*meeeting A Friend For Coffee* Friend: How's Work Been?

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

This weekend I was told a story which, although I’m kind of ashamed to admit it, because holy shit is it ever obvious, is kind of blowing my mind.

A friend of a friend won a free consultation with Clinton Kelly of What Not To Wear, and she was very excited, because she has a plus-size body, and wanted some tips on how to make the most of her wardrobe in a fashion culture which deliberately puts her body at a disadvantage.

Her first question for him was this: how do celebrities make a plain white t-shirt and a pair of weekend jeans look chic?  She always assumed it was because so many celebrities have, by nature or by design, very slender frames, and because they can afford very expensive clothing.  But when she watched What Not To Wear, she noticed that women of all sizes ended up in cute clothes that really fit their bodies and looked great.  She had tried to apply some guidelines from the show into her own wardrobe, but with only mixed success.  So - what gives?

His answer was that everything you will ever see on a celebrity’s body, including their outfits when they’re out and about and they just get caught by a paparazzo, has been tailored, and the same goes for everything on What Not To Wear.  Jeans, blazers, dresses - everything right down to plain t-shirts and camisoles.  He pointed out that historically, up until the last few generations, the vast majority of people either made their own clothing or had their clothing made by tailors and seamstresses.  You had your clothing made to accommodate the measurements of your individual body, and then you moved the fuck on.  Nothing on the show or in People magazine is off the rack and unaltered.  He said that what they do is ignore the actual size numbers on the tags, find something that fits an individual’s widest place, and then have it completely altered to fit.  That’s how celebrities have jeans that magically fit them all over, and the rest of us chumps can’t ever find a pair that doesn’t gape here or ride up or slouch down or have about four yards of extra fabric here and there.

I knew that having dresses and blazers altered was probably something they were doing, but to me, having alterations done generally means having my jeans hemmed and then simply living with the fact that I will always be adjusting my clothing while I’m wearing it because I have curves from here to ya-ya, some things don’t fit right, and the world is just unfair that way.  I didn’t think that having everything tailored was something that people did. 

It’s so obvious, I can’t believe I didn’t know this.  But no one ever told me.  I was told about bikini season and dieting and targeting your “problem areas” and avoiding horizontal stripes.  No one told me that Jennifer Aniston is out there wearing a bigger size of Ralph Lauren t-shirt and having it altered to fit her.

I sat there after I was told this story, and I really thought about how hard I have worked not to care about the number or the letter on the tag of my clothes, how hard I have tried to just love my body the way it is, and where I’ve succeeded and failed.  I thought about all the times I’ve stood in a fitting room and stared up at the lights and bit my lip so hard it bled, just to keep myself from crying about how nothing fits the way it’s supposed to.  No one told me that it wasn’t supposed to.  I guess I just didn’t know.  I was too busy thinking that I was the one that didn’t fit.

I thought about that, and about all the other girls and women out there whose proportions are “wrong,” who can’t find a good pair of work trousers, who can’t fill a sweater, who feel excluded and freakish and sad and frustrated because they have to go up a size, when really the size doesn’t mean anything and it never, ever did, and this is just another bullshit thing thrown in your path to make you feel shitty about yourself.

I thought about all of that, and then I thought that in elementary school, there should be a class for girls where they sit you down and tell you this stuff before you waste years of your life feeling like someone put you together wrong.

So, I have to take that and sit with it for a while.  But in the meantime, I thought perhaps I should post this, because maybe my friend, her friend, and I are the only clueless people who did not realise this, but maybe we’re not.  Maybe some of you have tried to embrace the arbitrary size you are, but still couldn’t find a cute pair of jeans, and didn’t know why.

Can't decide whether it's funnier to say "my hungry ass could never work at a" and then say something that implies you're eating something truly grotesque or something that just, makes no sense

thinking about how when you experience a lot of shame in your formative years (indirectly, directly, as abuse or just as an extant part of your environment) it becomes really difficult to be perceived by other people in general. the mere concept of someone watching me do anything, whether it's a totally normal activity or something unfamiliar of embarrassing, whether I'm working in an excel spreadsheet or being horny on main, it just makes my skin crawl and my brain turn to static because I cannot convince myself that it's okay to be seen and experienced. because to exist is to be ashamed and embarrassed of myself, whether I'm failing at something or not, because my instinctive reaction to anyone commenting on ANYTHING I'm doing is to crawl into a hole and die. it's such a bizarre and dehumanizing feeling to just not be able to exist without constantly thinking about how you are being Perceived. ceaseless watcher give me a god damn break.

my actual coming out story is in fifth grade a guy named asa was like "hey are you a faggot" and i was like what's that 😨 and he was like "it means you like boys" and i was like ohhhhh then yes ☺️ and then i got home from school and was like hey mom guess what i am ☺️

I actually really like the thing when you're starting to get the hang of a new language, enough to understand and say simple sentences but you gotta get creative to get more complex thoughts across, like a puzzle. I remember a time in the restortation school when a classmate who wasn't natively finnish and did her best anyway dropped something and sighed, telling me "every day is monday this week. I have had four mondays this week." And I understood.

I don't think I speak much of spanish anymore, but in the nursing school training period I did there, I did manage to get by with making weird Tarzan sentences. I got a nosebleed at some point and startled another nurse. Not knowing the words "humidity" or "stress", I managed to string together: "This is ok. It is hot, it is cold, I have a bad day, I am sad, I have blood. This is normal for me." And she understood.

And sometimes you just say things weird, but it's better than not saying it. One time, I was stuck in a narrow hallway behind someone walking really slowly with a walker, and he apologised for being in the way. I was not in any hurry, but didn't know the spanish word for "hurry", but I did know enough words to try to circumvent it by borrowing the english "I have all the time in the world."

The man burst into one of those cackling old man laughters that they do when something in this world still manages to surprise them. He had to be somewhere between 70 and a 100 years old, and I guess if there was one thing he wasn't expecting to hear today, it would be a random blond vaguely baltic-looking fuck casually announce that he is the sole owner and keeper of the very concept of time.

Sex is cringe. "Hey do you wanna come over and play boners together?" What naked bullshit. They have played us for fools.

crazy that in the 1970s they were like, "fine, women can play sports. but because they're innately less athletic than men, only in a special ghettoized League For The Frail And Delicate where they get paid less 😊". And not only is that still the system in 2023, but viciously lashing out at the smallest challenges to that system gets framed as Feminist Praxis