The morning after the medical talk, it's raining and Julie and her mother get breakfast. A bonding mother-daughter moment.
My life so far, episode 14: Medical Talk
Letters : 20415 Words : 3821
In this chapter, Julie discovers that she might have a medical problem, which well, the co-author of this book suffered from. This is in part why my daughter retreated from naturism as a teenager.
Her goal, when initially drafting this book, was to talk about her problems, but as writing began, Julie diverted a lot from what she suffered and the character took a life of her own.
Robert came back, and proposed that I lead the way.
I picked a random direction.
"I suppose your parents told you my worries, right?"
"They did. And I appreciate it"
"Good, I prefer that than to be lectured to mind my own business, you know?", he says, smiling
I look at him, and wonder if cool people have cool parents, but my sample size isn't big enough to draw a conclusion.
"Well, it's your job, so in a way, it's your business, no?", I replied
"There is that, indeed. But you'd be surprised how many of my patients don't see it what way"
"Is it serious?"
"Ah, straight to it. Is it serious? That is a pretty interesting question. Yes. No, Maybe. I don't know"
"Isn't that like, all of the possible answers?"
"Ok, Julie, may I call you Julie?"
"That is my name"
"Good. When you were born, many of your functions were already on. If you didn't breathe, you wouldn't be here right now, but some of your functions weren't ready yet, right?"
"You didn't need to get pregnant, so no need for everything get ready, including having breasts since you need milk, not to produce milk"
"But here is the problem, for our species to continue, you need to be able to have kids, so at some point, these need to be turned on"
"I know that"
"Good. Now guys are the same, and we mainly have one hormone, Testosterone, that is used to make us into a man, but girls, on boy. It's complicated to turn a girl into a woman."
"Well, girls are more complicated than boys, no?"
"Oh no. Boys are as much a handful as girls in general, but yeah, hormonally, girls are more complicated"
We turn on a crossing, I pick right, for no reason.
"So, many things have to fire up just right, just at the right moment for puberty to start. It's almost a miracle that for most of the girls it works perfectly, and yet, sometimes, it just fires too early or a little too late"
"So it might be normal?"
"It might. Julie, there is probably nothing wrong with you all."
"But I don't have my puberty yet and you are worried"
"Can I tell you why I am worried?"
"I'd like that"
"On average, it takes about 2 years between the moment a girl starts to get her breasts, and the moment she gets her periods. Give or take a few months"
"But for periods, you need to start having your eggs first, right?"
"What, no, you already have them"
"Even if I didn't go through puberty yet?"
"Julie, you had all of your eggs in your ovaries before you were born. All of them. That means that half of the genetic material of your future kids, if you have any, were inside your mother's womb, and that half you were inside your grandmother's uterus."
I look at him,
"I am serious."
"That is a weird fact"
"Well, it depends if you like Kylie's mom. If you do, you are closer than you thought"
"She died a few years ago"
"Oh, I am sorry to hear that."
"I was young. I was 2 years old"
"Yeah, so late onset puberty is usually worrying when the girl didn't have her periods when she turns 15"
"And since I am 12 and half, I would need to get my breasts in the next 6 months or I wouldn't have them when I am 15"
"You are a quick thinker. And Julie, you aren't getting your breasts in the next 2 months, so that leaves a window of 4 months for you to bloom"
"But again, do you know why we pick 15?"
"Me neither, and it's my field of work. Well, I have some ideas. Because in the past, the age of consent was 16, not 18 for girls and many 16 years old were married that young. So if a girl would bear children at 15, it was worrying, you know, since you don't want to get pregnant in your first few periods, the system is still booting up. That, by the way, is a father talking, not a doctor. I am not supposed to be that careless when talking to patient"
"But that's horrible."
"Sorry, I'll only give my medical advice then"
"No, I appreciate that, I mean, 16"
"I knew that. I have a big sense of humor. Listen Julie, if you decide that you are in no rush to get menstrual cramps and use pads or tampons every month, all I suggest is that you get tested to make sure there isn't something wrong. Late is sometimes just late. But late can be a indicator of never, and we wouldn't want you to not ever get puberty"
"It could happen?", I say, panicking
"Because of my start of pubic hair?"
"Exactly. And you aren't lethargic. You still have cortisol and other hormones you had from birth. But it could also be that your pituitary, that's a gland in the brain, simply doesn't know it's time for puberty, so it simply doesn't tell your body to wake up, or the body doesn't listen"
"And you will do tests to tell which one it is?"
"Oh yeah. One blood test and I will know. Wait, I might have a pad in my car. I'll write the test, you get a blood test Monday morning, and I will get most of the results by the time I see you Tuesday. Of course I have a pad. I always do."
"I can't help you without a blood test, sorry Julie."
"Would that explain why I am short?"
"Is that a bad question?"
"No, it's just, why are people so obsessed with being tall! But yeah, the tragedy of woman's puberty is that it helps growth, like for a man, but then, periods stops the process"
"So, with the blood test, you will know what is wrong?"
"Not only the test but with the blood test and an x-ray, I'll know if there is something wrong. You might simply have genes for having puberty later than others, and if we weren't in our society, no one would bat an eye. And unless I find something worrying, and I will not, I am almost certain, you wouldn't even need to get it treated. Seriously, late onset puberty is just that. Puberty that occurs later than the socially, and medically, expected averages. But, you might want to get puberty so you have a chance to fit in, you know?"
"Oh, I can't wait to develop. Can I ask a question?"
"You can ask any medical question about yourself, I am a doctor."
"I don't know if it's medical"
"Well, if it's mechanical, I can't help. I don't understand car engines" he says, smiling
That is a rule of cool, but I can't put my finger on it yet.
"Is that why I don't see the point in boys?"
"Well, boys to me, are pointless. Except my son. He fills my life"
"I mean, why don't I find them interesting?"
"Well, I don't either", he says, laughing,"but yeah. Until puberty, they will just be annoying to you. Some girls develop an interest before puberty, that is a fact. It might be social mimicking. It might be a hormone receptivity earlier than the norm. Or you might be asexual. Nobody talks about that, but you'd be surprised how many teenagers I get with no sexual desire or romantic attractions who are just asexual or aromantic. But let's not get ahead of ourselves. It's normal not to feel any attraction at your state of development. "
"Thank you, that reassures me"
We turn again.
"Oh, can I tell you something that stays between you and me?"
"No, about you. Well, about a possible you"
"Ok, did you know that some people are born with the wrong gender?"
"Yeah, transgender people"
"Oh good, In this section of our country, not a lot of people accept them"
"What about them?"
"Many girls with late onset puberty, well, not all, but a few of them still have enough testosterone in their bodies to affect their brain"
"But I am a girl"
"And estrogen is the woman's hormone and yet, I have it in my body. Julie, you have testosterone in limited amounts in your body right now."
"I don't understand"
"What determines if you express as a boy or a girl isn't which hormone you have, but which one is dominant"
"Oh. I didn't know that"
"No worries. But what I want to tell you is, if at some point, you feel you might be a boy, not a girl"
"I don't feel that."
"Good, but if you do, bear with me, it's probably the hormones"
"So transgender people have hormonal imbalances?", I ask
"No, they don't. That's my point"
"Huh, you are losing me"
"Ok, if you want to be a woman, and are a girl, is that being transgender?"
"If you want to be a man, and are a boy, is that being transgender?"
"If your hormonal system is confused because it's not starting properly, and for a moment, your body thinks it would like to be a man, even if you are a girl, is that being transgender?"
"Right, condition, I might have moments when I think I might be a boy?"
"Not to me, not so far"
"Good. I help transgender children too, but I see girls confused on their identity because of late onset puberty, because testosterone doesn't wait. It just comes in and floods the body"
"Wait, could it cause anger?"
"Maybe I had a little of that recently"
"Maybe. And it calmed down?"
"Very recently, like two or three days ago?"
"It might return if it's hormonal, or it might be a sign your body is waking up. "
"So I might get breasts in a week?"
"No. You need more pubic hair"
"Wait, so if I weren't for naturism, I wouldn't get treated?"
"I guess so. Huh. Of course, I don't see the pubic hair of random girls outside my office. Good point"
"Wait, I'll be nude in your office?"
"Nude, no. You will be wearing an ugly gown. I told your parents, you might want someone else, someone you don't know"
"Don't I want someone I know?"
"Julie, I might have to use a speculum to view your cervix, do you know what that is?"
"It's the muscle ring at the base of the uterus, right?"
"Yes, but I mean a speculum"
"It's a sort of tube that lets me open your vagina so I can see your cervix. I might even need to put gloves on and touch it. I am not saying I will, but if medically, I need to inspect it, and in some cases I do, it might feel awkward for you"
"It's medically needed, right?"
"Or I don't do it. It's not fun for me, you know? I am usually just as awkward"
He looks around
"No. At first, yeah, but after a few years, you get used to it. And I am fast enough now. The worst is GPs when they check for prostate cancer. Thank god I rarely have to do that"
"Well, the prostate is sort of where the uterus is, but men don't have a vagina to allow to check it"
"So what do you do?"
"Stick a finger in the butt", he says, making an odd face, so I make the same face
"I am glad I am not a boy"
"Well, the problem isn't in boys, it's in men. I'll be due for my first test soon and I am no looking forward to it"
I can sort of tell what he is doing. Is it defusing the situation?
"But in theory, just a blood test"
"And an x-ray. Sorry, I can't avoid it. I'll give you the prescription tomorrow morning too, but you can get it at my clinic. In fact, do get it there, when you arrive, because I get the results directly. I don't wait for the radiologist. I am supposed to, but hey, I do that several times per week and it's usually very obvious, to me at least"
"Wait? Oh, not. They barely show in an x-ray. No, you left wrist"
"My left wrist?", I say shocked
"How old are you?"
"12 and a half"
"And how old are your bones?"
"Well, 12 and a half, or I guess 13 and a quarter if you count the pregnancy"
"No, we don't know"
"Bones don't grow the same speed for everyone. Time goes by. But maybe, your body took breaks and it's only 11 years old or even 10 years old, so it's not your puberty that is late, but your whole body"
"Why would that occur?"
"Genes, malnutrition, eating disorders, a few sicknesses, genes, lack of calcium, magnesium or B12 vitamins, I mean, I am certain that I am missing over 50 causes. And I am certain we were here before", he says, looking around
"Yeah, this there, at the back, is our cabin. We've been circling so I can find the way back"
"Nice. I was planning to just find the lobby and find my way back, but you had a plan"
"Well, I made one up on the spot"
"Julie, there might be nothing, and I insist, nothing wrong with you. And you might still want to get hormones to start your puberty, even if nothing is wrong. Tuesday, you might have a big decision to make, and I will be there as a doctor to help you, but eventually, it will be your decision. And your parents, sadly, but if they don't agree with you, and you feel strongly, there are options"
"I can get a court order"
"Seriously?", I say, shocked
"I've done it before, and I will do it again if I have to. If you ask me to. I'll even go in jail if I have to defy a court order to protect a patient"
"I think my parents will support my decision, whatever it is. What are the options, is it complex?"
"Either you take some estrogen pills, or a patch, or you don't. "
"Isn't that the contraceptive pill?"
"No. Dosage will be much lower, and there won't be progesterone. Thought, when you get your periods, you might switch to one with it, depending on your progress"
"How fast would it work?"
"Girls and that question."
"No, it's normal. Now, I want to insist. Most girls I treat have to wait until they are 15, I rarely treat them so young, but usually, they were well into B2, or not at all in it. You are somewhat in between."
"Ok, so B1 is the stage pre-puberty. No changes at all"
"B2 is when scant pubic hair appear"
"Yeah, but also when the areolas enlarge, and yours didn't"
I look at my nipples and indeed, no change from when I was a kid, unlike women I saw at the resort.
"And normally, you see a little bump under the nipple, but no breasts yet"
"B3 is when the breasts start to grow, pubic hair becomes more voluminous but still coarse and forms a triangle. Skin becomes oiler, which means acne, sorry, or and hair under the armpits"
"So Mindy is in B3"
"Well, she is more in the middle of B4, to be honest."
Wow, she is almost 3 stages ahead of me.
"Nipples start to protrude, too many pubic hairs to count, more acne"
"She doesn't have it"
"Oh, she does. But it's small. Lucy, also in B4, has more problems with it"
"What? Her skin is perfect!" I say
"Today. Who knows for tomorrow? She needs a lot of treatment. The difference, is that I suspect that Mindy doesn't have her periods yet, while Lucy got hers a while ago"
"It's not shameful to talk about this, Julie, but before we got side tracked, your question was how fast it works"
"On average, for my patients, about 6 months to get firmly into B2, 1 year to get in B3, and about 2 years to fully get into B4 and get your first period."
"So when I would be 14 and half?", I ask
"No because I would be treating you earlier"
"B2 perhaps after 3 to 4 months so by the new year, and B3 after maybe 9 months or next summer, and B4 after a little more than 2 and a half years"
"Wait, breasts faster but periods later?"
"No, they get them around 17, you will be B4 around 15 to two years earlier. It's not as fast in treatment time, but you start earlier, But, I have to warn you, when under treatment, your first periods might occur in late B3, which might freak you out"
"Normally, menarche stops a lot of the puberty process, but yours will be artificial, so your breasts will keep growing, and your pubic hair too. You will stop getting taller, well, gain 2 to 3 inches, but it will occur later than girls without late onset puberty so maybe, maybe you will get your biological height"
"Menarche? Biological height?"
"Ah, menarche is the first period. Sorry, it's a medical term. For biological height, all the bones have a programmed maximum height. Most boys reach it, but most girls are interrupted by their puberty so that's why girls tend to be smaller but still make tall boys when they have kids"
"We get the short end of the stick"
"Yeah, good thing girls like tall boys, right? If it were the other way around, I'd be screwed"
I look at him, and for the first time, realize that he is perhaps only 5 foot 7. His son is tall, but not him.
It's the second comment he made about height, but it flew over my head the first time.
"Listen, we'll know more with the blood test and the x-ray, and we'll talk more in my office. I don't have any appointments after you, so if you do come, we'll be able to chat and I'll offer guidance on your own actual condition"
"Hey, I picked my job because I love helping kids like you. "
"With puberty problems?"
We are nearing the end, so I steer him toward where my parents are.
"No, most of my patients have thyroid problems or diabetes."
"You treat them?"
"Every day. And between you and me, I prefer them to you, do you know why?"
I look at him, but don't say anything
"I'll see you Tuesday, have a phone call in 2 months, a follow-up after 6 months, and then see you once per year on average. I see my thyroid patients every 2 or 3 months and my diabetes patients up to once per month. They give me more money!", he says, laughing.
I make a nervous laugh, since these kids are sick.
When we make it to the fireplace, my parents bid a good evening to everyone, and my father carries the current beer he has with him to our cabin.
"So, you talked a lot", says my mom
"It feels good. He explained a lot. He will give me tomorrow a prescription for a blood test for Monday morning, and an X-ray before the appointment"
At the cabin, my father drops the remaining of the beer in the sink
"You didn't finish that one?", I told him
"Sugar, I don't drink beer, so I didn't even start it."
"Why did you take it?"
"When a man offers you a beer at his fireplace, you take it. And you pretend to drink it.", he says
I look at him. Is that a rule of cool, or the opposite?
"So what did he say?", my mother asks
"That it might be normal. That I might just take a small dose of estrogen to help me start my puberty. That it's early, and I should start getting my breasts in what, about 4 months? And my periods in like, 2 and half years? Assuming nothing else is wrong, but he doesn't think so"
"Because I have some pubic hair"
"Right, he talked about the fire"
"The fire?" I ask
My dad explains.
"He said that it's like starting a fire. If the wood is wet, it won't start, but if you get some spark, it might just need some help. That your start of pubic hair shows that the fire wants to start, but maybe it needs a little push"
I think about it. It makes sense.
"He also said it might explain my anger recently", I said, a little sad.
My mother smiles. "We knew, kiddo"
"We were teenagers once", says my dad
"No, I mean because my puberty doesn't fully start, I might not have enough estrogen to counteract my testosterone", I said
"But you are a girl", says my mom.
"Wait, you don't know either?" I say.
"Know what?", she says
"Honey, women have testosterone too, and men have estrogen and progesterone. Hey, we even have prolactin!", says my dad
"What is that?", I ask
"It's the hormone which makes women produce milk, men have it too, in low dose", says my mom
"And it's catastrophic on a man when high"
My mom nods
So, she knows about prolactin being high in a man, but not women having high testosterone?
"It happened to grandpa", she says, a little sad
"Wait, your father?" I ask
"He got a severe kidney disease, and it caused a benign tumor in his pituitary which caused a high level of prolactin. It made him a shadow of who he was"
"Wow, I barely heard about him"
"Well, he died before you were born."
Right, I knew that. Well, that part. Not how, just "of a disease"
"From the prolactin?"
"No, from the kidney disease. But the prolactin made his life less interesting"
We talked some more. I told them almost everything. I didn't mention the transgender part, it seems too weird to me.
Even today, I almost thought not to mention it, as it's not even relevant to the story, but I now have a transgender friend I thought that being more inclusive might help their cause if only one of my readers realizes that trans kids are important.
We ended up brushing our teeth, wishing ourselves a good night and falling asleep.
I did hear my parents whisper a little, but couldn't make out the words, and it didn't prevent me from falling asleep.