“Hardy?” the nurse said. “Andrew Hardy?”
I stood and took a few steps toward the door. The horrible twisting in my gut that normally accompanied the sound of that name was barely present. I was too excited about what was about to happen.
“Andr— Amanda?” Mom said. I turned and saw her standing with her hands clasped, a look on her face like she was afraid this was the last time she would ever see me. “Do you want me to come with you?”
“No, thank you,” I said. I hugged her and backed away again. “I think I need to do this by myself.”
I turned back to the nurse and followed her into a bright, white hallway. She had me stand on a scale and clucked reproachfully when she saw how underweight I was. Then she had me sit on the paper-covered exam bed and took my blood pressure, which was normal, and asked me the usual questions. Did I have any allergies? No. What medications was I taking? Wellbutrin and Lexapro. Did I have any ongoing medical problems? Not really.
“So what brings you to us today?” the nurse said finally.
“My therapist referred me,” I said, my voice barely above a whisper. I hesitated in saying the rest. “I have, um, gender identity disorder. I’m … I’m transgender.” I tore absentmindedly at the paper seat cover and took a deep breath. “I need to start hormones.”
“Okie dokie,” the nurse said, scribbling one last note before smiling and closing my file. “You just sit tight and Dr. Howard will be with you shortly.”
I fell back on the bed, stared at the ceiling, and crossed my hands over my heart. It was really happening. It was really, finally happening. I wasn’t going to grow hair on my chest and back. My voice wasn’t going to deepen any more than the little bit it already had. My shoulders weren’t going to widen. My jaw and forehead weren’t going to bulge. I was never going to grow a beard. All because of this moment. I heard the door open and sat up to see an older man with a thick beard and bald head examining my chart.
“Afternoon, Andrew,” he said, putting down the chart and holding out his hand. I shook it and he smiled. “I’m Dr. Howard. How are you doing today?”
“Good,” I said, and I felt a sudden, unprecedented surge of courage. “But I would prefer it if you called me Amanda, sir.”
“I see,” Dr. Howard said, still smiling. “No problem, Amanda. Let me just make a note of that in your chart.” He made the note quickly. “Let them know at the desk if anyone gives you any problems about that in the future.”
“Thank you, sir.”
“I’ve looked at your chart and gone through the notes your therapist sent us,” Dr. Howard said, “and this all seems pretty straightforward. We’ll start you on one hundred milligrams of spironolactone to block your testosterone and two milligrams of estradiol to replace it with estrogen. We’re starting at a low dose at first because you’re going to have some mood instability and the estradiol can be hard on your liver. I like to ease in so we can observe you and make sure things don’t get out of hand. We’ll bring you in for a blood test in about a month and stay in touch with your therapist and see how we want to proceed from there.”
“Yes, sir,” I said.
“There is one other thing I want to go over before I write this prescription though,” he said. “Your therapist doesn’t seem to have any doubts, and I don’t doubt his skill at his job, but I would be remiss if I didn’t make sure you understand a few things.”
“Okay,” I said, my throat feeling suddenly dry. I was so close, and some small, scared part of me screamed that he was about to take it all away.
“Not to be crude, but you are going to grow breasts,” Dr. Howard continued. “They’ll shrink if you ever change your mind and go off the hormones, but they’ll never completely go away unless you get reconstructive surgery.” I nodded. “And more importantly, you’re going to be sterile within a few weeks of starting the spironolactone. It might be reversible if you stop the hormones within your first year, but after that point the effect is almost completely permanent.”
“I understand,” I said, looking down at my hands.
“All right then,” he said, pulling out a prescription pad and scribbling on it. “Stop by the front desk to take care of your copay and make your next appointment, and I’ll see you back here in a month. Good to meet you, Amanda.”
“You too,” I said, feeling like I was walking through a dream as I made my way back to the lobby.
*