As late as last night, I hadn't made up my mind whether or not to postpone this visit to London to see Dr Curtis. On one hand, it was important: it was to review my appearance, state of health, and the ongoing hormone treatment. On the other, I was still not well, still racked by exhausting coughing fits and generally not feeling energetic enough to face the journey there and back with the slightest enthusiasm.
But I wasn't going to be beaten if I could help it. I woke up today after my fifth dreadful night slumped in the reclining armchair in my lounge. Not that this chair is anything but very comfortable: it was just that lying completely horizontal on my even more comfortable king-sized bed induced coughing within a few minutes. Even so, by three in the morning, I was determined to give the bed another try. I was highly surprised to awake at seven after four wonderful hours of proper sleep - the most in one go for about a week. I took that as a sign that the London trip should be attempted.
I flinched from using my usual means of travel - drive north to Haywards Heath, and then catch the train. I was coughing way too much, and my roughened throat would give me away! The last thing I needed. I had looked into driving the whole way, via the M23, clockwise up the M25, and then 'attack' London using the A40 route through the north-west suburbs that would take me straight in to where I wanted to go. It was a big round-the-houses journey on paper, but given Fiona's motorway capabilities perfectly feasible, and possibly quite fast. So I paid my Congestion Charge online, and set off.
I didn't get very far before realising that I couldn't safely drive the entire distance. My concentration wasn't up to it. So I pulled in at Gatwick Airport, parked there, and caught the Gatwick Express, which runs non-stop between Gatwick and Victoria. I thought I could bear that. In fact it went at decidedly less than express speed, and suppressing a series of deep-sounding throaty coughs did me no good at all. To add to this, there was trouble on the Underground, but I was lucky and got a train at once. So I arrived at Dr Curtis's with ten minutes in hand.
I gave Dr Curtis my test result printouts. The present indisposition apart, I was in good health and he was very happy with the 427 pmol/L level for oestragen. He recommended that I continue with my longstanding standard dose - 100mcg Estradot patches twice a week.
I enquired about the limited breast growth. He made no promises there. It looked as if heredity and age were against me. Most growth occurred pre-op, within two years of starting hormones. The younger you were, then the more growth that could be expected. In particular, if your testosterone level was high, so that it had to be specially (and completely) suppressed with anti-androgens, then this allowed the oestragen intake to have full effect - and enhanced breast growth generally resulted. So in a way, I'd been unfortunate in (a) having a low pre-op testosterone level that had not begged for anti-androgens; and (b) having pre-existing blood-pressure and cholesterol problems that made imposing another level of treatment on top rather unwise, because of the complications arising. So that my oestragen intake had more work to do, and its effect was partially compromised. According to Dr Curtis, the often-referred-to 'post-op surge' in breast growth was rather a myth. It might occur, but in my case I shouldn't pin any great hopes on having larger boobs.
In short then, my pre-existing medical requirements and naturally low testosterone level had kept my transition treatment simple and easy to live with. But I hadn't been able to grow a pair of amazing knockers. I might well have to resign myself to being one of those small-beasted women, because I didn't want implants. The upside to that would be the very wide range of clothes I could wear, and the ability to exercise without pain.
I asked also about having a chromosome test. This was sheer curiosity, and I was pretty certain that if carried out, such a test would simply show that I was bog-standard XY. And really, when you thought about it, anything other than straightforward XX or XY might be a sign of genetic trouble in store. Dr Curtis said that in fact genetic abnormalities are by no means rare. Many do not matter; but if a test identitfied some unusual feature, it still wouldn't be possible to say conclusively that this feature 'caused' my gender dysphoria, even if it was a sex hormone abnormality. At least not at this time. I decided not to pursue it, if matters were not clear-cut. Another factor was cost - some £200, a bit too much to satisfy a wish to find out. In any case, supposing the result showed that I was actually (and astonishingly!) XX, just like most natal women, so what? Was I going to wave the test result in the face of every person who thought me a freak and an abomination? Would they have the patience to take in a quick resume of human genetics by way of background, and then see what I was driving at? I thought not.
We will meet again in early November. By then I will have 'officially' got in two full years of 'full time living as a woman' - which I reckon from my Deed Poll name-change date of 1 November 2009 - and I can apply to the Gender Recognition Certificate panel. Dr Curtis will be one of the doctors who support my application, in his role as the gender specialist; my local GP will be the other doctor; and in three weeks or so I see Liz Hills and Mr Thomas at the Nuffield in Brighton, and will get a 'surgery letter' from them. Apparently you put a bundle of stuff together by way of evidence for the panel to consider - it's all on a government website, at http://www.justice.gov.uk/guidance/courts-and-tribunals/tribunals/gender-recognition-panel/index.htm. I'll be studying that in the months ahead.
Let's hope this awful cold will have cleared up by November.