A Summer of Changes
by Louise Anne Smithson

Book 5 Chapter 5

Some preliminary investigations

Denise and Samantha compared notes about their respective weekends as they travelled into work on Monday morning. In the end, neither of their anxieties had been justified and their different worlds had not come crashing down. Samantha’s father had no idea about his daughter’s sexuality, and was inevitably a little surprised and disappointed that he would not be able to help celebrate her marriage and was unlikely to have children. However, as with Denise’s mother, he had taken the news in his stride and decided that the best way he could show his love was in supporting his child’s choices. By the end of the weekend she had felt closer to her father and sister than she had during the last few years of pretence on her part. Denise too confirmed that opening her soul to her mother and her sister had brought their family together.

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During the morning coffee break Samantha quietly announced her lesbian sexuality in the middle of a conversation with her colleagues. Once again there was no big deal. No-one spluttered or dropped their coffee cup. Some of her colleagues merely displayed mild surprise, or else a concern for her future, but there was no sense of shock or of condemnation that she had half expected.

‘Maybe we exaggerated these things in our own minds, and they never were going to be the great issue that we feared,’ commented Samantha as they began to get themselves ready for the next series of shots. ‘Perhaps most of the problem is in our own minds.’

‘Possibly you're right,’ said Sue, ‘but I don't think it has always been so.’

‘No, our world is a lot more broad-minded and understanding of the complexities of human life than the one in which our parents’ grew up,’ said Denise. ‘Those who differ from the norm, like Samantha and I, are no longer as isolated as we once were. We can now find information and an understanding of our respective conditions on the Internet. We can now access advice or therapy to help us come to terms with our true selves and, if we wish, make contact with others just like us. We no longer have to think of ourselves as freaks, and try and hide our feelings from our friends and families.'

‘Yes, but as you discovered last weekend, there are still are pockets of ignorance and bigotry,’ said Samantha. ‘Even the law does not yet recognise your right to live as a woman if you choose, or my right to marry a woman.’

‘True, but I understand that things are about to change, as a result of various rulings by The European Court of Human Rights which have forced the UK Government to introduce new legislation. By the time I complete my transition I should be able to be legally recognised as a woman, and, if the Civil Partnerships Bill goes through Parliament, you and your chosen partner will soon be able to enjoy most of the same rights as a married couple, and even adopt children, if you wish to do so,’ said Denise.

‘No doubt things are getting better in Europe and the USA but there are still large areas of the world where to be different is to invite persecution and perhaps even death. Even in the west it will still be necessary for us to live our lives with a degree of discretion so as “not to frighten the horses”,’ added Samantha.

During the remainder of the morning session, their conversation moved on to other less serious subjects. Sue certainly did seem far chirpier than her usual self. The two models tried to extract some more information about her boyfriend, but she was not particularly forthcoming, beyond the fact that his name was Adam; he was a professional photographer, and that they seemed to be getting on quite well. There was an element of good-natured banter between the three of them, but Denise and Samantha soon found that their friend was beginning to blush and so let the matter drop for the time being.

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Although Denise enjoyed her job, Monday afternoon and Tuesday seemed to drag on interminably as she waited for her next appointment with Dr Collett first thing on the Wednesday morning. Now that the details of the therapy she was undergoing were known to her colleagues, it was relatively easy for her to arrange things with Sue and Samantha so that her appointments did not unduly disrupt their work. There was always plenty for her to do at other times to make up for the lost time and even to work some overtime to help pay for the consultations.

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Dr Collett began their next meeting by raising the issue of Denise’s sexual orientation, which they had not had time to discuss the previous week.

‘To be honest with you, Dr Collett I'm confused about my sexuality’ she replied. ‘Until I started to live as Denise a few months ago I was always too shy to have any physical relationship. I've always preferred the company of girls to that of boys, but I'm not sure whether that was because I sub-consciously wanted to be one. As I mentioned last week, I have had one brief sexual relationship with a man, and I must admit I quite enjoyed the experience of the power that it gave me. However, in retrospect I feel it may have been a mistake. I am also currently sharing a house with a young woman who is coming to terms with lesbianism. I greatly enjoy her company, but we both need a prolonged period of abstinence and reflection.’

‘Once your transition has been completed, you may wish to explore your sexual orientation but in the meanwhile, I suggest you should rather concentrate on the process of transition itself.’

‘Very well Dr Collett.’

‘Now, did you go and see your mother last weekend?’

Dr Collett listened carefully to his patient’s account of her previous weekend and questioned her about her conversations with her mother and sister. He also read her mother’s letter. Eventually he seemed to be satisfied with what he had been told.

‘Alright then Denise, I can now say that it is my professional opinion that you are indeed suffering from Gender dysphoria, and it would be in your interests to receive medical intervention to assist you to live in their preferred gender identity as a woman. Under normal circumstances I would have expected two or perhaps three more sessions before I made my diagnosis, but you appear to have adopted a female life-style without any difficulty, and to have thought through the implications of what you are planning to do.’

‘Thank you,’ she replied, feeling greatly relieved by the news.

‘It's also fortunate that you do not have established financial, family or legal commitments, and that your mother and sister both appear to be supportive of your wishes,’ he continued. ‘You are still young and your male body does not appear to be fully developed, for reasons which your endocrinologist will no doubt wish to investigate. This has been the main reason, why you have been able to pass so well as a woman.’

‘So where do I go from here?’ asked Denise.

‘I think the time has come for you to move on to the next phase of your treatment and I am willing to write you a letter of referral to an endocrinologist recommending hormone treatment as a means of furthering your transition. However, this does not mean that your mental health therapy is at an end. The treatment of gender dysphoria is a collaborative process between different health professionals. I would therefore like to see you from time to time during your continuing treatment. If, at a later date, you wish to proceed to have surgical intervention you will need letters of referral from both your endocrinologist and a mental health therapist.’

‘Yes I understand,’ said Denise.

Not all endocrinologists will have experience working with transgendered patients. It is up to you to decide, but I could recommend one to you if you wish.

‘Yes please.’

‘If you call back to my clinic after you have finished work this evening, my secretary will provide you with your letter of referral and also the names and addresses of a number of endocrinologists that I have successfully worked with in the past. However, do not expect to come away with a large bottle of pills after your first visit, your doctor will need to examine you and carry out various tests to establish what is going on in your body before they start to prescribed a hormone regime. I would like to see you again in late September. By then you should have begun your journey to become a physical woman.’

‘Thank you very much for your help Dr Collett,’ said Denise as she got up to leave.

‘Good luck with your transition,’ he replied smiling.

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That evening Denise conducted a web search of the four names on Dr Collett’s list based in London. She also rang Alison for advice, but she could not help, except to say that once she had been given the relevant prescriptions she would probably be in a position to supply the hormones at a substantial discount from a normal pharmacy prices. In the end decided on the only female doctor on the list, Maude Spencer, who happened to be based at a large National Health Service hospital about fifteen minutes’ walk from her work. The following morning she rang her clinic for an appointment, and was told that there would be a six week delay. She then indicated that she wished to be treated as a private patient and was offered a one-hour appointment late the following afternoon. Having to make up the time for two medical appointments in one week, would have been problematic, however, now that she did not have to make time to see John at the weekends, Denise was free to work. She therefore arranged with Helen to spend the whole of Saturday working on enhancements to the ordering system.

On Thursday night she also carefully unstuck her breast forms, knowing that she would probably have to undergo a physical examination the next day. The skin underneath was pale, but fortunately there was no trace of soreness. It would do her no harm to leave them unattached for one day, in the hope that soon she would begin to grow a pair of her own.

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Denise arrived at the clinic in plenty of time and gave her details and Dr Collett’s letter of referral to the receptionist. She provided her with a leaflet for private patients, describing the services offered by the clinic, including Gender Identity therapies, together with contact numbers and setting out a scale of fees. These were expensive, so she hoped that the number of consultations and period of treatment would not be prolonged, but Denise estimated that she would have enough money to cover this first stage or her transition without calling on the funds held by her mother.

After waiting for a few minutes a friendly, down-to-earth, woman in her early fifties came out to greet her.

‘Good afternoon Miss Symonds, I have just read Dr Collett’s letter so please come in to my office and sit down.’

‘Thank you,’ she replied, ‘and please will you call me Denise.’

‘Very well, Denise. No doubt Dr Collett has explained to you my role in your transition. The aim of hormone therapy will be to make you more comfortable with yourself, both in terms of your physical appearance, and how you feel about yourself. The hormones will begin to change your body shape so that is more female. These changes include the shrinking of your penis and testicles, the loss of some muscle and increase of fat on your hips. It will make it harder for you to get an erection and have an orgasm,’ she said.

‘That is not an issue for me,’ replied Denise.

‘Your breasts may also increase in size slightly, and you may have less facial and body hair. However, to be frank, several of your facial features already appear to be quite feminine already so you must not expect dramatic results,’ continued the Doctor.

‘The main thing is to ensure that I do not start becoming more masculine looking,’ answered Denise.

‘Hormone therapy will not have any effect on your voice, but again that does not seem to be a problem for you. Nor will it alter your height. While you are taking these hormones, you will need to have regular check-ups at my clinic to find out whether the hormone treatment is benefiting you. However, before we go any further I will need to give you a full physical examination and take some blood and urine samples for testing. We can then meet again in about a week’s time to discuss a possible treatment regime. Dr Collett also refers to your lack of masculine development in his letter, which we will have to investigate.’

‘There is one thing that perhaps I ought to mention Dr Spencer.’

‘What is that?’

‘A few weeks ago I took some Aldactone tablets for about ten days but they seemed to make me feel faint and so I decided to stop taking them.’

She frowned.

‘I see! I doubt if they have done you any permanent damage if you have stopped taking them, but if we are going to work together successfully you must promise not to take any medicines without first consulting me. I always believe in involving my patients in decisions about the treatment I prescribe, but I am not prepared to have my patients self-medicate whilst they are under my care.’

‘Yes Doctor, I understand and I realise now that it was a stupid thing to do, but it was just that I was frightened that my puberty might re-start and that I would turn into a man.’

Dr Spencer smiled.

‘There is probably no harm done on this occasion, but we have to trust one another if we are going to work together, and you are going to safely undergo hormone therapy.’

Denise found the medical examination to be rather embarrassing and also a little demeaning, particularly as it involved a detailed examination of her scrotum and the measurement of her penis, both of which she had rather wished to forget she ever had.

‘It is odd, almost as if your puberty has started and then come to a stop for some reason’.

The doctor also examined her chin for sighs of beard growth, her throat chest, where the breast forms had been attached.

‘Don’t worry’, said Dr Spencer, trying to dispel the embarrassment, ’we should soon be able to help you to grow some breasts of your own, without having to rely on silicone forms.

‘That is what I would really like above all else,’ Denise answered.

‘I can’t guarantee that they will be quite as large as the ones you have at present, but there is always the option of artificially enhancing them at a later date if you wish,’ she added.

Finally she was allowed to get dressed and the doctor took some blood and then gave her a bottle and asked to go to the toilet and provide a urine sample.

‘I am afraid it is too early to say anything definitive at the moment Denise, but given your desire to live as a woman, you seem to have quite a lot going for you in terms of your general appearance, absence of beard growth etc. If you come and see me this time next week, and we will have the results of your tests and know what is going on in your body. I will then be able to advise you on a suitable course of treatment’.

‘Thank you Dr Spencer’

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‘The last week has really dragged and the next seven days are bound to seem like as many years,’ thought Denise to herself as she made her way home. ‘I must do something to take my mind off the waiting for news. Perhaps I could organise a girls’ night out for next weekend to give me something to look forward to.'