hi.

my name is jessica parent. i have an appointment with dr. ====== confirmed on monday dec 14, 2020 @ 14:30. this fax is in reference to the topic of that appointment - and sent by fax because sometimes things are better sent in writing.

the short story is that i'm asking for an rx of cyproterone acetate of 200 mg/day, effective right away, either via direct rx or via sending a note to dr. ======= to ok him prescribing it. dr ======= claims he can't do it without an ok from a specialist. my understanding is that, while this is a safe request, it is an unusual one. but, my situation is unusual, and i will explain it. 

so, that is the reason i was referred to dr. ======= - i need an endocrinologist to overprescribe cyproterone acetate. to my knowledge, i don't have prostate cancer, although it's a frustrating reality that i'd have a quicker path to what i want if i actually did :\. rather, i'm a male-to-female transgendered person that's gotten myself into a bit of a mess, and i need to tell you the story to let you know what i'm looking for.

this is a somewhat desperate request, and i can only hope you enjoy the writing style, in compensation.

while i was on them earlier and put the transition on hold for longer than initially intended, i initially started taking hormones in 2009. they were prescribed to me by an endocrinologist in ottawa named dr. ======, who, amongst other things, put me on 100 mg of cyproterone acetate per day in order to aggressively suppress testosterone. dr. ======= was both an endocrinologist and a gynecologist who ran a fertility clinic that carried out some unethical practices and is now barred from practicing medicine. but, to the trans community in ottawa, he was the only doctor there was. being able to see an endocrinologist for treatment meant that he was not bound by clinical recommendations around dosages the way that my gp is. while i simply followed the recommendation of my doctor, i realize in hindsight that this was a powerful dosage with the intent to completely ameliorate any testosterone production at all.

and, in fact, it worked exactly like that. it took a few months to kick in, but i then experienced more than five years of essentially 0 testosterone production. this meant i had absolutely no male sexual urges, never masturbated, and would have been unable to produce an erection at the most urgent plea for one. i was fully chemically castrated. and, i not only got used to this but absolutely loved it. i was happier in those years than i've ever been in my life.

but, cyproterone is a drug, and i am a user of it, so, as is this case with all drugs, i eventually developed a tolerance to it. it was around 2017 that i first noticed the return of symptoms of rising testosterone. so, i went to my doctor and initially asked for a voluntary orchiectomy, which i'm still trying to work out due to delays (some on my behalf due to finances, some on behalf of the doctor's office, which apparently lost my application for over 13 months). when the doctor tested me for testosterone, he claimed it was very low, but that didn't address the symptoms i was experiencing. we agreed to look into surgery as an option, rather than prescribe further medication.

when i came back the next year, my testosterone, while still very low, had doubled. the symptoms had increased further, but it was still at such trace levels that the doctor insisted it didn't make sense to prescribe further.

and, when i came back in 2019 and again in 2020 it had doubled again and again, in the midst of continued delays around the surgery, until i decided i had to take action this year.

so, in 2016 my testosterone was 0. today, it's around 0.8, which my doctor doesn't seem to understand is a problem for my quality of life. i want it back at 0, like it was.

my doctor initially suggested i move from cyproterone acetate to spironolactone, but that seems to have been in the context of misunderstanding what i've experienced and what i want. i took his advice, and filled an rx, but i never took any spiro. in fact, the maximum safe dosages of spironolactone appear to be unable to suppress testosterone beyond the levels i was experiencing at that time (the spiro would increase the levels from .8 to 3!), so moving to spiro would mean i would have to expect an increase in testosterone production. and, this may even be desirable for certain people that are approaching their transsexuality from the filter of a previous life as a homosexual male. that is, if somebody wants to go into transition and maintain a healthy sex life, then some level of testosterone production is going to be desired so they can continue to have sex.

but, i am not entering into this with a history of living as a homosexual male and i am not interested in maintaining a sex life. this is the point i don't seem to be able to get across effectively. i want total annihilation - i want zero testosterone, like i had from 2010-2017. i want to be unable to have an erection, again.

so, i ripped up the spiro rx, and doubled the cyproterone to 200 mg on my own, expecting my gp to fill it. but, he didn't, and i couldn't reach him for months for an explanation. this was at the beginning of june, and i then spent all of june, july and august taking 200 mg/day, and waiting for my gp to update the rx accordingly.

it wasn't until the end of august that i got a clear answer that he could not update the rx, and i found myself forced to move from 200 ack to 100 until i could speak to an endocrinologist.

unfortunately, at this point, the suppression is barely working at all. i'm experiencing unwanted erections on a nearly daily basis, as well as angry feelings and suicidal thoughts as a result of it. i'm extraordinarily unhappy and can't do anything about it.

the best answer would be an emergency surgery. but, as of now, due to the pandemic, voluntary surgeries are not likely to occur any time soon. worse, i would need to go to toronto to do this because there isn't a urologist in windsor willing to perform this kind of operation - every single one of them appears to have a religious opposition to it - and the greyhound & trains are all canceled...

as the drug is currently barely working at all at the prescribed dosage of 100 mg/day, i don't feel i can wait until december to speak with dr. =======.

as dr. ======= is aware, this drug is not dangerous, and is routinely prescribed at much higher doses than 200 mg/day. the problem is just that the clinical recs for trans people (as set in the literature) are well below that. but, it's with the assumption that surgery will occur well before ten years. if i had had the surgery before 2016, the drug would have worked the way it as supposed to at the recommended levels. but, coming up on 12 years of daily cyproterone use is highly unusual, and requires unusual dosages to maintain efficacy.

i understand that we haven't met, but i'm really in a crises point. and, i would certainly like to see dr. ======== in december, regardless. we may even decide to go higher than 200, if testing suggests it's necessary to get back to absolute 0 testosterone.

but, if there's any way to give dr. =========== the ok to overprescribe to 200 mg as of, like, now, that would be about the only thing that's really going to help me get back anywhere close to 0 before i implode in a fit of rage and self-hate.

i would appreciate some kind of response, whatever the answer is.