A young trans man is offered a new kind of HRT that proves to have devastating dental consequences.
The pressure sensor on my toothbrush flashes. I ease off, but two seconds later it's blinking again. I ignore it. I've never really trusted the thing, anyway; I know my mouth better than some anxious piece of plastic. I spit white foam and run the tap, smiling as I picture all the overnight bacteria screaming as they're washed away.
After breakfast, I swill with mouthwash twice, following up with a pristine length of floss; ten strokes for each tooth, right up to the gumline. An interdental brush follows, probing into those difficult spaces where trapped remnants of my meal lurk in the dark and the wet, waiting for me to forget them so they can squirm in deeper. All it takes is one forgotten crumb, and the next thing you know you've got gingivitis, six fillings, and a root canal.
A thump on the bathroom door makes me jolt, hissing as hard bristles jab into my gum. Paige, my housemate, pounds the door again.
“Hurry the fuck up, Casey!”
“Give me a minute!”
“You've had twenty. I'm about to piss myself.”
I sigh, and spit blood. Great. Now there's an open wound in my mouth. I wipe off my face, trying not to linger on how smooth my chin still is. I haven't done my Testogel yet today, but doing it feels so pointless. Nothing's happening.
“Casey, I'm going to be late for work!”
I unlock the door, and she shoves past me. I leave her to her pissing and pre-work primping and go to dress, running my tongue over my teeth as I struggle into my binder. Twenty-eight, all in place. Nothing shifted, nothing swollen, no wisdom teeth emerging to upset the balance. Twice over and a third for luck—aside from the sore spot where I jabbed myself, all is well.
I'm still not sure what this appointment's about. I just got a text saying I had one. Some new bullshit to make getting my useless testosterone harder than it needs to be, probably. Four and half years just to get started on it; God save the NHS, right?
At least I've got the morning off of work. Unpaid, but hey—nice to not be stocking shelves first thing. I fasten on a pronoun pin and double check I've got spare mouthwash in my work bag. My co-workers like to make fun of me swilling after my lunch break, but they won't change my mind.
You have to take care of your teeth.
“Thanks for coming in, Casey. Have a seat.”
I perch on the edge of the faded plastic chair. It creaks ominously. The doctor—and it's a doctor today, which surprises me; usually I get a nurse who glares at me like I'm wasting her time—taps away at her computer for a minute or so in silence. Going over my records, I guess. She's very tall and very thin, like a stick insect in a skirt-suit, and pale as porcelain.
“You've been on testosterone for eight months now, correct?” she asks, finally turning to me.
“Nine in a few weeks.”
“How are you finding the gel?”
“It's fine. I hate needles, so. You know. It's better.”
“How would you feel about trying a new delivery method?”
I frown. “I thought those were the only options.”
“It's still a gel,” she says. “But it applies orally, instead of externally. Like...” she cocks her head and smiles brightly. She's toothy—in a crocodile way, not a horse way. Too many, not too big. “Like Bonjela, but for hormones.”
I run my tongue over my gums. “Will it affect my teeth?”
“It's perfectly safe,” she says. “You might experience faster physical changes, if that's something you're worried about.”
“I'm not,” I say quickly.
“Excellent.” The doctor unfolds from her chair. Her knees click audibly, and I try not to wince. “You can pick up your prescription at the front.”
Five minutes later, I'm back out in the cold car park, clutching a small paper bag. Nearly nine months and all I have to show for it is a carpet of leg hair and an abundance of acne. My voice has barely changed. I know things come in different for everyone, but I feel like I'm trapped in amber.
I fiddle with my pronoun pin as the bus rattles me home. Faster changes.
She'd better be right.
Sat on the edge of the bath, I carefully read over the instructions on the folded paper. It's straightforward stuff: once a day, wash hands before and after, massage into gums, don't eat or drink anything except water for an hour after application. I gnaw the inside of my lip.
It doesn't say anything about when to clean your teeth.
I scan the tiny print again, hoping I've missed something. Before or after? How long in either direction? Will the chlorhexidine in my mouthwash affect it? Can I still use it if I cut my gum, like this morning? I could call the GP and ask, but even if they answer the phone, they'll just tell me to read the instructions, or wait two weeks for another appointment.
I've waited years. Two more weeks might as well be a lifetime.
I decide to apply it before I go to bed. Easier to plan the whole eating thing. So that night, after I've brushed and flossed and brushed again, I peel back my lips with one hand and work thick, clear, scentless gel into my gums with the other. It leaves a faint, filmy taste in my mouth, one I can't quite identify. Something medicinal and sweet.
I resolve to be extra diligent with cleaning while I'm using this—the last thing I need is some weird sugar hanging around for plaque bacteria to gorge on.
I lay in bed and tap my teeth with my tongue. Molars, pre-molars, canines, incisors, all rooted solidly in place. I count and count until I finally drift off. I've counted like that since I was a kid, and let me tell you—it's a hundred times better than sheep.
Stubble springs up overnight—literally overnight, like I was paid a visit by transgender Santa. I gape into the mirror, running my hand over the rough, dark hair. I'm late for work because first of all, I have to shave—what the fuck, right?—and second of all, I have to have a bit of a cry on the bathroom floor about it. Finally! I could kiss that doctor—fucking finally!
A few days later, my voice drops. And when I say drops, I mean plummets, because I'm cracking through puberty on Monday, and by clock-off time on Wednesday, I sound deeper and smoother than my own brother. I ditch the pronoun pin no-one ever looked at with glee, and nearly give Paige a heart-attack when I call out that I'm home.
“I thought bloody Idris Elba was breaking in—you sure he's not out there?”
“I wish. Just me and a few hard-working hormones,” I say, grinning. She rolls her eyes.
“Can you and your hard-working hormones clean the sink after you shave? It was rank in there when I got back.”
I'll happily fish hair out of the plughole for the rest of my life. It's my hair. From my face. My face, growing my hair—I grin around my toothbrush, the me in the mirror one I've dreamt of for years, and every night I work gel into my gums and dive into bed, eager to see what new changes another morning on this miracle-T will bring.
At the three-week mark, I wake up, count my teeth, and one of my molars moves. My heart nearly stops. I probe it again—I've imagined movement before, mistaken slight natural shifts for incipient loss—and no, it's real. It's loose.
I race to the bathroom, breath sharp and shuddering, a hot flush of panic on the back of my neck. I fishhook myself, mouth wide, trying desperately to see. There's a thin line of blood at the gumline around the offending tooth; it thickens as I focus on it, dark and red and accusing.
“No, no, please—”
This can't be happening. I do everything right, I've done everything right my whole life; I'm not going to end up like my dad, gums full of gaps, more fillings than teeth. My dentist's sick of the sight of me—they banned me from getting check-ups more than every six months, because nothing's ever wrong because I do everything right.
I poke at the molar again with my tongue. I can't help it. As soon as I touch it, I know I've fucked up. Something falls into my mouth, hard and small and sharp, and I spit a chunk of enamel into my palm. I grip it tight in my fist, fighting back a sob.
I can't go to work like this. I call in sick, then call the dentist, pacing the living room while saccharine hold music tinkles into my ear for a small eternity. Their first available emergency appointment isn't until the middle of next week. I try to explain—there's a piece of me missing—but the receptionist ignores me.
“Eat carefully, brush gently, use mouthwash after your meals,” she says. “Stay away from foods that'll get stuck.”
“But I—”
“If anything comes free sooner, we'll let you know,” she tells me, and that's it.
I hide in my room for the rest of the day, ignoring Paige when she knocks. I keep probing at the missing chunk, like maybe the next time I touch it, it'll be back to normal. It never is.
I apply my gel without looking, stroking the evening stubble along my jawline when I'm done. I can do this. It's a few days. It's one tooth. I'm a grown man.
It'll be fine.
A canine and a molar sit either side of the plughole. Water-thinned blood trails from their perfectly intact roots, swirling with spit-foam into the drain. I can't uncurl my fingers from my toothbrush, still buzzing in my hand. I close my eyes. Count to ten.
The teeth are still there.
I pick up the canine. There's hair coming in on the backs of my fingers, just like my dad has. The tooth is so small in my palm. Both of them are so small outside the safety of my jaw, yet the voids they've left are cavernous.
The phone drones a dial-tone into my ear all day, hour after hour. Neither dentist nor GP pick up as the holes in my mouth continue to throb. She said it was fine, she said it wouldn't affect my teeth!
I make aborted starts to the door half a dozen times, meaning to go down there and get answers in person, but I can't go out. I can't talk like this, can't eat, can't drink—I don't even want to breathe. Middle of next week. That's all I can do, wait until the middle of next week for them to tell me it's fucked, my whole mouth is fucked; all the care I've taken, all the effort I've put in is for nothing.
I refuse to stop making the effort now. It doesn't matter if I haven't eaten, there's always a chance of something getting infected. That evening I steal one of the manual brushes from Paige's half-used packet of them, and carefully clean around the gaps, trying not to look too closely. The rest of my mouth I subject to the usual level of care, minty and meticulous.
But when I spit, it hits the sink with a heavy splat. Thick and clear, neither blood nor toothpaste. I run my tongue over my gums, sticky with residue.
All she said was that it was safe. She never said anything about my teeth.
There are teeth in my bed. I don't need to count how many, because there are none left in my mouth. Bloody drool coats my chin, and my breath hisses out in a strangled, high-pitched whine.
They grow back when you're a kid. You spend weeks crying about it until the spares erupt from your jaw, replacing your fragile baby teeth with something sturdier. When you're seven, you get a second chance.
You don't get one when you're twenty-seven.
For once, the receptionist picks up on the first ring. “Crown Dental Services, how can I help?”
Tears clog my throat, my mouth full of something metallic and sickly sweet. I don't know how to speak without teeth.
“Hello?”
My desperate plea—you have to help me, they're all gone!—comes out as a series of choked sobs.
The receptionist hangs up with a huff. I moan into my palms, splattering them with blood. Paige is at work. I'm all alone in an empty flat with an empty mouth, huddled on the bedroom floor with my racing pulse throbbing in my ruined gums.
I could kill that fucking doctor. What was her name—I've never seen her at the GP before. Who was she, that woman with too many teeth in her smile? Is this how she got them? I need to find her, make her fix this, there has to be a way to fix this!
It's not the front door I end up walking through. It's the bathroom. My neat box of dental care mocks me, all of it useless now. Lying beside it—the gel. The tube isn't even halfway empty.
The boy in the mirror is a bloody-mouthed, tear-streaked mess, but he's undeniably a boy. Less than a month. Less than a month and I look like I've been on T for years. I look the way I'm supposed to. I can't go back. I won't.
I pick up the gel. Close my eyes.
Pull back my lips.
“Crown Dental Services, how can I help?”
“I need to cancel an appointment.”
I can hear her frown as she types in my details. “It says here you reported a broken tooth. If that's the case, we can reschedule—”
“I was mistaken.” I cut her off. “It wasn't broken. It's fine.”
“Sir, are you—”
I hang up. I don't have time to waste arguing, I have to get to work. After last night, I don't have to fight with a binder anymore, though my shirt's almost too tight, snug over firm biceps and broad shoulders. I'll have to ask if I can get a new uniform, go up a size.
I run my tongue over my teeth as I finish getting ready. Twenty, thirty, forty-five—it's getting crowded in there, and it's going to cost me a small fortune in floss, but I don't mind.
After all, you have to take care of your teeth.