“There was, for me (and perhaps most transgender guys), an unspoken need for hormones to be a kind of miracle cure.”
Inject 1mL (200mg) intramuscularly every other week.
It’s noon on Tuesday and I’m sitting at my desk, the metal chair pushed back and angled toward the wall. This particular Tuesday was during the second week in March 2013. For almost two years, I have spent nearly every Tuesday, somewhere between 11 and 12 preparing an injection. My pants are down around my ankles; the old knit upholstery makes my bare thighs itch and I feel exposed.
My ritual typically begins by gathering all of my supplies, which I keep collected in a Ziploc bag. I rip open the alcohol swab and clean the vial first. Then I rub the swab in a large circle on the fatty part of my upper thigh. I learned from other guys that I ought to alternate thighs every time, or every other time at least, to prevent a buildup of scar tissue and reduce the pain associated with ripping apart muscle. I followed this advice for a while and I suppose that I did notice less pain. The swab’s cold and it stings. I toss the wipe into the garbage. I open the pink packaging of the 3mL, 18-gauge syringe. I remove a 22-gauge tip from the much smaller packaging as well, leaving it ready for later.
Finally I prepare a bandage; I started keeping one handy after the second shot. That time, I extracted the needle from my skin and bright red blood squirted in two separate jets onto the wood floor. I stopped the bleeding with my fingers. My jeans were around my ankles so I had to waddle, hunched over, to reach the paper towels. Another time I managed to bleed long stripes onto the cream colored carpet in my room at home. Awkwardly, I had to ask my mom to clean it. It wasn’t that my parents disapproved of me starting hormones; we just disagreed on the timing. They wanted me to wait until I was out of college. I chose to make a consultation appointment at the tail end of my junior year of college. We very rarely acknowledge the shots themselves or the changes they’ve brought.
The 18G needle is a little stumpy looking, thick and maybe an inch and a half long. I jab it into the rubber top on the vial and tip them upside-down. The needle needs to be thick to draw it out to 1mL of the vial’s syrupy liquid—that equals 200mg of testosterone, the rest being cottonseed oil. This is the only part of the process that frustrates me. If I try to rush, I’ll just pull a mess of air bubbles into the syringe, which is almost impossible to fix, except by ejecting it all back into the vial and beginning again. Even the slower draw doesn’t guarantee an absence air bubbles, just a longer session of sitting exposed. Today, two air bubbles pool around the shoulder of the syringe, not quite inside the body of it, but not floating up into the neck either. If they would pool in the neck, it’d be easy to depress the plunger and let the oily substance eject them back into the vial. But since they’re caught in the shoulder like this, I shake the syringe a little and tip everything right-side up. The bubbles stay put. Sometimes these little problems aren’t worth dealing with. If they don’t move when the oil pushes past them now, they won’t later. I ignore the bubbles and continue.
I unscrew the 18G needle with a small jerk and replace it with the 22G. It’s considerably longer, I’d guess two and a half inches, but very thin.
By now, as usual, my legs have started to tense. The problem started after I’d been doing injections for about eight months. My leg had built up scar tissue, and the sight of the needle sent neurons zapping painful distress calls up and down my leg. The needle was halfway in, but it hurt so much I nearly aborted the attempt.
I always use my left hand to spread the skin taunt and hold the syringe in my right. The needle touches my leg and I can feel the sharp tip scratch my skin. I take a breath and consciously relax my leg. Slowly, I force the needle in until I feel the snap of skin breaking. About half of the needle moves easily as it glides through fat. There’s resistance once I come to muscle. My leg tenses again. I take a breath. There’s another sharp pain, but it passes. I go until the entire needle is embedded in my skin. I push the plunger but because the needle is so thin and the oil so thick, it moves down slowly. It takes a few seconds before it’s all inside my leg, being absorbed by muscle, entering into my blood stream, spreading wherever it’s meant to go.
With one exception, no one has ever seen me give myself an injection. I suppose this is partly because I don’t want to gross anyone out and partly because I don’t want to have to talk about it; but it’s also partly because of my last roommate, my first male roommate. Jason and I got along quite well. His best friend was openly gay and Jason was as open-minded as his conservative Korean Christian upbringing would allow. After about three or four weeks of living together, we were at the dining hall and the conversation turned to working out. I was still so scrawny at this point that I felt the need to claim I took testosterone injections to correct a hormone imbalance. He laughed and joked, “Well as long as you’ve always been a dude—you’ve always been a dude, right?” There was a spark of muted horror in his eyes, a desperate fear of seeing a dickless man with sagging breasts strutting around nude. I lied, and laughed as I said, “Fuck off.” We never spoke about it again.
I pull the needle out as quickly as I can bear to, which honestly isn’t that fast. As usual, my skin stings just a bit as the needle leaves my body. This day the tiny wound just dribbles a bit of the greasy cottonseed oil. I place the bandage over it to stop the flow. Afterwards, I pull up my pants. Except for the wrappers discarded in the trash, the Ziploc bag of needles that I slide behind my tea supplies, and the bright red sharps container sitting on my dresser, it’s like it never happened.
There was, for me (and perhaps most transgender guys), an unspoken need for hormones to be a kind of miracle cure. Before hormones, just to look at my reflection—too see my smooth, baby fat cheeks; wimpy, short arms; saggy lumps of flesh on my chest, the fat only equal to about a B-cup; fatty hips forming a natural, unbearable hourglass shape; a young woman’s face disguised to look like a boy’s by bushy eyebrows and short black hair—filled me with disgust. All too often, I refused to speak to people because I knew my voice would give me away. I felt so much smaller and younger than my peers. I didn’t know how to talk to them anymore. But I was certain that a surge of testosterone fueling my body would transform me into a confident young man with a deep voice that would command attention.
I told my mom that I wanted to start hormones because it would make me more comfortable, because then I would be more social and happy. I thought it would solve the depression and anxiety problems I’d been dealing with. My mom thought I was too emotionally unstable and too childish to make any kind of decision. She wanted me to wait until after college. I hated her for this. I could hardly talk to her about any of it. Only a few months after I came out, she called me while I was away at college. I hid in a suitemate’s room, where I hoped no one would hear. I tried to explain the process, the information I’d found out, the guys I had talked to, but all I heard was no, no, no. I saw myself being trapped in that body for life, with its sagging lumps and high voice. My words were trapped in the back of my throat. I remember the taste of snot on my lips and the embarrassment of crying as my suitemates listened from the other room.
In reality, it wasn’t just a desire to go on hormones. It was a desperate, dark addiction. I’d watch videos of other transguys on YouTube and Tumblr. They’d record four-, five-, ten-minute vlogs documenting their changes on T, their biweekly voice changes, their one-year anniversary montages showing the physical changes. Some discussed the problems or changes in their personal lives—work, sex, and family being the big topics. There were product reviews, arguments for or against one type of testosterone versus another. Some guys even recorded themselves doing a shot; some for the posterity of documenting an important injection, such as their first ever or an anniversary, but most for educational purposes. Surgery updates were incredibly popular and I devoured them with an envious zeal.
My mother was right. I was driven single-mindedly toward my goal, seeing only the distant benefits without weighing the costs or consequences, without being able to consider what I’d do if hormones alone didn’t solve everything. But what did she know about dysphoria? What did any of them—my parents, the doctors, the insurance gods—know about the experience of anxiety, restlessness, disgust, discomfort, hopelessness?
It’s generally accepted that before an endocrinologist will prescribe hormones to a transsexual, the person needs some kind of written diagnosis of transsexualism from a psychologist. The Harry Benjamin Standards of Care states an endocrinologist requires a referral from a mental health profession who can assess the following criteria: “persistent, well-documented gender dysphoria; capacity to make a fully informed decision and to consent for treatment; […] if significant medical or mental health concerns are present, they must be reasonably well-controlled.”
I went to a psychologist, an older man who got his PhD working with kids suffering from endocrine disorders and somewhat accidentally stumbled into the world of adolescent transsexuals. My parents approved of him and his slow Southern method; more than anything they wanted a professional opinion of what to do. I was acutely aware that I needed him to deem me trans enough and sane enough to proceed: one, so he’d write me a T-letter, and two, so my parents would agree to hormones. I believed the doctor’s approval was the only way to achieve that, so I lied.
During our first few sessions together, he asked to draw three different pictures. The first was of what I thought a woman looked like. I drew a smaller, somewhat unflattering person with curves and breasts and long hair. (I’m not much of an artist.) The second was what I thought a man looked like. I drew a slightly larger, squarer person with short hair. I drew the most binary, stereotypical, “normal” man and woman because I figured that was expected. But the third was supposed to be me. I fumbled with this for a while. I couldn’t decide if he meant to draw myself as I actually was (smaller with breasts and curves and short hair); as I assumed people saw me (without breasts, since they were bound down, but with the same curves and short hair); or as I saw myself in my head (without breasts, larger, straighter). In the end, I drew a smaller image of the man. I wanted the doctor to believe that I saw myself as male without a trace of womanhood.
After that, I filled out a number of assessments. One listed nearly every body part and asked me from 0-5 what my level of discomfort was. Things like breasts, hips, genitals, height, voice, etc.—the major hitters in the trans world—I marked as 4’s and 5’s, sometimes higher than I really felt. Places that had nothing to do with being trans, like nose and belly and thighs, I gave straight 0’s, even if maybe I was a little self-conscious, just to take any focus off them. Monthly I filled out a short form to assess my level of depression. Was I eating less? Perhaps, but it helped my hips to shrink. Was I moody, sleeping more, tired? Of course, I was a college student. Was I suicidal? – No matter the truth, my answers never scored higher than a 2, well below clinical level. I wanted to be just sane enough, just dysphoric enough for hormones.
I’d chosen a doctor in Buffalo so that my parents could feel involved and so I could stay in touch even once I was done with college, but it added the unfortunate hindrance that my visits had to be scheduled around school breaks. Getting my T-letter should have taken 3-6 months; instead I waited an entire year. At the beginning of my winter break junior year, a year after my first visit, the psychologist decided that I met all the requirements for hormones, that I had enough money to afford them, and that my parents were reasonably supportive. Despite this decision, he didn’t write the T-letter. I just kept agreeing and agreeing—whatever got us closer to the end result, I didn’t care. He wanted to consider which endocrinologist to send me to and I said that was fine. But then he told me in his slow, no longer Southern accent, that I should come back in three weeks and we’d finish up our discussion. My soul sank behind my agreeable façade.
I found my dad’s van down the road, parked on a meter with twenty minutes left. I sat there for a long time, silently shivering. Hadn’t I waited long enough? I wanted to yell. What was there to look into? What more was there to talk about that we hadn’t already covered? What was the point of me driving all the way out there in the morning traffic if not to get the letter that day? But I’d said nothing.
I had hoped, beyond reasonable hope, to call the endocrinologist’s office as soon as I’d left the psychologist, expecting that I could experience the first painful rush of hormones surging through my body before I went back to school. Instead, three weeks later, I returned to the psychologist’s office. I didn’t even receive a physical copy of the T-letter. Just an assurance that the endocrinologist had received it.
A couple of days later, I stood on a street corner outside of a 7-11 and across the street from my on-campus apartment and I called my new endocrinologist. I wouldn’t go home again until mid-March for spring break; the secretary offered me a day in mid-February, just five weeks away. For a fleeting moment I thought about flying home, but I could only just afford hormones, much less a plane ticket. I made an appointment during break and that killed me. Two more months of waiting.
I saw the endocrinologist the first Monday of my spring break. He was a short man with round, thick glasses, a firm handshake, and a surprisingly intimidating way of speaking for such a small man. The appointment lasted at most ten minutes. He wanted me to take Androgel, instead of the injectable forms of testosterone I had researched because he liked the results better. Androgel is a testosterone cream. You rub it onto your legs or chest in the morning and the testosterone is absorbed throughout the day. According to the endocrinologist, this method is superior to the injections. He drew a quick graph, adding two parallel lines to show the maximum and minimum natural levels of testosterone. Then he drew a line to represent an injection of testosterone: it begins well above the maximum, dropping into the normal range, plateauing, then dropping below the minimum by the last day or two of a two week cycle. He explained that this is why they’re not as stable and don’t mimic natural testosterone patterns. Insurance companies rarely cover Androgel for any condition, making it about $100 a month or more than injections. I told him that I couldn’t afford it. He handed me a coupon for $15 off and wrote the script anyway. If it wouldn’t go through, I could call for the other script.
I didn’t want the Androgel script; I didn’t want the stress of organizing a second prescription. But I agreed, I took it, and I left without much protest. I suppose I blame him mostly for the way his magnified eyes loomed over me and the tone in his voice that said ‘this is what we’re going to do.’ And I suppose I did say something, with my weak plea that I couldn’t afford the Androgel. I guess I learned to be indirect with doctors from my mother. I can still picture her sitting in the plastic chair, one leg crossed tightly over the other, her purse hugged to her chest. I was eleven or twelve, prepubescent, a tomboy, an anomaly. My mom wanted to say, “I think my child is different and needs help, but I don’t know what’s wrong or how to fix it.” What she said was, “She’s always wearing boys’ clothes.” The doctor, a middle-aged woman, looked right at me and told me to consider wearing dresses and pink. I learned then, too, to never trust that doctors really care about who you are or how you feel.
After I drove the forty minutes back to my hometown, I tried to fill my prescription. Predictably my insurance had declined coverage. I told the clerk to forget about it and called the doctor’s office to ask for the new script. It turns out that in New York State, testosterone scripts can’t be faxed to pharmacies. I had to drive back to the doctor’s office and pick it up, drive back to Rite Aid and wait. My first vial (a 20-week supply) cost $83.
I bought that first vial on a Tuesday; the next morning, I drove back (again) to the endocrinologist’s office to learn how to inject myself. Sitting beside me on the passenger’s seat were a small plastic bag filled with needles and a little box containing the vial, all stored in a Rite Aid bag. This was shortly before my name was legally changed so I signed in at the main desk as John (Sara) Chapman.
I remember sitting in one of the grey cushioned chairs, holding the bag in my lap, staring at the ground and trying to figure out what I was feeling. It wasn’t exactly nerves. It wasn’t exactly excitement. I felt fairly confident that I was certain about my decision. My whole life was about to change, everything (I hoped) would start getting better. Before long, a nurse with a clipboard ducked into the waiting room. She called out for Sara. I hunched deeper into my chair. The nurse searched the room but no one stirred. She called the name again. I stood and avoided, as best I could, meeting the eyes of the aged diabetics and thyroid patients.
The shot itself was brief. The nurse explained everything in a rush; I was hardly able to see what she was doing. She wanted, at first, to do the shot in my butt, but I protested. I’d be giving myself the injections in my thigh and wanted to be able to see what it was like. She jabbed it in and pulled it out in one quick motion. A bruise was already forming by the time I pulled my pants up.
After that first shot, I started keeping a pretty detailed record of the changes. YouTube and Tumblr blogs seem fairly common among transguys. I think it’s foremost a matter of record keeping so we can go back and see for ourselves how far we’ve come. But it’s also intended to be informational and inspirational for others like us who haven’t yet started or who are wondering what’s in store for them in the months and years to follow. It was important to me to watch my body evolving in the mirror. At week five, I noted, “thicker, faster chin and neck hair growth. Also some sideburns growing in, but not very thick at all.” I was desperate for sideburns. By week eleven, I wrote, “my feet have definitely gotten bigger. I just barely fit into my shoes now.” For a while, this was quite exciting. I went up an entire shoe size. I gained muscle, my shoulders broadened, fat moved around, I grew a little, and suddenly the clothes I’d been wearing for two years actually fit me properly. I looked normal in them.
I made a list of the top five things I was looking forward to once on hormones: (1) deeper voice, (2) sideburns (and facial hair), (3) fat distribution and muscle gain, (4) confidence and self-esteem boost, and (5) facial changes. In fact, the very first observation I made during week one was “throat hurt/scratchy” and a few lines under that “Day 14 – friends confirm my voice sounds lower.” Before hormones, I had so much anxiety concerning my voice because it was so high. It rarely gave me away but I constantly obsessed over the fear that no one could believe a college kid’s voice hadn’t broken yet. As early as three weeks, I wrote, “I feel like my voice has deepened some, and I feel more comfortable speaking in public.”
What’s hardest to acknowledge is the record of my last period. My last one started the day before my second shot; it was early, light, and lasted five days. For a few months, I kept expecting it to resurface.
I never even made a one-year T-versary post. I actually didn’t notice that my one year had even passed until a week or two late. The thing with testosterone is that it fixes most of the surface problems. It makes it easier to blend into society on your own terms and it makes standing naked in the bathroom a little more bearable. But stripping away all those problems forces you to see the root of yourself—lost, scared, confused, disconnected. It’s not the miracle cure that I wanted it to be. As soon as I realized that, the biweekly injections just marked the passage of another fourteen days in a long line of injections.
I hardly realize the significance of this Tuesday as I’m sitting at my desk, giving myself my 53rd shot. The date is March 12, 2013, four days away from my two year T-versary. These five-minute sessions have become just another shot, another chore to remember, another two days of a sore, itchy thigh. There was a time when I looked forward to them. I used every injection as a way of marking time and, more importantly, progress. I saved each depleted vial because it seemed symbolic of my journey forward. Four days before my official two year T-versary, I opened up my sixth vial. It should seem impressive to me that I’ve made it this far.
Recently, Brittany, an old school friend, got hired by the same company I work for. It had been four years since I started the process of transitioning, probably five since we’d last seen each other, and I had no idea what she’d heard from others. I didn’t know if I should tell her about me or just sever the old friendship and begin anew. We worked together for several hours without speaking until she finally came right up to me and said, “I thought you looked familiar!” And I thought, she must know. She must have heard on Facebook or maybe she just recognized me and understood somehow and the greatest cloud of relief passed over me. She knew and understood. I wouldn’t have to bury another part of myself to maintain the facade of being male.
But then, “You’re related to Sara Chapman, aren’t you? Are you her brother or cousin?”
This is the name still on my birth certificate, along with the marker “female.” Luckily, I live in NYS; I can change this once I can document my legal name change and provide letters from my endocrinologist, and from surgeons verifying that chest surgery and a full hysterectomy were performed. My chest surgery wasn’t covered by insurance and the other surgery won’t be either. The combined cost for the two ranges in the neighborhood of $12,000-16,000.
I sometimes manage to forget that I was once Sara Katherine. The memories of high school and of a freshman year in college spent trying to be a normal girl—I see them from my own eyes, but often I can’t remember how I felt. I remember, for instance, my first kiss. His name was Kevin. We met during my sophomore year of high school. It was drizzling out. We stood in front of someone’s tall, untrimmed bushes as a maple tree splashed us in the wind. He took my face with his calloused palms and tilted my lips towards him and covered them with his own. I don’t remember if it felt good. I don’t remember if I even had feelings for him.
Sara is a presence I’ve been slowly removing from my life, but she creeps up when I least expect her. It’s often in pictures I can’t destroy (and perhaps don’t want to?). She arrives in the mail, credit cards wanting her to apply. Just the other day, I saw an advertisement for a presentation I was giving and happened to glimpse the name “Sara.” An irrational flare of fear ignited in my chest. In nanoseconds I was angry that my old name had been used, scared and confused how they had found and exposed it. And then I realized it wasn’t me, but another student presenting.
I’m thinking about all of this now as my two year T-versary approaches. I’m thinking about everything I’ve accomplished, and about the three surgeries and thousands of dollars ahead. I’m also thinking about a moment three years ago when my mom stood on the carpeted section of the basement floor carefully selecting towels and jeans from the laundry basket and moving them into the washer. She was silent for a long time, and then her shoulders dropped, making her grey sweatshirt look even baggier than normal. She leaned heavily against the washer and said, “You’ll never really be a boy. You know that right?” Today, my mom supports me one hundred percent, but even now, after everything, I still feel those words slithering around the back of my mind.
Image by Kevin TS Tang.