a-lotus-leaf

[a-lotus-leaf]

I’m visiting my friend right now in her 18th century home she’s restoring where the lights don’t work in one part of the house, creeping to the bathroom like some sort of haunt, feeling for the walls with rising dread, utterly lost in the perfect darkness, like Jonathan Harker in Dracula’s castle, if Jonathan Harker were the sort of person to trip and stand there cringing in the night as his can of trader joe’s sparkling rhubarb-strawberry juice bangs all the way down the oaken staircase, one step at a time, the cacophony of a freight train, and then proceed to practically crawl through the remaining dark to the bathroom for a washcloth, to wipe up the trader joe’s sparkling rhubarb-strawberry juice before it can soak into the wood floor, with the fevered terror of lady macbeth hallucinating blood on her hands

[a-lotus-leaf]

Love you (ALL)

You are important

The world would be a worse place without you in it

You matter

I care

There are other people who care

You will find people who care in this very thread

You matter more than you know

Don't give up on yourself

ALSO DRINK YOUR MEDS AND WATER and at least try to eat something today if you haven't already

If you can, please put one thing away, one clothing item in your closet, one piece of trash in the bin

You are doing good

Take care of yourself

You deserve good things

[a-lotus-leaf]

a blanket of snow on fairy lights

[a-lotus-leaf]

[a-lotus-leaf]

The picture I sent my mom:

The picture I sent my husband:

[a-lotus-leaf]

Sumerian/Mesopotamian Amulet Seal in the Form of a Bull, c. 3250 BCE.

[a-lotus-leaf]

[a-lotus-leaf]

I know you guys only care about Wrapped right now, but @narcissistcookbook released a new album so I gotta blare it through the entire office

[a-lotus-leaf]

YOINK!

Source: US fish and wildlife service on instagram (https://www.instagram.com/reel/C817Hl-qrm-/)

[a-lotus-leaf]

bluey and blue!

[a-lotus-leaf]

[a-lotus-leaf]

seasons greetings 

[a-lotus-leaf]

Chinese artist Shou Xin creates the most wonderful cats with just a few pencil lines

[a-lotus-leaf]

others: “so, how ~southern~ are you?”

me: “The entrance of my hometown has a shrimp boat sitting in the main street. At Christmas theres a shrimper Santa and alligators pulling him instead of reindeer.”

others: “what?!”

me:

[a-lotus-leaf]

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

[a-lotus-leaf]

"everybody hates me" factoid actually just a statistical error. The average person doesn't hate you, especially not your friends. You, a person who sits in your room experiencing self loathing every day, are an outlier adn should not have been counted.

[a-lotus-leaf]