Monday, September 10, 2012

Sometimes I Take Them

Sometimes I take them, sometimes I don’t.

I often keep them on my desk, pushed back behind the stacks of bills and papers I should’ve already sent out and filed away. Or on my bureau, somewhere visible between the tissue box and my cacti and the TV I rarely watch because I don’t have cable. I try to hide them, and I try to remember them. Other times, I throw the orangey-brown vial into my purse – or more rarely, my backpack – and hear the pills shaking along as I move like maracas. I sometimes put this vial into my purse's outside flaps or the top zipped pocket of my Jansport, where I’ll hear its insistent percussion more clearly, and I’ll relent and take a pill. Other times I bury it deep under keys and papers and cardigans and gum wrappers so I can’t hear it, but get to feel slightly responsible for at least carrying them with me as though I might take one anytime. I try to remember them, and I try to hide them.

It is not particularly hard to take a pill every day. My doctors and my parents have encouraged me to get into a routine – to take it at the same time every day, so I won’t forget. Sometimes I try to do this for a day or two, but most of the time, I don’t want to be disciplined about taking those pills. I don’t want that routine. And yet I want to be able to take them every day, without these mixed feelings, because what they symbolize to me, in part, is not really what they are at all.

My body doesn’t make estrogen, and it doesn’t respond to testosterone. If my gonads had not been removed as an infant, I wouldn’t have been able to use the testosterone (at least not directly, but more on that later). I have taken estrogen since a very young age – 8 years old, at the time I first started seeing clinicians for my intersex. After being withheld information, and given “facts” that conceptualized intersex as a weird, shameful disease...after much confusion and soul-searching and internet-ing for hours and hours when I was alone in my college dorm room...after finally gaining context that intersex bodies are normal and natural and healthy and beautiful – I was angry. I was angry that intersex was presented as a medical condition, a thing to be fixed, when it was so clear that I didn’t need fixing, that there was nothing wrong with me. What really needs fixing is how intersex is perceived, how clinicians intervene to alter our bodies without our consent when these treatments don’t track our health.

And so I’m ambivalent about taking my pills. I either don’t take them for days or weeks as they stare me in the face, or when they run out, I fail to fill my prescription for weeks or even months at a time. Having to take a pill every day is a reminder of how medicalized intersex is, and my refusal to get and take pills is my own personal protest that my intersex should have anything to do with clinicians at all. Other times I’m terrified about not taking them. Sex hormones are really important for bone health, and throughout our lives, estrogen and testosterone play crucial roles in depositing new bone and removing the old stuff. I understand that if I don’t take these pills, I may have severe bone loss as I age. I don’t want my arm and leg bones to be the size of pencils when I’m forty. No way. So I take them.

I also consider that the daily pill I have taken for years would actually have been unnccessary had I been able to keep the body I was born with. My testes produced testosterone, which would have naturally been converted estrogen inside my body. Many times, I am aware that the substance contained in that chalky white pill I swallow is something I used to make, myself. I didn't need help, or doctors, or a reason to shell out for my co-pay every few weeks. I am in the fortunate position of having both access to medicine and health insurance, so comparatively, I am very privileged, and lucky. But it's strange to think that this whole process could've been sidestepped had someone just let me keep all the body parts I had at birth. Sometimes the hoops you jump through as an intersex person are really strange.

I vacillate back and forth. By refusing to take these pills, I am not rectifying any of the things I wish I could about my past. Each time I avoid my meds, I won't erase a traumatic memory from my brain – poof, gone, I don’t have to think about that anymore. Not taking a pill won’t karmically send of jolt of doubt into my former clincians’ hearts, so that they wonder whether the “treatments” I received were appropriate, these treatments that I couldn’t say yes or no to and have changed my body forever. Wonder whether they will make the same decisions when other intersex kids pass into the hospital room with one body, one sense of self, and leave the room with different ones. My choice to take or not take a pill affects only me, and no one else. My anti-pill protest is not logical. I know this. Taking these hormones every day is an act of self-care, something I want to do for myself. But sometimes I can’t, and although I understand why, my reasons for not doing so are flawed.

After holding and hiding the hundreds of vials I’ve had throughout my young life, I realize that they say something greater about my intersex. These vials perfectly symbolize how medicine and clinicians can be involved with intersex individuals by addressing our actual health concerns, instead of trying to “fix” and alter our bodies so that we’re more easily shoved into one box or the other. We don’t know what the effects of hormone replacement are on our bodies over time. We don’t know how bone density may affect intersex individuals throughout our lives, with or without taking hormones. There’s very little research out there addressing things that are medically relevant to us. Intersex is not a medical condition, but there are legitimate medical concerns that are relevant for particular forms of intersex. If clinicians shifted their focus to address our health concerns with our consent, and not our genital form without it, the relationship between intersex and medicine would be radically different.

Today I’m going to take my pill, because I’m feeling more hopeful, I’m taking my future self to heart. But I know that the next day I’m pissed off enough to chuck those damn pills out the window, let them scatter and roll all the way down the block – I have some compelling reasons to gently put the bottle back. Maybe things are looking up.

2 comments:

  1. hi Claudia,
    from working with trans* patients I know that the typical medical reaction to not taking any hormones is negative--concerns about long-term bone health being the #1 reason why. but i haven't personally read any studies about not taking estrogen as prescribed. nor have I read any studies about how medically necessary it reeeeally is to remove undescended testes that may become cancerous (ex: is there a screening process that could be done annually instead of a one-time surgery to prevent potential cancer? i mean we don't give every breast-possessing person over 40 a mastectomy, which would certainly prevent a lot of breast cancer...) my point is, thank you for writing your blog and helping people question whatever "truths" about medicine and intersex we have had ingrained.

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  2. Thank you so much for your kind words. :)

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