I had three physicians.  The first was an internist who was my primary-care physician; the second was the gynecologist who was also listed as a primary-care physician; the third was my psychiatrist.  I didn’t ever have much respect for the internist – he seemed clumsy, ill-at-ease with me as a patient – when I picture him, I picture him dropping a file and bending to pick it up.  I disliked him for that.  I didn’t see him too often – probably not more than half a dozen times during my transition, while I lived in San Francisco.

I got testosterone injections at my gynecologist’s office, on the fifth floor.  Because he was also a primary care physician, his office could keep the testosterone prescription on file.  I also saw my gynecologist for semiannual checkups – and I went to him when I was worried about some of the side effects of testosterone.

I saw my internist about back and neck pain, about bursitis, perhaps once or twice in relation to my testosterone injections.

I spoke with my psychiatrist about testosterone in general – she was by far the most knowledgeable, and I saw her every two weeks (more or less) the whole time I was in transition and on testosterone.  She was most accessible, and part of my therapy was frank discussion of the effects of testosterone and how I felt being on hormones.

I was also more or less healthy during transition – I didn’t have many problems to bring to a primary-care physician.

He was the first doctor I spoke to about going back, and he disappointed me.  I was distraught.  I was in despair – I was convinced that I had destroyed my own life – and I was also deeply ashamed.  I was ashamed to tell my doctors that I had been mistaken.

When I scheduled that appointment, I didn’t tell my internist’s office that I wanted to quit; I didn’t mention that I was desperately worried about the prospect of going back.  I think I requested a visit on the basis of knee pain – some repetitive stress problem, some minor complaint.  My internist saw me, examined my knee, my ankle, my hip – and then I broke down in tears and told my doctor that I thought I wanted to go back.

He told me that he did not have time to discuss this with me, that he had only booked fifteen minutes for my joint pain, and (either) that he would contact my psychiatrist or that I should certainly do so.  Then, perhaps in an impromptu effort to address my grief, he said that he might prescribe me anti-depressants, if I wanted.  He mentioned Paxil.

When I write it out like that, it sounds damning – it sounds as though I want it to be damning, as though I am trying to write this man as cold and crudely inept in my care, as someone who couldn’t wait to wave me out of his office, who preferred to hand my desperation off to some other professional, or mute it with pills.  It’s true that he offered me medication in lieu of immediate counsel; it’s true that he reminded me of my quarter-hour slot and the line of patients waiting after me.  It’s true that I can’t find much to defend him with, or soften the impression I’m giving here.

It’s also true that he called my psychiatrist to advise her that I was in trouble – and he must have told her that I urgently needed help, because she immediately called me.  (I had called her, just before or leaving her office – and it’s true that I called her more out of a sense of guilty obligation than to ask for her help.)  He didn’t offer me more of his own time, or any advice.

One of my physicians – either my gynecologist or this internist – said almost as an aside, “Of course, you’ll never be exactly the same” – or something similar.  This is a paraphrase, but a close one.  One of them may have said, “You’ll never go back to looking exactly the same,” or, “You’ll never look exactly like you did before.”  They may have used more specific or more general phrasing.  If my internist said it, he would have been referring to my appearance in general; if my gynecologist said it, he would have been referring to my genitals.  And it’s true that they didn’t – they don’t – go back to the way they were before, to normal.  (None of my doctors ever called me abnormal.)

It turned out to be preliminary, this confession, but it felt decisive, official.  It felt like a necessary step – I didn’t so much go to this doctor seeking help.  I went to apologize.  I felt like I had to inform my doctors that I was dropping out – I believed they were entitled to know.  And as silly as it sounds, I felt obligated to tell them in person.  It was as though I was announcing my resignation – and if I had to tell them, that would make them my managers, my superiors.

When I picture myself in my internist’s office, I am also hunched over, but in grief.  That picture recurs when I remember my visit to my psychiatrist, which was much more official, detailed, and decisive.  I can see my hands and sleeves; I remember picking a tissue smooth in my hands.  I cried in front of both doctors.  I think I was rueful and good-humored in front of my gynecologist – it may have seemed improper to cry hitched into stirrups.  I remember reclining in front of him, raised up, laid back, bare-shouldered in the paper wrapper.

For this first doctor, the internist without time, I think I wanted two things: support, which at the time I had from no one else, because I had told no one; and…gravitas?  I’m not sure I felt like I could ask for reassurance; I don’t think I would have accepted it.  I wanted a professional to agree with me that this was serious, that it deserved real attention.  I suppose by that point I had decided that I needed to stop; I wanted a doctor to agree with me.

He didn’t.  He didn’t listen to me and then solemnly aver that, yes, it was time to stop.  He was hurried and reluctant.


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