Hormone Replacement

A stifled sob snuck between Kelli's pursed lips as she sat on the edge of her bed. With the curtains drawn and the door shut, her bedroom was dark even though the evening sun peeked through small gaps around the windows. It was that time of the month again and the cramps were as bad as ever. Along with the cramps came the despondency, the moodiness, the listless morass of clinical depression that plagued her every time she got her period. Not that it was that much better the other two and a half weeks of the month when the rush of manic energy filled her and swept her along a rollercoaster of emotion that swung rapidly between fits of laughing hysteria to uncontrollable weeping, neither with any basis. Throwing herself back on the bed she wished there was a way out of this carnival ride life but she knew, as certain as she knew anything, that that wasn't to be. Tears spilled from her eyes, streaking down her cheeks, as hopelessness filled her.

The door opened quietly and then shut. A moment later the bed shifted as her husband of six years sat on the edge. She waited, unwilling to let him see her crying again. He waited too, and the silence grew stifling. Finally, she turned her head and opened her eyes. He was just sitting there, somber look on his face, watching her.

"I'm sorry ..." she started but he quickly put a gentle finger to her lips.

"Don't be." He shook his head as he spoke. "It's not your fault."

"I shouldn't be like this." She kissed his finger softly.

"I made an appointment for you with Doctor Wemble."

"He'll want me to see a psychologist."

Mathew, her husband, shrugged. "Maybe. If so I'll make that appointment for you too."

"Do you think I'm crazy?"

He laughed but quickly stopped. "Of course I do, Kelli, but only in a good way." His face turned somber. "It's gotten worse and you know it. You can't go on like this and it shouldn't be this way. I'll pick you up from work tomorrow at ten. Your appointment is at eleven. We'll go eat lunch after and then I'll take you back to work."

"Richard won't like it."

"I already spoke to your boss. He's an ass by the way. He agreed that he'd rather you take the time to see a doctor about this than spend the next six weeks in negotiations with my lawyer."

"You didn't!" Kelli pushed herself up on her elbows, her eyes wide.

"No, but I wanted to, really bad. One good labor lawsuit against him would do wonders for his attitude."

She dropped back down on the bed and covered her eyes with her forearm. "Geez, I thought for a moment you'd gotten me fired."

"I know you like your job even if Richard is an ass."

"I do, but today was hard."

"I know." Mathew brushed his hand along her cheek. "I made supper. Grilled salmon, asparagus, and a spinach salad with lemon dressing."

She had smelled the salmon as it cooked. It smelled so good that she wished it would make her hungry, but when this hit, it always took her appetite away. Nodding she forced herself to sit up. She would eat, just to make Mathew happy.

The next day she sat in the doctor's office waiting room with Mathew by her side. He'd taken off work to make sure she went to the appointment. It was nearly ten forty-five when the nurse called them back and well after eleven before Dr. Wemble knocked softly on the exam room door and entered. The nurse had already taken her vitals and the middle-aged doctor studied her chart for a moment and then looked at her, with a comforting smile.

"So, why are you here today?"

Kelli glanced at her husband, sitting in the lone visitors chair and then back at the doctor perched on his small round rolling stool. She felt idiotic being there, sitting on the exam table when there wasn't anything wrong with her; taking up the good doctor's time for nothing except her not being able to handle being a woman. She shook her head.

"I guess it's the hot flashes," she mumbled.

"Hot flashes?" Dr. Wemble asked, eyebrows raised. "You're too young for hot flashes."

"I'm thirty-five. My mother started menopause early."

"I see. Well, let's take a listen then." He stood up and used his stethoscope to listen to her breathing, ordering her to take deep breaths. As he listened he studied her face. When he'd finished he sat down and looked over at Mathew with pursed lips.

"Can you excuse us for a few minutes, Mr. Greene?" The doctor asked.

Mathew nodded and then rose. "Certainly. I'll wait in the waiting room."

Once her husband closed the door behind him, Dr. Wemble took a deep breath. "Now, young lady, tell me what is going on."

Kelli could feel the tears welling up inside her. "You didn't have to send Mathew away. He's not the problem. It's me. I have terrible mood swings. I go from manic to depressed in the blink of an eye. I hurt all the time. When I'm on my period it's cramps and when I'm not it's headaches and back aches and leg cramps. I can't sleep, and I can't think straight. I work out but my belly is still fat and I'm weaker than I was even six months ago. I used to be able to run five miles, now I can barely go half a mile before I'm wheezing like an old woman." It all came out in a rush and with the words came the tears; streaming down her face and ruining her makeup.

The doctor handed her a paper napkin and waited for her to compose herself, nodding to himself as he waited.

After a few moments, Kelli shook her head. "I know, I'm just a silly woman and I need to just deal with it."

"Now that is the first silly thing you've told me," Dr. Wemble said in a flat voice. "The symptoms you describe are classic for testosterone deficiency. Tell me, how is your sex life?"

Kelli laughed. "I'm surprised Mathew hasn't kicked me to the curb. I never want sex anymore. I give in to Mathew every month or so, but I don't get anything from it. And it hurts most of the time. I mean, Mathew is always gentle, but still it hurts. He uses lubricant and everything, but I just don't ..." She blushed and stopped looking at Dr. Wemble.

He nodded. "I want to do some tests. If the tests confirm your low testosterone levels there are several treatments we can pursue. If that turns out to not be the problem, then we'll keep looking until we find it. Don't worry, Mrs. Greene, we are going to find out what the problem is and get it fixed for you."

"You think it might be a hormonal imbalance? You think that can cause all of this?"

"Several studies show that low testosterone can cause many of the symptoms you describe. You may also have other imbalances. We won't know until the test results come back. We should have them by the end of the week."

"Thank you, doctor." Kelli's eyes were wide. "I really didn't think you would take me serious. I thought it was just all in my head."

Dr Wemble patted her hand gently. "Please wait here, the nurse will be right with you. We will get you feeling better. I promise."

After the doctor left, it was only a few minutes before a nurse came in to draw her blood and then she was given her exam sheet and released. As she approached the business desk, she saw Dr. Wemble in a small open consultation room talking to Mathew. Her husband joined her at the desk before it was her turn. He paid the bill and then led her to their car.

"What did Dr. Wemble tell you?" Kelli asked as they drove out of the parking lot.

"He just asked me some questions. And then we talked for a bit. He's a good doctor."

"I've always liked him. He thinks I may have a hormonal imbalance." Kelli watched her husband's face as she spoke, noting that his eyebows popped up when she mentioned the diagnosis. So Dr. Wemble hadn't told her husband after all.

"What kinds of questions?" Kelli asked.

"Well, he asked me about your mood swings, and how long they had been happening. He asked how our marriage was. And about our sex life."

"What did you tell him?"

"I told him the truth, Kelli. It's nothing to be ashamed of."

Kelli knew Mathew would be honest. It wouldn't even occur to him to lie to the doctor. And he would be brutally honest. That bothered Kelli because it had been almost a full year since she had given in to Mathew and allowed him to have sex with her. Despite what Mathew thought, she knew that was something to be ashamed of. Silently she vowed to herself to do better. But she knew that was a lie too.

"So what can they do about a hormonal imbalance? Is there a pill for that?" Mathew kept his eyes on the road, but reached over and patted her leg.

Kelli shrugged. "I don' know. He wants to see me again once they have the blood tests back. He said he would get me feeling better."

"That sounds encouraging."

Kelli leaned her head against the car window and closed her eyes. She would have sex with Mathew tonight, she vowed. She would.

The week passed slowly. Kelli hadn't been able to bring herself to be intimate with Mathew despite her best intentions. On Friday she got a call from Dr. Wemble's office. They wanted her to come in on Monday and discuss the results of the tests. She made the appointment for Monday morning and then let Richard know she would be in late that day. He gave her a strange look, but just nodded and Kelli wondered what Mathew had told him. She was too tired to press him about it though.

That night, as they ate hamburgers that Mathew had picked up on the way home and watched some inane sitcom on TV, she told Mathew that she had an appointment to see Dr. Wemble on Monday.

"Did he tell you the results? Do they know what's going on?" Her husband had immediately forgotten all about the television and was looking at her, excitedly.

She shook her head. "No. Just that they wanted to see me. The appointment is at nine."

A flicker of worry crossed his face. "Dang it! I have a meeting with Senator Talbot on Monday from nine until noon. I can't miss that." He turned and took her hand. "I'm sorry, Kelli. I want to be there." His voice trailed off.

"It's okay, Mathew. I know you've been trying to meet with Talbot for a month. I don't want you to miss it. I'll be okay. I'm starting to feel a little better. Dr. Wemble will probably just write me a prescription and send me back to work anyway."

Monday just after nine-thirty, Dr. Wemble entered the exam room where the nurse had stashed Kelli. He had a tray full of literature in one hand that he sat beside the sink before plopping down on the little rolling stool.

"So the results confirmed that your testosterone is low. Very low. Your testosterone reading was two nanograms per deciliter, normal for a woman your age is fifteen to seventy. Two is very low. However there is good news. Your T4 and TSH tests both came back normal. This means your thyroid is in good shape." Dr. Wemble patted her hand gently as he spoke.

"So what can we do?"

Nodding his head, Dr. Wemble smiled at her. "Well, we have some options. How we proceed will be up to you. The first option is the standard treatment that has been around for years. I would prescribe either a pill or a patch, in your case, I think the patch would be the better approach, and we would monitor your testosterone levels and try to get you into the normal range. The patch provides a little more consistency than the pill but it still isn't a good match for what your body does. It starts out giving you a lot of testosterone and then by the end of the week it's giving you almost nothing. This creates a rollercoaster effect in you that can have some negative side effects. The pill is worse because the rollercoaster goes up and down more rapidly.

"The second option is much better, in my opinion, but, like the pill and patch, it isn't generally covered by insurance and it isn't cheap. It is a bioidentical pellet that is implanted surgically in your buttocks. In your case we would implant three pellets because your testosterone is so low. Our goal would be to get your testosterone up to somewhere around thirty-five."

Kelli nodded. "What are the side effects?"

"Well, if we over correct you could experience an increase in facial hair, acne, or even a change in your voice. That is why it will be important to monitor you frequently. If we find your testosterone levels going up too far, say you are getting over sixty, then we will reduce the amount of testosterone you are receiving."

"If we do the pellets, how do you reduce the levels?" Kelli leaned forward. She did not want to become the bearded lady!

"It is a simple procedure to remove one or more of the pellets." Dr. Wemble smiled at her and patted her hand.

"And you think this will solve all my problems?" Kelli kept her eyes locked with his.

"Oh, heavens no! Increased testosterone should decrease the severity of your menstrual cramps. It will most likely increase your libido and give you more energy. It might even out your mood swings some but it isn't some kind of wonder drug. No, Kelli, what I'm suggesting is that we do this as the first step and see where we go from there. If after two months of being on the testosterone therapy we have your testosterone numbers where we want them and you are still having symptoms then we will do more tests and decide where to go from there. I may want to refer you to a psychologist." He took a breath and smile at her. "But first I want to see what the testosterone therapy does for you. Assuming, of course, you decide to pursue this." He reached over and took the sheaf of pamphlets and a small book from the tray he'd set by the sink. "I want you to read this. Talk it over with your husband. Do some research on the internet." He shrugged. "Whatever you need to do be comfortable with your decision. Once you have decided, come back and we'll start on whatever plan you prefer."

"And if I decide I don't want hormone therapy?"

Dr. Wemble smiled and held his hands out palm up. "Then we will pursue other avenues of treatment."

Kelli nodded. She took the pamphlets and small book from him and looked at them for a moment.

"I'll talk to Mathew. What is the cost of the pellets? You said they weren't covered by insurance."

"Not typically. We can check with your provider, but most insurance companies don't cover this treatment. The cost is around seven hundred and fifty dollars and the pellets last around three months."

"Three thousand a year?" Kelli shook her head. "And how long would I have to do this?"

Dr. Wemble's face took on a somber look. "This isn't a cure, Kelli. It's a treatment. Once you hit menopause your hormones will find a new balance and we would have to look at how to adjust the treatment or whether or not to continue."

"Oh!" Kelli blinked several times taking in what he'd just said. Three thousand a year for the rest of her life. Finally she nodded. "I'll talk to Mathew."

"Just to be clear, Kelli. Insurance companies don't cover the cost of most hormone therapies. Unless I were to lie and misdiagnose you with one of the few conditions they do cover them for. That wouldn't be ethical of me and I won't do that. Pills and patches are less expensive, but not cheap either and they are not as effective."

Kelli nodded. "Thank you doctor. I guess Mathew and I have some thinking to do on this."

-

That night Kelli showed Mathew the literature. Mathew poured over the pamphlets and then, while she read the book, got on the internet to research the treatment. By nine that night she had read two-thirds of the book and was convinced that this was the best treatment for her. The book seemed to have been written specifically for her, with a chapter devoted to each of her major symptoms. She didn't understand all of the science, but if what the author, another doctor, said was true then maybe there was a light at the end of the tunnel. She sat the book down on the coffee table, only then realizing that her husband was standing by the living room door watching her.

"What?" Kelli asked, studying his face.

"You are beautiful."

"I'm a fat ugly cow."

"No! You're not. You are a beautiful woman." He crossed the room in four steps and knelt in front of her, taking her hands into his.

She marveled at how much larger his hands were than hers. She looked like a child next to him, and yet he was always gentle and kind to everyone.

"I love you, Kelli."

"I love you too, Mathew." She wished she felt her words, but she hadn't felt any emotion other than sadness and depression in so long. Looking up she met his eyes and saw pain there. Not physical pain but emotional pain. He'd seen through her words and it had hurt him.

"I'm sorry, Mathew. I'm just tired."

He nodded, his lips tight. "So do you want to get the pellets? Or do we look elsewhere?"

"What did the internet say?"

"Everything and nothing. There are pages that call all hormone therapy a hoax and other pages that tout the pills over everything else and yet others that say the patch is the best way to go and some more that talk about bioidentical pellets like they are the savior of the universe. Each of them have their horror stories about the others. There are so many people who don't have a fucking clue what they are talking about posting shit on the internet that it is incredibly frustrating. The one thing I did learn is that Dr. Wemble is right. Our insurance won't cover hormone therapy unless you have a full hysterectomy."

She nodded. "Three thousand a year is a lot of money."

"We can afford it. I'll make it work."

"Speaking of that, how did your meeting with the senator go?"

"Better than I had feared, worse than I had hoped. He is already bought and paid for, but not by Wilkes Industries. He'll talk to those holding his leash and go with how they want him to go. So at least it won't necessarily go against us, but it won't necessarily go for us either. If I could find out who owns him, I might be able to negotiate with them."

"I'm sorry Mathew."

He smiled. "Don't worry about it. If we don't get this contract we'll get another." He kissed the back of her hand gently. "So, do you want to do the pellets or the patch or what?"

"How much do you trust Dr. Wemble?"

"He's one of the best men I've ever known. I believe he truly wants to help his patients. He and I have talked about how the laws are eroding healthcare and keeping doctors from really helping their patients but he won't break the law, not even the spirit of the law. He's upstanding and moral. Really it's refreshing talking to him after dealing with slimy, corrupt politicians all day."

She nodded and made her decision. If there was even a chance this would help her feel better then she wanted to do it. "If we can afford it, I want to do the pellets."

Mathew nodded with a smile. "I'll call Dr. Wemble tomorrow and get it scheduled. I love you, Kelli. I really hope this helps."

"Me too."

-

It had been six weeks since Kelli had the simple procedure to implant the testosterone pellets in her butt. The soreness had lasted only two days, although it took almost a week for the small incision to completely heal. Just yesterday she'd gone and had another blood test done. Her testosterone had finally hit the fifteen threshold. Her levels were normal. So why didn't she feel different. She climbed off the elliptical, checking to see how many calories she'd burned and then reached for her phone to put it into her log.

"Congratulations!" The pop-up window from her app announced. "You've burned 3,000 calories this week!"

Her eyes narrowed. She'd never burned three thousand calories in a week before. Opening the history on her app, she surveyed. She'd been steadily burning more and more calories every day for the past two weeks. Her eyes went wide and she began to think. She hadn't had a cramp in nearly that time as well. She trotted to the scale in the corner of their workout room and stepped on. One-twenty-six. She'd lost four pounds that week without changing her diet. She glanced over at Mathew where he was still running on the treadmill. He was engrossed in his workout, pushing himself like he always did, sweat turning his shirt dark in large circles under his arms and on his chest and back.