Wednesday, 9 April 2008

Who Ordered THAT???

I've just failed my blood test.

Let me explain... every few months, I have to go and see my endocrinologist in Sydney. My peculiar metabolic whoopsie of nearly 3 years ago - the rapid femininisation - is still unexplained. We have a good theory, but we're still in uncharted territory.

It had been hoped that after removal of various dysfunctional glands as part of the genital reconstruction, that my system would follow that of the standard transsexual transition. Transsexual women, with male or mostly male bodies, after Sex Reassignment Surgery, usually have an increased rate of feminisation, even if their doses of hormones are reduced. Typically, they might be on 2 or 4 mg of oestrodiol valerate before, plus an anti-androgen to remove the testosterone, but the latter is not always needed. Some endocrinologists prefer increasing the oestrogen, the female sex hormone, as this often removes the need for anti-testosterone medication. 2mg of oestrogen and an anti-androgen, or 4 without, is not uncommon, though some endos prefer larger doses. 6mg and an anti-androgen is also not that unusual. 8mg and an anti-androgen "nukes it" in extreme cases, for those pre-op.

The dose is then usually reduced, and in some cases removed entirely, when post-op. In some cases again, up to 4mg of oestrogen is maintained, and possibly some anti-androgens to stop scalp hair loss, if that happens. But 2mg is more usual.

I'd been on 4mg, just in case.

Well, now the changes that happened nearly 3 years ago are reversing. My skin and hair oil content has risen. Instead of losing weight dramatically, I'm gaining it, and the psoriasis I'd had for 30 years, which had vanished overnight, has made a comeback. I'm sprouting body hair again too, after losing it all. My eyes haven't changed colour again, at least, not yet, and there have been none of the psychological changes I had before either, thank goodness.

I don't have the blood test results to hand, but they show the usual inexplicably low oestrogen levels - well, low for 4mg intake - a low female level of testosterone, but SHBG levels (sex hormone binding globulin) levels that indicate lots of sex hormones being produced, and immediately being consumed by the cellular receptors.

At this point, I should remind everyone that all my sex glands have been removed. I should be close to a tabula rasa, with only tiny amounts of hormone from other glands, primarily the adrenals.

If the prime theory as to what happened is correct, reversal was always a possibility. One I tried hard not to think about. To me, the genital reconstruction and permanent facial hair removal, the artificial changes, were a way of "putting money in the bank" so to speak. Things that couldn't be reversed, just in case.

My appearance is about 80% from natural causes, 20% from medical intervention. If we play it right, all that will happen is that the "medical intervention" percentage will rise, and I will continue to look normal. Or normal-ish.

The model for my treatment regime now appears to be that of a standard 46xx female with Congenital Adrenal Hyperplasia. It's not CAH, but it's like it in some ways. That would be in accordance with the ultrasounds I had nearly 3 years ago, which showed peculiarities in the adrenals.

I conjecture (a fancy name for a wild guess) at this point that even if I had been born with 46xx chromosomes, I would have looked male. Instead, I have 46xy ones, then an Intersex condition on top of that, which would have made me look somewhat feminised, then a CAH-like condition on top of that to reverse it again. That is in accordance with the theory behind what happened 3 years ago as well. Or it could be something else entirely, we just don't know. Oddly, despite the somatic changes, the rest of my system is boringly normal, I'm in perfect health.

We Shall See. In the meantime, my oestrogen dose has been doubled(!) to 8mg, and I've been given a prescription for the same powerful anti-androgen I was taking "pre-op". Nuking it till it glows.

I'm back in the position I was in three years ago: not knowing what the heck I'm going to look like in a year's time. One thing's for sure though: I will never, ever go back to doing the Boy act. With the medical intervention I've already had, that has become physically impossible, and you have no idea how much comfort I derive from that fact. The gates of that particular Hell are closed, I locked, barred and barricaded them just in case something like this happened. Even if I was dragged kicking and screaming backwards, there's no way I can get there from here. GOOD.

I'm trying to look on this as something most other women suffer at age 50, just a peculiar kind of menopause, and one that might even be halted and reversed. It might be just a glitch, a temporary hiccup. Hopefully, I will look on this blog post as being embarrassingly melodramatic, a mere record of what I felt at a time when my hormones were in chaos. I got the news less than 24 hours ago too, it wasn't a surprise, but it was a shock to have my suspicions confirmed.

I'm just trying very hard to be objective, rational, the scientist, and not under any circumstances to think of Flowers for Algernon.

It's not working. Still, worse things happen at sea, etc. My life has not always been easy, and not always been fun. But it is continuing not to be in the slightest bit boring. I'm surrounded by love and support, and I have my son, who turns 7 soon. Too many blessings to count them all, so I'll stop this post there, and go and have a cup of tea.


Anonymous said...

My Heavens Zoe! I am so sorry to hear about your recent problems. 8mg is a great deal, even more than I ever prescribed myself pre-op. I hope it will solve the problem. I will be thinking of you and sending positive vibrations your way (what few I have).

Don't forget though that at the bottom of the pile of diagnosis you are you and that is the best any of us can be.


RadarGrrl said...

As I've mentioned elsewhere, no matter what this does to you, it will never be able to shut down the wonderful person that is you. This is not a's a hiccup, an IPSR menopause thingy. Never alone!

Mother Bear

Anonymous said...

There comes a point when there is no comment smart-aleck enough to do justice to the situation.

However, this is not in fact that point--I just need more caffeine.

You might enjoy The Android's Dream, by John Scalzi. Despite the accusations of the GZG ECC mob, I was in no way responsible for the book.

Anonymous said...

Life's a ride - hang on in there, Zoe!

Anonymous said...

Holy Snapping duckshit, Zoe!

Murphy just doesn't like you, does he?

Briana and I are thinking of you. and as one of your other friends says, this does NOT change who you are.

I've known you both before and after the change, and I am here to tell the world there is no finer, kinder, more loving friend than you.

Hang in there, OK? you will overcome this. And yeah, look back and laugh at yourself.

many hugs!

Mark (who posted anonymously only because he doesn't have an ID and won't get one ;) )

RadarGrrl said...

Are you who I think you are, Mark?

Anonymous said...

Yes, he is :) And how ARE you??? :)

Anonymous said...

Zoe, I'm sending hugs your way. You are a beautiful woman, your heart and soul are beautiful! You'll be in my thoughts as you deal with this!

Hugs and love from VA!

RadarGrrl said...

I am well. Get Zoebie to send you my e-mail address, k?

Anonymous said...

I asked her weeks ago, but alas, she doesn't love me. I shall have to just munch on some tim tams and pout.

Zoe Brain said...

You didn't get it? Ok, I'll re-send the list tonight.

Lloyd Flack said...

Now that Mother Nature has had her little joke I think it is time you composed little satire. Let her see what it is like to be the butt of a joke.

RadarGrrl said...

That's 'Tim-Tams and POUTINE'!

Calamity Jane said...

Good grief - and I thought I had problems. I prescribe for you what you usually do for me - lots of chocolate. Keep yer chin up) x