Prescription Insurance Blues

My current employer recently changed the way it funds its employee health insurance policies--and its prescription plan.

I haven't been to a doctor since the change, which took place on the first of last month.  However, yesterday I went to pick up a refill for my estrogen (Premarin) prescription.

The last time it was refilled, in August, I received a 90-day supply for a co-pay or $45.  That had been the cost almost from the time I had my surgery, about five years ago.  Before that, I was paying ten dollars for a 30-day supply.

When I went to the Callen-Lorde pharmacy center, the clerk told me that, according to the current plan, I am allowed only 30 days at a time.

That, in and of itself, would have been nothing more than an inconvenience. But the next bit of news she gave me could have a real impact on my life:  It's now $81.24 for that 30-day supply.

When I called Express Scripts, who manages the plan, the person kept on saying "I hear you, I hear you."  When I asked for an explanation, he said, "Well, it costs more now."  Well, duh.  He said I'd have to contact the insurance company, whose name he didn't have.  

"That price is for in-person pick up," he said.  "If you want it mailed to you, you can get a 90-day supply for $243.72."  Now, the highly atrophied part of my brain that does math couldn't make the calculation on the spot, but it didn't sound like a discount--and, of course, it isn't.  

"So how did the price more than quadruple in the three months since I last got my prescription.  Did cows become an endangered species or something?"
(Premarin comes from pregnant mares.) He repeated, "It costs more now."  Then he gave an ever-so-helpful suggestion:  "You should call the insurance company."

That office--or, more precisely, the office of the person who administers the plan for my employer--was closed by that time.  I left two voice mail messages yesterday: one in the morning, one in the afternoon. The second time I called, I was switched to the main number, where I was told the person I needed to talk to was "out to lunch".  On Friday, you know what that means.

I hope to hear from her on Monday.  How, exactly, does a drug I need go from $45 for a three-month supply to $81.24 for one month?

When Transgenders Self-Medicate

For about nine months before I began to live and work full-time as a woman, I was taking estrogen and Spironolactone.  For about a year and a half before that, I was attending support groups and participating in various activities related to the community, some of them at the LGBT Community Center in New York City.

At a Center event, I met a trans woman who was probably a few years older than I am now.  I don't know whether or not she ever had the surgery, but it was easy to see that she'd been living for a long time as a woman--and, most likely, taking hormones.  I also suspected that she had--or might still have--been involved in sex work.

I haven't seen her in a long time, but early in my transition, I was bumping into her everywhere--or so it seemed.  She always had advice--some of it good--on some aspect or another of the life on which I was embarking.  Thankfully, I ignored what was probably the worst advice she gave me.

"Forget about the doctors, clinics, even--what's that place you go to?"

"Callen-Lorde", I said.  

"Yeah, forget about them.  Forget about all of that.  You have to go through so much to get your hormones."

"I've got them."

"But those horomones will take forever to work on you."

"Well, I am on a low dose now.  So far, so good.  As long as my next tests are good, my doctor'll up my dosage."

"Still, it's going to take years and years for them to work."

"Well, I've had to wait years to get to this point..."

"Don't you want to have a woman's body soon?"

"Yeah. But..."

"Well, I can get you some German hormones."

"German?  What's the difference?"

"Well, you know, German girls are bigger.  So they get stronger hormones."

I squinted at her.   She pulled a package from her bag.  I know a few dozen words of German, but somewhow I knew, just from looking at that label, that ingesting those hormones wouldn't be a good idea.

Later, I learned---from where or whom, I can't recall--that a lot of trans women--especially young ones engaged in sex work--buy those German hormones, which are meant for livestock.

I mention this incident because I came across this article advising trans people not to self-medicate with hormones.  Turns out, there are a lot of discussion groups about that very subject, including some on how to go about getting hormones from outside the medical establishment.

The temptation to do so is great, especially for young trans women, many of whom have run away from abuse at home or bullying at school and have no medical insurance or other resources and are scarred by prejudice and hostility they experienced from health-care professionals.

Self-medication is generally a bad idea for anybody.  But the risks are even greater for trans people because the precarious situations in which too many of us live leave us even more vulnerable to exploitation by "professionals" with questionable--or no--credentials.

That might be the biggest hazard trans people face, after the discrimination and violence to which too many of us fall victim.

 

The CDC Catches Up

If you are transitioning from male to female, you may have discovered something I've learned:  The world of medicine was created by and for males.

If you didn't already know that, you will understand it when you climb into the "stirrups" for your first vaginal examination--if you hadn't already learned it from getting a mammogram.  That machine they use is almost as tortuous as the stirrups, and both devices were invented by, ahem, men!

Still, you need to do both.  OK, I'll admit:  I'm overdue for a mammogram.  But at least I'm procrastinating because of the unpleasantness of the experience, not because I can't pay for it. Or, more precisely, I don't have to pay for it.  That makes me one of the lucky ones.  Lots of other trans women--both pre- and post-op--don't have insurance policies that cover their mammograms or access to any medical provider who does them for free.  

One reason for that lack is the Centers for Disease Control and Prevention (commonly known as the CDC) provided free screenings only to those designated as females at birth.  Even those of us who have had surgery weren't provided with examinations from the CDC. And other health care providers, insurers and related organizations take their cues from the CDC.

However, last week, the CDC changed its policy after a trans woman in Colorado sued.  

One would think it shouldn't have come to that.  After all, one would expect that the folks at the CDC would be conversant in current research and literature.  According to decades' worth of investigation and practice, trans women who are taking estrogen are at a higher risk of breast cancer than they were before starting treatments, though their risk is not as great as that of "born" women.  And our risk of breast cancer increases after our surgeries.

 

Fatigue, At The Beginning And The End

I'm so tired now.  I've been tired for so long, I want to close a door and cry.  Mother used to do that sometimes.  But there's no door here for me to go behind and close.  And the tears won't come now, anyway, because I don't have the emotional energy, or even a space inside me, to allow anyone else to see them.  For crying in the presence of others is always an involuntary form of sharing, or at least diverting one's attentions.  Those activities require energies I just don't have right now.

Maybe it's the day, and my hope that it will be my last on this block , that's so drained me.  But taking hormones does that to you, too.

The first time you take them, you're expecting something to happen, even though the doctor or whoever prescribes them tells you nothing will, at least not for a while.  Two pills:  One, the anti-androgen, is white and has the texture but not the taste of an aspirin tablet.  The other--the estrogen--is small, with a hard shell in a shade of candy-coated cow piss, which is pretty much what it tastes like.  Not that I've ever tasted cow piss, candy-coated or otherwise.

After I took those pills every day for a couple of months, I couldn't notice any difference.  But Vivian did.  She called me that day, ostensibly because she wanted to return something I couldn't recall leaving at her place.  It'd been a few months since she pronounced me "too much of a woman" for her tastes and broke up our relationship.  She'd found a watch with a woven black leather band when she was cleaning, she said.  And indeed she gave it to me when we met for supper that night, in a restaurant a few blocks from where I was staying.  

But there had to be another reason for her wanting to see me; I could hear it in her voice when she called.  I couldn't imagine her wanting sex with me again.  So what, I wondered, did she want?

As I cut into the piece of chicken I ordered, I got my answer.  She called my name--my old one.  I looked up at her.  "Something's different about you," she intoned. 

"What?"

She reached across the table and dabbed my cheek, where she used to stroke with her fingertips.  "It feels different."

"How so?"

"It's...softer."

"Huh?"

"It really feels softer."

"Really?"

"Yes."

"All right," I said.  "I'll confess something:  I am taking hormones."  Her face grew longer.  "The doctor said my skin would get softer.  But not this quickly."

Then she asked me to stand up.  "Wow!  Your body's changing."

"How so?"

"None of your clothes fit you right."

"I think I've gained some weight."

"Maybe you have.  But it's in your rear.  And you're growing boobs!"

I couldn't notice those changes yet, I said.  And I felt like I needed more sleep.  "But," she cut me off, "you don't seem depressed.  Or angry.  You always were one or both, especially near the end of our relationship."

"To tell you the truth, I'm not.  I don't even feel sad very much.  Maybe..."

She cut me off again. "Maybe you accept things, or are resigned to them."

"You could say that."

She could. None of it surprised her.  Before that night, I hadn't told her I was taking hormones.  In fact, I hardly told anybody.  I don't know who could' or would've told her.  But I knew, then, that she'd asked me to supper so she could find out what I was like on hormones.  Why else would she want to see me again?

The old lady whose name I never knew is looking my way again. Who could' or  would've told her?

Make it tomorrow, please. I'm so tired.  All I want is to have my operation, then to get some rest.

Charlie's Pillow

The weather has been autumnal for the past few days:  cool and breezy.  Today some rain was added to the mix.  


I suppose that if I were another sort of creature, I'd be thinking about hibernating.  Actually, I did that, more or less, this afternoon:  I took a nap when I didn't have much incentive to go out.


Charlie and Max appreciated the time I spent at home today.  They took turns curling up on me.  Charlie especially seemed to be enjoying my time at home:  He fell asleep on me.  And he propped his head on my right breast.


Now, my assets aren't going to rival  Pamela Anderson's, nor do I want them to.  But I think they've grown, if just a bit, since my surgery.  When I started taking hormones, the doctor said my breasts would grow for about a year or two until they were about a size smaller than my mother's.  That's what happened.  Nobody said anything about breast growth after surgery.  And, while they don't look bigger, somehow they do feel as if they've grown.  Or, more precisely, they seem more supple, which may be the reason why they seem a little bigger. 

Maybe that's what Charlie noticed.  He used to curl up on my torso and prop his head on my shoulder.  But the last few times he's curled up on me, he's used my breast--the right one--for a pillow.


I guess I should be happy that he's not using my belly for a pillow, though he could.   Still, it's odd to know that I have enough on my chest for him to lay his head --and close his eyes.    Somehow it's even stranger than--although as exhilarating as-- the first sensation I felt in my new clitoris and vagina.  I guess I was expecting to feel twinges, pulses and tingling in my new sexual organs, but I wasn't expecting my breasts to serve as a headrest.


Will there be more surprises?  I suppose that question answers itself:  If you have to ask about what will happen, it is by definition unexpected, and therefore a surprise.   At least these surprises are interesting, and even pleasant.

Riding Like A Girl

"You throw like a girl!

That taunt ruined gym class for me for life. I heard it more than once, not only from other kids, but from teachers, too.

I never quite mastered the manly art of throwing a ball. However, I got pretty good at kicking one. So I played some soccer (football to the rest of the world) when I was in high school. We didn't have the same cachet as football or basketball players, but those of us on the soccer team nonetheless had the same privileges as other athletes in our school. Among other things, we didn't get the shit beat out of us by the school bullies.

Since I no longer had to throw a ball, people forgot that I did it like a girl. Or, at least, they stopped reminding me of it. And I forgot about it, too, for a long time.

And I didn't hear about the other things that made me a "sissy." Like the way I talked: my emotional, descriptive and, at times, adjective-laden speech was mocked by teachers and other kids. So I talked less and less as time went on. Then I acquired new labels, like "high-strung."

The thing about bicycling--which I continued all through my teen years, my twenties, thrities and early forties--was that there was hardly anyone in the place and time in which I grew up who could criticize the way I did it. Oh, some mocked me for riding at all when I should have been behind the wheel of a gas-guzzler. But no one seemed to know how a boy or a girl pedalled.

And, more often than not, I was riding alone.

So what's different about my riding now?

Well, for one thing, I don't do nearly as much of it as I once did. There were years when I rode my bikes more miles than most sales reps drive. These days, getting out a couple of times a week is a big deal for me.

But even if I were still riding 360 days a year (Yes, I've actually done this!), I still don't think I would be riding the way I once did.

For one thing, I simply don't have the physical strength I once had. My doctor said the hormones would do that: Sinews and muscle would turn to flesh. That's the way of being a woman.

But something else is different: my attitudes about riding. For one thing, I used to feel that I absolutely had to ride every day, whether or not I felt like it. It's true that I raced for a time and I did some touring on a bike laden with camping equipment through the Alps, Pyrenees, Green Mountains, Adirondacks and across the mountains of California and Nevada. You certainly have to be in some kind of shape to do that. But, while those feats were arduous, they were hardly Herculean.

The mountains...They were there to be climbed upon, conquered, subjugated. I realized this the day I did my last long, steep climb: up the Col du Galibier. While a long, struenuous climb, it's not the most difficult ascent of the Tour de France route. Arguably, that distinction belongs to l'Alpe d'Huez, which I'd climbed earlier, ahead of the TDF pack. Getting up those mountains was not just about the conquest of them; it was also a matter of pushing forward through the muck and mire of this world, of my life, on my anger and sorrow.


When you conquer something, you can only be a stranger. You can never be part of what you conquered and it cannot become part of you. Somehow that is what I learned that day when I pumped my way up the Col du Galibier.


As I began my descent, I recieved a message. It wasn't visible or verbal; somehow it reached me. "You don't have to do this. You'll never have to do this again." I mouthed those words to myself; I had no idea of where they came from. I hadn't the slightest idea of what they meant. Of course, I don't have to do this, I mumbled. But how could I not? What am I going to do? Ride around the block to a craft shop? To Sunday brunch? That's not real bicycling, I told myself.


But the message, whatever it was, took hold of me. I wasn't trying to show my exquisite bike-handling skills as I descended those turns through a glacier, fields of wildflowers and finally part of a farm. My senses filled with the smells and colors of flowers and field. "You don't have to do this anymore"--the message repeaed itself.

Later that day, I reached a town called St. Jean de Maurienne, only a few kilometers from the Italian border, just as people were walking or riding home from work. I stopped at a traffic light. (Yes, small-town gendarmes pull cyclists over for running red lights.) Back in those days, I resented any intrusion on my bursts of speed and power. However, that day, I knew somehow that I was stopping for more than a red light.

The light turned green. I didn't click my feet into my pedals. Instead, I straddled the bike as cars made semi-loops around me and, diagonally across the intersection from me, a slender middle-aged woman in a long button-front dress accompanied her shadow along a beige stone wall. Her steps were not meant to push away the distance between her and wherever she was going. Instead, her every step took her further into the sunlight that blazed between that brick wall and wherever she was going. No doubt she wanted to get there quickly; however, she did not seem to be pushing toward her destination. Rather, it seemed, the light and air were drawing her toward it, and she was following and being filled by them.

I had no trouble imagining her following the moon. However, I could not imagine her conquering a mountain.

Needless to say, the rest of that tour was very different. So is the tour I have taken as Justine.

This afternoon, I took a short ride I took through some local back streets and to a recently-opened open-air mall (where I checked out the bike and shoe stores), under clear skies on a very warm day.

I was filled with that light, that ride, even if , in spite of all the ways in which my current bikes are beter than the ones I've had before, it seemed that I was expending as much of my strength as I did when I was climbing the Alps. Yes, I'm out of shape, but I have an excuse: My body has changed permanently.

But more important, my spirit has, too. I was on the bike today. I got fresh air and sunshine in return. The guy in the bike shop complimented my bike; a guy driving home from work yelled "nice legs" as he passed me. Heck, I even stopped for a cat I saw looping around in the yard around a house. And--no film-maker could make this up!--the cat, a pretty calico, tiptoed toward my hand and rubbed her head against my fingertips.

Even Lance says it's not about the bike. His life hasn't been about cycling: cycling has been about his life. He got up l'Alpe de Huez, le Col du Galibier and all those other climbs faster and with more elan --actually, more like la force vitale--than any other rider. He ran--pedalled--for his life, not to get away from or conquer something. Nobody conquers anything in order to stay alive; one simply lives and is not consumed by his or her circumstances or choices.

If I recall correctly, he said that around the time of his fifth Tour win, he was really starting to hate cycling. Of course I can't presume to know what he was thinking. But I would guess that he was trying to live up to the conquests that the press and other people thought his victories in the mountains and "over cancer" were. Also, I wonder whether he simply got tired (literally and figuratively) of pushing his body to its limits every day of his life.

Not to impute my own feelings to him, but I felt something like that, too, during my last conquest--the one of le Col du Galibier. Descending that mountain, I began to learn how to ride like a girl--or at least like Justine.

By the way, I'm getting rid of my last bike jerseys. I'm selling them on e-Bay, with the proceeds going to the American Italian Cancer Foundation.