Guest writer Beck: ”That‘s because you were on T”

By Beck

When I began the medical side of my transition, many years ago in rural Utah, I anticipated issues accessing care. And yet, with a letter from a university counselor and the enthusiastic help of a local nurse practitioner, I walked out of the clinic with a testosterone prescription the day I sought it. I also learned that not only was there a provider who performed top surgery in Salt Lake City, it was the most affordable top surgery in the U.S.—and she had the best track record: a 0% nipple loss rate (yeah, that’s a thing).

After college, I switched to a local family doctor in Utah for my gender care. I again anticipated pushback—but it never occurred. My physician, like many of the Mormon individuals who provided me care, was friendly, respectful, and happy to look after my health.

My providers were willing, but not too knowledgeable about trans care, so in every case, except with the surgeon, I played the dual roles of patient and educator. To my first appointment, I brought information on the different types of T, which the nurse practitioner consulted, as she was not well versed in them. With the family doctor, I was able to provide information that helped him better treat his other trans patients.

Poorly phrased

Almost every nurse or assistant who drew my blood or took my vitals asked well intentioned (if often poorly phrased) questions about my identity, needs, and experience. That’s not surprising. This was eight or nine years ago: people had seen Laverne Cox in Orange is the New Black and maybe a few episodes of Drag Race, so they knew of being trans. But they were more familiar with trans women and drag queens than with trans men at that time.

I guessed I would face awkward personal questions. What I never guessed is how receiving gender-affirming care would affect my healthcare ever since.

Getting off T

Three years after starting T, I stopped it. To be clear: I did not detransition; I was, and am still, a trans man.[1] I got off T for personal reasons. And because an upside of T is that many changes that happen while you take it are permanent—my voice wasn’t going to un-drop, for example—I still look and sound like the man I am.

But now, five years later, in almost every single healthcare setting, I am haunted by my time on T in the assumptions doctors make. It doesn’t matter what concern or symptom I bring. The first thing a provider says is, “Oh, that’s probably because you were on testosterone.”

These will be, mind you, the same providers that ask me a question like, “So what exactly is transgenderism?” while they draw my blood, and then, if wonky results come back, state with all confidence, “That’s because you were on T.”

Assumptions

I realize that not every patient has HRT in their medical history. But if a few years on a low dose of testosterone was enough to instigate every health issue I have experienced since, I don’t know how cis men are surviving out there.

If a few years on a low dose of testosterone was enough to instigate every health issue I have had since, I don’t know how cis men are surviving out there.

The problem is not that my past HRT is being considered as a cause. Doctors are trained to look for what has changed over a patient’s history. The problem is that doctors are making assumptions, not practicing medicine.

For context, here’s my one positive experience of the past few years. While living in Georgia, I saw a PCP who was trying to get to the bottom of a thyroid issue. He walked into our appointment and said, “I wondered if your HRT could have caused this. So I did the research, and I’ve ruled it out.”

A fight

I was so sad to lose that doctor when I moved out of Georgia. I would give anything to find another like him. The way he worked should be the rule, not the exception: wondering about my HRT, and then investigating.

Instead, I have to fight to get most providers to look at any other cause. I have to push for tests. Past admonishments, past eye rolls, past the “OK, but this is just wasting your money and my time” vibe.

Besides the fact that “T was the problem!” doesn’t provide me with any treatment avenues—I’m already off testosterone, I can’t be any more off it—am I supposed to accept that I am cursed with mediocre health now, despite none of my issues being known as a potential HRT side effect, despite some being preexisting, despite a family history?

How do I get treated like any other patient, with a variety of factors affecting my health, instead of having That One Thing that is the Cause of Everything?

Dangerous

I am lucky that none of my issues have been debilitating or life-threatening. But I wonder how many folks are having their medical concerns brushed aside due to a past or present course of HRT, and how many of these issues could be dangerous if left untreated. It is tough for a patient to know when an issue is “not a big deal” and when it is vital to push for that test. To say nothing of the expense: when a doctor doesn’t think a test is necessary, you pay a bundle for it out of pocket.

As a trans person, I need my healthcare team to support all aspects of gender-affirming care. That should go without saying. It should also go without saying that doctors need to understand the actual, proven side effects of my care and the effects it may or may not have on my future health. Doctors must educate themselves to advise patients seeking HRT and to care for those who are, or have been, on it.

Hell, they need to at least bother to look up whether HRT could be the cause of an issue.

Because right now, the upshot for me, as I know it must surely be for others, is that I rarely actively seek healthcare. I try to take care of myself and hope for the best. It seems about as good as paying a co-pay just to hear, “It’s because you were on T.” Which is starting to sound like, “This is just a consequence you get for being trans.”

[1] Trans people make a variety of decisions regarding HRT: whether to get on it, how long to stay on it, at what dosage, and so on. Many remain on HRT for their whole lives, but many don’t. Some organizations consider someone stopping HRT, for any amount of time, as evidence of a “detransition.” There are people who detransition, but not many. Most who stop HRT are not detransitioning. Something to keep in mind when you see “detransition” numbers.

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Beck is a writer in Maine.