By Paula Gaikowski
Two roads diverged in a yellow wood,
And sorry I could not travel both ― Robert Frost
In 49 B.C., Caesar was confronted with a major decision. Should he surrender or should he march southward and engage Pompey? A crucial geographical point figured in his decision. A stream marked the boundary between Gaul and Italy, the Rubicon. To cross it with an army was a breach of Roman law—an act of open rebellion. Once he crossed, there would be no turning back. It became an irrevocable decision.
Caesar approached the stream; after some hesitation, he issued the command, “Advance!” When on the southern side, he shouted, “The die is now cast.” Those words have echoed across more than 20 centuries; they have become an adage for a decision that once made cannot be overturned without serious consequence and in some cases, not at all.
Dr D’s office is pleasant and welcoming; a comfortable chair awaits his client, and a window looks out over the streets of Boston. It is bright and cheery and reflects how I felt that morning. It was a cool spring morning.
I was dressed in a new Talbot’s tweed skirt and LL Bean black cotton sweater. Like any girl I love wearing a new outfit and as I shuffled thru the streets of Boston among the crowd of commuters, I was just another woman on her way to an appointment. Being able to do just that had always been a dream of mine before I came to see Dr D.
I have been seeing Dr D for about four years and as I look back, I am amazed at how far I have come. In 2009, I was emerging from the darkness of yet another crossdressing purge. But as any transgender person knows, purging doesn’t work. My need for feminine expression had returned with a vengeance. I had tried to solve the problem by myself for 50 years. I tried reading all the books and websites, wrote countless emails to peers and posted on all the forums.
Finding an objective and informed person you can discuss, share and solve your issues with was a key ingredient in my journey. In my case, this was Dr D. I’ve grown a lot over the last four years. I no longer see being transgender as a problem to be solved. I am not doing anything wrong. I’ve cast off society’s condemnation of being transgender and realized that I am a good person and that part of my personality and character involves being transgender. Attributes I see missing in many men, such as nurturing, kindness, compassion and cooperation are parts of my personality that I believe come from my feminine side.
I had reached a plateau of sorts. In the last four years I had moved forward in haphazard intervals. I lost weight, had laser hair removal, shaved my legs, shaped my brows and built a wardrobe. I made friends as a woman and traveled as Paula when on business. I ate in restaurants, went to concerts, had makeovers and shopped for evening gowns.
That morning, as I poured out my feelings to Dr D seeking validation for the incessant belief that I am in fact deep down a woman, that this relentless desire to be female and the need be perceived as a feminine being is not some type of self-delusional parody, he reassured and comforted me and perhaps sensing my angst, suggested, “Maybe it’s time you considered hormone therapy.”
Wow, the room fell silent, the heating vent hummed gently and traffic rumbled by out the on the street.
What unnerved me was how fast I nodded affirmatively and mouthed the word, “Yes!”
Hormone Replacement Therapy (HRT) is one of the watersheds of the transgender journey. I started asking myself how had I arrived at this point? It was hard to believe that the 10-year-old boy who didn’t play baseball after school, but instead ran home to raid his sister’s closet was now at that point.
This was something that other people did, you know, the real transsexuals. Didn’t I say just a few years ago that I was just a crossdresser? Was I deceiving myself back then or was I fooling myself now?
It was a record-breaking winter for Boston, cold and over six feet of snow. And to use a metaphor, it would also be a stormy one for me. I wasted no time calling the endocrinologist. It took a while getting things coordinated between my therapist and his staff, but I finally received a call at work one day from his office. I quickly found refuge in a conference room and a young woman asked, “Why exactly do you need to see Dr S?”
“Oh, gosh,” I thought, “I hope these walls at work are sound proof.”
Carefully and slowly the words came out “I am transgender.” There it was three simple words. It was cathartic, liberating and invigorating to say and hear.
She responded nonchalantly and professionally, “Oh, of course, I see you are being referred by Dr D.”
Her voice hesitated slightly as she inquired, “You are male-to-female?”
Her question took me by surprise and the words just kind of hung out there. I took a deep breath, swallowed and it felt astonishing as the words rolled off my tongue, “Yes male-to-female, female.” I said female twice just to hear it again. I then I repeated to myself I am “to female, going to female.”
The Berlin Wall just fell.
I would have two appointments with Dr S over the course of two months. The Boston weather would reschedule them more than once.
For practical reasons, I would go to both appointments in androgynous boy mode, wearing ladies jeans and top, I wanted to send a message.
At the first appointment, I met a young woman, who was a medical student. Dr S who teaches at Boston University Medical School, is leading a movement to include transgender health in medical school curriculums. It was enjoyable to share my narrative with this future doctor, knowing I was helping my transgender sisters down the road.
Dr S came and asked me a few questions about why I wanted to start HRT. He then outlined the results I could expect from HRT and the risks involved with it. His words on what to expect, “Murphy’s Law!” he began, “My 19-year-old patients looking for breast development are impatient and get little growth or redistribution of body fat.”
“My older married patients, who want to minimize the physical effects of HRT are sometimes surprised by their breast development.”
Most if not all of his patients, he added, are happy to be on HRT once they start. He outlined the dangers of increased cancer risks and the need to stop HRT when I get into my mid to late 60s because of the increased risk of stroke.
He asked that I participate in a study of transgender persons and that if my medical information could be used in that study. I was happy to comply knowing I was helping my sisters.
He wrote up orders for blood work at the lab on my way out.
I closed by showing him some photo’s of Paula, “Wow,” he said, “I think HRT would work well work you!”
The second time I met with Dr S, I also met another group of medical students. They too were inquiring and enthusiastic. I offered to answer any questions they had for a transgender person.
One young woman asked, “Why do you want to use feminizing hormones?”
I thought for a moment and while doing so, looked down at my arm which was waxed smooth and hairless and remembered how disgusted I felt when look at my hairy arms or body.
“How would you feel if one morning you woke up and your arms had male hair?”
She looked down at her arms for a second and then cringed, “I see what you mean.”
My blood work came back very good. Dr S cleared me for take-off and recommended a starting dosage of 1mg of Estradiol and 100mg of Spironolactone. The ball was over the net and in my court. It hit me right between the eyes!
I didn’t want to go into HRT without bringing my wife in on this decision. She typically wants to know very little about my transgender issues and keeps an out-of-sight, out-of-mind philosophy about it all.
I presented it this way: that both my doctors felt a low dosage HRT would benefit my anxiety and overall well-being. She was surprisingly accepting. Her only concern was me developing large breasts. She also added that if I decided to become a woman, she couldn’t and wouldn’t stay married to me. She would always love me, but this was something she could not deal with.
I had a woman who loved me so much, a family, friends, and a career. It was clear what I had. Where would this lead me? What would be the ramifications? It took me only a day to make my decision.
I decided not to pursue HRT. I felt guilty as if I let the woman in me down. Going on a low-dose regimen of HRT was not for me. I’d rather continue expressing my femininity without HRT because a low-dose regimen did not get me what I want in womanhood and puts so much of what I value at risk. But I realized that all women make difficult decisions. Putting one’s self behind the needs of your family is perhaps one of the most feminine acts I could make.
Dr S has left the opportunity open for me to pursue HRT if and when I want. I am glad I went through the process of getting approved for HRT. Having the approval of the medical community has validated and corroborated what I have felt since childhood. Having that option readily available has given me a certain peace and satisfaction.
Rivers start as a trickle and grow as they move through the landscape. Rivers provide life to people, agriculture, drinking water, transportation and energy. My river has grown deep and wide; to change its course now would be complicated; people have become dependent on it.
Oh, if I were at the trickle stage now, living in a post-Caitlyn Jenner world. If I were 20-years-old, there would be a transgender flag in my dorm room and I would set a different course.
However, everybody has that turning point ― a flash or a second, when you know you are about to make a choice that will chart the course for your life’s journey. Choose wrong and there may not be anything left to choose. That’s the conundrum, perhaps, what appears to be the incorrect decision may in actuality be the only way you can complete the journey with self-respect and the confidence of knowing you made the right choice.