Medical discussions

You take the regular chair beside the desk, crossing your ankles—block heels, tights, the whole professional package—and Dr. Okafor settles across from you with her folder open. She doesn't sit behind the desk. She sits next to it, angled toward you, like this is a conversation and not an interrogation.

"So," she says, clicking her pen. "Tell me what brought you here today."

And you do. You tell her about the suitcase. About LUXE dressing you and the strange relief that came with it. About the moment in the shower when everything clicked—when woman stopped being a costume and started being a diagnosis. You tell her about the certainty. How it feels like a bone that was always broken finally being set.

"I've known for about a week," you say. "But when I say 'known,' I mean—my whole life was there. I just couldn't see it. I was watching someone else's life from behind glass."

Dr. Okafor nods slowly. She's not writing yet—just listening, her brown eyes steady on yours.

"And you're certain. One hundred percent."

"Yes." No hesitation. "I can't go back. It would be like cutting off a limb."

She writes something down. Quick, efficient strokes.

"Good. That clarity is important." She sets the pen down. "Now—what do you know about HRT already? What have you read?"

"Some. Estrogen, anti-androgens. I know the broad strokes—breast development, fat redistribution, skin changes. But I want to hear it from you. The real timeline. What actually happens and when."

Dr. Okafor leans back, crossing one leg over the other. Her locs shift against her shoulder.

"Alright. Here's what you can expect, honestly." She holds up fingers as she counts. "First three months—skin softens, you might notice emotional shifts. Some people get breast buds within weeks, others take longer. Three to six months—breast development continues, fat starts redistributing to hips and thighs, muscle mass decreases, body hair thins. Six to twelve months—those changes deepen. Facial feminization becomes noticeable. Voice won't change on estrogen alone, but many women find their speech patterns shift naturally."

She pauses.

"One to two years is when most people start reading consistently as their gender. Two to three years, you're looking at near-complete development. But everyone's different—some changes come fast, some slow. Genetics plays a huge role."

"And the anti-androgens?"

"Spironolactone is what we typically prescribe. It blocks testosterone. You'll notice decreased libido, softer skin, less body hair growth within a few months. Some people experience fatigue initially—it passes."

She lets that sit for a moment.

"There are risks. Blood clots with oral estrogen—so we use the patch or injection instead for most patients. Liver function needs monitoring. Fertility will decrease, potentially permanently, even if you stop. You should consider sperm banking if that matters to you."

Fertility. The word lands differently than you expected. Not with grief—with something more like acknowledgment. A door closing that you hadn't realized was still open.

"I understand," you say quietly.

"I believe you do." Dr. Okafor uncrosses her legs and leans forward. "Based on what you've told me today, your intake forms, and your clear and sustained sense of your gender identity, I'm comfortable starting you on a standard feminizing protocol. Estradiol patch and spironolactone."

Your heart stutters.

"Today?"

"Today." She smiles—that same genuine crinkle around her eyes. "Informed consent means exactly that. You've informed me, you understand the risks and benefits, and you've given your consent. I don't need you to prove anything to me, Riley. You've already proven it to yourself."

She stands, moving to a cabinet against the wall. "I'll need to draw some blood first—baseline levels, liver function, potassium. Then we'll get your first prescription filled at the pharmacy across the street. The sliding scale for today's visit is thirty-five dollars."

She turns back with a small tray, a tourniquet coiled neatly on top.

"Any questions before we start?"