Toward an Informed Consent Model for All Drugs
Hormone Replacement Therapy
It’s May of 2018, and I’m sitting on an examination table at Howard Brown Health Center’s TPAN location. My nurse practitioner, Jon, is a cheery, open-faced man with a trimmed grey beard. He’s sitting facing me, with a laptop at his side, and asking questions with a degree of patience and warmth that I’m not accustomed to in a medical provider.
“So you’re in today for a safe passage letter?” he asks.
A safe passage letter is a document provided by a physician to the court system, indicating that for the sake of a patient’s safety, the gender marker on their ID needs to be changed. I’ve asked for a safe passage letter so that I can change my legal gender to male.
“Yes,” I tell him. “But I was also thinking of starting low-dose testosterone.”
“We will get that letter ready for you today either way, that’s no problem,” he tells me, which is a relief. It turns out I don’t have to be on any kind of medical regime in order to legally transition. “And if you’ll just give me a moment, I’ll pull up some information about your options for low-dose T.”
My NP hands me a sheet of paper listing many of the effects a patient can typically expect when they take testosterone. Body hair growth, fat redistribution, thickening of the vocal chords, increased muscle tone, potential loss of periods. Some risks are listed as well: my blood pressure might increase, and I’ll be at an elevated risk of cardiac problems. I’ll have to monitor my levels with regular blood tests.
Jon talks through all of these bullet points with me, but I don’t have many questions for him, because I’ve been reading about T for years. After lots of research and deliberation, I know that I’m ready to give it a try. Jon doesn’t grill me, and he doesn’t doubt me on this.
“There’s just one thing,” I ask. “Will I have to do shots? I’d like to try Androgel, but I’ve heard it’s expensive.”
“Oh, we actually have a grant to help cover some of the costs of testosterone gel for our patients,” Jon tells me brightly. He pulls up a table showing how the expenses will break down. “You…