My Transition Diary

I just got a very unexpected phone call: William Conners, my amazing urologist, passed away very suddenly over the weekend. He was only 43. I'm in absolute shock, and honestly feeling heartbroken over this loss.

Dr. Conners was one of the best doctors I've ever had. He had the best bedside manner, was always glad to see me even when he was clearly tired and stressed, and worked with me when I had some issues with Testopel early on but didn't want to switch back to other forms of T. I wasn't his first Trans patient, and my Transness was a complete non-issue. He knew how to discuss and handle Trans-related stuff and I never once had to educate him — which, for Trans people, is a very rare and special thing when dealing with healthcare providers. He always asked how my kids were doing and how swimming was going; he told me about trips he'd taken or wanted to take; and he answered every last one of my incessant questions with so much care. I've spent the last six years saving up questions or misinformation around testosterone that I see in the Trans community and bringing them to my quarterly appointments, and then doing my best to bring his answers back to the community. I hope they continue to spread like ripples in a pond.

The last time I saw him was in April. I showed him pictures of my kids' dog. I feel like I've lost a buddy, not just a provider. I already miss him.

I had my Testopel insertion today. My health insurance has always covered my urologist, but apparently not his practice, and not the other doctor at that practice. I nearly didn't get my Testopel because they couldn't get an authorization from my insurance. Fortunately they finally got a one-time-only authorization (normally it's for four insertions, to cover a whole year), so we were able to proceed as scheduled. The PA on staff did my insertion and it went great.

Yesterday I had a consultation with a new urologist, who is happy to provide my Testopel from here on. I'm due for my next insertion in early November, but he wants to get authorization from my insurance before scheduling the appointment.

I also had my yearly physical today, so here's my relevant test results. Reminder that I've been on atorvastatin (Lipitor) since 2013 for my genetic high cholesterol; seems like it's still working great.

Vitals:
Blood Pressure: 96/64 mmHg
Pulse/Resting Heart Rate: 77 bpm (standard range: 60-100 bpm, lower is healthier)
SpO2: 96% (healthy is between 96% and 99%)

Lipid profile:
Cholesterol: 183 mg/dL. Standard range: ≤199 mg/dL
LDL Direct Measure: 105.6 mg/dL. Standard range: ≤130 mg/dL
HDL: 55 mg/dL. Standard range: ≥40 mg/dL
Cholesterol/HDL Ratio: 3.3. Standard range: ≤4.9
Triglycerides: 112 mg/dL. Standard range: ≤149 mg/dL

My insurance denied the authorization request from the new urologist, saying it conflicts with the existing authorization from the summer — which was for precisely one insertion, and was used on August 6. Apparently I was wrong in thinking that once it was used, it would no longer be considered valid or relevant.

I called my insurance customer service, and the rep understood the issue and said she'd pass it along to the relevant team in order to be resolved. She noted that I'm due for my next appointment in November, which will hopefully hurry them along. I'm hoping to hear back from her in the coming week.

We forgot to do our normal hormone panel at my physical, so I did that today. I'm about 2/3 through my Testopel cycle, so these are mid-range levels.

Hormone levels:
Albumin: 4.5 g/dL. Standard range: 3.7-5.1 g/dL
Total Testosterone: 481.1 ng/dL. Standard range: 241-827 ng/dL
Sex Hormone Binding Globulin: 33.7 nmol/L. Standard range: 17.3-65.8 nmol/L
Follicle-Stimulating Hormone (FSH): 10.04 mIU/mL. Standard range: 1.27-19.26 mIU/mL
Luteinizing Hormone (LH): 0.73 mIU/mL. Standard range: 1.84-8.62 mIU/mL
Testosterone, Free: 97 pg/mL. Standard range: 47-244 pg/mL
Testosterone, Bioavailable: 238.0 ng/dL. Standard range: 130-680 ng/dL
Estradiol 17 Beta Serum: 23 pg/mL. Standard range: 14-55 pg/mL

I had my Testopel insertion today with my new urologist, after calling my insurance three times to continually follow up and get them to resolve the authorization issue. Apparently it expired on October 4, which they didn't notify me about, so I was glad I called a few days after that and was able to find that out. Since there was no longer a conflict, this time the authorization request went through fine, and I was able to schedule my appointment completely painlessly — and not any later than it should have been.

I've been having hot flashes for the past few days, which is interesting given that my labs were fine last month and this insertion was actually a little bit earlier than usual — 91 days after my last one in August. No labs today, but I'll have them done a week before my next insertion in February.

It's always a bit of a crap shoot with a new provider, but the physician's assistant is the Testopel guy at this office, and he was great. Three (I think) lidocaine injections, not too painful, and the insertion itself went smoothly. Eight hours later, I'm still barely sore at all. Mostly I'm just incredibly relieved to have gotten my T — and on time! — after two months of insurance stress.