i'll write a first person blog narrative tonight or in the morning.
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I feel it's necessary to produce some background information. That is, I'm going to tell you the whole story...
I am a male to female transgendered person that has been on hormones for most of the last twenty years and checks levels roughly once a year. I also have a diagnosed stress disorder; initially i was diagnosed with ptsd, which was later altered to social anxiety disorder, but the differences between these things are not entirely clear. what is clear is that i suffer from stress and anxiety in profound enough ways that i am considered to be unable to work, and currently live on odsp. Unfortunately, I have been noticing that my testosterone levels have been creeping up over the last several years due to the onset of tolerance to the testosterone-suppressing medication (cyproterone acetate), which has been decreasing the efficacy of the estrogen (the feminizing hormone) and having a general masculinizing effect that i've been taking steps to try to undo. In addressing this concern, i've run up against the problem of already being prescribed a high level of testosterone suppressors, and needing to take some other kind of approach to get testosterone levels down to full suppression.
It was decided at my 2017 appointment that, because i was already taking such a high dosage of cyproterone in the context of gender transition, it would be better to have my testicles removed than to try to increase the dosage; while the drug is considered clinically safe at relatively high dosages, and i still had a ways to go before concerns became relevant, if i were to continue to increase my dosage of this medication indefinitely, i'd eventually run up against the potential of damaging my organs, like my liver. it was just time to take the next step in transition, which is removing the source of bodily testosterone, allowing for a reduction of a drug that can have longterm consequences, rather than increase it at the potential of eventual harm, one day.
I saw a urologist in 2017, but he refused to remove my testicles as an elective surgery for what seemed to be religious reasons. While i considered launching a claim at that time, i was in a conflict with my landlord over second hand smoke (i had recently quit smoking) that preoccupied my time, and i ended up with little choice but to put the process off. it wasn't until my 2019 appointment that we made a more serious attempt to have the testicles removed, but when i returned for my 2020 appointment, i learned that the funding request got lost in the office (i had called several times to ask for the status, and was told in error that it was in process).
I also learned at the 2020 appointment, which was at the beginning of june of this year, that my testosterone levels had doubled over the last year, which was consistent with what i was feeling. Given the realities of elective surgery around the pandemic, and the fact that my funding request had been lost, i found myself in a crisis point and suggested that the dosage of cyproterone acetate be increased to prevent the onset of further remasculinization. My doctor instead suggested i try spironolactone if i was unhappy with the cyproterone, and i accepted a prescription, but when i got home and did research into it, i learned that (1) the spiro is less effective than the cyproterone (so switching didn't make sense) and (2) the spiro has more severe complications at lower dosages, indicating that it would make more sense to double my dosage of cyproterone, if what i was concerned about was primarily the safety of the drug. i also double checked that my new dosage was safe by checking the data sheet for it, and learned that i was moving from 33% to 66% of the maximum safe dosage. so, i cancelled the new prescription and sent a fax to my family doctor to double the rx of the initial prescription. as i was confident in my own research, i just merely assumed he would act upon my request, and went ahead and started doubling up, assuming that the new rx would be available for me on my next renewal.
however, when i went to renew, i found that the doctor had faxed back the initial rx for the dosage i was previously on, without explanation. i assumed this was an error. so, i asked the pharmacy to fax back a request for a doubling of the rx a second time, and continued with the increased dosage. i also received a letter in july, indicating that my funding request for testicular removal had been granted; by that time, however, i'd already increased the dosage and decided to stick with it until i could see the doctor next. this carried forwards until the end of august, when my rx ran out and i tried again - with the same result. i took my last cyproterone dosage at 00:00 on august 31st; i needed to find another dosage by noon.
on the evening of the 30th, my pharmacy informed me that, while my rx was still valid, i would no longer be able to bill my insurance company for it because i'd already used up the rx until mid october. i would either need to pay out of pocket (an impossibility, considering my disability status) or ask the doctor to double the rx, to conform to what i'd been taking since early june. worse, my appointment with my family doctor had been postponed at this point, apparently because he was out of the office until mid-september, so i would be unable to speak with him directly.
the pharmacy sent another request on the morning of the 31st, and received back exactly the same response, confirming the initial rx.
baffled by this, i went into the dr's office and spoke with a doctor that was covering for him, who told me that the reason they kept sending back the initial dosage was that there were treatment guidelines that would not allow for a dosage beyond what i was taking. that is, i was already maxxed out on the cyproterone. i explained the situation to him, but he told me his hands were tied - he was *unable* to increase the dosage without exposing himself to liability, and would not do so. while he agreed that the dosage i requested was technically safe in the short term, he insisted it should only be prescribed to prostate cancer patients, and was not moved by my insistence that it was short term, until i could have my testicles removed, as a cancer patient might. he told me i'd have to pay out of pocket, knowing i could not.
so, faced without options, and feeling suicidal, i took myself to the er to explain the scenario - after twenty years of being female-identifying, that is essentially my entire waking life, i was forced with the inevitability of imminent detransition, without there being anything i could do about it. while i did not want to kill myself, i was fully cognizant that the effects of remasculinization would be too much for me to bear, and that i needed immediate intervention to prevent myself from falling into a downward spiral of depression that would have no conceivable endpoint besides me taking my own life. this was a very stressful realization; as mentioned, i suffer from a stress disorder, so an episode of some sort was inevitable, and the er was the right place for me to be while it was happening.
while waiting in the emergency room at the ouelette campus of the windsor hospital, i found myself badly triggered by the temperature. i was wearing a tight-fitting pink tshirt and a pair of stretchy jeans; i would have needed a winter jacket and a toque to feel comfortable in the temperature in the waiting room. while my inability to climatize to even the slightest amount of air conditioning is a known condition for me, i was not able to prevent myself from becoming episodic, and found myself engaging in erratic behaviour to try to warm up - running back and forth across the er room, running on the spot, swaying side to side, and sort of bicycling in motion while sitting in the chair. this attracted the attention of security, who demanded i stop, and this is where the complaint begins.
while this behaviour may have been slightly annoying, it was not threatening to the people around me, and i felt that preventing myself from falling ill due to the cold - something that i know from experience was of serious concern - was of greater importance than stopping some of the other patients from feeling annoyed. i know that i've been in er rooms where patients were experiencing far more annoying symptoms, due to schizophrenia or even mental retardation, than i was; dealing with people having mental breakdowns in whatever capacity is a part of the experience of going to the er, and they'd just have to suffer the minor inconvenience, which is all that it was.
the security guard, however, took it upon himself to get very aggressive with me at this point. first, he asked triage to discharge me without being seen by a doctor, which was granted by the nurse - who i had told moments earlier i was suicidal and episodic. so, i need to get that point across: i told the nurse that i suffered from anxiety and was at the er because i was suicidal and episodic, and she discharged me for being episodic. so, i was asked to leave for displaying the behaviour that brought me to the er in the first place.
rather than leave on request, i cited the canada health act and insisted i had the right to see a doctor when suicidal under stress from anxiety. the security guard on duty, who i later learned was named ryan, denied the universality clause in the canada health act and called the police to remove me from the property instead.
initially, the police attempted to remove me by force, but when i resisted they realized that i was having a mental health episode and relented. after all, when the police are faced with an individual in a mental health crisis, what they do is bring them to the hospital, which is where i already was. after some discussion and debate that i only vaguely remember due to being episodic, but that i recall was at times very heated, the police left the premises. i was called into the hospital shortly after that, but what follows is a continuation of the initial point of conflict, as security clearly felt i should have been removed.
the nurse i saw after triage was the one bright point of all of this and rather kind, as she realized i was shivering due to the air conditioning and brought me some warm blankets. the episode left me both physically and mentally exhausted, and i found myself falling asleep once i got under them - first it was two blankets, and then it was three more, and i could have used another ten to really warm up. this just demonstrates the extent of the situation, and how cold i really was.
i spoke very briefly with a dr. attan, who told me he could prescribe me a dangerous opiate (which i refused), but would not take my request for cyproterone seriously. he told me he'd take a look at my file, and did not return to speak with me. instead, i was asked by the nurse to provide blood & urine samples, and then eventually falsely accused of being under the influence of methamphetamines (something i've never taken before in my life!).
so, to recap: a patient who is diagnosed with a stress order (myself) entered the hospital in a suicidal state due to fear of detransitioning, and when she demonstrated symptoms of that stress disorder due to a real fear of an inevitable traumatic event, she was refused serious treatment, offered opiates as a treatment option instead and then told she must be on methamphetamines, instead of acknowledging the trauma she was experiencing.
if that was not outrageous enough, a psychiatrist (who's name i did not pick up) then appeared to try to talk me through the meth addiction. he asked me a number of questions, including whether i suffered from depression, and if i would take anti-depressants; i told him that i am diagnosed with anxiety, not depression, and would not take drugs for something i have no diagnosis for, and little suspicion i suffer from. further, i felt the best treatment for the anxiety was access to the testosterone suppressant, given the totality of the situation. what the psychiatrist essentially told me was that i should get used to detransitioning, and while he would prescribe me medication to deal with it (an opiate, or an ssri), he would not do anything to prevent it. when i told him that i did not want to detransition, he became agitated, accused me of manipulating the system for my benefit, told me i was lying when i claimed i was episodic and suicidal and then discharged me without further concern, insisting it was my choice if i killed myself over the effects of detransitioning.
at that point, this was all too much to take, and i decided i would starve to death, on the spot; the psychiatrist demanded that i immediately leave the premises, and called the police back in when i refused.
when the police arrived, i told them that i would not leave, and they could do with me what they will, as i no longer had any will to live. the police repeated the accusation that i was lying, as presented by the psychiatrist, and insisted that i was trespassing after having been discharged, and i could go die somewhere else if i insisted. at one point, i was told point blank by security, who was called into help remove me, that they didn't care if i killed myself or not.
some combination of security & the police (four large men, all and all) then handcuffed me and dragged me out of the er, yelling and screaming, and brought me to a holding cell in the windsor police station, where i was ticketed with trespassing on hospital property and released within a few hours. the ticket says 8:53 pm; i made it home a little after 00:00 on september 1st. the sergeant seemed pontius-like; he didn't think i did anything wrong, but felt the obligation to obey the requests of hospital staff.
as it was now after midnight, and i was still without access to the testosterone suppressors, and consequently still suicidal, i felt little choice but to make sure i had a sweater this time and go back to the hospital, to try again. what else was i going to do? what i hoped was that the staff had turned over, and i would be able to get a second opinion.
while the staff had indeed turned over - there was a new security guard, and new nurses at triage - i did not make it in to see a doctor the second time. instead, the police were called in to remove me from the waiting room before i was allowed to see a doctor. when i told the police i was suicidal, they seemed to take me more seriously than the doctors did, but they ultimately had to defer to the diagnosis that i was making it all up, and lying to manipulate them into prescribing, forcing me into making the choice to have to actually make an attempt to kill myself to prove the psychiatrist wrong, rather than have them react rationally to try to prevent me from actually doing that. i was arrested a second time at about 3:00 on the morning of the 1st and held in a cell until 8:30 am, when i was ticketed a second time and told i'd be charged criminally if i went back to the er, presumably leaving me to my own devices to die on the street.
while i intended to go back to the er, i did not doubt that they would arrest me a third time if walked right back in, so i decided to try a different approach; my family doctor was now open, as it was the morning of the next day, so i walked to his office and presented myself to reception, who told me he was not in the office. i told the receptionist that i would not leave as i had no other options surrounding existence, and asked her to make a decision to either call an ambulance to take me to the er (would they arrest me if i came in in an ambulance called by a physician's office?) or call the police to have me removed. the receptionist refused to make that choice, as she was not a doctor, and suggested i ask a walk-in clinic to make the choice instead. i decided that this was more likely to get me to the hospital in an ambulance, which was the choice i wanted made, and went to the closest clinic - which was closed, due to the pandemic. i tried a few more, and they were all closed as well. so, i decided to go home and make some calls to see what the best way to get into the hospital was, or maybe to try the other er campus (the met campus) in town. i first sent a fax to the windsor hospital when i got home, and then called my pharmacy to inquire as to the price of a very small supply - as i had now been off suppressors entirely for nearly 36 hours, and was starting to feel the effects. if i could buy a week's worth, it could prolong my life until i could convince somebody to prescribe...
thankfully, i got some empathy from the pharmacist, who fronted me a month, and that ended the crises for that time. it remains to be seen if i can either quickly have the surgery i need (which is now the priority) or find an appropriate doctor to overprescribe until i can.
while i take some responsibility for user error, as it is, the reaction by the security staff, the initial doctor and then the psychiatrist were outrageous, and there is little doubt in my mind that i would have been treated differently if i were a ciswoman seeking comparable treatment. neither the psychiatrist nor the doctor accepted my stress disorder as real or saw hormone replacement as an acceptable outcome - they both wanted to treat me as a drug addict, and ultimately prescribe me drugs for depression, instead (would they receive royalties for that?). this refusal to accept the premise of gender dysphoria as an existing condition at all, and clear insistence that i accept detransition instead, was a blatant demonstration of bias and an overt example of discrimination.
it could be many years before i'm able to approach the health care system in the same way again, if i ever can at all.
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well, i was threatened with arrest three times and arrested twice for the crime of presenting myself to the health care system under extreme duress in the middle of a suicidal episode, and accused of lying about it by two doctors in order to manipulate the system, as a welfare recipient. i then spent roughly eight hours in a holding cell, instead of receiving medical care. this has severely shaken my faith in the health care system, and left me unclear as to how to react the next time that i suffer from my stress disorder, to the point that i have suicidal thoughts. will i be told i'm lying and arrested? put in jail? sent to county? i feel like i've been barred from receiving care, due to being transgendered. it's deeply traumatic, but they'll just tell me i'm lying if i push the point. while the past cannot be undone, and i will always live with the trauma of what happened, i feel that some kind of lesson needs to be learned, and some kind of changes need to be made. further, i feel that i should be compensated for what i went through.
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