Every journey begins with a single step

Just before high noon one otherwise unremarkable morning thirteen months ago, I entered the lobby of a nondescript medical clinic in Sydney. I nervously selected an elevator to take me to the fourth floor, as if my choice might have some bearing on the outcome of my visit. In 10 minutes I would attend my first appointment with my newly appointed endocrinologist. A year on, I still find this concept a little absurd … people have general practitioners, they have physiotherapists and they have dentists. Who actually has an endocrinologist? Reality check: apparently now I do.

My first appointment was to talk about the benefits and risks of using sex hormones to physically transition. I had prepared by reading about endocrinologists and what they attended to. I had read many personal anecdotes about transitioning. I had assumed, as it turned out quite incorrectly, that his waiting room would contain patients variously presenting with thyroid problems, possibly diabetes and maybe even someone would be there to see him about transitioning. After my first appointment I have stopped using the word patient when I refer to seeing my endocrinologist … it just doesn’t fit. I don’t feel sick. I don’t feel that I need to be cured of anything. I see him more like a mechanic or an auto electrician, whose job it is to get my vehicle humming.

Much of my nervousness related to the fact that I had absolutely no idea what was about to unfold. I guessed that there were two probable outcomes: either I would leave with a script, or I would leave without a script. Confusingly, I found both of those potential outcomes terrifying. If I left with a script, that meant that my physical transition was about to begin, and my life as I knew it would never be the same again. If I left without a script, then my life would ostensibly remain the same. The first option filled me with fear. The second option filled me with dread.

I needn’t have been nervous though. Opening the clinic door, I noticed that there were three people sitting patiently in the waiting room. The first person I noticed was a young woman in her late twenties. I briefly wondered whether she was assigned female at birth, then quickly decided that although she probably wasn’t, it really wasn’t relevant. Sitting across from her was a teenager that appeared to be in the very early stages of transitioning, though their gender was indeterminate to my glance. They were accompanied by an older male who I assumed to be their father. I made eye contact with the receptionist as I approached the reception desk on the far side of the room. I noticed that she too was a trans woman. I relaxed. I knew then that I was definitely in the right place. I checked in, and sat down, but not before  asking for the toilet key so I could get my nervous wee out of the way. Whilst waiting for my turn, another person emerged from the endocrinologist’s room. She appeared to be a middle aged trans woman. If there was any lingering doubt as to whether I was in the right place or not, it evaporated immediately.

It was soon my turn to be seen. I was asked what goals I wanted to achieve, and how quickly I wanted to achieve them. I explained that I wanted to commence my physical transition, and that I wanted to continue my approach that I had been using for the previous 9 months: proceeding tiny step by tiny step, however painfully slow the process felt at the time. I wanted to be able to gauge and analyse each step and every one of my emotional responses as individually as could be managed. In fact, when my GP had recommended this particular specialist to me, I eagerly accepted. That decision meant trips to Sydney, booking flights, booking accomodation and making appointments to tell my story to a new specialist: lots of decisions and new experiences that I could monitor to help me ensure I was still on the right path.

Based on my research, I had assumed that the best approach for me would be to be initially prescribed a testosterone blocker. I was keen to feel what my body felt like with reduced testosterone. I wouldn’t say I had ever felt very blokey or quick to anger, but I have always felt that my emotions were more beige and washed out than I expected them to be. My background reading indicated that testosterone could be blocked before adding oestrogen, as long as the gap between the two steps wasn’t too long. My specialist advised that the best approach for me, however, would be to start off instead on a low dose of oestrogen in the form of Estradiol as it was already a testosterone blocker in it’s own right. I was prescribed initially with 2mg per day, but that I could increase my dose to 4mg per day, and then to 6mg per day if I so chose, based on how I felt. If I felt that things were happening too quickly, I could reduce my dose. If I felt that it wasn’t for me, I could stop. I just needed to be aware that I would feel “more emotional” as my body adjusted to each dosage change. I was told that I would notice positive mental and emotional changes on a dose of 2mg per day, but there would be no physical changes. If I increased my dose to 4mg or 6mg per day, I would also start to notice physical changes, such as you would expect with the beginning of female puberty. After being told the rules, my specialist said that in reality, once I started taking the Estradiol, I would find it extremely difficult not to increase my dose, and that it would feel quite addictive. I had not had any previous problems with addiction, except possibly maybe caffeine, so the idea that I would become addicted to oestrogen amused me. I dismissed it as being very unlikely, if not impossible.

My prescription was filled within 45 minutes of closing his clinic door. I was simply too excited to wait. As I made my way through the bustling inner city pharmacy, I instinctively felt that everybody was keenly watching me, that they knew why I was there and what prescription I was having filled. I felt that they were secretly judging me. The pharmacist asked me if I had taken this hormone before. I nervously said no. The risks were explained to me verbally, again, and I was handed a printed handout. Both the conversation with the pharmacist and the printed handout didn’t tell me anything I hadn’t already gleaned from my own reading and my appointment with my endocrinologist, although it did comfort me that everybody was taking this rather seriously. Sex hormones are serious chemicals and they are not to be taken lightly.

Up until that moment, I had assumed that once I had the box of little blue pills in my hand, I would be wanting to swallow the first one immediately. Once I had the box, and my future, in my hand, I realised that waiting only another two days until I was back home would be more than bearable. Two days delay wouldn’t kill me, and I spontaneously realised I wanted to take the first pill with close friends present. I proudly and confidently strode from the pharmacy towards my new life.