PART IV.......FINISHING TOUCHES
Counselor Hunter referred Danielle to an endocrinologist within a few weeks even though the Harry Benjamin Standards of Care recommend three months of counseling before hormones are started. Danielle was well into puberty and time was of the essence. The first endocrinologist did a complete physical and lots of laboratory tests and prescribed the estrogen, Premarin. His charge was $360.00. The doctor owned the lab, and this made me wonder a about conflict of interest. Danielle was thrilled and anxious to get the prescription filled so she could start the estrogen.
It did not work any magic, but she began to have some breast tenderness, and the growth of her facial hair seemed to slow down a little. Her voice had only begun to change, and we hoped the hormones would keep it from getting lower. But there was also a downside to taking hormones. She experienced fatigue, nausea, and emotional ups and downs as she started down the long and rocky road of side effects from hormone therapy. She became hypersensitive to people looking at her, not paranoid, but just very aware that people seemed to notice her. She became anxious even around people who were loving and accepting of her and needed to get away to rest after several hours with them.
During her first check-up, I questioned the endocrinologist
the fatigue, but he didn't think the Premarin had anything to
with it. Her testosterone was still not down to an acceptable
level, so he prescribed even more Premarin. On the lower dose
was already missing days of school because she was tired and
didn't feel good.
After networking with other transgendered persons, I learned that fatigue is a very common side effect as is clearly reported on the information sheet that comes with the Premarin. They also told me there was another endocrinologist whose prices were better, and he prescribed an androgen blocker, spironolactone, in addition to Premarin.
During her first visit with the new endocrinologist, the doctor asked Danielle why she had come to him, and was very surprised to learn that she was a transsexual. He lowered the dose of estrogen and added spironolactone. He also said he did not think that fatigue was connected to the hormones. His charge for the complete physical and the necessary laboratory tests was $160.
After reading all the books I could find about hormones written by experts, and talking to several others, I came to the conclusion that there are several choices in the treatment of transsexuals, and each has its advantages and disadvantages. It seems that every doctor has his favorite type and amount of estrogen that he prescribes. I was really amazed that the endocrinologists were not aware of the emotional toll that their patients were experiencing because of the estrogen therapy. They do tests for liver damage and heart problems, but they have no way to measure fatigue, depression, and distraction. Our transgendered friends had found what worked for them including hormone injections or additional non-prescription hormones from Mexico. Everybody experiences a different degree of benefits and side effects from hormone therapy, and some feel neither fatigue nor depression.
Danielle did her own research and reduced her dose until she could handle the fatigue and emotions, but it was not enough to give her breasts. She finally decided that she would rather buy her breasts from a plastic surgeon and stay on a hormone dose that allowed her to function.
The first therapist (the hippie) we saw about the gender dysphoria made a good impression on me, but Danielle was not yet ready to see a counselor. She felt she had no emotional problems, she just wanted to be a girl. However, we found we had no choice in the matter because we needed a counselor's referral for hormones and later for a recommendation for surgery. Although I would have trusted the first counselor to work with Danielle, we could not waste our time on a therapist who could not refer us to surgery, no matter how nice he was.
After waiting three months with no word from Counselor Hunter, I called to ask him if there was anything else we should be doing. He set up another appointment at which time Danielle reported that she was having unusual fatigue, and cried easily since being on the hormone therapy. He thought she needed Prozac for her depression; he too said hormones would not cause fatigue. I rejected the suggestion of Prozac because of its reputation for treating mental dysfunction, and I was reluctant to add more drugs to her young body. From the questions he asked, it was apparent he had not looked at the information questionnaire we had returned to him (with $150) three months earlier. I couldn't see that we were getting anything that could be called "counseling." We left without any return appointment or any mention of seeing him again.
Danielle wanted surgery, but I needed to know the costs involved, and whether anyone would do Sex Reassignment Surgery on a young transsexual. I wanted a realistic time frame before raising Danielle's hopes.
We found there were only four or five Sex Reassignment surgeons in the U.S. and Canada who were well known. One surgeon would not treat anyone under age 21. Another was not well known in our area so there was little information. The surgery cost less in Canada, but we heard rumors of postop complications. This was no time to scrimp because I wanted the best for my daughter. When I talked to post-op transsexuals, Dr. Schrang in Wisconsin was given rave reviews by all his patients, and I learned that he had treated younger patients. We felt it was important to have the operation soon to give Danielle the best chance for adjusting to young adulthood. When we contacted Dr. Schrang and he learned of the circumstances, he said he would be glad to work with Danielle. He named one price that would cover his fee, the hospital stay and all expenses involved with the actual surgery.
I had been without health insurance for years, betting that my children and I would avoid any catastrophic injury or illness. When I learned of the expected expenses of Danielle's hormone therapy and surgery, I inquired about insurance coverage for her needs, even though I knew we'd probably have to wait a year to satisfy a waiting period for pre-existing conditions. Several companies never returned my call. The representative for one company said the expense for hormones could probably be taken care of if the doctor cooperated, but there was no way surgery could be covered.
I applied for Crippled Children Funds through the State of California, and learned that non-necessary medical expenses could not be covered. I talked to the Shriners and several other groups who help with special medical needs for children. They were very polite to me on the phone, but their organizations did not cover this situation. I talked to one group who would only fund medical expenses for children who had a terminal illness. There are man "feel good" programs available for teens in an effort to prevent suicide, alcohol and drug abuse, but there were no funds available for my child. Finally, I figured my financial resources would cover the cost of the surgery in the next year or two if I used credit cards for some of the cost.
Now that we knew that surgery was possible, we needed to seriously pursue counseling in order to get our two surgical referral letters.
Since I hadn't heard from Counselor Hunter in six months, I called to set up a third appointment. At that time we discussed the psychological testing that he had previously mentioned at a cost of $700. The tests included:
MCMI-III (Million Clinical Multiaxial Inventory)
The Draw A Person/Family
TAT (Thematic Apperceptual Test)
MMPI (Minnesota Multiphasic Personality Inventory)
I questioned the need for testing since he had written me a note stating that "Danielle seems relatively stabilized all things considered." He said, "There is no pass or fail to the testing. I just have to do it to protect myself against law suits. I don't have to defend myself. All my previous associates have gone out of business due to lawsuits. My wife does the testing and it is a real bargain at the $700 price that I am giving you. It would cost twice as much at the University."
Somehow I kept feeling like a victim. He was taking my money and doing no counseling. I appreciated that he did not make us wait for three months of counseling before sending us to an endocrinologist, and he was not wasting our time with many appointments. But we were getting no help from him and he seemed to only want money.
As we learned more about the situation, we learned that we had few choices. If we went to another counselor, the six months of counseling required (at $100 an hour) before surgery would have to begin again. To save time, we might as well pay the $700.00 to Counselor Hunter and get on with it. I called the counselor and undiplomatically told him. "OK. I'm ready to be screwed."
He called back to say, "I really do not want you as a client, but I will send your records to Counselor Bell."
I had previously met Counselor Bell when I attended a transsexual support meeting which he was conducting with an associate, Counselor Jenny. At that time I had the opportunity to ask if there was anything more that I could be doing for Danielle. They said I was doing very well with Danielle, and had no further advice to give me. When I told them that I felt Counselor Hunter was not doing any counseling, Counselor Bell told me he could not see us unless Mr. Hunter referred Danielle to him because of professional courtesy.
I continued to attend their support meetings and became part of the support system. Counselor Bell suggested that Danielle attend the support meetings in order to meet others like herself. Danielle went only once. She had already met several transsexuals whom I had invited to our home to chat, and she and Laura were fast friends by then.
The counselors discontinued their meetings at the end of the summer, but Danielle continued to see Counselor Bell privately. He was a very quiet, soft spoken man, and I was well enough acquainted with him to feel comfortable having Danielle see him alone. Danielle told me she had to save up things to talk about during the sessions since the counselor didn't say very much. Danielle always referred to being transsexual as her "situation"; she never called it a problem. After her first session, the counselor told me that Danielle seemed to be doing fine, and he could see no problem with referring her for surgery when the time came. He would also arrange for the second opinion by another associate in his office. Counselor Bell believed the psychological testing was unnecessary.
The date for surgery was finally set, and we had the first
surgery referral letter in the bag. Dr. Bell referred us to
Counselor Wolf for another letter, but that was not as simple
it sounded. Our encounter with Dr. Wolf is well documented in
two letters that follow:
Tim Wolf, Ph.D.
Individual, Child, Adolescent & relationship Psychotherapy
25 Park Boulevard, Suite 207
San Diego, Ca 92116
I need to address several issues with you about teenage Gender Dysphoria, and my teenager in particular. These are the facts as Danielle and I perceived them about our encounters March 15 and March 29.
We were referred to you by Dr. Chris Beletsis for a 2nd opinion letter for SRS surgery. You quoted a 2 hr minimum at $90.00 an hour and $25.00 for a letter. We filled out the standard consent forms, you said you would be doing some testing with Danielle, and you said you would contact us to set up the 2nd appointment.
After the first hour, she said she had talked to you for a few minutes and then had done some kind-of dumb tests where you asked her questions about hypothetical situations and also had her put pictures in order, which she felt could have been correctly placed in several orders with an explanation.
Since you did not seem to need my input at the first appointment, she felt she could go by herself to the 2nd appointment and I would not loose the time from work.
She called me about 4:30 the afternoon after her 2nd appointment, which did not last even 1/2 an hour, to tell me of her 2nd experience with you. She wisely waited until my work day was almost over because she knew I would be upset. She said that you told her that you did not believe that anyone under 21 should have SRS surgery, but if they tested above average you might consider it. You then told her that her scores showed that she was below average intelligence.
I called and asked you for a written summary of your evaluation of Danielle, which you sent. In the letter you said "Danielle appears to be experiencing alterations of mood, impulsivity of behavior, social oppositionalism and peer adjustments." And you recommended that she wait 2 years before making a decision on SRS surgery.
Danielle has had a learning disability that we have been dealing with for many years. I have worked very hard to maintain a positive self-esteem about her intelligence. Her two older brothers have always done really well academically and she felt bad because she could not keep up with them. I always emphasized other talents that she has. Since her transition, she has progressed amazingly in her academic abilities and had been feeling really good about herself. She was crushed by you telling her that she was below average intelligence. She was very discouraged at the thought of facing another 2-4 years of having to tuck her penis, of having to take the megadoses of hormones, that she herself knows alter her moods and makes her physically nauseated. The thought of not being able to date as her peers are doing. The fear of being discovered. A teenager with any less maturity might have thought of ending her life.
1. You knew she was 17 when we came to you. You should have been honest with us about your apparent preconceived belief that anyone under should not have surgery
2. I thought you were going to base your decision on an interview with her, not on standardized testing. I did not know there was a pass/fail situation with standardized testing.
3. I thought you understood that people on mega hormones, are emotional and impulsive. It is the equivalent to PMS or worse.
4. If you had talked with me at all, you would have understood that she gets her social oppositionalism from me. Which is one of the reasons that she is doing so well in the situation that she is in. I have always promoted being an individual, questioning authority, not paying any attention to what others might think.
5. You should never have told a teenager who is struggling with so many other issues that she is below average intelligence. That to me is unforgivable. Especially when you are supposedly an expert on adolescent & relationship psychotherapy. I am sorry that I exposed my teenager to you. You did more harm than good. Several times since she met with you she has asked me for reassurance that she really is intelligent. Shame on you.
6. if you had taken the time to know her at all personally, instead of basing your opinion on testing, you would have understood that she is doing really well under the circumstances. She attends a regular high-school full time with a B average. She is not on drugs, does not smoke, or drink. She has a job doing peer counseling through "Planned Parenthood". I often have to be out of town overnight and she is responsible enough to be left alone without getting into trouble. I feel she is wise beyond her years in the insights she expresses in dealing with her situation and the real world around her. (Not hypothetical situations.)