More People Would Exercise If This Culture Didn't Make It Absolute Hell

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Me: *stubs my toe* "AH FUCK!"

Mass of quivering flesh that's been growing in my cabinet and slowly feeding off my suffering until it develops sentience: *takes first breath*

My genuine expectation for that sentence

The thing about ADHD is that the "lack of reward chemicals in your brain" doesn't just mean that you don't want to do any tasks that don't feel particularly yummy :(, it means that your brain will look at chores and tasks that need to be done like "doing this would be painful and tedious for absolutely nothing to gain from it, Do Not Do That." The same thing that your brain tells you about everything else that would feel really bad and hurt the entire time that you're dying. The part of your brain that stops you from doing the thing is the same part that keeps you from shoving your arm into a wood chipper.

With unmedicated, unmanaged ADHD, "I have to do this assignment or I fail and my life will be ruined and I die" feels like a SAW trap, every single time.

things that made me stop wanting to die that require no effort whatsoever

change the color used to highlight text on your laptop

move the pictures on your wall

stack whatever clutter is in your room into piles even if you don’t have time to clean it all

slightly vary your commute, even just by one street

change where you sit and scroll aimlessly on your phone even if it’s only to the chair in your room instead of your bed

drink water or juice out of a wine glass in the morning because nothing is real

shower with the lights off, without music

buy $3 flowers at trader joe’s—they look bad next to the more expensive ones but they look so good in your room

start typing things you don’t post into your notes. your thoughts can be worth documenting even if you don’t deem them worth sharing

wake up super early just once. you don’t have to make it a habit it’s just extra satisfying to go to bed that night

listen to the entirety of your favorite album from 2015

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

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Something like this would be so colossally helpful. I'm sick and tired of trying to research specific clothing from any given culture and being met with either racist stereotypical costumes worn by yt people or ai generated garbage nonsense, and trying to be hyper specific with searches yields fuck all. Like I generally just cannot trust the legitimacy of most search results at this point. It's extremely frustrating. If there are good resources for this then they're buried deep under all the other bullshit, and idk where to start looking.

yknow i kind of forget sometimes that like. pregnancy is innately tied to sexual stuff. like "haha hey guess what. gets you pregnant" is actually kind of. a horny thing to say in fact.

roommate texted this to me……..

saying "whoever did this should be stabbed" whenever i dislike anything ever just in case julius caesar happens to be behind it