me. I got up to submit my paperwork, feeling the eyes of the teen girl following me in every step. I met her eyes for an instant, and quickly looked away. I pretended to feel normal. I pretended I belonged there. I did belong there. I didn’t attempt to pretend to read magazines. Instead I sat awkwardly, secretly watching the other people. I couldn’t shake that I was making them a little uncomfortable. I didn’t know whether to feel guilty or proud.
My name got called, my birth name. The girl watched me get up and walk out. I kept my eyes forward. Once I was out of the waiting room, I could feel a little more normal. I was sure the nurses were somewhat aware of who and what I was, and even if they weren’t, to them I was just another patient. It didn’t really matter how weird I looked.

I sat up on the table as the nurse took my blood pressure and asked the usual questions about medications, exercise, and my female body.
“Are you using and contraceptives?”
I kept my answers short. “No.”
“And when was your last period?”
I stopped. “Um…” I looked up, pretending to think. My thoughts started to cloud in panic. I couldn’t think. I wondered if I should say “I’m on testosterone so I don’t get it any more.” I didn’t want to say it.
“Here’s a calendar, if it’ll help.” The nurse handed me a small calendar of 2008.
I stared at it, almost laughing at myself. “Well, this isn’t gonna help me at all.” I thought. “Um,” I finally spoke, “It’s been months…”
“Oh, ok, I’ll just write months then.” said the nurse casually. “Dr. Phelep will be right in.”
I sat alone in the room and waited. It felt like it had been more than a year since I had been there last. Everything was familiar, but like a dream was familiar. There was a knock on the door and Dr. Phelep appeared from behind it. She smiled a big smile at the sight of me.
“Wow, that’s a new color.”
“Yeah,” I said, still a little shaken from the period talk.
“Let’s head into my office and catch up.” she said, leading the way across the hall.
I don’t know if it’s possible for a gynecologist to be associated with comfort, but if it was possible, Dr. Phelep would be the one to do accomplish it. She had been with me since the beginning.

Two years earlier:
I sat in her office, listening to her explain the newest birth control. I stumbled over my words, telling her I didn’t need it anymore… because I was dating a woman. After being her straight, female patient for almost five years, I could tell it wasn’t exactly what she expected to hear, but she didn’t bat an eye.
“Oh, alright, then you certainly don’t need it, do you?” she smiled.
I brought down the other shoe. “Also… I just came out as transgender… and I’m living as a guy.”
Again, clearly not something she expected, but I didn’t have to explain it to her. She knew exactly what I was talking about. She wrote JAC on my medical chart, and immediately started practicing male pronouns. She even answered all my questions about safe sex with women. She treated me like I was normal, which was priceless.
A year later, I decided to start taking T. I was having a hard time finding a doctor who knew what I was talking about. I was hesitant to go to one of the two doctors all the other transguys saw because I didn’t want a Gender Identity Disorder diagnosis. I knew someone who had avoided GID by getting a prescription through their gyno. I had high hopes. I brought her all the information I could find, and popped the question. She looked at me intently.
“I’ll be honest. I don’t know anything about this. That makes me hesitant to be your primary care giver for this… I’ll read everything over and let you know.”
She called me a day later, saying she felt it would be better if I had a doctor who knew more about it, incase something went wrong. She said she was more than happy to run my blood work, and do anything else, but she couldn’t give me the script. I wanted to try to convince her, but I didn’t. I understood her reasoning, and could respect it. I wouldn’t want her to go against her better judgment or her knowledge base, especially if she was treating me.
I tried my general practitioner, Dr. Wooster. He said the same thing. “I’ll gladly do the blood work, but I won’t give you a prescription.”
It’s not that I wasn’t grateful for the offers and support; it’s just that it wasn’t enough. Blood work wasn’t what was hard to get, it wasn’t what I needed. I needed the piece of paper. I needed the prescription. And I needed a doctor who would give it to me.
I went back to trying the doctors who were experienced with transguys. I picked the one who seemed mostly likely to be supportive, Dr. Gess, and called her up. I used all my big words, theorizing about oppressive, outdated thinking and medical gate-keeping, jumping through every hoop to win the prize. Dr. Gess was impressed, and agreed that she could give me what I was looking for.
“I’d like you to do at least one psychological screening.” she said.
I hesitated. “Ok.” I understood she needed to know I wasn’t maladjusted or schizophrenic. I was willing to compromise.
I wanted to do things safely and honestly. I didn’t want to hide my life, my sexuality, or my medical history in order to get T. I wanted it all out in the open. After six months of working, and searching, and negotiating, I got the script. I got it filled. I knew nothing about injections, other than seeing a friend do a shot of T once. I figured it would be better to have a nurse teach me. I called in an appointment, and showed up at the doctor’s office. Today was the day six months in the making, a year and a half in the making… I had stayed up all night. I was nervous. I was pumped. I was charged. I was ready. The nurse checked the testosterone and needles.
“Where do you want to inject it?” she asked.
“Um,” I tripped over my words, trying to avoid vulgar phrasing, “I my upper ass cheek?”
The nurse smiled, and started to fill out forms. There was a bit of confusion with my chart so the nurse called Dr. Gess to double check the dosage. I sat in the empty waiting room with my friend, Al, and kept my hands tightly clasped around my Stroheckers box. We waited… and waited… and waited. Finally, a nurse came out. She didn’t call us back. Instead, she came out to us.
She sat down next to me. “Dr. Gess said she doesn’t feel comfortable with you taking your shot today.”
“Why?”
“She said she wants you to talk to a counselor before you do it.”
“I already did.” I said shortly.
“She wants you to see the counselor again. You can come back and do it after that.”
I stared out into the room. All my adrenaline crashed down in an emotional implosion. I couldn’t hold it in. I bent my head, and cried. I remember the nurse rubbing my back a little, saying something I wasn’t hearing. I remember she got my pronoun wrong and I corrected her. I remember Al clenching her fists.
I don’t know why I got so upset. Maybe it was the exhaustion kicking in, maybe the stress letting loose, or maybe I was just feeding some dramatic sense of oppression. I thought I had finally made it to the finish line… and as soon as I saw the tape, it was taken away. Everything felt extreme. I couldn’t think ahead. I couldn’t rationalize or reason to myself. I was physically and emotionally exhausted, and now there were more demands.
I collected myself. “I want to talk to Dr. Gess.” I said intensely, “Personally.”
“I’ll try to get her on the phone for you.” said the nurse, getting up. “Do you want a pop or something sweet?”
“No… thank you.” I growled. “Just get her on the phone… please.”
After about twenty minutes the nurse called me back into the small conference room/break room. The phone rang. I picked it up.
“What’s going on here, Dr. Gess?” I said. I seethed, silently listening as Gess started to sympathetically bloviated about how I should at least plan on going into therapy regularly. “I signed a consent form, and got a psychological screening that said I was well adjusted enough to take T. Why do I need therapy in order to take testosterone?”
“It isn’t just because of testosterone,” she said, “There are other concerns when it comes to your mental health.”
My heart sunk as I saw my plan for doing things “honestly” blew up in my face. I stayed calm. “I understand that you want me to be well-rounded in my health.” I said, “But what does me being bipolar have to do with me being trans?”
“Nothing but…” she paused, “Don’t you agree that therapy is a good idea when you’re experiencing a big change? And this is a big life change.”
“So is pregnancy,” I argued, “but you don’t need therapy to have kids, do you? The parents can be bipolar or alcoholics or drug addicts or homicidal maniacs, but they still get the right to choose without having someone controlling their choices. What makes a couple having a baby more trustworthy than me? I’m actually more trustworthy because my decision isn’t affecting anyone else. I’m not bringing anyone else into it.”
“These are the regular standards the treatment goes by.”
I took a deep breath. “The standards are wrong.”
“There has to be reasons so many people use them.” she said.
“The reason is society would rather think I’m mentally unstable than to challenge it’s concept of gender!” I said strongly. I calmed a little. “I understand why you’re doing this. You’re trying to be responsible. You’re inside a system and you feel the need to watch your back. But the standards of care aren’t law. They’re suggestions derived from one straight, cisgender man’s opinion which he falsely presented as psychological research over 25 years ago. There is no real evidence to support the idea that trans-people are incapable of being well adjusted enough to make their own decisions about our bodies.”
“But therapy is a positive thing.”
“I know it is!” I stressed, “I’m studying to be a psychologist for crying out loud. I think everyone should be in therapy, but no one should be required to be in it. Studies have shown again and again, mandated therapy is not constructive.” I wanted to laugh at myself for using the expression “studies have shown” in an argument, but it wasn’t the time for it. I was doing all I could to remain professional and mature on the outside, but on the inside I was a kicking and screaming. “If I’m maladjusted about something, I’ll go into therapy.” I said, “My gender identity is the one thing in my life that I’m actually adjusted about.”
“But you already said you were going to go to into therapy the first time we discussed this.”
“I told you I was willing to go to therapy after taking T if I ran into problems.” I said, “I never agreed to go as a requirement.”
I could tell she wasn’t trying to be difficult. She kept angling for me to say “I will go to therapy,” even if I didn’t mean it. As long as she heard the words, she could say yes. “Why don’t you just go for other reasons then, and don’t make it about taking testosterone?” she asked.
“If it isn’t about testosterone, then we don’t need to be talking about it. I said. I will go if I need it, but it will be by my own decision made for me. I won’t do it just for you and your approval because even without a GID diagnosis, it wouldn’t be any different than following the standards of care. I refuse to support that system.”
“If you don’t work within the standards of care, you can’t take hormones.”
“The informed consent policy is used in big cities.” I said, “It’s used in Canada, it’s used in Europe… Why can’t we use it here?”
“Because I’m not comfortable with it.” Gess said.
“I don’t understand why.” I said, starting to loose steam…and faith… and hope. “I know you are trying to create a safe space for me.” I said, “But you’re doing the exact opposite.” I felt my ego pumping up again, “You don’t seem to understand, Dr. Gess. I don’t need you. I can do this by myself. Don’t you think I know other transguys on T? Don’t you think we have a knowledge base beyond your doctors’ offices? I was trying to do things the right way. I wanted to do it as safely as possible, and you are preventing that. I already have the prescription. I can go shoot up in the parking lot right now, instead of wasting 80 bucks on watching a nurse do it. I don’t need to be here…” All at once my heart felt heavy again. I started to feel guilty for ranting and raving like I did. I didn’t want to hurt her feelings… My eyes felt hot and wet. I inhaled. “Like I said, I understand why you’re doing things this way, but I think that it is the wrong way. And I think it was unfair for you to wait until now to tell me this, and not even in person. I don’t hate you and I’m not blaming you personally. I’m just very, very disappointed.”
“Yes. I understand you must be very upset right now.”
I swallowed my tears. “Upset doesn’t even begin to describe it.”
“I’m on my way to the airport right now for a conference.” she said, “How about we talk about this when I get back? I’ll try to get a hold of a counselor for you.”
I spoke with a dead voice. “You do what you have to do, Dr. Gess. I’m going to do what I have to do. I will tell you though; by the next time we talk, I probably will have taken my shot.”

I pushed the door open, slamming it on the wall, and stormed out of the back office. I waved to Al. “Let’s go.”
Al stood up. “What?”
I wrapped my anger and pain in my pride. “It’s not happening. Let’s go.”
“Are you serious? Why?”
“Because I’m bipolar and won’t go into therapy.”
Al furrowed her eyebrows, “I thought bipolar was a manic/depressive thing, not a boy/girl thing.”
“Guess not.”

I curled up in the car, and we drove back to Al’s place. After an hour or so I thought “What the hell. Today is the fucking day. Let’s do this.”
I had seen my friend take his shot, and had it explained to me. I basically knew what to do. I just needed a little more information. So, I looked it up online. Where else? Then, in Al’s bathroom, with my friend Ale video taping, I sterilized everything and measured out the T. But stabbing yourself in the ass with a needle doesn’t come easy, at least not to me. So, I had Al do it.
“Ok,” Al picked up the syringe, “The website says to throw it like a dart.”
“But you don’t really throw it.” I said as I clung to the bathroom door, “…Right?”
“That’s throwing the needle.” she said, “You flick your wrist… or something.” I looked over my shoulder and watched Al flicking her wrist back and forth.
“This situation seems a little ridiculous.” I said, laughing to ease my nerves.
“You think it’s ridiculous.” Ale laughed from behind the camera, “I’m the one videotaping your butt right now. Crack is whack, JAC. Crack is whack.”
I held the door and closed my eyes. It didn’t hurt at all. I looked back at the needle. It was just about as weird to have a needle in my skin as it was to have Al’s face about three inches from my ass. The syringe was plunged, pulled out, Al and Ale clapped.
“Yay Jacy!” Ale cheered. “You did it!”
And that was my first shot. I’m glad it happened the way it did, in the warm and ridiculousness of a friendly, familiar space, not a stuffy exam room. We walked down to the bar were our friend Amanda was bartending. In honor of the occasion, we made up my very own shot called the JACY-T shot, also to be known as the JAC’s Upper Ass Cheek.
Two weeks later I got a call from Dr. Gess.
“How are you, JAC?”
“I’m doing great, Dr. Gess.” I said, secretly gloating about my victory. “How are you?”
“I’m fine, thanks. I was calling to see if you wanted to make and appointment to talk about your testosterone therapy.”
“Yeah, we can do that. I took my second shot yesterday.”
There as a pause. “Ok. Well, then I should come in and have your blood work checked in a couple months. We’ll see where your levels are.”
I smiled in relief. Dr. Gess was the kind of doctor who would monitor their patient no matter what. I assumed she understood I was going to do what I want, so she might as well make sure I was ok.
Everything was going well. I was pleasantly morphing on my baby dose of T and I didn’t have to sell out to get it. Gess was going to level out on my end of things, and it was all going to be alright. Then I read my prescription label more closely.
“NO REFILLS REMAINING.”
Shit.
After three months I went in for blood work. I told her how well I was doing and she agreed that I looked like I was “progressing nicely.” I pointed out my lack of refills.
“I’m not going to refill it if you aren’t in therapy.” she said.
We spend the next hour repeating our phone conversation, except this time I had a slightly lower voice. I told her I couldn’t budge.
“You don’t seem to understand.” I said, “All my activist work circles around how the GID system is wrong. I can’t do all that work speaking out against it and then use it for my own personal gain.”
“You could just not tell anyone.” she said.
“You’re suggesting I lie to my family and friends about being in therapy? How is that healthy?”
She let out a sigh. “I think we’re just at an impasse here. If you aren’t willing to do things this way, I’ll have to recommend you see a different physician.”
“You realize there are no other physicians, right?”
“There’s one other doctor…”
“A doctor who is even more rigid.” I interrupted. “That’s why I picked you over him. He won’t take a patient without a therapist letter. No one in Cincinnati is going to do this for me without a GID diagnosis.”
“Then perhaps you should rethink what you want. If you want to continue on testosterone you will have to choose.”
“No, I’ll just go to a different city.” I said, “Chicago’s not that far from here.”
“What if I can get you a second opinion saying I didn’t need therapy?”
“I might be able to work with that.”
“Ok.” I took a deep breathe. I had one more try.
Gess felt so bad about how things went she said I didn’t have to pay for the visit, which was very convenient because I was already semi-planning on walking out. It was a semi-plan because sure as hell didn’t’ want to pay $80 for an hour of disappointment and emotional tear down, but I wasn’t sure I had the balls to go through with it. I didn’t want to be an asshole. I really believe that Gess was trying her best.
I made an appointment with one of the few known therapists who worked with transfolks, Dr. Bower. She only had experience with women, except for one guy she saw, who was a friend of mine. I went to see her, ready with my speech about what I wanted.
“Well, it’s clear you are very intelligent.” she said, “But for all I know you could just be a very convincing multiple personality, or a very controlled schizophrenic. I won’t be able to just write a recommendation without seeing you more.”
“But you’ll write it once you’ve seen me more?”
“No.” she said, “I support the standards of care. It’s foolish to go outside of them.”
“Foolish?” I said, trying not to show how offended I was. “How is it foolish to want to be autonomous?”
“The standard of care is a good system.”
“It’s an oppressive system.”
“It’s not oppressive.” she argued calmly.
“You aren’t trans.” I stressed, “How can you tell me I’m not oppressed? You don’t think it’s oppressive because it doesn’t hurt you. It pays your bills.”
“I don’t think this is really about politics.” she said, “You’re just doing this to rebel for the sake of rebellion.”
“That’s a comfortable way to invalidate me.” I scoffed. “This isn’t just some act of teenage trouble making for my own entertainment. This is a massive movement. I’m not the only one. There’s a lot more where I came from.”
“I would not consider you to be an average transsexual.” she said, “Another reason why I feel you need further exploration in therapy.”
I was so irritated, I couldn’t even speak. “And I suppose you know what the majority of trans people are like. You have met so many of us. You know exactly where the bell curve is. Or are you basing your opinions off of what you might have read by of other non-queer, non-trans people.”
I couldn’t get out of there fast enough. I was partly in shock at how horrid she was. I only paid her a third of her price. I told her I didn’t see a reason in paying for an hour of degradation, but I was paying her for time, not opinions.
Bower talked to Gess, which I wasn’t expecting because I didn’t sign anything. It was the last nail in Cincinnati’s coffin. I never saw Dr. Gess again.
I took my time paying Bower, which lead to communication over email. She seemed to be worried about me and, even though I hadn’t yet paid her for the last session, she offered to continue seeing at a lowered price to fit my budget. I don’t know if it was because she wanted to help, or because I was an interesting “non-average” case. I politely thanked her for her kind offer, but declined.
“…Seeing that I have no problems in my adjustment, interpersonal relationships, or personal function, I don’t see a need for therapy. Especially if therapy is as detrimental to my obtaining testosterone as our last session was. Each professional I have seen continues to make it more and more difficult to safely obtain testosterone. I now have little choice but to go outside the city for resources Cincinnati practitioners are too close-minded to provide. I believe that you are unable to truly understand the trans position, regardless of how many trans patients you have seen.”

I also sent her some web site links and book recommendations in hopes of having the last word on proving the presence of the genderqueer revolution. She politely thanked me for the information, and I never spoke to her again.

I made a second attempt with my Wooster and Phelep. Their answers were the same. When I told Dr. Phelep about the trouble I had been having, she called Dr. Gess herself to try and find a solution. She didn’t find one, but she was able to explain Gess’ position better than Gess could.
“I think you’re just gonna have to go out of Cincinnati for this.” Dr. Phelep said sadly. “The city is just too conservative. It’s awful.”
I had all but run out of options, and all but run out of testosterone. I was so tired and emotionally raw… I started to doubt myself. Was I doing the right thing? I couldn’t hear myself over all the doctors speaking against me. Should I just do it their way? Or should I do it at all? Am I conforming somehow by desiring testosterone? No, I was sure I was right. It was what I need to do. It was what was right for me, and I had a strong support system of friends and other genderqueer kids backing me up. I was sure I could get more T, and I did. I went to Yellow Springs, a random hippie down nestled in Ohio, and got a vial. I was set for another 6 months.

Back to the present:
Dr. Phelep and I sat down on either side of her desk. She couldn’t stop smiling.
“Forgive me for staring at you,” she said, “You just look fantastic. I’m amazed.”
Somehow, her compliments didn’t make me feel awkward. I was able to smile and thank her more genuinely than I ever have with anyone else. Maybe it was because she was a doctor, I felt completely asexual and objective to her. I didn’t feel like her comments were othering me or fetishizing me.
“It’s like you’re a completely different person.” she said, “I mean, I saw you a year ago and you didn’t look like a regular woman, but you still looked very feminine. Your face has become so masculine.”
“Yeah, I was thinking about that on my way here.” I laughed a little. I wasn’t sure if I would weird people out or not.”
“I was thinking about it myself.” she said, “Right before you got here I thought to myself “Wow, I’ve never done a pap-smear on a guy before. I wonder how this is going to go.””
Some how I managed to find a balance in Cincinnati doctors where the good ones do enough to keep the shitty ones from destroying everything. When Dr. Gess pulled out, my general practitioner, Dr. Wooster started to do my blood work for me. He recorded the labs under various related things the insurance would cover it. That’s a big favor, considering labs cost hundreds of dollars that I don’t have. I’m so used to not being accepted by the establishment, and not being recognized by people, that when I am, I go into a slight shock which is then followed by a warm, indescribable gratitude. It’s as if my brain can’t even conceive how amazing that person is for giving me recognition. As closed minded as this city is, there are always little pockets of “open” popping out and surprising me. The word queer started to resonate though the city, and like a big gay marco polo, people came out of the wood work. Every now and then I catch a new one. Even the people who hinder me, and label me, are often times trying to understand and trying to do right by me. They just don’t know how. The system warped them into ignorance… I just get tired of always being the one to bend them back.