#cedarriverclinics

[the-mira-life-project-mtf]

My MtF Journey

Maybe A Non-Starter - Regarding Virginia Mason

So, last Friday I made the fateful decision to call Virginia Mason to hopefully schedule an appointment to see Dr. Worth, and from the initial call...it seemed hopeful!

However, waiting all Monday for that call which never came...I decided to call them back to see what the decision was as it is now Wednesday and I still have heard nothing. So when I called the second time, I must have received the main number in Seattle (whereas, last time I spoke to the receptionist on Bainbridge), I gave my name and birthdate and when I said I was waiting to hear if I could see Dr. Worth, she could no further assist me as Dr. Worth wasn’t accepting any new patients and that I should call Bainbridge directly via option #2.

So I called again (odd she could not transfer me over), and selected option 2, and spoke with a woman who did not seem that cheerful I was calling. It was 7:49 in the morning, probably was still waking up! I told why I was calling, provided my name and birthdate and waited.

After respelling my last name a few times (probably tried to spell the Americanized version), she informed me that she saw no notes or messages from my Friday call. This certainly concerns me!

I tried explaining what the receptionist and I discussed, but without a name, my words were useless!

She informed me that she sent a 🚩 (Flagged message) to Dr. Worth to be viewed asap; however, she also has today off and will not be in office until 8am tomorrow. So I will have to wait till Friday to know where I stand!

I am grossly disappointed with the reception I have so far received from Virginia Mason. I would have been waiting in vain for no reason! This could be a sign that maybe this isn’t the right path (however, it is the only path in Washington State). It also could have been a simple mistake made at 3pm on a late Friday afternoon! Nevertheless, this does not bode well for the future. And from what I am feeling, it is quite likely that I will ‘not’ be seeing Dr. Worth after all.

Considering The Future Of My MtF Care...

With these recent developments; last Friday I would have gave seeing Dr. Worth a 70% chance, however; now, it seems a meer 10% chance. What a way to crush your hopes. But, these is still one more path I could follow...

The Bainbridge Clinic has one other transgender physician, Dr. Tomberg...

I don’t feel very comfortable speaking to a gentleman about my transition; however, a Doctor-Patient relationship could formed if Dr. Tomberg has the same bedside manners as Dr. Khattar (From Cedar Rivers). It might be also easier to speak about potential SRS with him too...

I just don’t know! Augh!

No matter the circumstance, I am proud that I at least made the attempt to call...and will follow the path to wherever it leads...

[the-mira-life-project-mtf]

A Dysphoria In A Dysphoria?

Personal Entry

     Lately I have had some intense dysphoria in the past two months. This sudden onset comes as a surprise as I’ve had no prior anxiety about what I am trying to accomplish.

     In May 2018, I made a major change to my life as I decided to treat my gender dysphoria with the aid of hormone replacement therapy and for six months, I felt no mood changes, no anxiety about the process or outcome, no fear of my actions...until about two months ago.

________________________________________________________________

Personal Account Of My Anxiety Month By Month Using H.R.T.

May 2018 = Month 1 - Just commenced hormone replacement therapy and only noted light dysphoria due to my appearance.

June 2018 = Month 2 - I recall feeling anxious about wanting this process to be quicker and was discourage in seeing no changes. No fear of what I was doing or affects to my health.

July 2018 = Month 3 - Like June, I noticed no changes to my appearance and considered upping my estrogen dose. No fear or what I was doing or affects to my health.

August 2018 = Month 4 - With my breasts ‘budding’ I was ecstatic that I was finally changing. My dysphoria was replaced with confidence (both physically and socially).

September 2018 = Month 5 - At the start of September, I began to have concerns about fitting in. I ran into resistance and condemnation with the pharmacy and with the Transgender Laws back in the news, was concerned about the consequences of my actions. By the end of September, I was hospitalized for two weeks due to lung infections as was off my H.R.T.. I recall wanting to go back on H.R.T. when I started noticing that my buds were ‘softening’.

October 2018 = Month 6 - My dysphoria of my appearance seem to manifest into ‘feeling’ socially awkward and I began to isolate myself from going to the YMCA. Ironically, this was the same time that I was getting compliments about how I looked. I considered discontinuing H.R.T. and even threw my pills away. About a week later, after my gender dysphoria returned, I began about three days of taking the pills and ended back in the hospital with respiratory failure (due to asthma and cystic fibrosis). I resumed taking my pills on the last week of October, but began to get sick.

November 2018 = Month 7 - (Only 19 days of progress report) I tried to resume my therapy, but began getting nauseous and vomiting in the morning. The sickness would last until about afternoon and then I just felt queasy for the rest of the day. I would take myself off of the pills and about a day later, began feeling better. I would go back on the pills and the symptoms returned. At this moment, I’ve been off H.R.T. for about one month as I weighed my dysphoria’s. By the 7th of November, I threw away my pills once more and considered that H.R.T. was bad for my overall health. About two days later, my family came down with a similar sickness and was diagnosed with stomach flu. By November 18, after a week to reflect my decision, I decided to reinstate my H.R.T. and will see what happens.

 _______________________________________________________________

A Battle Between Gender Dysphoria And Consequential Dysphoria

     I began my H.R.T. after nearly seven months of research, considerations and weighing the consequences and concluded that undergoing hormone replacement therapy would be best for my overall psychological and mental health. Prior to H.R.T., I struggled with accepting my appearance and even developed a disdain for my overall ‘self’. I concluded that if I remain on this path, it would lead to depression, isolation and self-harm.

     The first 4 months of H.R.T. seemed to ‘cure’ my gender dysphoria and it was reflected in my attention to appearance as I regrew my hair and became aware of my needs of ‘looking appropriate’. I began styling my hair and began experiencing a ‘placebo’ effect as I thought my appearance had changed (face looking softer and younger). I became comfortable taking pictures of myself and even went as far as posting them online (something I rarely did in the past). At month 5, my breast development came as a shock to me as the budding made my nipples very sensitive and they always seem to be so visible in my perspective; however, no one made any comments about them. When I was hospitalized, I went off my pills and began to suffer from fear of changing, fear of rejection and fear of harm. I became overwhelmed about the consequential effects of taking H.R.T. and was concerned about estrogen making my lung diseases much worse (which seemed to have happened).

     With the ‘morning sickness’ and recovering from two hospitalizations, I considered that taking hormones was unhealthy and even thought about calling Cedar River to conclude my therapy; but my gender dysphoria would reinstate and overcome my consequential dysphoria. As of November 19th 2018 (the date of this post), I have resumed H.R.T. and will keep a close watch on my health. It is quite possible that my estrogen intake is too high (however, this dose is needed to increase my estrogen levels as last blood draw found my testosterone and estrogen levels to be tied).

[the-mira-life-project-mtf]

MY MTF HRT JOURNEY ~ A NEW YEAR, A NEW ME

THE END OF 2018

     2018 certainly presented its challenges and reviews. Here is a synopsis of the year at a glance...

JANUARY 2017

Since October 2016, I experimented with the use of bovine hormones and saw no results. The pills were God awful and made me feel sick. November of 2016; I called Cedar River Clinics to begin experimenting with HRT. Due to scheduling conflict, I was ordered to call back in February of 2017.

During the month of January, I began conducting research to decide if HRT was the right answer, that research would be concluded in April of 2017.

FEBRUARY 2017

After a month of deliberations, I decided to call Cedar River Clinics on February 10th and schedule a consultation.

My research conducted included cause-and-effect from taking hormones; punishment from my family and friends and long term analysis of not taking hormones.

MARCH 2017

March was mainly spent reading the IPATH book for MtF HRT, no deliberating was done.

APRIL 2017

April was spent considering what ‘type’ of HRT I wanted, cost and desired goals. I decided (based on a poor sociological test I performed on myself) to take my transformation as slow as possible.

I also began considering names and what spectrum I wanted to be called. By the end of the month, I decided on being called ‘David Mira’ and my spectrum fell somewhere between: Gender Fluid, Gender Non-Conforming, Non-Gender with my sexuality being: Asexual or Abstained .

MAY 2017

On May 5th 2018; after two long years of deliberation, I finally decided to instigate my plans to begin Hormone Replacement Therapy (with possibility of SRS and Chest Agumentation in 2-5 years). Under the direction of Cedar River Clinics in Tacoma, Washington. It was very exciting (that I was finally doing this!) and scary (that I was finally doing this!).

     I was seen by Doctor Marsh; we did not get along very well and I sought a second opinion. Baseline bloodwork was done and I was scheduled for a follow up on May 12th with a PCA named Sarah H.

We began a very low dose of hormones (spironolactone and finasteride) and plan to go one month to see how I tolerated.

At the time, I was simply called ‘David’ due to confusion in my name. The dose was so low that there were no changes physically or mentally.

JUNE 2017

About a month into my HRT, I felt like I had a new release on life. Transiting was still non-existent. The effects of transiting was still non-existent, but the knowledge that nothing would ever be the same brought hope to my despair that plagued my happiness and confidence in my person. It is difficult to describe the psychological aspect of having body dysphoria; it is like living in a mask or costume that is not you and you can not break free. Inside is your hidden self, you know what you look like, but the thin skin is a lie.

By the end of June, I began experiencing my first signs that the transformation was about to begin: Sharp stinging pain on the sides of my areoles. It was an ingrown hair and for awhile, I did not know what to think.

JULY 2017

My third trip to Cedar River brought more consideration as I was finally starting to adapt to my transitional name. I changed my gmail accounts, Facebook...all social media and names on my Apple devices from just David to David Míra.

With my desire to achieve more results (and handling two months rather well), we added estrogen patches which turned out to be a terrible idea when you also have CF. The salty sweat just ruins them!

AUGUST 2017

     By month four, the estrogen patches were having very little effect on my HRT. So we moved from patches to pills, beginning with a very low dose of just one estradiol pill in the morning and one at night.

Slowly, the hallow void under each nipple began to blossom like a tumor, growing in size. I was entering the earliest stages of budding, a very painful period of breast development.

Besides only some remote discomfort in the chest, there was very little that was changing. Only thing that was rapidly changing was my weight! I was losing pounds and it wasn’t muscle mass. I also began to notice a change in my mood...I was becoming emotional (it was so easy to cry) and became quite extroverted as I was going out with friends more often and socializing.

SEPTEMBER 2017

     With budding breasts, you’d think that they would start growing! But they did the opposite, they shrank in size by almost 2 inches! Certain changes were beginning to become noticeable to me. For awhile I wonder if they are hopeful wishing, but over time, you can root out what is fact from fantasy. First most, my skin was changing. I was expecting my skin to become dry, but it never did...only became very silky. The skin on the gentials and nipples also changed, feeling, rubbery.

Nipples had greatly changed as they were standing erect more often and the areoles began to ‘puff out’. This was the first major change I noticed and pictures were documenting.

OCTOBER 2017

Month six, I returned back to Cedar River to review over the plan. We increased the dose and began to change. Mentally, I did not ‘feel’ different and began to only use one name: Míra.

Things were going so well...until I became very sick, as my lungs collapsed and I ended up in the ICU. Without my hormones on file, I did not receive my meds and this triggered the worst depression I have ever felt. I began to have negative thoughts about what I was doing to myself and considered calling the clinic to stop my HRT.

About a week off hormones, my buds literally felt like they were ‘deflating’, the hardness softening and the pain deadening. I became desperate to get back on my hormones as I did not like the way I felt.

NOVEMBER 2017

The whole month of November, I only took my HRT meds about three days out of the whole month. I began having horrific stomach pains, nausea and vomiting. I did not know what was going on and thought it was the hormones. When I took the pills, I got sick...when I did not take the pills, I was hunky-dory.

To add a new layer of ‘oddness’, I began to experiencing some form of lactation from both nipples. Not unheard of, lactation is common in girls who have high progesterone levels in their blood.

With the sickness and depression, I did not began to clear out until about the last week of November and began considering if it was worth taking HRT and called to cancel my appointment...only to reschedule.

Even off hormones, my body continued to manually change. My breasts began to blossom once more and grow! I was starting to cup, which delighted my heart, but also troubled me as I did not know with I would do with a partly metamorphosed body.

DECEMBER 2017

Come the Christmas holidays, I resumed my HRT and when I went to have my bloodwork completed, I expected high testosterone and low estrogen, but both were very high! This certainly battled the doctors.

     Considering my gender fluid life, I was going through so many other changes that I was surprised of the choices I was making. In a few articles, I wrote about the effects that HRT has on the brain, and to be honest, I did not think there would be many changes. But I began to ‘think’ differently. Acting off emotional impulse instead of rational impulse.

     Some of the thoughts I have experienced have startled me, some have made socializing so much easier...for some reason, as I am actually comfortable in my own transitional skin.

[the-mira-life-project-mtf]

My MtF~H.R.T. Journey — Month 7 Blood-work Done

    So I just went to Cedar River’s in Tacoma to have blood work done. It has been a few months since I had my blood tested and the last results were:

     50% Testosterone ~ 50% Estrogen

     They upped my spironolactone and estradiol to elevate my estrogen levels to that of a female. For a month, I was dedicated to my regiment, then my health declined.

     I don’t know what the levels will be this time, but I am expecting somewhere around the same. I can only assume that my estrogen levels are high as I am still having breast growth, even with my low dose.

     While I was off my estrogen, the budding had soften, but I was still experiencing development, so it is likely that the production of testosterone is diminished.

     When I arrived to Cedar River’s, I did not know what to expect. I fear I will lose my HRT; but also concerned that my HRT might be impacting my health.

     Typically, winter time is the hardest for me to adjust to; and my breathing issues might be just do to my end-stage lung disease. When the nurse saw my oxygen tubing and tank, she asked what it was about, and sadly, it was progressive...but my lung disease caused the need for oxygen.

     On the 20th, I will know the future of my HRT when I see the doctor.

[the-mira-life-project-mtf]

Don’t Go To Walgreen's

     If you are a trans-patient...DON’T GO TO WALGREEN’S!

     I had many choices of pharmacies in my area and chose Walgreen’s Pharmacy to supply my meds. I have ran into many problems with Walgreen’s that are:

Don’t have all medicine in stock...

Unable to supply your full dose...

Unfriendly pharmacist...

Not Trans-friendly...

Question why you are taking the medicine over and over...

No public privacy...

     I spoke with Cedar River physician about Walgreen’s and was informed that many patients have had a bad encounter with the staff retaliating against the patient for them being Trans.

     I have switched over to Rite Aid to see how they handle my scripts and found that they have the medicine in stock, the pharmacist does not ask why you are taking these meds (but will ask if you want pharmacist to talk about your meds) and appear trans-friendly.

[the-mira-life-project-mtf]

My MtF~H.R.T. Journey — Is My Hormones Making Me Nauseous?

     One of the difficult side effects I am dealing with right now is feeling nauseous early in the morning and sometimes extending through the day.

     I’ve read that some experience this during their transition...

     To be honest! It sucks!

     I’ve noticed that the symptoms seem to have begun when I upped my dose of estrogen in the morning. Right after swallowing the pills, about 10 minutes later I feel a wash of nausea in my stomach where I don’t want to eat anything or smell food as I feel like I might vomit.

     My appetite is greatly impacted as I am not hungry and if I do eat, it is in small quantities.

     I am trying drinking a lot of water; which seems to help, but does not ease the symptoms to the point they are manageable.

     Some report that this is due to our since of smell is changing...and that might be true! For example; I was remarking how delightful perfume was. I typically am appalled by perfume and to actually ‘like it’ was a surprise. I am not certain if this might be true with my foods as my diet has not changed.

      Another possible reason could be an increase in my estrogen levels nearing the levels of a pregnant woman; making me experience ‘morning sickness’. It certainly seems like morning sickness as the morning time is hell! I doubt that my estrogen levels are high as I’ve been on and off my hormones for almost a month.

     I will see my doctor at Cedar River in two weeks to discuss this.

[the-mira-life-project-mtf]

HRT MtF Appointment

So, I went to see my doctor (who has been following my care) yesterday. I have been so busy these past few days that I didn’t really want to go...but the effort and time to be seen at a HRT (for Transgender Services) providers office convinced me to get out of bed at 7:30am to get to my 8:55am appointment in Tacoma. {To be seen at Cedar Rivers Clinics, the wait period is about 9 months}

The drive over to Tacoma was quite pleasant, and I arrived early enough to write a few blogs. I’ve been here many time already, however, this has to be the first time in my visits, that there were so many other transgender individuals. One young MtF was just beginning their transition and two others seemed to be in their early months like myself. Very little development or change...if they were not here, I’d never guess they were transgender (except for the way they spoke).

I am always curious—as a scientist—about what circumstances that have lead them down this path: Was it abuse, inadequacies, single-parent family, dysphoria, mental disease or something I have not considered yet? One thing I could easily tell; and have noticed from time-to-time: We are not a very attractive bunch of people. Then again, I personally found them not attractive. There is just something...off. This is possibly due to them being ‘biologically’ male and still appearing so. And I am not attracted to men, so my bias would influence my views on attraction.

Two other things I’ve noticed since coming to clinic: In all of the patients I have seen at Cedar Rivers; I’d say that 97% were genetically male (MtF) and only 3% were genetically female (FtM). The male to female ratio of patients seeking transition certainly collaborates with the research and the social effect of the feminist movement. The other thing I’ve noticed is that, not once, have I’ve seen anyone speak, look or sit next to another, even during this busy appointment...we seem to all avoid one another.

Besides the observations; I like coming here as the staff are quite friendly. The receptions (even though she has only seen me about 10 times) knows my name and greets me upon arrival, allowing me to skip the ID check and unlocks the door. It is nice to be called by my preferred name, instead of my given. As usual, the doctor is always late (not once has my appointment been on time), however, this time my doctor called me back which was nice as usually there is another 10 minute delay waiting for the doc (and praying it isn’t Dr. Marsh).

Dr. Anuj Khattar (my provider); I recommend if you plan on receiving services from Cedar River. He is quite professional and kind. I was pleasantly surprised that he recalled our last appointment and was wondering how I was now handling the treatment, as the last time we meet, I was nauseated and though it might have been the HRT; but turns out it was only pneumonia and my antibiotic therapy.

“How is your changes going? Are you seeing any results?” I would answer that it was slow, as I intended, but not seeing much results. Just some chest development. “Any changes in your skin?” he prompted and added “Your face looks softer since the last time I saw you.” He was correct, my skin seems to have taken on a soft silky texture as I acknowledge him with a nod.

We then talked about my breathing. “How has your breathing been? Is it COPD?” Dr. Khattar asked. I dismissed the incorrect diagnosis as we never covered my respiratory disease before.

“Cystic fibrosis actually, we seem to have noticed that breathing episodes have greatly occurred since I’ve begun HRT, but can not correlate this being due to HRT or end-stage lung disease.” as I explained my hypothesis. There was only one research document I read about estradiol causing further asthma exacerbation in MtF patients, but due to the limited knowledge, it is only a hypothesis at this time.

Dr. Khattar wanted to follow this, to make sure it does not become an issue as I am only one more appointment away from graduating from the required 1 year commitment Cedar River requires of all its LGBT patients (as required by the iPATH standards). My last blood draw and follow up will be in June...and afterwards, all my appointments will be just once a year.

This has been a rough road to go down, but still have 2 more years before all changes reach their maximum. With my research coming to a close, I will have to consider transferring my care to a PCP ... but I still have not made that call as I don’t know what to expect.