Alice in Wonderland, Andrew Cuomo, androgynous, answer, blending in, blessing, bureucracy, Charles Dickens, Christian, confusion, consult, counseling, Counselor, diagnosis, doctor, Dr. Carolyn Wolf-Gould, Dr. Sherman Leis, family medicine, gender transition, general practitioner, government agencies, health insurance, herbal equivalents, Hurricane Sandy, Kathleen O'Brien, Lewis Carroll, Lord, Medicaid, mental health professional, Obamacare, Oneonta NY, patient navigator, Pennsylvania, personal, personal care physician, plastic surgeon, prayer, prescription hormones, professional courtesy, psychiatry, psychology, real-life experience, sessions, shark, surgery, Transgender 101, transgender health care, upstate New York, VCS Rockl;and, wait
The Journey Begins
Well, it’s different for me, anyway. In no way do I consider myself a pioneer. Even so, I’ve decided to chronicle the next step of my gender transition journey.
Where to begin? Charles Dickens began “David Copperfield” with the sentence “I am born.” No, I think that is too far back. Perhaps the more appropriate Dickens quote would be (personalized), “Lois Simmons asked for more.” (Or for less?)
Part of the necessary steps for me to start on prescription hormones and to live my life as Lois was counseling sessions to determine if transgender was a valid diagnosis in my situation. By the third session, we worked together well: she would give me one or more assignments and I would come back the following session with my homework extensively done. The single most-used phrase uttered by my counselor was “Hold on, let me catch up.” We usually were pressing up against the end of the session and would squeeze in the scheduling of the next appointment at the very end.
But one time, somehow we ended up with about 15 minutes left and everything from my assignments had been covered. So my counselor, Kathleen O’Brien, brought up the topic of surgeries. We hadn’t discussed them up to that point.
I dismissed bottom surgery immediately, totally for financial reasons. I didn’t have health insurance at the time. Besides at the time, most health insurance policies weren’t covering transgender related health care of any kind.
As far as breast augmentation, I said that I would wait to see how well hormones worked. But then I added, I might consider some minor facial feminization procedures.
Kathleen looked at me in astonishment. “Why do you think you need that?” she replied. As it turned out, she was spot on. While I am no beauty contest winner, no one has read me for male, even when I first started appearing female in public and had been on prescription hormones for less than a month.
I also took mild herbal equivalents for about one year prior to getting prescription hormones. In fact, my first day was the day of the October blizzard in the NYC metro area. The last day was the day that Hurricane Sandy hit my area and knocked out my power for three days (and a lot longer for some).
Within four months of counseling, I had my transgender diagnosis confirmation. (Your time may vary.) Kathleen and I then started to work on finding a source of hormones for me. Her preference was an endocrinologist in Albany. But he had a six month waiting list for new patients. And that would put me needing to go to Albany in mid-March with the possibility of winter weather and the certainty of tax season getting in the way. Six months became eight.
A clinic in the Greenwich Village area of Manhattan was the next choice. Over the phone, I was told that there was a six week waiting list. Later, I was told that the time frame was not definite and I should not have been given one. The point was moot. Hurricane Sandy hit their facility hard and pushed everything back.
Then I remembered that I had found a transgender knowledgeable doctor in Northern New Jersey: a different state but closer to me than the other two. I received a referral letter from Kathleen, waiting for phone service to be restored to this doctor. I faxed the letter there. They claimed that they didn’t receive it.
I told the receptionist that I would drive it there. She said they were closing in a few minutes, but I could do so the next day. I showed up, referral in hand. “When would you like an appointment?” I was asked. “As soon as possible,” I replied. “How about tomorrow?”
My wait time went from six months to six weeks to sixteen hours! It was the first and last time that doctor saw me in male mode. He was pleased and amazed by what he saw on my next visit. A few visits later, he confided to me that occasionally one of his cisgender patients would ask him if he knew who was in his waiting room. One of his transgender patients was there, sticking out like a sore thumb. Then he added, “No one has ever mentioned you.” Indeed, I would sometimes engage in light conversation with another patient, family member or pharmaceutical salesperson in the waiting room.
But then Obamacare came along. Not only did my GP sell his practice because of all the additional record-keeping requirements, but my public insurance (Medicaid) would not port over the state line. As I wondered about waiting lists and finding a new doctor, Kathleen told me about Dr. Carolyn Wolf-Gould in Oneonta. It has been my good fortune for my basic medical care that I have not needed to provide Transgender 101 training for a medical practitioner. And that was certainly true of Dr. Carolyn.
Dr. Carolyn and her husband, while also providing family medical care, have built an upstate New York oasis of medical care for transgender patients par excellence. Their practice continues to grow and their patients come from surrounding states as well as New York. Words cannot describe how much of a blessing she has been to me.
And one of those blessings came during a six month checkup. She asked me if I knew that Governor Cuomo had issued an executive order that required insurance companies in New York to cover transgender health care, including gender reassignment surgery. I said I did, but I thought it only covered private insurance. She replied that it covered public insurance as well. Furthermore, she had done some investigation and found a surgeon in the Chicago area who was experienced and took Medicaid. Since inexplicably no surgeons in New York were doing the surgery, let alone accepting Medicaid, I could port my insurance outside of the state.
So I started pointing toward Chicago. And I had two hurdles: a letter from my counselor (an MSW) and a letter from a mental health professional with a “Dr” title in a related field (i.e. psychiatry or psychology).
Kathleen was ready to write the letter right then and there. She knew how successful I had been in my real life experience, far beyond the one year minimum requirement. Then she looked through her notes. We had only talked about surgery for a few minutes.
And I was glad for a few sessions devoted to the topic. In some ways, this was a tougher decision than presenting my true self full-time to the world. This meant a major surgery, something that never should be taken lightly. Furthermore, I had passed age 60 and never had a reason to stay overnight in a hospital since my mom brought me home after I was born. In December 2014, I had a tiny cyst removed from my eyeball: in by 7 AM, out by noon. They don’t even put you under for that surgery: just a local plus a nice floating feeling, but you can still respond to instructions from the surgeon to look in various directions. Until 2017, this was the only surgery I ever had.
No, this was going to something completely different. Was I tempting fate? As a Christian, I reminded myself that this wasn’t the right question. Instead, would the Lord be with me in this or against me doing it? It was even possible that this wouldn’t be considered a sin in general, but it might not be His will for me.
After prayer and contemplation of scripture, I didn’t receive any dissent from the Lord. I was reminded that when I was a pre-teen, I had prayed for a while to wake up with a girl’s body. I didn’t get the results I prayed for (although my body remained quite androgynous). But I never got a “no”, either. At that age, I lacked the knowledge and sophistication to understand that “wait” is a possible answer from God.
Now I needed to search for that second mental health professional, one at the level of doctor, for that second letter. I found many who took my insurance, but none in my county who had the slightest experience in transgender issues. I was tipped off on a husband and wife practice in a neighboring county that fit both conditions. He had an 18-month waiting list; she wasn’t taking any new patients at all.
Then a new door opened. VCS in Rockland, a group I was very familiar with by this time, had started a mental health clinic that accepted Medicaid. By January 2016, I had my second mental health professional. By the end of tax season, I had the second letter. And by this time, Dr. Carolyn informed me that she had found a surgeon closer to me. She assured me that he had an excellent reputation, was known for being very caring, and that he accepted Medicaid. And that was how I found out about Dr. Sherman Leis in Pennsylvania. He was everything advertised … and more.
But that is skipping ahead a few steps. There is always a bureaucracy to deal with. And it rose up at every turn.
Early in my adult life I worked for HUD in New York City. I left that job to run a housing assistance program for a local housing authority. After four years in public housing I became a financial professional, starting as a stock broker and adding other specialties over the years. This might be the heart and soul of capitalism, but I still dealt with a government agency (SEC) as well as bureaucracies with the NYSE and NASD.
Even so, that was a relative lull until I started preparing taxes professionally. Now I was dealing with the IRS and various state tax agencies (usually New York and New Jersey, but also Pennsylvania and California to name a few other states: over the years, I have prepared tax returns for 28 different states, DC and Canada).
The first step is for the “patient navigator” to request approval for a consult with the surgeon. This was submitted at the end of May, shortly after I delivered all the necessary paperwork from my two mental health professionals and Dr. Carolyn added her required letter. I was told that this process should take about six weeks.
In mid July, six weeks had come and gone. The patient navigator admitted surprise. She told me that around the same time, she had submitted a request for another patient with the same circumstances: same surgeon, same insurance carrier, same surgery, same state of residence. The other patient’s request was approved promptly.
This would be the first of many times I would become a ping pong ball between various people acting for my benefit, each claiming someone else needs to solve the problem. Finally in mid-September I put my foot down and demanded that these people talk to each other and to stop going through me, the least influential in the process.
(I have been on the other side of this dynamic, when I deal with tax agencies on behalf of clients. I have far more clout than the clients do. I illustrate this with the following joke.
A ship wrecks and three men end up in one of the life boats. One is a priest, one is a soldier, and one is a lawyer. After rowing for a while, they spot an island nearby. But the current is against them reaching the island with normal effort. Furthermore, there is a school of sharks between them and the island. Swimming to the island seems out of the question.
Finally they decide that maybe one could get through to the island and hopefully get help on the island. But who should be the one? The priest argues he should go because the Lord would protect him during the swim. The soldier counters that he is by far in the best shape and would have the best chance of getting through, either outswimming or fighting off the sharks. Rather than enter the discussion, the lawyer simply takes off his shoes and jumps in the water.
To the soldier’s amazement, the sharks open a path for the lawyer to swim through and he makes it safely to the island. The soldier asks the priest if he knows why that happened. The priest replies, “Professional courtesy.”)
Finally the parties involved talked directly to each other. And what did Dr. Carolyn’s office find out? My insurance carrier wanted paperwork that pertained only to an in-state service request. This service was being performed out of state. Even so, it took another few days for the patient navigator to decide that the best way to resolve this impasse was to simply fax the request again.
With the cover page please include a statement that this is an out of state request, I suggested. She did. On September 26, I had approval for a consult with Dr. Leis. There was a minor problem that the approval was good for only 30 days and it took over 60 days to get a consult with Dr. Leis. In a few days, the approval was extended and I had an appointment for a consult with Dr. Leis on November 30. It was a consult that should have been held before Labor Day. Little did I know my trip through health insurance Wonderland was just beginning.
O Lord, righteousness belongeth unto thee, but unto us confusion of faces … – Daniel 9:7 (portion)