What happens when your testosterone is contaminated (shot 59)

Now that I know, when I think back over the past few months I feel like a cellophane balloon that woke up on the floor of the gymnasium long after the dance ended. The trip down was so gradual I hardly noticed. I held my shape on the ground for what now seems like forever before realizing the air was gone.

Eight hours after shot 58, I walked out of the museum with my phone wedged in the crook of my shoulder as a voicemail from the pharmacy that compounds my testosterone played. No information, just a “please call us back.” It had been three months since I last placed an order with them and my mind quickly jumped to the worst conclusion – something must be wrong. But it was after 5pm and I couldn’t call them back, so I tried talking myself out of it thinking maybe it was a credit card issue. It wasn’t.

The next morning I got a call from my doctor letting me know that the pharmacy had called them too. The batch of testosterone that I had been injecting into the thick of my muscle every week since January had been contaminated…with estrogen. <pause> I felt everything you’re imagining. Probably worse.

I called the company. I asked them how much contamination there was and how it happened. They told me a “small amount,” that they didn’t know. I pushed. I work in a lab and I know that a “small amount” doesn’t actually mean anything, could they please give me a number. They said they didn’t know, but that they would send me a new vial and a return label to send them back what I’d been using. They patted themselves on the shoulder that their quality assurance testing helped them catch this. They never said they were sorry.

I hung up the phone filled with the anger you get when you know someone you trust is lying to your face. And as the initial panic died down hours after, I was filled with revelations of what I wish I would have said. I knew I was being lied to because they had to have measured something to warrant the call in the first place. I also recognized that they couldn’t tell me anything  because depending on what had happened, their license could be on the line. I told myself that’s why they couldn’t apologize.

There was disappointment. And the loss of safety. There was fear and uncertainty. I spent the next few days somewhere between panic, anxiety attacks and breakdowns. There was the guilt that I was so angry at one of the only companies that provides hormones to trans patients at an affordable cost. I was between a rock and a hard place. It was lonely.

I googled estradiol to learn about the side effects. I scrolled through MTF hormone treatment pages to see what the prescribed doses were and how often they injected.

There are two likely ways contamination could have happened. Someone could have made a mistake. Then the likelihood that I was injecting full doses of estrogen on top of the testosterone was high. Someone could have also been negligent. When I’m sequencing sea slug DNA, despite protocol and my best efforts, sometimes contamination happens and instead of slug DNA sequence, I get fungi, frog, shark or even human. It’s close to impossible to pinpoint at what step in the process it happened. The contamination could be a “small amount” too, but it opens the door for who-knows-what to be in there too.

I felt crazy, really. Like the kind of crazy where you aren’t sure you can trust your feelings and aren’t sure what’s true or placebo.

A week before I found out about the contamination I received some sad news. I almost cried, which is something you lose the ability to do when you start taking testosterone. It has been over a year since I cried in a meaningful way, and I felt excited enough to be possibly getting that back that I told my friends. A week later, after I found out I had been injecting estrogen, I had a disappointing and hurtful experience at work and I also almost cried. When I told my female friends I said, “you know that feeling when you’re at work and you’re doing all you can to not start crying in front of your coworker?” It felt like that. I was’t excited that I might be able to squeeze a few tears out, I was mustering up all I could to not. I caught myself saying this only to women. Every one of them nodded that they understood.

Then a week later I had my first uncontaminated shot. There was something about the inkjet-printed label that irked me this time. It looked more like a sticker on a mix-cd from the 90s or what you’d find on a bake sale bag of brownies. I didn’t trust it. I didn’t trust them. But if I wanted what was inside, I needed to get over it.

The difference was instant and extraordinary. My heart felt like it was going to beat out of my chest – a feeling I had almost weekly when I first started hormones. My energy rose, my confidence and calmness arrived, my mind and body felt connected in the exact same way I felt when I had my first injection. Over the next few days, my adolescent ache started coming back. I was relived and thankful to feel like myself. I was horrified at how different I felt.

The psychological struggles of the past few months haunt me, and I push the idea that any of this was linked to increased estrogen away. I spoke with my doctor again and learned that the pharmacy was alerted to this “mistake” when a different doctor tested the estrogen levels of one of her transman patients, a test rarely done during routine blood work for transmen because estrogen levels in cis-women are very low and within a small range. His levels came back unusually high so she phoned the pharmacy. Then they performed a “quality assurance test.”

I’m not feeling very assured. I am feeling uncomfortably lucky that because I’ve been injecting this for three months, I know that there is nothing medically alarming happening (that I can tell from the outside). I’m also thankful that if it is only estrogen, that everything is reversible, and that it will clear my system shortly. I’m thankful in that way that I was able to have an emotional reaction because there was space for me to do that because I wasn’t dying. I hate consoling myself with thoughts of “it could have been worse”. But it could have.

It’s never a convenient time for this type of thing to happen. I talked with friends, doctors, my therapist. I reached out to the Trans Law Center for advice on learning the truth, and to see that I’m taking the right steps towards getting answers. I’m getting ready to pull some strings and reach out to some of my medical center connections to see if I can get the contaminated medication tested myself. I’ve been busy this past week though. Busy writing a talk for an lgbt scholarship that would significantly help me afford my first year of my PhD. These types of applications are difficult because I don’t like to think of my life as more difficult as a result of being trans.

Tomorrow, I’m going to put on nice pants and a button-down shirt and sit inside a courtroom filled with people I don’t know and a judge is going to ask the room if anyone has any objections to my name and gender change.

Every night I get a Google News alert for the keyword “transgender”, and read about legal battles and laws, pop culture strides and setbacks, teenagers and youth who take their own lives, murders. And the cultural needle shifts while a comfort inside myself decides where it’s going to settle.