106
[Disclaimer: This
segment is based on my understanding and advice from the early
nineteen nineties, I'm sure the state of scientific knowledge has
improved since then so please only use the details here as a jumping
off point for your own search for answers, not as the sum total of
your knowledge...]
With the Hollywood check received, deposited & cleared, I went
ahead and made an 'initial evaluation appointment' with the best
doctor I could find knowledgeable in intersexed conditions. I was
able to get the appointment before other things came up during the
month of August and I asked Daina if I could borrow her car for the
day so I wouldn't have to use the trick of taking a national bus to
Denver one day, staying over night, and then returning the next. She
agreed and I put down the sense of butterflies the appointment date
gave me as I continued through my next two weeks of College. Finally
the day came and Daina picked me up at my apartment on her way to
work, and then I dropped her off at her job and pulled onto the
highway to get to Denver and the appointment.
Dr. 'Czarnecki' was a family doctor who had come into the intersexed
field through a patient of his who he was already seeing for routine
matters. As such, he was the closest available doctor I could see
about my condition and after fifteen years since my surprise puberty
I might finally get some serious insight into my condition.
Arriving, it was like any other doctor's office and I checked in,
gave my insurance information for future reference and then paid up
front for my initial appointment that wouldn't be covered by the
insurance. I then got to take a seat in the waiting area and
wondered how many, if any, of the people I saw
in there were also of an intersexed background. No clue.
My name was called and I was lead to the doctor's little office room
with his desk, not an examination room. It's always nice to
get to know a doctor before you're told to undress! He was
pleasant and asked about my personal background, first, before
getting into the puberty side. But then we got to the topic and he
told me how rare it was for an intersexed person not to be identified
at birth as checking genitals was a standard procedure after
delivery. I had also wondered about this and it was one of the
things my psychologist, 'Samuel', and I had discussed one time. The
theory was, given my troubled delivery, I was chucked aside without
further examination as the doctors and nurses focused on saving my
mother. I passed the theory on to Dr. Czarnecki and he took it as a
likely possibility.
And so he explained to me that each fetus starts out as female with a
default set of hormone receptors and then a few weeks later half of
those receptors further develop for all fetuses and for 'X/Y'
chromosome pairs the baby will then physically masculinize. In the
case of Androgen Insensitivity Syndrome, though, most if not all of
the receptors remain in their default condition, in the case for
sex hormones that would be for estrogen, and as such the
resulting body has little to any response to testosterone once born.
I could now understand why my body hadn't significantly responded to
testosterone at puberty but I asked how this would explain my
developing as a woman since, as far as I knew, I had nothing to
produce estrogen in my body. He noted that testosterone and estrogen
are very similar hormones and as such a low level of each opposite
type is produced in both sexes while the primary hormone is created
by the body. This is referred to as 'the backwash effect'. Thus
while my body was pumping out a high puberty level of testosterone,
which I had very few receptors to notice it, it was also
creating a lesser amount of estrogen which my body had many
additional receptors to respond to it. Thus in my case a
little went a very long
way.
I told him of the test of my testosterone level a few years back
which had showed I was still at a puberty level of testosterone. He
wasn't surprised by this as, without the receptors to notice the
testosterone level in the body, the pituitary gland sends out signals
for the testicles to produce more and more endlessly. Because
of this perpetual demand to produce abnormal testosterone levels, the
testicles often go cancerous after many years of this. It is
traditional practice to remove the testicles of intersexed patients
as a safeguard against this cancer potential and such would be the
recommendation for me regardless of how I otherwise wished to handle
the rest of my 'situation'. It was time for the physical examination
and I was lead to an examination room and told to undress and get
into a gown while the doctor saw another patient.
When he came in, he reviewed my body, examined my pubic area, over
all body hair and facial hair level and my breast development. He
asked me if my parents had been mostly body hair free. I laughed at
this as I recalled a time I had once seen my father naked and hadn't
realized it at the time given his high level of body hair. In the
case of my mother, I believed it was average as she did shave her
legs and underarms. The physical review was done, it was time for me
to get dressed and meet him in his office, again. He then checked
with another patient in the meantime as I got clothed and made my own
way to his office and took a seat, glancing around at his books,
mementos and degrees on display as I waited.
When he returned he told me that I suffered from Partial Androgen
Insensitivity Syndrome given my male genitals were not fully
developed and my significantly reduced response to the testosterone
in my body. He doubted my body could masculinize any more than it
already had but he wished to redo the testosterone level test to make
sure I was still in the high range. With this as the diagnosis one
option was to remain 'male' and have surgery to remove my breasts and
the testicles and a surgeon could also remove the excess tissue
currently engulfing my under developed penis which would allow me
fewer problems with urination. If I wished I could go an additional
step and have a penile implant put in place which I could use to
participate as a male in sex. I noted that I had never actually been
interested in having any sex. He said this was also not uncommon as
testosterone triggered the sex drive for both men and women,
and without the receptors in my brain to be triggered by the
testosterone in my body, I would likely never have a biological sex
drive. Such was the case for many intersexed people, if not most.
My other option was to live the rest of my life 'female'. In that
case I would still need to have my testicles removed as well as my
existing penile 'nub'. Again this would make peeing easier as I
would have a straight path for urine flow and I would no longer have
to live the rest of my life with my breasts bound for social reasons.
In this case a surgeon would also perform a vaginoplasty which would
allow me to have sex as a female, if I wished, as well as resolve any
questions about my physical sex. In this case, I would also likely
need an estrogen supplement to replace the estrogen level currently
produced with the testosterone in my body. As part of looking into
this option, he would first want to give me an estrogen injection to
see what my response to it would be as, if I didn't tolerate estrogen
supplements, then it would make less sense to take the female route.
Either way, at the very least it sounded like I should have the
testicles removed to be safe, even if I pursued nothing else.
This was a lot to think about and he recommended I should spend some
time discussing it with my counselor. I agreed. In
the meantime he asked if he could give me a B12 injection to see what
my response would be to it. I saw no reason not to and he left his
office to get it as I remained and mulled everything over.
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