Transitioning Saved My Life. Twice.

VA and Medicare/Medicaid Cuts To Gender Affirming Care Are Written In Blood

The First Time Transitioning Saved My Life

The day I finally admitted to myself that I was transgender I decided to take that secret to my grave. I had a wife and a career. Friends. I didn’t want to upset anyone. I didn’t want to lose anyone. I suspected that if I transitioned it would end my marriage and several of my friendships. I was fifty two and thought that I could keep it a secret until I died of old age. I tried my best to tough it out. Five years went by.

I’d been depressed for most of my life. One of my friends said that I’d “always had a deep sadness” about me. The depression grew worse. I wasn’t taking very good care of myself - back then I smoked a pack of cigarettes daily and ate fast food every day. I rarely slept more than a few hours at a time. My depression worsened.

The only two things that kept me going were my dog, Luca, and the fact that I’d recently taken up fly fishing. I took Luca for long walks and spoiled him with attention. I kept my fly fishing gear in the trunk of my car and would stop to wet a line whenever I drove across a river. There are many rivers in Texas, and being out in nature was good for my physical and mental health. It was more of a bandaid than a cure.

The depression started to win and one day I came up with the perfect plan. I was spending a lot of time fishing the Guadalupe river. I decided I’d put on my hip waders without fastening the belt that cinches them tight around the waist, then I’d find a secluded spot to fish and walk out into the deep part of the river until my waders filled with water and I sank to the bottom of the Guadalupe, too heavy to rise back to the surface. I’d be reported missing. They’d find my car and a search team would drag or dive the river until they found my body. My friends would shake their heads and say, “He died doing what he loved.” My wife would take care of my dog. She’d also get a nice payout from my life insurance policy.

I needed life insurance.

I started looking at policies. It was going to be expensive because I was a life long smoker. I studied how long they had to be in effect before they would pay out. As much as I wanted to leave a significant amount to my wife I found it hard to justify. Finally I landed on a figure. One hundred thousand ought to do it. It simultaneously seemed like too high a value to put on my own life, and not as much as she deserved.

When I had it narrowed down to two different policies I started imagining what life would be like for everyone after I was gone. They would move on, of course. My wife would probably meet someone. My friends had other friends and families of their own. My dog would miss me but at least he would be loved.

Then a thought came bubbling up from my subconscious, a “Hail Mary” from some part of me that still wanted to live. If I was going to lose anyway, what if I transitioned and lost everyone? It would almost be as if I had died. They would still move on. My wife would probably still meet someone. My friends had other friends and families of their own. But I would still have my life. I would still have my dog, and he would still be the good boy who loved me. Either way it looked like I was going to lose everyone else. What if I gained myself?

I’m a Navy veteran and had just started to receive my healthcare at the VA. I decided to go to the Austin VA instead of the branch that I was assigned to in San Antonio. After doing a little research I knew they would see me at the mental health desk without an appointment. The next morning I drove to Austin and gave the person behind the desk my name and told them that I needed to speak to someone. After a few minutes an on-duty psychiatric nurse brought me to an exam room, closed the door for privacy, and asked what she could do for me.

In other words, what’s wrong and why are you here? I’d never said it out loud before. I took a deep breathe, looked at her and said,

“I have gender dysphoria. I’m transgender.”

Then I started to cry.

They were tears of relief, from a lifetime of repressed feelings and low self-worth. They were also tears of compassion for my wife, because I was sure that she would take it badly. I didn’t want to cause her unhappiness, or pain. I didn’t want to cause anyone pain, but especially not her.

About a month later I had my first appointment with a staff psychologist. A wise, compassionate woman who has helped me immeasurably. After the required number of sessions and after receiving an official diagnosis of something I already knew, I came out to my wife and started hormone replacement therapy (HRT).

Once my brain was operating on the proper hormones a miracle happened. It took about four months, but the lifelong depression and anxiety lifted. I wanted to live! Even though it would be several more years before I socially transitioned, the act of starting, of acknowledging that I was dealing with something that was real, saved me. That was the first time transitioning saved my life.

The Second Time Transitioning Saved My Life

Because I was receiving my mental health care at the Austin VA all of my healthcare was transferred from San Antonio to Austin. This meant I got a new primary care physician. Five months after I started HRT it was time for my yearly physical. The doctor performed the standard tests for someone my age, and at the end of the session said something along the lines of,

“We’ll have to wait for the blood tests to come back, but so far everything looks good. You’re in great condition for someone your age, keep doing what you’re doing.”

I looked at him and asked, “Except for the smoking, right?”

“Wait a minute…you smoke!?” For some reason when my medical records were transferred from San Antonio to Austin the fact that I was a life-long smoker didn’t get transferred along with everything else.

“Yeah, Doc, I smoke.”

“How much and how long?”

I was a month away from my fifty-eighth birthday. “Let’s see, I started when I was fourteen so…about a pack a day for forty-four years.”

He was incredulous.

“Okay,” he had a rueful but gentle smile on his face. “There’s no way the smoking hasn’t affected your body, the indications just aren’t visible in any of the usual tests we run during an annual exam. I’m going to schedule you for a stress test, an electrocardiogram, and depending on those results, probably an angiogram as well.

The stress test was two days later. It ended early, when my pulse was only at about one hundred and twelve beats per minute. They found something they referred to as “artifacts.” The cardiologist running the stress test explained to me that sometimes an artifact was just a glitch due to the equipment, but that it could also represent something wrong with the patient. He was explaining this to me while taking my pulse. He started to get a worried look on his face.

“Your beats per minute should be close to normal by now.” They weren’t. He gave me a couple of nitro glycerin tablets and within a few moments my pulse slowed to a resting rate. He looked worried, and kept asking me how I felt.

“The artifacts along with the pulse rate not going down mean you most likely have at least one significant blockage to your heart. I’m going to push through the request for an angiogram.”

Less than a week after my off-handed comment to my primary care physician about smoking I was at the VA’s teaching hospital in Temple, Texas to get an angiogram. There were six cardiologists in the room - the instructor and five first-year residents. A small camera on an even smaller wire was inserted in the vein in my left wrist, then manipulated and maneuvered until it passed through a carotid artery in my neck and down into the blood vessels leading to my heart. There was a large flat screen television just off to my left, barely in my peripheral vision, so that the doctors could see what was going on with my heart.

“Wow!”

“Wow!”

“Wooow.”

“What?” I was straining to see what they were looking at, the screen was too far off to my left. The instructor said, sharply,

“DON’T MOVE YOUR HEAD!”

I stayed still, the suspense almost more than I could bare. He backed the camera out and then leaned over me with a smile on his face.

“Okay, I’ve got to debrief my team first, then I’ll see you in the recovery room in about ten minutes to go over everything.”

Ten minutes later he walked in, the smile still on his face. He was scratching his head.

“Do you know what collaterals are?” I didn’t. He explained that when someone does heavy cardio exercise over a long period of time, the body will start to build extra pathways to the heart in order to keep it supplied with a sufficient amount of oxygen. When I was in high school I jogged four miles every night after I got off of work. After I graduated I quit running but started riding my ten-speed bicycle the twenty miles to my new job. So, forty miles a day riding a bike, for about six months. That’s when my body grew the extra pathways.

He drew a picture of my heart, with four arteries, one coming out from each chamber. Then he drew an X through three of the four arteries.

“One hundred percent blocked, one hundred percent blocked, one hundred percent blocked!” On the fourth and last artery he drew a line and stopped just before it went completely across.

“Seventy percent blocked, but look here!” He started drawing smaller lines between the seventy percent blocked artery and my heart, connecting each chamber.

“I have to tell you, normally when we see something like these blockages we wouldn’t even be having this conversation right now. We would have had you anesthetized immediately and performed emergency open heart surgery on the spot. You would’ve woken up with a zipper scar on your chest.” He continued.

“I’ve been doing this over twenty years and I’ve never seen collaterals this good! You’re still going to need surgery, but we’ll send you to the Heart Hospital in Austin to get it done. You’re lucky, your heart doesn’t seem to have any damage at all.”

That explained why he was smiling. The next morning I had the echocardiogram, which confirmed that my heart was completely undamaged. A week later I had a quintuple bypass. I felt beat-up and weak, but on doctor’s orders I was gingerly walking a few laps around the cardiac ward the next day. Four days after the surgery I was recovering at home.

A month later I had a follow-up appointment with the surgeon. He was pleased with my recovery and said that I was a poster child for the procedure.

I was thinking about how my off-handed comment to my new primary care physician about smoking started this domino effect that led me to the surgeon’s office. About how I wouldn’t have even had that conversation if I hadn’t switched VAs because I decided to transition. They knew I smoked in San Antonio, yet they never ordered the tests that my new primary care physician insisted on. His insistence saved my life and he was my doctor because I was transitioning.

I had one last question for the surgeon.

“If things had turned out differently, and you and I had never met, how much longer do you think I would have?”

He started to get philosophical, until I asked a more pointed question.

“I turn fifty-eight next week. Would I have seen sixty?”

“Oh no, you wouldn’t have seen fifty-nine! You were going to have a heart attack, and you probably would have had to have had it in the lobby of this hospital to have a fifty percent chance of surviving!”

**********

Transitioning saved my life. Twice. Study after study says that gender dysphoria is real, and that treating it with gender affirming care saves lives.

The current administration wants to end all gender affirming care through the VA and Medicare/Medicaid, but they don’t intend to stop there. They’ve already threatened to withhold funding from hospitals that offer it. They are trying to eradicate us from society.