Denise discovers the nature of her condition

A Summer of Changes
by Louise Anne Smithson

Book 5 Chapter 6

Two appointments at the clinic

Denise was right in her prediction that the following week would drag, even though she was very busy at work and continued to work overtime whenever she could. Her thoughts were forever drifting off to the results of her tests on the Friday, and what they would mean to her future life. One night she rang Julia, hoping for the opportunity of a long sisterly talk and to have her re-assurance. However, it was clear that she was experiencing the opposite. Before she could begin the conversation Julia had said that she could not talk for long on the phone as time was running away and she had so much still to do in preparation for her move to London that weekend.

‘How will you be transporting all your belongings?’ asked Denise.

‘I was originally going to pay for a removal van, but I don’t have that much in the way of furniture and certainly not enough to fill a removal van. However, your friend John telephoned me last weekend and has offered to hire a small van in London and collect me from Norwich and then drive me to London. All I need to do is to have everything boxed up and ready to go by 10.30am.’

‘That is very kind of him,’ said Denise slightly surprised and pleased by the news.

‘Yes it is. I will make sure that I refund all his expenses, and will also invite you both to dinner soon afterwards, by way of thanks.’

‘What time do you expect to arrive at your new flat?’

‘’John thinks we should be there by about 1.30pm, but, if you like, I will send you a text message confirming our expected time of arrival.’

‘I will be there to help you unpack. Would you like me to bring some sandwiches and a flask of coffee for when you arrive?’

‘Yes please.’

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Samantha also seemed pre-occupied with her own issues that evening and so, to help pass the time, after she finished work Denise sat down and began to compile a list of all the new documentation she would need for her new life as a woman and the official bodies that she would need to notify. She then searched the Internet to find the necessary regulations and procedures. It was going to be a lot more complicated than she had imagined. Once she had started on her medication, she would legally change her name by means of a Statutory Declaration which would involve visiting a solicitor. Then she would notify her bank of her new name and apply for a new National Insurance Number Card from the Department of Work and Pensions. This in turn would enable Helen to regularise the paperwork relating to her job, and thereafter she would be employed and paid in the name of Denise Simons. Once this was done and her salary was being paid into her bank account she would be able to apply for a credit card in her new name, and begin to create a credit record for herself. She would also apply for a provisional driving licence in her new name which would also show her new gender, and so serve as an identity card for many other purposes. However, she would need a letter from the Endocrinologist confirming she was undergoing treatment before she could obtain a replacement passport. She would also need to register with a local doctor, which she had so far failed to do since she moved house in June, and ensure that she was listed on the register of electors. At every stage there would be a host of things to do, different forms to complete, and sometimes difficult explanations to be made, but in the end it would all be worthwhile.

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At long last Friday came around. As usual when she had an appointment, Denise chose her outfit very carefully to make a clear statement about who she was and who she wanted to be. She had refrained from gluing back the false breasts during the last week just in case Dr Spencer needed to examine her again, but was anxious to do so as soon as possible. In truth she was anxious to have her own breasts as soon as possible but realised that it would be a year, at least, after she began her hormone therapy before she would see much signs of growth, and perhaps a further six months before she could even think about breast enhancement surgery. It was all going to take a long time and she had to be patient.

The morning was spent modelling clothes as usual, and then she used her lunch break to ensure that her hair and makeup were immaculate, before making her way to the clinic.

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Denise was shown into Dr Spencer’s office, feeling decidedly nervous. The doctor smiled and invited her to sit down.

‘Thank you for coming Denise. I now have the results of the blood and urine tests we took last week. I have to tell you that you are suffering from the XX male syndrome, which is also sometimes called the de la Chapelle syndrome.’

‘What is that?’ asked Denise.

‘It is a rare sex chromosomal disorder affecting about one in every 20-25,000 male children who are born. Normally there are twenty-three pairs of chromosomes, in each cell, twenty-two of which are the same for men and women. The last pair, which is known as the sex chromosomes, differs: there are two X chromosomes in females and an X and a Y chromosome in males. In your case that last pair contains two X chromosomes.’

‘Well doesn’t that mean that I am really female after all?’ asked Denise hopefully.

‘No, I am afraid not. Although you have some female characteristics in terms of your build and general appearance, you also have fully developed male genitalia including both testes,’ she replied sensing her disappointment.

‘So am I male or female?’ asked Denise.

‘Neither entirely one nor the other. You have female chromosomes but male physical features. Most men with XX male syndrome will have a male chromosome gene known as SRY attached to one of their X chromosomes, but you are one of the minority with this condition that do not do so. There must be other genes on other chromosomes that are responsible for your male physical features. To be honest, we do not fully understand the condition.’

‘So I am among a minority of sufferers of a very rare condition.’

‘Yes, I am afraid so.’

‘But what does it mean for me?’ asked Denise sounding increasingly worried.

‘Clearly your condition has not affected your intellectual development in any way and is now most unlikely to reduce your life expectancy, but there is one important issue. Although you have descended testes, I am afraid you will have no sperm production. In other words, you are infertile and there is nothing that can be done to alter that.’

‘That is not an issue for me. I am quite resigned that I will not be able to have children either as a man or a woman.’

‘There is also a chance that, in time, your testicles, will become cancerous. My advice to you would be to have them removed as soon as possible. We would then be able to control your condition and give you a relatively normal life in all other respects by administering either male or female hormones. You were referred to me because of your stated desire to live as a woman. In that case, as soon as your gonads have been removed I suggest that you should begin a course of oestrogen. In your case there would be no need to treat you with anti-androgens or progestogens at the same time.’

‘When can you begin?’ asked Denise.

‘It is a simple procedure that I would be able to carry out under local anaesthetic, at my clinic. But you have to be clear that the procedure is irreversible, as also would be the effects of taking oestrogen. In my opinion the orchidectomy (or removal of your testes) is necessary to safeguard your long term health, but you are welcome to get a second opinion if necessary.’

‘I thought you said that I was sterile.’

‘I did, and I am afraid there is nothing that anyone will be able to do about that.’

‘In that case I wish to proceed with the orchidectomy as quickly as possible. I do not need a second opinion. When would you be able to do it?

‘If you wish I could do it on Tuesday morning. The procedure is quite straight-forward and you would be able to return to work after an hour or so.’

Would I then be able to begin on the hormone regimen?’ asked Denise.

‘Yes, I recommend taking estradiol, which is the main sex hormone present in females. It is less expensive compared with some of the alternatives and in my experience it is just as effective. The results for my previous patient have been very satisfactory. I think you should take it in the form of a combination oral estrogen and gel in the first instance.’

‘Why is that?’

‘We are aiming to provide you with a continuous low level supply of oestrogen throughout the day, rather than as large does, as this is less likely to have any effect on your liver. The best way to administer it is to place a 4 mg tablet under your tongue each day, plus two measures of estradiol gel. Injections and skin patches are possible alternatives, but I would not be happy with you administering your own daily injections, and skin patches can cause irritation.’

‘How long will it take before I notice any changes due to the hormone therapy?’ asked Denise.

‘It is difficult to say, perhaps a week or two, perhaps longer. Don’t get frustrated at how long it takes to produce results. It can take a few months for some changes to develop. It may be that you will notice differences in how you feel before you see any physical alterations to your body.’

‘What sort of differences?’

‘Estrogen levels have a noticeable impact upon mental health. You may experience sudden mood swings, heightened emotional feelings, such as bursting into tears and even bouts of depression once you start taking the tablets. This is not unusual and should be temporary once your body adjusts to the new levels of oestrogen. That is why we will need to monitor your treatment at regular intervals during the first few weeks.’

‘When can I start with the oestrogen?’

I will give you a prescription today, and I suggest you could start taking them as soon as we have completed your orchidectomy on Tuesday.

‘Thank you Dr Spencer.’

‘There are other areas where my colleagues often provide support to transgender patients, such as advice on dressing, body language and general behaviour in your new gender, language, speech therapy, or hair removal treatments. However, at first sight you do not appear to need much help with these. You seem to be able to pass as a woman without any difficulty.’

‘Thank you. My work has helped me a great deal with my dress sense and posture. Also I have been trying hard to listen to my female friends and colleagues and improve my use of language and gestures.’

‘Your medical condition has also greatly helped with your overall appearance, and reduced the need for hair removal treatment. Things seem to be going well for you in your proposed transition, but both your psychiatrist and I will wish to make another full assessment of your progress after three months.’

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As soon as she left the clinic, Denise rang Alison at her work and told her, what the doctor had said and what drugs had been prescribed for her.

‘There will be no problem in my providing them, except that it is a Bank Holiday weekend. However, if you can provide me with your prescription sometime over this weekend, I will be able to let you have your medicines by Tuesday lunchtime,” she replied.

‘That will be fine I do not need to start taking them until Tuesday evening. I’ll bring the prescription round to your flat on Sunday night, if that is convenient.’

‘Unfortunately both Sue and I are planning to be away until Monday afternoon. How about coming round on Monday evening instead then you could stay for dinner as well and we can have a chat?’

‘Thanks I should like that.’

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That evening Denise told Samantha all about her consultation with Dr Spencer, the diagnosis and the procedure she would soon go through.

‘So at the moment you are neither male nor female.’

‘Yes, but we will soon begin to correct that.’

‘It sounds as if next Tuesday will be “crunch-time”,’ said Samantha.

‘I sincerely hope not,’ said Denise. ‘I think she will use a scalpel, rather than two bricks.’

Samantha smiled.

‘But she won’t be cutting off whole thing?’

‘No that will come some time later. She will just be removing contents.’

‘Well, there is an old proverb that says ‘better an empty house than an ill tenant’.

‘In other words, 'better out than in'.’

‘And then you will also start taking the oestrogen?’

‘Yes, and then I am afraid you may have to put up with some tears and temper tantrums from me for a few weeks.’

Samantha rolled her eyes, ‘I remember the feelings; puberty can be a tumultuous time for a girl.’

‘So I understand.’

‘So Denise what are you planning to do to mark the loss of the last vestiges of your manhood and the advent of your womanhood?’

‘I don’t know really, I had wondered about inviting some friends out this weekend, but it is a Bank Holiday and a number of them will be going away,’ answered Denise.

‘In that case we should organise a little celebration for Tuesday evening, after the deed has been done.’

‘I should like to do something to acknowledge the help of my female friends.’

‘Great, it will be a girls’ night out. Leave it with me, I will telephone around and organise something,’ said Samantha.

‘Thank you.’

‘What are your plans for tomorrow Denise?’

‘My sister is moving in to her new flat, and your cousin John will be driving her down from Norwich. I thought I would look for a suitable flat-warming gift tomorrow morning and then go and help her to unpack and get settled in.’

‘Would Julia like me to help as well?’ asked Samantha.

‘Oh yes, I am sure she would, and I would be pleased as well. That way I won’t feel as if I am playing gooseberry in the afternoon.’

‘Do you think there is something going on between them?’ asked Samantha.

‘No, not as yet, but I should not want to get in the way in case it does,’ replied Denise.