Thoughts about what waiting has been for me.

I'm going to begin by saying that I understand the many phrases about things not being a race. I also understand, though I am gradually coming to loathe, the ones about it "happening at my pace" or "when I'm ready." While I appreciate (and believe) the intended point, they can easily be misapplied, usually innocently. The problem I have with those two phrases is that the delays have been in spite of my desired pace and when I was ready.

I need to make a distinction at this point about the nature of delays. There is a delay I do not count here; a delay of about three months for my wife to be comfortable with me starting HRT (specifically, being referred.) I consider that to be a very different class of delay; one I made the choice to have. Also, while the option of a non-prescription route was available to me, I did not choose it for a particular reason (it would have meant the end of my relationship.)

Finally, one note about time: the numbers, particularly for months, don't exactly add up due to rounding.

I patiently went through several therapy sessions while waiting out the "required"* waiting period before referral for HRT, then waited the four months from when I finally had the go-ahead from my therapist until the first available appointment in May of 2009 I was ready for HRT then. I was sitting in my endo's office at that point, and while I could accept that I had a part in a communication failure that might have caused the first three months of delay, the remaining ten were in spite of me directly asking for HRT - thirteen months from when I first sat in her office until she would prescribe me an HRT that even began to be effective.**

The point at which I had access to effective HRT was 22 months (19, subtracting the previously stated three) after I began taking the steps to transition. I finally had an anti-androgen along with the Estradiol patches.

What happened to me during the first week of that combined HRT remains the single most profound, amazing change I have had, and practically none of it was physical. It was the most important forward step for me and those effects remain with me today. It ended a large amount of suffering, including suffering that I hadn't even realized I had as it had become ever-present. My therapist tells of another client's description of the effect in terms of Crayola crayons - it being like going from the eight color box to the 64. My imagery is a bit different, but the point definitely remains. I truly had no idea that it was possible, let alone that I could, feel and experience such things, and with that sort of clarity.

And for more than a year, during which I was saying, "I am ready for and want this," my medical professionals forced me to wait. I find it tempting to ascribe motives but, for this time, I won't. It doesn't matter why, what matters was that I was made to continue to suffer for no good reason. I will also note that it is yet a low dose for that is usually given (AA is average but E is 63% of the usual for this type) and, due to recent, proper blood tests, there is no reason to believe a higher dose would be dangerous for me but my endo remains resistant to that.

* It's a guideline that is designed to be flexible but some see it as a rigid requirement instead. Further, I later learned that had I been self-medicating for HRT she would have referred me immediately.

** My endo did begin to prescribe HRT at a level that is affective for some people (and one friend has had her HRT needs completely met by the same level dose as my initial,) however, until July of 2010 I did not have a prescription for HRT that was at all effective for me.

Thinking a little more about HRT.

One thing I did do was be self-informed; I knew what the normal dose range was for this course of HRT. Specifically, the usual was 200mg Spiro and 0.20mg Estradiol transdermal (i.e. two of the maximum available dose patches at a time,) and it was noted several people needed 0.30.

Whenever I argued this, though, I was told that's just the normal dose, not what is appropriate for me. It became immediately apparent the default assumption was that what was appropriate for me was far less than the normal dose. However, I have never received a justification for this view, and I feel a justification of it is absolutely necessary in light of all evidence I have (blood work, in particular) pointing to my case being within the range for whom the normal approach would be entirely appropriate. It should seem there was no way for me to prove in a way they would find satisfactory that I wasn't the low-edge case.

This endo's reticence has primarily been about E. She did attempt to dissuade me from Spiro, but when she agreed to prescribe it she went straight to the 200mg/day dose. Her attempt to get me to drop that request was to assert that I was one of the people for whom HRT was not effective (at the time, I was on only the 75mcg/day patch.)

In concrete terms, what it comes down to is that I have had at least a one year delay in transition (or, as it has felt to me, a year of living my life on hold) not because I was not ready but because my medical professionals decided it in spite of me and my stated desires. Had it not been for that, it is very likely I'd would today have social transition at least most of a year in my past.

I have also gained a terrific understanding about why people self-medicate for HRT. I do know there are some relationship issues that would need to be addressed (in the past, my wife has directly stated that she would divorce me if I attempted to self-medicate for HRT,) but it is an option I'm very willing to consider now and I feel I do not have the option of dismissing. I'm just waiting to see how my new endo goes.

Slight update

The HR meeting, scheduled for today, was canceled.

IMHO, the messages have been a great example of directly stating one thing then all but directly negating it. One sentence saying the target date is still on followed by a dozen that suggest it "might" not be possible. Basically, they've done very little of what they must do.

Not much I can do but soldier on here.