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Edited by S.L.Hawke
Image Copyright © 2012 Tracey Willows

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 Chapter Eighty-One

As my father and I sat in the waiting area beside the changing rooms for the ultrasound technician to show up, I fiddled with my Nintendo DS. It was next to impossible to focus on playing Harvest Moon. I really liked Harvest Moon, but planting crops, raising animals, mining and deciding which of the eligible bachelors my character would marry didn’t really distract me. It merely killed time; I wasn’t truly into the game.

“How you holding up, Scott?” This was my dad’s fifth, or maybe sixth, attempt to start a conversation this morning.

“I’m fine.” He had used my boy name, but I just let it go. I didn’t want to talk about it, or anything else, with my father. I was caught between hope and dread: There was the tiniest chance that I might have real girl parts in me, but the needle biopsy scared the crap out of me. I really shouldn’t have watched the procedure on YouTube. However, as scary as that was... the worse fear was that they would test me and find nothing but boy parts. Sigh. I had hardly slept at all last night. I just wanted it all over with. I wanted to know one way or the other. Maybe if Julie had been here I could have talked with her, but my father wouldn’t understand.

No small part of my discomfort was due to the way I was dressed. I don’t think anyone likes wearing a hospital gown, but I couldn’t help feeling it was worse for me. I’d started off the day in boy mode, since the clinic was a public place. Now, I was kinda in an awkward half-way place, whitey-tighties, a sports bra full of boobs and only a thin gown to cover it all up. I was also wearing it backwards, as they’d told me to put the opening to the front. I was holding my arms and the DS up to mask the bra as much as I could, but it still felt pretty obvious that I wasn’t boy or girl, but something in between.

The receptionist had even noticed before I had changed. I wasn’t sure what to make of that. She’d taken us into the rear change rooms and private waiting area earlier, and told me how to put on the grown. Then she had paused and given my chest a thoughtful look and added a belated comment about it being okay to leave a bra on for this particular test. I'm not sure how I felt about that. It was the first time that anyone had ever read me as a girl while I was in boy mode. A part of me was pleased that she had noticed... while the other half had wanted to die of embarrassment, since I was supposed to be being a boy right now. Oh, well. At least it was only a medical professional that noticed, and not someone at school. Or sort of a medical professional. Clerks and receptionists deal with confidential patient data all the time, so they must have some sort of oath about that sort of thing... right?

A young blond woman wearing faded green scrubs popped into the room. “Good morning, I’m Pam Roberts, call me Pam. You must be Taylor. I’ll be doing your ultrasound today, if you would like to come with me. Please bring your things with you." She lead the way down the hall to an unoccupied exam room, asking the usual more formal patient identification stuff of me while we were walking before adding, "So, how are you doing this morning?” She was amazingly chipper and upbeat with the sort of body I hoped I would one day have. Beautiful, curved in all the right places and large breasted, she could have been the life-sized version of Ultrasound Tech Barbie.

“I’m fine,” I replied, repeating my mantra for the day. Maybe if I told everyone that often enough, I might start to believe it myself.

Closing the door behind us and gesturing for me to place my bag of clothing in the corner, she spoke briefly to Dad about having a seat on the chair by the door, then turned back to me. “Why don’t you make like a bunny and hop on the table? I’ll just take another quick look at your chart.”

Hop like a bunny? Oh my god, was she a candy striper pretending to be an ultrasound technician? Or did she think I was six or something? I climbed up on the paper covered table, trying not to flash the world while wearing that stupid exam gown. “You know, I’m not a child. I’m thirteen years old and I know why I’m here.”

She closed the file folder she was looking at and gave me a smile. “Do you now, Taylor? So why are you here?”

“My doctor thinks that I might be intersexed and he’s having you look for female parts inside me.” Please, please, let there be.

Dad coughed. “It’s a possibility that needs to be investigated.”

A little bit of her perkiness faded, but she still smiled showing rows of gleaming perfect teeth. “Well, let’s investigate it then, shall we?”

She turned on the machine and computer screens came to life. One of them looked like just some kind of control menu, while the other was the actual imaging monitor. I didn’t get to look at them long because she adjusted the screens to angle them away from me. Handing me a towel to drape over my lap for modesty, she had me lie down and open the front of the gown to expose my abdomen. I stopped short of my bra, but I’m sure she knew it was there. That thin gown didn’t hide much. Then again, she likely knew already. My diagnosis of KS with gynecomastia was probably in that file she’d read.

After squirting some cold jelly stuff on my belly, Pam began running the ultrasound wand across my abdomen. “Just try to relax, Taylor. This won’t take long. So, what grade are you in?”

“Eighth. I start high school next year.” I couldn’t see the monitors so I strained to hear anything going on, but the machine was very quiet. It didn’t beep or ping like the medical equipment on TV. The only sound it made was a slight whirring noise that sounded like a cooling fan.

She moved the wand slowly about my torso, paused while telling me to take a deep breath and hold it, and then typed some keys. “That’s a great age. Are you in any sports?”

Taking that as a clue that it was okay to breath again, I did so before answering. “No.” Certainly not. I was frustrated by the way this test was going. I’d watched some videos of ultrasounds on the internet, so I had a pretty good idea of what she was doing. She was taking pictures of my organs. “Can you tell if I have any girl parts?”

“I’m still looking.”

“Yes, but what are you seeing?”

She repeated the holding breath instruction and typed on her keypad a few more times, then glanced at my file again, before she answered. “You should discuss that with your family doctor, or as I see your file is marked for a duplicate copy to go to Dr. Wexlar, possibly discuss it with him instead... but I’m not seeing anything to be worried about."

I couldn’t help sighing in disappointment. I knew the chance of having even a malformed ovary was small, but I’d still hoped for a miracle like in some of the TG stories I’d read. The ones where I might have all the working girl bits – ovaries, womb and vagina – hidden up inside me.

Although she had started higher up on my abdomen, she had been steadily working her way down my body and had gradually pushed the towel far enough south to reveal my underwear. “Taylor, I’ll need you to remove your underwear now. Did the receptionist forget to mention that you should take those off?”

Actually, she hadn't. I just had been hoping that it wouldn't really be necessary. “Huh? Why? You’ve already done the ultrasound.”

“I’ve done part of the abdominal ultrasound, but I also need to see your pelvic area... which means the shorts have to come off. Besides, you’re also down for a testicular ultrasound.” She wasn’t looking at me or my father when she said it.

“Oh, will that show if I have an ovotestis?” I was half-eager to know now, but I was also curious as to why they needed to stick needles in my balls if an ultrasound could tell.

“Perhaps, that would be for Dr. Wexlar to interpret. Would you remove your underpants, please.” She was still looking down and not at me.

I lifted my hips enough to let me wiggle out of them, then pushed them down past my knees and slipped them off, hiding them under the towel while feeling awkward. Not that the towel stayed in place much longer anyway. First she kept pushing it down further and further while doing the rest of the abdominal stuff, but then she had me spread my legs and started imaging the dangly bits. Embarrassing, although not as bad as it was with Doc Buford. Even though I still had my useless boy parts, it wasn’t as weird having a woman touching me there as it had been when a man did. With Doc Buford it had felt almost gay. With call-me-Pam touching me with her gloved hands and the ultrasound wand, I was just uncomfortable. Well, until I saw my father watching me. “Dad! Don’t look!”

“Sorry,” he apologized as he turned away in his chair, and pointedly looked at the door to the room returned to his corner.

I’m sure I was blushing now. I could feel my face getting hot. “Can’t you give a girl some privacy?”

Call-me-Pam gasped and flinched enough that she gave a little tug on my balls.

She didn’t hurt me, but it sure got my attention. “Did you find something?!” Hope bloomed within me.

“No,” she responded in a strained tone. Then she gave a nervous titter that better suited her Barbie doll appearance than her profession. Then she blushed. “I’m sorry, that was unprofessional. You startled me. I’ve had the training, but you’re my first transgendered patient. I was skeptical. I just realized that you’re the real deal.”

My father stood up. “What do you mean? What did you find?”

Pam glanced back at him. “No, I haven’t found anything physically. I'm sorry; I just...” She looked back at me and sighed. “Most of my patients are pregnant women, but I do have other patients both male and female. I’ve done other testicular ultrasounds and the men always... react... to having their private parts handled by a woman like me. You haven’t even twitched, and you’re embarrassed by your father seeing down there.”

“Oh.” I hadn’t even thought about her fondling me as anything close to sexual. It was just a procedure that I had to endure, and she was just moving things around as necessary to do her job. I was more interested in the outcome. Leaning over me like she was, I could even see some of Pam’s cleavage through the neckline of her scrubs. The only thing the glimpse of her perfect breasts stirred in me was jealousy. I wanted to be like her.

“You can get dressed now. I’m done.”

As much as I was interested in the results just a moment before, I found myself awkwardly aware of the implications of my disinterest. Even though Pam was too old for me, I should have felt some lust for her. I liked girls. At least I liked Cathy... didn’t I?

“So what were the results?” asked my father in an irritated tone.

Pam hesitated for a minute, chewing her lower lip thoughtfully before she started spewing medical babble. “Policy is that you should direct those sort of questions to your physician... but I suppose there is no harm in telling you this much. Taylor’s testes are abnormal in a manner that is consistent with his previous diagnosis of Klinefelter’s syndrome: they exhibit microorchidism and apparent hypoechoic striations indicative of fibrosis of the seminiferous tubules. The good news is that there are two well defined testicular masses in the anatomically correct locations. I see no indications of additional streak gonads or other genital abnormalities. So, I think that our staff consulting radiologist will recommend skipping the X-ray genitography and the MRI that your file has optionally indicated. That will save y’all at least a little in copay fees. As for ‘girl parts’, I didn’t see any anomalous abdominal masses, nor were any observable ovarian follicular characteristics noted by myself on the testes.”

All that gobbledygook was hard to follow, but I think I got the gist. “So no girl parts?”

She looked me in the eyes and gave me a sympathetic smile. "No girl parts... sorry." With a shrug, she looked back at Dad before continuing. “Or at least, not so far as I can tell, but the radiologist will, of course, review the sonograms taken. Maybe he’ll see something I didn't. He’ll present his findings to your own doctor... or rather, Dr. Wexlar in this case, since I see from the file that Taylor is scheduled to consult with him next." She offered me another sad smile. "Dr. Wexlar will need to interpret these results, but basically what the technical jargon means is that your testicles are very small for your apparent stage of puberty. He’ll also need to discuss the more unusual aspects with you.”

I sighed. “I understand.” Or at least I hoped I did. No obvious girl parts, but maybe, just maybe, still a slim chance of an ovotestis.

Chapter Eighty-Two

My urologist for the day was Dr. Wexlar. He wasn’t as old as Doc Buford, but he was close. He had a slight Eastern European accent, German or Russian or something. I could imagine him being an escaped Nazi from one of those old movies I used to watch with Grandpa on television. “We have ways of dealing with girlie boys,Ja. Now we will slice open the boy’s scrotum, Ja. Und then we will stick the needles in his testicles.” Okay, so no, he didn’t really talk like that – that was just my demented imagination running wild. He was actually far too professional to show the secret joy I knew he felt over turning my balls into pin cushions.

“Is the needle biopsy really necessary? You already said my testicular ultrasound showed no sign of an ovotestis.” Dr. Wexlar had just completed the job that call-me-Pam had started. My dreams of being like one of those TG miracle stories where I had girl parts had been crushed. I had no womb, ovaries, or a closed off vagina hiding anywhere up inside of me.

“Your testes appear to be abnormal in a manner consistent with Klinefelter’s syndrome, although histopathological and cytological examination of a tissue specimen would still be preferred. While the ultrasound showed no sonographically apparent signs of ovarian tissue, given your estrogen levels, the biopsy is a justified step. Microscopic examination of extracted samples will allow us to be certain, and it will also let us know if you are infertile. I would think that would be something you would like to know.”

I shrugged. I wasn’t sure with all the fancy words, but apparently I still had a small chance of having ovarian tissue, even it hadn’t been visible on the ultrasound. That should be worth knowing. Didn’t I want to be certain?

My dad spoke up. “Yes, that is something we need to know. We also need to be certain.”

The doctor smiled, and nodded. "Good. While some of my colleagues might do a simple pure needle biopsy, I always feel more confident of my diagnosis when I do a visual inspection as well. I trust that meets with your approval, since you want to be certain?"

I could tell that Dad was out of his depth here. He just nodded and said, "Whatever you think is best."

I sighed. I didn’t really give a damn whether I was fertile or not. Actually, I’d rather not know. If I was fertile, that would be a tiny reason for staying a boy. Since I wasn’t going to stay a boy, it was easier not knowing. Regardless, I wasn’t looking forward to the surgery. Even if it was supposedly a minor procedure, it was a pretty big deal to me. I wasn’t real clear on what the difference was between ovarian tssue and an ovotestis, but apparently there might still be a little girl in me. I suppose that was something, but I just had the feeling they were grasping for straws. Unfortunately my objection had been brushed aside. It didn’t matter what I wanted. Dad and Dr. Wexlar had decided. It was going to happen. The only thing I had to compare it to was a visit to the dentist for a filling: I knew it was going to be painful, but I’d been told it was necessary. My parents and the doctors all agreed it was necessary... and that was that.

That’s how I found myself lying on my back looking up at the bright lights and waiting for the surgery to start, and deciding it wasn’t all that bad. Sure, having a nurse shave off what few pubes I had managed to grow, and scrub my private parts, had been awkward and embarrassing... but once they’d given me a tranquilizer everything got better. Whatever they gave me wasn’t supposed to knock me out. It was just supposed to help me stay calm. It certainly did the trick. I felt all floaty-like. It was sorta like being on cough syrup with codeine, except nicer.

I could hear them talking as they worked on me. It just didn’t seem to matter that much. I knew what was happening. I was too smart for my own good. I’d looked it up on the internet and even watched a video of the procedure. While I couldn’t really see what was happening, I knew what was going on. They gave me a local anesthetic first, just like at the dentist, something to numb the area. Except when the dentist does it, it goes in the jaw. They shoved a needle down in my scrotum and that was an entirely different level of pain than I had expected. It got through the fog of the happy pill, but I didn’t cry out, just made a little ‘ooft’ noise. I recall this was only supposed to be a ‘moderately uncomfortable procedure’. Whoever was in charge of the pain scale obviously needed to recalibrate...

While the surgical drapes blocked my view, I noticed the bright lights they had pointed at me also had a polished chrome framework that was almost mirror-like in places and if I looked carefully, I could see somewhat. I noticed this just in time to watch Dr. Wexlar take a scalpel and cut open my scrotum, otherwise known as my ball sack. It didn’t even bother me as the blood began to flow. Did that mean I was a girl or were these really good drugs. The only thing that bothered me was realizing that I was going to have a scar down there. Not that I was vain, as scars go it would be pretty well hidden. However, if I ever had SRS – not that I had decided to have it yet – but if I did then that was the ‘donor material’ and I didn’t want a big old scar on my future vagina. Hopefully that wouldn’t be a problem. I really should have asked about that before they were cutting me open...

Under the outer skin there were a couple of more layers with fancy medical names I vaguely remembered reading about, but it was too hard to think right now. Whatever. Ouch. Hey, I thought they said I wouldn't feel a thing? Liars. Not that it was bad or anything, but I could sort of hazily feel pressure as he was cutting through things until he got to my testicle. And what was that smell, anyway? Are my balls supposed to be smoking like that? I think I remember seeing a couple tiny puffs of smoke on the video, but somehow I didn't really connect that to their burning me deliberately. Well, I suppose that would be their cauterizing things so that I didn't bleed too much. Dr. Wexlar did say something about doing that when they stuck that big patch on my leg and hooked up a wire to it. Still, it can't be good when you hear that crackling, popping sound of frying bacon coming from your own body...

That drug must be really good stuff, as when he’d squeezed my little testicle out into the open, all I could think about was how funny that was, and how it looked like a weird grape dangling there. Sigh. Well, okay, more of a big raisin in my case. I was mesmerized enough to watch as he brought out the biopsy needle.

Fuck! It wasn’t supposed to hurt! That’s what the local was for, but it hurt like crazy. Then he did it again. What the fuck?! Didn’t he know I felt that? No, apparently he didn’t, because he did it again. And again. And again. How many times did he need to stab me in the balls with a sharp needle anyway to get a sample? It was like I was stuck in some horror film. I could see him stab me, feel the pain, but other than some huffing and puffing I couldn’t seem to engage my vocal cords or move. Maybe they expected guys to just 'take it like a man', but I wasn't a man, and that hurt! I closed my eyes and that helped a little, but I could still feel it. If I couldn’t take it like a man, maybe I could take it like a woman. My mind flashed to what they always tell women to do when showing a birth on TV. I started taking long slow deep breaths: breathe in slowly, let it out slowly, focus on breathing. It helped. I still felt the stabbing pains but they felt farther away. I tried to just breathe. It would be over soon. It had to be over soon.

Up until they’d given me that pill, I’d been worried sick about things. Now, I kinda felt like telling him that as long as he had my balls out that he might as well just chop them off instead of sewing them back in there. For some reason that even felt funny. Why did I need my balls anyway? I was a girl wasn’t I? Wasn’t a girl with balls an inherent contradiction? There had been a reason for keeping them, but right then I couldn’t remember what it was. Oh, because they might be ovotestes… or at least ovo-something. That would be a reason to keep them. So maybe I shouldn’t tell him to make with the snip-snip yet.

“Taylor, we’re done.”

“Oh-kay. T'ank you, herr Doc-e-tor.” Oops. Did I say that last bit out loud? When had he finished? I remembered the stabbing pains, but when had he slipped things back in and sewn me up? Oh well at least it was over. I wonder if this is what it feels like to be stoned? I felt pretty good as I was wheeled down the hallway on my little gurney. The orderly pushing the gurney wasn’t Dr. Wexlar. He was young and muscular. He reminded me of Kurt on Glee. He was probably gay like Kurt. What a waste; he was really cute.

Chapter Eighty-Three

By the time Dad drove me to my appointment with Dr. Flynn, my endocrinologist, the happy floating feeling was gone. I wanted it back, because it felt like Rick had used my balls as punching bags. They didn’t have that sharp, oh-my-God, pain that came from just being racked. Rather they were at that tender, please-don’t-move-fast, please-don’t-touch-anything stage that followed. Dad’s truck didn’t have the best shocks in the world, and every time he hit a bump I’d wince.

“Do we have to do this today?” I knew that I was whining and I didn’t give a damn. I hurt and I wanted to go home. To just take the painkillers they’d prescribed for me, and sleep.

Dad looked sympathetic. “I know you’re in pain. It hurt me just to hear what they were going to do to you, but it isn’t easy for me or Julie to get time off. This is important. Something is going wrong with your body and we don’t know what it is. We need to find out.”

“Okay.” I agreed, but I didn’t like it.

I played Harvest Moon on my Nintendo DS while I waited. I’d been playing all day, on and off to distract myself, but with the happy pills I’d lost track of what I’d been doing. What had I planted? When we got called back to see Dr. Flynn, I put my game away immediately. I needed to pay attention. Dr. Flynn was important. He was the endocrinologist. I knew that word very well from TG fiction: He was the one who controlled the magic drugs that would let me stay a girl, or force me into being a boy.

I walked as slowly as I could, but tried to hide the pain I felt as his nurse put me through the usual intake measurements. She noticed my pain, but understood when I told her that I’d undergone a testicular needle biopsy just a few hours ago. Eventually, I got to sit on yet another paper covered examination table. I was getting wearily familiar with exam rooms. This one was much like any of the others, just large enough for an exam table, a sink and some counter space. I was collecting quite a stable of doctors. Hopefully, my endocrinologist would be the last.

While Doc Buford had his country doctor thing, Dr. Flynn seemed to have aspirations on being the cowboy doctor. He wore expensive boots, which isn’t that unusual for Texas, but he also had on a string tie. I could tell it was a deliberate look. While my fashion lessons had focused on women’s clothes and not men’s, his shirt and pants were clearly chosen for style and not practicality. His hair also looked too dark for the wrinkles he had. He probably dyed it. Oh well. Maybe it was for the best that he was a drugstore cowboy, as goodness knows I was waddling around as bowleggedly as a real cowboy right now.

“Hello, I’m Dr. Flynn, good to meet you all. I take it that you are Robert and you are Taylor?” He shook my dad’s hand first and then mine. “I’ve received your medical records from Dr. Buford and I’ve just spoken with Dr. Wexler, as well as reviewed the documents and images he had you bring over for me in that sealed envelope. Unfortunately, I haven’t been able to speak with your psychologist yet, but I understand you’re seeing Dr. Yeatts?”

“That’s correct,” said my father. “Is that a problem?”

“Not at this stage. What is more important right now is solving this medical mystery. Did you bring in Taylor’s prescriptions like I asked?”

My father nodded and held them out. “These are the original prescriptions, and these are the ones that Doc Buford issued.”

“And these are the only prescriptions that Taylor’s on?”

“Yes,” said Dad as I shook my head no.

“Taylor, I see you shaking your head. What else is there?”

“I have my inhaler which I use as needed and an EpiPen just in case I have an allergic reaction.”

“Can I see the inhaler as well?” He took my inhaler, examined it, and made a notation on my chart. Then he launched into a series of questions, some aimed at me and some aimed at my father, all about my medications. Who administered them? How often did I take them? Did I always take them as prescribed? Blah, blah, blah, all the same stuff that Doc Buford had asked, although he was a bit more elaborate about asking if there were any over-the-counter remedies that I might of taken... which I haven't.

“I’m concerned about the overdosing of my son. Doc Buford said that he was taking four times the recommended dosage. I want something done about it. Did the medicine do this to him?”

“We are already tapering Taylor off the medication as fast as it is safe to do, and I haven’t made that determination about his medication yet. At this point there are still a number of other possibilities that need to be considered first. Speaking of which..." He turned away and made a long arm over to a rack of forms and things mounted on the wall over the counter, lifting out a clipboard with some papers on it already. "Please look this list over, and see if you recognize anything on here as something that you regularly encounter or take."

Curious, I found a questionnaire with several columns of weird foods and things on it. Bizarre. Okay, I have at least heard of alfalfa and clover... although the type of clover I remember is green rather than red... but what on Earth is dong quai, fenugreek, or mung beans? And those were just a few of the odd things in that table. Ginseng quercetin and ginkgo biloba sounded sort of familiar, although I thought a ginkgo was a type of lizard. Or is that a gecko? Soybeans and soy products, okay – those I remembered from an article I read about gynecomastia, so that actually made sense. I smirked and tried to stifle a laugh as I saw coffee on the list: I wonder what macho Rick would think if he knew his favorite morning beverage was considered potentially man-boob causing? Carrots and apples, oats, barley and beans? Are they serious? Was there anything not on this list?

The more I read, the more I started to wonder: did I actually do this to myself, with my Taylor Project? I have been consciously trying to eat healthier, to avoid setting off my allergies, for months now. Eating rabbit food, such as alfalfa sprouts. Not everyday, but not avoiding that sort of health-food-nut stuff the way I used to. And soy products... I suppose that includes soy milk. I have a lot of allergies. I am not exactly lactose intolerant, but if I have too many dairy products it does upset my digestion. We have always kept some soy milk in the fridge for me, and as I have been having digestive problems for months now, I had been drinking more of the soy, and less of the dairy, to try to help with that. Was that part of my problem?

Whoa. Wait a minute. Grapefruit and grapefruit juice are on here too? That isn't just a sometime sort of thing for me, like the other stuff: I have been so thirsty lately that I drink big glasses of that several times a day. Was this important? The choices were rarely, monthly, weekly, and daily.

"Umm, Dr. Flynn? Is it important if I drink a lot of grapefruit juice? There’s not a choice for multiple times a day.”

“Multiple times a day? Just how often do you drink grapefruit juice?” He had his pen out and was scribbling notes down.

“At least twice a day, every morning and evening to wash down my medication, and often a glass in the afternoon besides. I like grapefruit juice. It’s not as sweet as orange juice.”

“What does grapefruit juice have to do with anything?” interrupted my father with a growl.

Dr. Flynn smiled. “Possibly nothing, but I believe there is a good chance that grapefruit juice has everything to do with Taylor’s problem."

Chapter Eighty-Four

“What?” My dad sounded upset. “We’ve already been through blood tests, ultrasound and surgery. Now you’re telling me something as common as grapefruit juice made him grow tits?”

“Actually, it’s quite possible. Medical science has known for decades that some foods interact with medications, and in fact grapefruit juice was the first of those food-drug interactions documented. It may sound harmless, but it is anything but harmless in reality. There have been actual fatalities from mixing this particular beverage with some medications, although fortunately not the one Taylor is taking. Grapefruit juice is contraindicated for many medicines because in some individuals it is a very potent inhibitor of the CYP3A4 enzyme. That’s an important enzyme and particularly relevant in Taylor’s case as it is the enzyme that breaks down estrogens. To put it in layman’s terms, grapefruit juice clogs the drain and prevents estradiol from leaving the system. So it stays around longer and hormone levels rise.”

“Lot’s of men drink grapefruit juice, and they aren’t growing tits or wanting to become women.”

Dr. Flynn actually laughed shortly at that one, although he quickly reassumed a more sober demeanor before continuing. "That is true, and by itself grapefruit juice would not do this. Even if grapefruit juice is involved, there would have to be other factors involved." Turning to me again, he asked, "Taylor, were you about done with that list? I see you marked up some other things that you take on a regular basis.”

"Yes sir. Not often, but I have been trying to eat healthier lately. I’ve been doing apples and carrot sticks as snacks instead of junk food. That’s almost daily, then there are the assorted legumes, alfalfa sprouts and soy milk. I’d guess I’m eating those maybe three or four times a week? Except the veggies are sort of a more recent thing. I already was growing boobs when I started eating those. And I don't know if it is important or not, but the amount of grapefruit juice I drink is also going up. I used to drink a lot of it, but now I drink even more as I always seem to be thirsty.”

Dr. Flynn gave me a nod of approval. "And eating all those is a good thing, which you should try to continue. By themselves, those would not be a problem, either. I wish more of my patients ate that well: it would make the job of the medical community a lot easier. They do have phytoestrogens in them, which are basically organic estrogen-like compounds, but the quantities you are ingesting are not normally significant enough to worry about. Most people would probably digest them with little to no effect."

His eyes lost focus for a moment as he chewed on his lower lip in thought. "I think it is significant that you mentioned already having breast development before starting eating some of these things, though. They might be contributing slightly to whatever is going on, but it seems unlikely they are the source of the problem. It's not really important, but just for your information that thirstiness and your digestive problems are likely caused by how much Prednisone you have been taking... as those are known side effects. You probably noticed those listed on your medication's fact sheets."

Fact sheet? Nope. I didn’t remember a fact sheet.

He frowned a little then. "The grapefruit juice, on the other hand, is another story. There are several versions of the usual drug fact sheets for Prednisone. Some of those sheets specifically mention grapefruit juice as something to avoid with your medications, some of them do not. You did not bring the sheets with you today that should have accompanied your medication. Did you read those instructions? And did they mention not taking grapefruits or grapefruit juice with your medication?"

We’d just gotten busted. I looked down avoiding his gaze."No sir. I never even saw them. Umm, Dad? Did you see anything like that when you received the packages?"

Wow. I don't think I have ever seen Dad actually blush before. He squirmed in his chair a bit before finally saying, "Err, there may have been some sheets of legalese that were in the boxes, but those things are impossible to read. I usually just toss those away."

Dr. Flynn just gave Dad a long, silent look... while Dad slowly turned an ever deepening shade of red. Finally, Dr. Flynn gave his head a little shake, and continued. "Be that as it may, since Taylor has been drinking grapefruit juice, there are some things about it that we have to consider. It may be a naturally occurring substance, which makes some people think it can't harm them, but that’s bunk. There are all sorts of things we eat that can be medically active or even poisonous if prepared wrong.”

“Like green potatoes?” I remembered that one from boy scouts, years ago.

Dr. Flynn nodded. “Correct, raw green potatoes contain solanine, which is a poison. Grapefruit juice isn’t a poison, but the point is just because it is natural doesn’t mean it is harmless. There are several active compounds found in grapefruit juice that can act as strong inhibitors of the CYP3A4 enzyme. Now here is where it gets a bit more complicated.”

If I didn’t hurt so much, I might have laughed. He thought it was just now getting complicated? It wasn’t complicated enough before?

“The CYP3A4 enzyme is found mostly in the liver and the small intestine. Now, moderate amounts of grapefruit juice, say one glass a day or less, affects the enzyme in the intestines, but not the liver. The CYP3A4 that is in your gut's walls normally protects you from a broad range of things, including estrogens, which might be swallowed as part of things you eat. It does that by breaking those estrogens, and other things, down before the body can absorb them... but it can't do that when grapefruit juice is around. There are things in grapefruit juice that sort of 'stuns' the CYP3A4 enzymes, making them stop working for up to three days after you drink this beverage. Which is to say, it can and probably does impact the phytoestrogens from the foods we highlighted. The protective shield of the CYP3A4 has been broken, so those are not being digested properly and are entering your blood. That’s adding some more estrogenic effects to your system.”

He shrugged. "Don’t worry too much about phytoestrogens. Even with the grapefruit juice you’re not getting enough phytoestrogens to make a significant change in your estrogen levels. Besides, the problem started before you changed your diet. You just go on eating healthy foods. They’re not the culprit.”

He dismissed that line of thought with a little wave of his hand. “However, returning to grapefruit juice, you haven’t been drinking one glass a day of that; you’ve been drinking two to three glasses a day for so long that there would be a cumulative effect extending into your body and affecting the hepatic CYP3A4 in your liver. It is your liver that normally flushes estrogen out of your system. That’s what I meant when I said your estrogen drain is clogged.”

I could tell Dad was lost in all the medical technobabble, but he was still gamely trying. "So you are saying that it isn't the medication overdose at all, and it’s not the soy milk or health nut foods, but all the grapefruit juice that Taylor has been drinking that did this?"

Dr. Flynn pursed his lips and stared off into space. “No-o-o... I would not go that far. In fact I don’t have any proof yet that the grapefruit juice is doing anything. Remember I said that grapefruit juice doesn’t effect everyone. I just think it is highly likely that it is one of the contributors in this case. Even if it a major contributor, grapefruit juice alone would not elevate Taylor’s estradiol levels anywhere close to the levels we see in Taylor. Plus, another thing about the CYP3A4 enzyme, it doesn’t just break down estrogen: it affects all sex hormone levels... including testosterone levels. For a normal male whose testosterone levels are far higher than their estrogen levels, the suppression of CYP3A4 causes an increase in estrogen that is usually fairly harmless – if it happens at all – as the testosterone levels are so much higher than the estrogen ones. But Taylor's case is not like that."

Straightening up, he turned back to me, looking me in the eyes. "What I believe we have in Taylor’s case is a confluence of factors: First, his Klinefelter’s Syndrome resulted in an underproduction of testosterone and a natural severalfold increase in the estrogen to testosterone ratio. Second, Prednisone disrupted the enzymatic balance of Taylor’s adrenal glands in particular, and indirectly of his body in general, resulting in further reductions in his androgen levels. Third, his age is also a consideration here, as at the start of male puberty the male body needs a much larger amount of estrogen that normal to induce the start of the bone growth spurt... and it gets that estrogen by use of another enyzme, aromatase, to produce estrogens from testosterone. That process would also use up even more of Taylor's limited supply of testosterone, by the way, further dropping his testosterone levels while boosting the estrogen. But by itself, even all that wouldn’t drive his hormones levels to what has been seen. That’s where you add the fourth factor, grapefruit juice inhibiting the metabolism of estradiol and greatly magnifying the effects of the other factors. It’s not one thing. It’s a superfecta of genetics, medication, age and metabolism.” He sounded excited about the whole thing.

I didn’t share his excitement. I could follow his explanation more or less, but it was disappointing. What he was saying was that I had no girl parts. I’d suffered through that surgery for nothing. I was just a freak accident. No, make that just a freak. Although there was one good thing if he was right. “So if I keep eating the way I have been, and drinking grapefruit juice, my estrogen levels will remain high?”

“Only until we restore your adrenals to proper functioning. We’ll do that as quickly as possible, but we have to be safe and it will likely take months of slowly tapering you off that drug down to a more appropriate level. However, in the mean time, I want you to discontinue grapefruit juice immediately. There is no readily available clinical test for a poorly functioning CYP3A4 enzyme, but that does not matter. We remove grapefruit juice from your diet, and if there is a significant drop in estradiol levels, then we have our culprit.”

I crossed my arms and was about to tell him that I didn’t want my estrogen levels reduced, but why bother? They weren’t listening to me. They’d already sliced me open once today over my objections.

Dr. Flynn eyed me suspiciously. “Is something wrong, Taylor?”

“Oh, I don’t know. I just had needles stuck in my balls, then was bounced around for an hour to get here, and I hurt. Now you tell me that, oopsie, just stop drinking grapefruit juice. Should everything be okay?”

“Scott, don’t snap at Dr. Flynn,” scolded Dad. “It wasn’t his fault. He’s trying to help you.”

I transferred my glare to my father. “My. Name. Is. Taylor.”

“This was probably not the best time to have this examination. I’m sorry that you are in pain, Taylor.” Dr. Flynn looked over to my father. “Didn’t Doctor Wexlar prescribe some pain medication for Taylor?”

My father sighed. “He did, but we haven’t had an opportunity to get it filled yet.”

“Let me see the prescription. I’m sure we have some samples that I can give Taylor.”

I decided that I’d had just about enough of them talking past me. “Excuse me, but if it’s this superfecta thing that is causing it, and I go off the grapefruit juice, will you be giving me the hormones I need to stay in female puberty?”

Dr. Flynn turned back to face me. “I’ll need to consult with Dr. Yeatts first, and make a diagnosis. Until we’ve determined the cause of your elevated estrogen levels, we cannot make a recommendation for treatment. I can also only present options. Ultimately it will be your parents who must decide on a treatment plan.”

Alrighty then. I gave Dr. Flynn a nod, but in my mind I was giving him the finger. He might not be planning to give me the HRT that I needed, but he’d told me enough to do it myself. All I had to do was keep taking my regular dosage of Prednisone, eat the way I usually did, and chase it down with glasses of grapefruit juice every day. I’d just keep dosing myself.

 

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To Be Continued...