A new treatment for AIDS?

Raised in a loving, traditional home on a dairy farm in Northern Vermont, I was ill-prepared for the patients I would meet in a big city like Nashville. On my first ER call as a brand new intern, a twenty-three year old male showed up with crushing chest pain that turned out to be a heart attack. The cause? Cocaine. But cocaine abuse wasn't the only thing that distinguished him from the rural folks I'd grown up with. Jamie was the most effeminate male I had ever encountered--his voice was a full octave higher than mine,  he wore long manicured red nails, and he sashayed his hips like a runway model when he walked. No wonder--he worked as a female impersonator at a gay strip club in town. I may be naive, but even I deduced that probably also meant he was a male prostitute. Thus, besides treating his heart attack, I ordered tests for AIDS, syphilis, gonorrhea, and every other sexually transmitted disease I could think of. Because he had no medical insurance, once his heart was stable we advised him to join Cocaine Anonymous and then we discharged him with the  strict advice to avoid cocaine, wear condoms and follow up in one week at my outpatient medical clinic.

His laboratory results returned a week later, but unfortunately, Jamie did not--he no-showed for his appointment. My jaw dropped in horror when not just one, but EVERY sexually transmitted disease came back positive! Since this was before AZT or any other AIDS drug had been discovered, I would effectively be handing him a death sentence. Plus, if he was a prostitute, there was no telling how many other men he had infected. I notified the health department, who call later that day to inform me the phone number and address he had provided  to the  hospital admitting office were bogus. Great! "Typhoid Mary" was still at large inflicted AIDS on anyone he "serviced." Thus, he had to be found and stopped. Desperate to get all his STD's treated, I called every gay male strip club late that night and finally tracked him down. While I didn't want to tell him he had AIDS over the telephone, I  did convinced him to come into my clinic for something very "important."

Legs crossed like a fashion model, he sat in the chair of my exam room, admiring his  manicured nails while I explained he had AIDS, syphillis, gonorrhea, Chylamdia, Herpes, Trichomonas, and venereal crabs! I gave him a shot of Penicillin and wrote antibiotics for the diseases I could treat. I then gave a simplified dissertation on what it meant to be HIV positive with a low T4 helper count and told him he must not ever have sex again or he could spread the disease. Knowing he'd be devastated,  when I finished my speech, I asked, "Do you have any questions?"

He glanced up and said in his high, effeminite voice, "Will you give me estrogen?"

My brow furrowed. "Estrogen? There aren't any studies showing estrogen will cure AIDS."

He shook his head. "That's not why I want it. I want it to make my breasts bigger."

I stared at him in shock. I'd just told him he had every venereal disease known to man and would probably die of AIDS and all he was concerned about was the size of his breasts?

I could not suppress my scowl. "I am NOT going to give you estrogen just to make your breasts bigger. It's not an FDA-approved use of the drug. Furthermore, estrogen has serious risks of leg clots and strokes."

Unphased, he squeaked out, "Do you know a doctor who will give it to me anyway?"

This encounter was not going well. I took a deep breath before responding. Stay professional. "There's not an ethical doctor anywhere who will give you estrogen just to make your breasts bigger."

"You know any unethical doctors?"

I stared at him, clueless how to respond. Why had the University of Vermont College of Medicine not taught me how to deal with patients like this? I finally told him I'd treat his AIDS and infectious diseases but he'd have to find the unethical doctor on his own! A few visits later, I noticed his breasts were indeed growing, so he was obviously getting estrogen somewhere. When AZT came out a year or two later,  he was non-compliant taking it. But his estrogen? He never missed a dose! No surprise, he died of Pneumocystis carinii, an AIDS-related pneumonia, several years later.

Sally Burbank M.D.