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I have officially started hormone treatment!

This past week I managed to find a way to stop running from the decision to start hormones by changing my outlook towards it. I’d previously viewed it as a monumental change of lifestyle and it felt like I was standing at the edge of a high cliff above a wildly crashing sea, trying to summon the courage to jump off. While it is a major decision which will change my life, it’s not something that will do so the day I start hormones and I have now built, along the side of that cliff edge, a gradual and winding pathway down to the shore, where there are calmer waters than I’d first thought. The changes which will occur will take time and these will be both physical and emotional. As I see the physical changes in myself, I can consider my options en route, as they develop. It’s a pivotal but gradual process rather than a redefining event, and with this in mind I’ve accept the permanent changes that hormone treatment will cause and can now start something which I expect will make me a happier and a more centered person. After all it’s very important to realize that I am not changing who I am by starting this process; I am changing only my physical attributes. I remain me, with my own personal sense of fashion, style, and attitude. My mental state may change with the new hormonal mix going on in my body and towards how I perceive myself and how others perceive me, but I will remain inherently me.

I arrived at Yanhee Hospital shortly before my 8am appointment and was immediately impressed with the facility, being greeted in the International Customers reception by a personable young man who was expecting me. I’ve previously mentioned that I’ve seen reviews of Yanhee which were none too complimentary, but from this one OPD appointment, my immediate impression was favorable, especially of the doctors, nurses and staff who were without exception friendly, helpful and professional, going out of their way to assist.

They were running about ½ hour late, but at any hospital visit, you need to prepare for a lot of waiting around, and Bangkok’s hospital whether you’re paying privately or not, are no exception. Still, the hospital is clean and comfortable with complimentary fruit drinks and water available, so I relaxed in a sofa and messed around on my phone for a while.

Mindful that I am diabetic and had been fasting since 7 the night before in readiness for my blood test, they had me see Doctor Patcharin in Endocrinology as soon as possible where we discussed my needs (noting my request to test for HIV) and she reviewed the documentation of tests done previously at St Louis Hospital in preparation for hormone treatment as well as my blood sugar and cholesterol history. She seemed quite surprised at first that I wasn’t currently considering any surgery. After this I was directed to the blood lab where 5 vials of blood were taken by two very friendly ladies who were excited to speak to a Westerner who could converse in Thai (to some level).

Finally I could have some breakfast! The only obvious place within the hospital was a Café Amazon which had very limited seating (6 chairs in total, at 3 small tables) as well as a limited choice of fresh food, but very nice coffee. I had a tuna mayo sandwich which wasn’t too sugary (a lot of “locally made” food out of areas popular with tourists can be quite sweet) and a coffee and was fortunate to get a table.

As it would be 2-hours before the results of my test were ready, I took my time at Amazon enjoying people watching and trying to spot how many staff and patients were also transgender, considering this is the No. 1 hospital for sex reassignment. There were a fair few around I could guess were male to female transgendered, but all Thai (no fellow Westerners) and all were so passable as to make me uncertain.

Psychiatric Consultation

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After about a half hour I returned to the nurse station and asked if I could see the psychiatrist before the results were ready, and with the doctor’s agreement a nurse escorted me to the psychiatric ward on the 10th floor where I was led into a private room and provided with 2 questionnaires to complete without supervision in my own time, as surreptitiously photographed by me below. Again, these questions approached the topic with the assumption that the patient is going through full sexual reassignment surgery as was the initial assumption of Dr Patcharin, and I found myself not answering them 100% truthfully, but to some extent putting what I thought they would want to hear; what I thought would be the “right” answers. This included the way in which I over emphasized the characteristics of the people I was required to draw, with the female consciously being the gender choice where it wasn’t specified and which I made very curvaceous. With the male, I exaggerated the muscle mass, and gave him broad shoulders and a square jaw. I most likely would have drawn a female when asked to draw a person anyway, but the way in which I drew her was very much influenced by the circumstances, and my personal goals for the exercise.

After handing these in at the nurse desk I had a 10 minute wait before seeing the psychiatric doctor who only spoke Thai, and my interview was conducted with interpretation from a bilingual nurse. This is what I’d been dreading and I had worried about it for weeks; the idea that someone who doesn’t know me at all will make a judgement call on whether I can or cannot proceed with something which I have taken years to reach a carefully considered decision on. The idea that, after making my informed decision and taking this step, they could deny it to me based on my performance at interview annoyed me. After all, who is more qualified to make that decision than me? Intellectually I appreciate that the hospital must protect themselves as well as the patients by making sure patients are ready for what hormones will do to them, and that they are in a sound state of mind. I applaud them for doing it and it is a small hoop to jump through when compared to the requirements of starting treatment in the UK, but as I am also seeing a private counselor for gender issues counseling, it made me uneasy.

Again the psychiatrist was very surprised that I was not considering any surgery at this stage, and I did find myself to a degree saying things that I would expect them to want to hear rather than the 100% truth of the matter. The psychiatrist wanted to know if my intention would be to change my gender legally in the UK, and I had answered honestly (and to their evident appreciation) that this journey was about me, not about any legality. It did give me food for thought though. I obviously have considered it, but not in any huge detail, and my legal standing once I appear for all purposes female, is something I need to look seriously into, as is the process for changing my name, of which I am completely ignorant.

Towards the end of the interview the Doctor informed me that she would greenlight me for hormone commencement and arrange to consult with me again in 3-months time as an ongoing assessment. Luckily after I explained that I am seeing a qualified psychiatric counselor for this issue on a fortnightly basis, she conceded it was not necessary to revisit her, if I could ask NCS-Counseling to provide notes on my treatment.

That done I had another little wait in the psyc ward while the psychiatric compiled her notes and then the nurse returned me to Dr. Patcharin’s waiting room, avoiding the document “runners” who whiz round the hospital floors on rollerblades with neon flashing wheels ferrying patient profiles from one department to another.

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Results

HIV negative thank God. My blood sugar was a little high, though not worryingly so at 160 (where it should be under 130). After a mild slap on the wrist for that, Dr Patcharin explained that she would prescribe the same pills as I’ve been on, in the same dosage, for my diabetes and cholesterol (albeit a different brand) and we’d check the levels again in December. She also prescribed 2mg tablets of Progynova Estradiol (estrogen – 1 to be taken daily after lunch) and 50mg tablets of androCUR Cyproterone Acetate (testosterone blocker – ½ to be taken daily after lunch). She wanted me to start with the estrogen immediately, and commence the testosterone blockers from November 1st. That way if I experienced any ill effects we would know which pill was the cause. One possible side effect of estrogen she advised me of, which I’d not come across from my online research, was a brown discoloring of the cheeks. To avoid this I should not be out in the sun too much and use adequate sun screen. (I have a habit of burning then going back to white after if I get too much sun anyway, so I generally avoid it and am hoping it therefore won’t be a problem for me.)

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The penultimate stage was to pay and get my meds! After a short wait I was called up to pay the sum of 16,000 Baht (around 355 pounds), 1,000 Baht of which would be covered by my medical insurance for OPD costs relating to diabetes. With 2,500 Baht being psychiatric evaluation, a significant amount of the bill was meds to see me through the next 3-months, with the rest being doctor fees and laboratory blood work. As I’ll need blood tests every time I attend the hospital, subtracting the psychiatric fee and 1,000 Baht insurance discount, I will paying around 90 pounds per month in total (4,167 Baht) for tests and meds for both diabetes and my hormone regime, which is quite manageable. (If I didn’t have the insurance, it would then be approximately 100 pounds per month.)

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So laden with a big bag of pills, my last stop was back to the International Customers Counter to collect a medical certificate enabling me to claim (directly to Bupa) my 1,000 Baht OPD allowance to be refunded to me. Usually just by showing this card upon registration, the discount is automatically deducted from the bill, but in some hospitals like Yanhee, Bupa doesn’t have a direct arrangement and it must be processed by medical certificate claim.

Certificate in hand I was elated and climbing into a taxi, excited to get home, have some lunch and take my first pill. Not even my taxi driver, who I named “Lurch” for obvious reasons, could bring me down, (though I maintain that if you’re legally blind, taxi driver might not be the best occupation to choose).

I’m nearing 24 hours after taking my first pill, and without the introduction of testosterone blockers until November, I’m sure what changes I’ll notice and when, so I will carefully monitor and note everything that occurs. After the weekend (as I have an old friend coming to visit) I’ll take some baseline photos of my body as a reference. This is it – the journey has begun in earnest!

Part 7

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