A True Alpha Chapter 54

Chapter 54

“Yeah, I heard you.” An overly agitated office worker threw detestable eyes at Lexa. 

“So?” 

“So.” She shot back with a follow up impatient glare. 

“Soo!” Lexa attempted to coax an answer out of the office worker. 

“So, you do know that when you have an appointment at ten in the morning, it is customary to show up… sometime before noon. Right?” 

“It is ten till!” Lexa reflexively defended after a quick check of her watch. 

“Yes, in that case, that changes everything! Now that you are only over an hour and a half late, we have an abundance of openings for you! In Fact! Every doc in the office is free and happy to do a seven on one checkup!”

Lexa was needless to say, less than amused, but she fought through. If she wanted to ensure Clarke this important meeting it seemed a modicum more sucking up might be required. “I am really really sorry. My mate’s rut came on spontaneously and we really need to get in to see the doctor Nyko today. Is she free at all today?” Lexa had finished, but it was clear from the office worker's face that more might be needed. “Please really. This is really important. I am so sorry!” 

“You two are damn lucky that Nyko kept a free morning scheduled for you two.”

“Are you fucking kidding me!” Lexa exploded in anger. “You mean to tell me!” She saw the cocked eyebrow of a woman threatening to change her mind. “That you were so damn nice as to ensure that my mate and I will still have an opportunity to see doctor Nyko today!” Lexa plastered on a false smile with the hope that it would be just about enough to buy her back into the woman’s good graces long enough to get Clarke what she needed. 

“Yes, I know, aren't I just absolutely wonderful?” 

“So fucking special! Just a goddamn angel!” Lexa forced. 

“So? Were they able to fit us in baby?” Clarke caught back up with Lexa after parking. 

“Just in the nick of time.” 

“Yup, she worked some magic and got us another appointment for today.” 

“Yes, I did. And Nyko says she is ready for you two in exam room three.” The secretary instructed. 

“Thank you so much!” Clarke cheered, unaware of the frustrations Lexa had had earlier. 

“No problem sweethearts. Good luck!” Her sudden sweetness sickened Lexa pushing her to want to snarl at the beta who had been playing with her, but decided against it before she made more enemies at such an ally's office. 

The duo made their way into the back, wandering around before stumbling upon the third exam room. They clung to each other, their bodies wanting as much contact as possible now that they had finally mated again after so long. “Thank you so much Lexa.” Clarke whispered appreciative with a follow uptight squeeze before she reached out and opened the door for them both. 

“Ah! There you two are!” Nyko cheered, spinning around in her stool, the paperwork she had been so diligently focused on entirely meaningless to her the moment that the alpha pairing passed the examination room door’s threshold. 

“Hey!” Clarke gave a soft and timid wave hello. 

“Yeah.” Lexa grimaced. “Hi!” 

“What held y’all up?” Nyko stood and outstretched a welcoming handshake for Clarke and then again for Lexa. 

Clarke’s response was simply a series of anxiously embarrassed groans as she averted her eyes from the welcoming doctor. 

“I, umm!” Lexa stalled as she shook Nyko’s hand. 

“What’s! Oh!” Nyko finally caught the scent of Clarke’s overly intense heat. “Oh god!” She stammered for a moment before grabbing at her stethoscope. “Umm, are they often that intense Clarke?” 

“No, no. Never. They are almost never this strong or quick to set in.” 

“It set in quickly?” Nyko searched for confirmation. 

“That is certainly one way to put it.” Lexa stopped herself before she reactively laughed. 

“Yes. It came on rather quickly.” Clarke nodded with a flush beyond that which her heat normally would give her.

“And I presume this is the first one since the…” Nyko trailed off, but neither Lexa nor Clarke could completely tell if she was avoiding it just because she didn't know exactly how to bridge the topic or if it was an attempt to be sensitive for Clarke’s sake.

“Yes. It is my first heat since the abort-” Clarke tried but that wasn't the right word. “Since the mis…” Nope not it either. “Since I lost the baby.” Clarke landed on with an uncomfortable shifting in her stationary stance before grabbing at Lexa’s hands. It was something small, but it was important to Clarke to ensure Lexa knew that she wasn't mad and that she had just been doing her best to describe the situation.

“It’s gonna be ok baby.” Lexa offered up some simple words with the hope they could help to put Clarke at ease despite the horribly loaded and pain-filled topic.

“I know. I know.” Clarke whispered back, squeezing at Lexa’s fingers. 

“Well, it is normal for the first heat after such a traumatic experience to both be delayed and to come on faster, but I would very much like to examine you if that is acceptable?” Nyko pulled at her stethoscope and stepped closer to Clarke. “Just to see that everything was alright?”

“Of course. Of course!” Clarke stepped forward as well, then she quickly surveyed the room for what she should or where she should sit. 

“Just on the examination table right there.” Nyko suggested softly wit a point to an all too common doctors office fixture. 

“Oh, yes, of course!” Clarke nodded and hopped up. 

“Start with some deep breaths for me, ok?” 

“Ok.” Clarke agreed and followed instructions as Nyko pressed her stethoscope up against Clarke’s chest the cold metal piercing right through Clarke’s thin sheer shirt. 

Lexa reached out, holding Clarke’s hand for support. “Is something wrong? Should we be worried?” 

“Nothing overly concerning at all.” 

“Not overly concerning doesn't mean not concerning!” Lexa snapped, a strike of fear for her alpha hitting her especially hard.

“I’m sure it is fine sweetie.” Clarke stroked fingers over the back of Lexa’s hand. 

“Another deep breath.” It only worried both of them further that Nyko almost entirely ignored Lexa’s question. “Your lungs are just fine, so that is good. But your heart rate is beyond elevated.”

“I… Yeah, that feels about right.” Clarke agreed, consulting her own heavy pulse in both her ears and her core. 

“Are you on suppressants at all?” 

“Oh well.” Clarke glanced to Lexa. “I stopped taking them after you told me the risks overconsumption of them caused for the pregnancy.” Her heart sank. 

“Yes, yes. And you haven't taken them since? Not at all?” Nyko stepped away, holstering her stethoscope back over her neck. 

“No, not at all.” Clarke agreed. 

“But this is your first cycle since the loss of the child?” 

“Yes.” Clarke’s voice shown thin with growing fear. 

“Like I told you last week on the phone, Clarke had some troubles with drinking after the loss. It was really rough on the both of us, and having the damage to her body, it was extra hard on Clarke.” Lexa attempted to explain. 

“I can't help but notice that you aren't in a rut currently Lexa?” Nyko noted as she fished around in her cabinets. 

“Oh yeah, no I’m not. I had my last rut about three, almost four weeks ago.” 

“So you would be due for one soon?”

“Yeah, I guess so. If my cycle returns to the same as it was before Clarke got pregnant, then it would probably start on Monday or Sunday.” 

“Yes, yes.” Nyko agreed emptily. 

“Does that matter?” 

“How many ruts have you had since?” 

“Oh, me? I’ve just had the one.” 

“And you two weren't around each other to share it?” 

“I, well no. I was trying to give her space to process and it was barely even a month after.” 

“Of course, of course.” Nyko agreed passively before grabbing down a circular pill holster labeled with days of a week for a full month. 

“Is there an issue?” Clarke spoke up fearful. 

“I want you to start you off with taking a suppressant.” 

“Uugh.” Clarke stalled for a moment.

“I am concerned about your heart rate. It is too high, and you are sweating just sitting there. Heats can be bad, but they shouldn't be that bad. Not to mention I presume your heat was just sated, what half an hour ago?” 

“Counting the time that we’ve been here?” Lexa winced. “Maybe twenty minutes.” 

“Your office is real close to home Doc.” Clarke blushed. 

“And the two of you knotted?” Nyko popped out one of the suppression pills and placed it into Clarke’s hand before grabbing the alpha a glass of water. 

Clarke and Lexa stammered embarrassed. 

“I apologize for being so blunt, but this is medically relevant.” Nyko passed off the small glass of water. 

“Yes. We did.” 

“Well, we didn't just. We also did the other thing.” Clarke whispered lowly.

“Other thing?” Nyko’s voice was hesitant of learning something she couldn’t unlearn.

“I! Uugh, is that medically relevant?” Lexa jumped.

“Well, if the reason why I asked for it and that we did it is an extra-strong heat?”

“I just assumed you asked for that because you wanted it.” Lexa whispered almost inaudible. 

“I did, but I wanted it terribly, even as you were inside me it was barely enough and I was craving for more… everywhere.” Clarke blushed, feeling the topic riding her up more in a way she was far from comfortable with in front of Nyko. 

“Uugh, is this something that I need to know?” 

“Well, she didn't just knot me.” Clarke blushed. 

“I am very sorry. Is there some overly interesting BDSM excursion I am unaware of that would explain your high heart rate? Because if so then taking the suppressant isn't necessary.” 

“No! No! It isn't that!” Clarke assured. 

“I kinda double-knotted her.” Lexa yelped out. 

“Huh?”

“Well, Lexa was extremely sweet and earlier this week she got me some play packers and holsters and strap harnesses. Uugh, in the heat of the moment I kinda requested for her to use it to umm, occupy the back door.” Clarke stumbled through her explanation awkwardly. 

“Aww, that is incredibly kind. And in that case, I think that taking the suppressant would be a good idea. If it can help slow your heart rate then everything is fine and we will be able to proceed.” Nyko explained.

“Ok.” Clarke downed the pill and eased her tight throat with a swig of water. 

“Is there anything in specific that we should be worried about Nyko?” Lexa pressed impatient, feeling like they were being strung along just a little too far behind whatever the doctor was planning. 

“I don't think so. If anything I think this will be in a way good news. But for now, we just have to wait on the suppressants to do their work.”

“Ok.” Clarke nodded with far more patience than Lexa. She sat back, leaning against the wall behind the examination table and then offered the space next to her to Lexa. 

The alpha glanced between her mate and the doctor, worried there was something about being close to Clarke that could in any way exacerbate the issue or be against the doctor’s rules. 

“No, no, sit with her, I am rather concerned with such a high heart rate, but having her mate close should help calm her.” Nyko urged. 

“Good, good, good.” Lexa muttered anxiously under her breath, scrambling up to sit with Clarke and hold her tight. 

Clarke whimpered softly, her inaccurate inner dynamic turning over in the joy of having her alpha’s arms wrapping around her and holding her close.

“That’s it baby, breathe. It is gonna be ok.” Lexa couldn't focus on whether the words were right or quite as affirming as she would normally hold herself to the standard of, all she could focus on was how to care for her mate, to calm that racing heart her alpha held. 

“I…” Clarke muttered weakly. 

“Here, would you mind putting this on your index finger?” Nyko requested, offering a heart monitor to Clarke.

“Yes. Yes, of course. Thank you.” Clarke took a quiet moment to slip it on and think to herself, her heart still racing a pace which was almost painful now that she realized how fast it was. “I! Nyko. I am sure all of this is very important and I am really glad that we are hopefully getting my heat and heart under control, but that isn't really why we had this appointment scheduled is it?” 

“No, no it isn't.” Nyko sat herself back down on her stool, settling in. 

“So… Should I be worried?! I feel like I should be worried! I feel like I should be really really worried!” Clarke stressed. 

“No! No of course not!” 

“But! Nyko! How should I not be worried! I don't really expect you to prescribe mind… DYNAMIC! Altering medications to someone less than a whole week sober, and especially not if she potentially has a heart issue! And even worse if it is connected to my heat!” 

“Shh.” Lexa tried to calm, caressing her hand down Clarke’s side, but it did nothing as Clarke began to hyperventilate. 

“I mean really! This isn't sounding good! Not at all! Like what even are my chances anymore?! Do I have any chance at actually being prescribed hormone therapy for my dynamic dysphoria anymore or is that already out the window?!” Clarke raced through her thoughts, her mouth barely able to keep up as she slurred half her words. 

“Clarke, please breathe. It will be ok. Just breathe. It is really important. If we can get your heart rate back down with the suppressant, then yes there is a good chance that we can still figure something out. But we do need to start working on some of this paperwork I have set up for you.” 

“Oh… ok.” Clarke stammered embarrassed as she shut her mouth and failed to calm herself despite all of her best efforts.

“Breathe love. I’m right here. This appointment doesn't have to be the one where you get your prescriptions, it can be the first step and everything will still be ok. I promise.” 

“She is right.” Nyko agreed in a calming tone, doing just enough to help Clarke begin to find some sort of regularity in her breath.

“So there is no chance I am getting them today.” It hurt to say and it was a defeatist attitude, but accepting a defeatist failure was worth some form of comfort to Clarke. Giving up meant there was no use in overly concerning herself for now and that today, in fact, could be just about building up the stepping stones to achieve what she needed, to start working towards her goal even if it didn't come today. 

“Not necessarily, but, before I can do anything I need to see your heart rate and blood pressure go down.” Nyko offered. “The medications associated with hormonal dynamic dysphoria therapy can increase your blood pressure and heart rate on their own, and I can't go prescribing something that will go getting you killed before it helps.” 

“I... I get it.” Clarke swallowed down her lingering hopes and found some dark corner of her mind to relegate them too for now. 

“It will all be ok.” Lexa tried again. 

“I… I know.” Clarke nodded and allowed herself to cuddle up to Lexa. 

“If it turns out this issue is just a side effect of the delayed heat, then that won't be an issue.” Nyko grabbed her papers and a clipboard, pulling them in and writing them in her lap. “And in the meantime, I think it is best to proceed as if that is the case. Plan for the future we want to see and all.” 

“O… ok.” Clarke attempted. 

“First.” Nyko announced, passing out a trio of pamphlets to Clarke. “There are generally three ways that people attempt to attain their hormone therapy. I only professionally approve of two. However, I am not so nearsighted as to say just because I only believe that there are two safe ways to go about it that everyone would heed my advice and warnings or even hear them to begin with. So yes. There are three common ways, whether I like the third or not."

“I think you mentioned this on the phone?” Lexa piped up, looking over the papers in Clarke’s hands.

“Yes. My clinic supports two, and predominantly focuses on the one I was planning to suggest today.” 

“Informed consent right?” 

“Yes.” Nyko nodded back. 

“So… uugh what’s that?” 

“It is me informing you of the risks, what is associated with taking alpha hormones and then you consent, if you want, by agreeing and signing this form.” Nyko flipped papers up and revealed the form at the back of her clipboard’s small novel of papers. 

“And the other two would be?” Clarke lead.

“Attending a therapist or psychologist, anything of the sort really. It takes about six months-”

“SIX MONTHS!” Clarke could feel her heart rate and blood pressure spiking in stress and fear as she screamed loud enough to alarm the whole office. 

“Yes. THAT method often does require attending regularly scheduled therapy sessions over the course of six months. Then if the therapist you are seeing decides that you are ‘trans enough’ and in a stable place to be prescribed these medications, they write a letter of recommendation for the patient to be prescribed hormones.” Nyko herself rolled her eyes at the term trans enough. 

“Trans enough! That is such fucking gatekeeping bullshit!” In all of her anger even Clarke forgot the main reason why she had originally decided to continue seeing Dr. Nyko; the one thing they had in common. 

“I agree, which is why we don't focus on it here whatsoever. But if someone were to come here for hormones with a letter, I certainly wouldn't turn them away.” Nyko agreed sternly. 

“Oh…” 

“I understand. I am trans too. And it isn't right that the system gatekeeps like that, but it is important for me to respect the system and not blatantly violate it, because if I were to so simply ignore it, I would lose my license in an instance.” 

Clarke cooked on her parched sandpaper throat. “Yes. Yes, that makes sense.” 

“Good. I am glad.” Nyko eased from her defensive stance. 

“She isn't the enemy baby.” Lexa whispered to her mate. “She opened up a slot for me and waited for us to ensure that we could have this appointment despite being late.” 

Clarke grumbled stressed and feeling her hormones and dynamic fight with the suppressants attempting to make her even more petulant for simply being away from her safe bed with her alpha. 

“Clarke.” Lexa sighed and tapped on her alpha’s arm in an attempt to ascertain any of her attention again. 

“Yes. Yes, she is on my side, I get it.” Clarke groaned. 

“Please baby.” Lexa moved in closer, whispering into her mate’s ear. “Please, really she is doing us a favor.” 

“I… I know. I’m sorry.” 

“I understand Clarke.” Nyko sighed. “I know it can feel like everyone and everything is against you, especially when you are told you will have to wait half a year for something waiting five minutes for feels like a lifetime in the wrong body, the wrong urges, the wrong dynamic.” She fiddled anxiously with her pen. “Just, I get it ok. I know how bad it can be, and I promise that I am doing what I can.” 

Clarke sat herself up slightly, however still at least partially leaning up against Lexa. “Yeah, I get it. I… I’m sorry. Uugh, but this six-month wait to get a letter, it is just one of three main ways to transition right? And then there was informed consent what is the other one you didn't approve of?” 

“Well, do you remember Tahani? The woman in the wheelchair? From the support group?” 

“I, yeah, I think so? I didn't know that was her name but yes I remember her.” Clarke replied tentatively. 

“She, and to somewhat of an extent, you as well, were effectively practicing the third method all on your own. Over consuming suppressants in order to somewhat and or completely subdue heats. Functionally it acts as one half of what I would prescribe as to do the same thing through informed consent. But simply overconsuming suppressants is not only dangerous, but it also leads to stronger heats when they finally come, and uterine issues like you have tragically already experienced.” 

Clarke shifted, the topic still clearly painful and dredging up more guilt than she could handle. 

Lexa, the ever dodging alpha wrapped her arms tighter around her mate, pulling her in and leaving soft kisses all over her neck and cheek. 

“And the other half?” Clarke followed up. 

“The other half would also attempt to mimic the other drug I would prescribe. But, sadly this too would be attained through less than entirely safe means. Often through simply buying alpha hormones online from less than reputable sources, where what you get is dubious at best, damn right toxic or poison at worse” 

Clarke clammed up and Lexa's stance sitting with her mate on the examination table grew almost overly protective. The biological alpha growled softly. It came out without any intention, just slipping so easily from her throat as she imagined her mate accidentally having been scammed and sold poison instead of an incredibly important medication. 

"But that is why I offer informed consent here. You know, take this form, it is dangerous to go alone and all.” 

Clarke snickered but Lexa didn't get the joke. 

“Huh?” Lexa’s face easily depicted just how confused she was with her mate’s laughter. 

“It’s ok, I will explain later.” Clarke kissed at Lexa’s forearm, finally taking an actual unbaited breath, the suppressants actually doing their job immensely effectively without her realizing it. 

“So then informed consent? That seems to be the best way?" 

"Well, I'm not waiting six months." Clarke assured with far too much confidence for someone so callously suggesting they would soon consider taking something their doctor has just described as potentially toxic or poisonous. 

"You sure as hell aren't just buying hormones online!" 

"I'll do what I have to do." Clarke huffed lowly. 

"Clarke!" 

Nyko gave a loud cough, realerting then both that she was still in the room and listening in, patiently awaiting an opportunity to interject important information. 

“Sorry!” 

“Yeah sorry.” Clarke apologized, much less sincere and with more of an attitude, but she did in fact apologize. 

“Hopefully, that won't be an issue.” Nyko’s eyes darted between the alphas. “Yes, waiting six months can feel horrible, but the reason why I ensured that you two could get this appointment when Lexa called me was because I was afraid the thought of waiting would push you back to unmonitored self-regulation.” 

“Thank you. Thank you both.” Clarke calmed, a sincerity growing in her voice as her guard lowered at a snail’s speed. 

Nyko smiled back politely before returning to her clipboard. “So, Clarke, I received your two most recent blood work results which you faxed over a couple of days ago.”

“Yeah, on Wednesday Lexa told me that you needed new bloodwork so we went to get some done with a rush speed and had my most recent ones sent over too. It seemed like a good idea at the time.”

“It is idyllic in fact, especially considering I still have your results from and before the hospitalization, so we actually have a good basis to work off of.”

“T! That is good right!” Clarke cheered with much more excitement than she had previously anticipated herself to garner so hastily. 

“Very good. Very, very good.” Nyko mumbled under her breath, rereviewing Clarke’s charts and recorded readings. 

Lexa squeezed Clarke supportive. 

“So… what exactly does very very good constitute?” The anxious alpha fished. 

“It constitutes an idea for what I can prescribe you without any issues. Your blood looks perfectly fine outside of what would be expected for the most part. Your hormones were, of course, haywire when you were pregnant. Your bp and iron levels were down while you were in the hospital, but that also makes sense given the internal bleeding. And the only issues I see with your bloodwork from Wednesday are your temp, bp, and heart rate. But those can both be explained with it still being the tail end of withdrawal, and potentially an early onset preheat.” 

“I… yeah that makes sense.” Clarke wearily agreed. 

“And about the drinking.” The words hit like a hammer, one Clarke knew was to fall at any moment, but simply knowing the strike was coming did absolutely nothing to guard or cushion the blow. 

“Yes?” A hint of contest rose back up in Clarke’s tone. 

Nyko removed her glasses, rubbing the bridge of her nose and then her right temple. “These drugs… Many alphas can lose control in their first ruts. But when they are just kids, it isn't much of a threat. But taking these medications as an adult can be affected with alcohol, have negative reactions if you overindulge. I am not saying that you are in no way allowed to drink while on these, but substance abuse can not only interact with these medications and amplify an alpha’s aggression, these meds can also feed into an addiction issue. For whatever reason, alphas can at times have further impaired judgment when inebriated, and this is obviously an issue, one which is exacerbated by any history of substance abuse issues.” 

Clarke gulped. 

“Now, given how informed consent works, it is still ultimately your choice as to whether you would like to pursue taking these medications. All I need to confirm and the only main thing which can stop me from prescribing these medications is if it would pose an imminent risk to your health. For instance, if your heart rate and or blood pressure are too high, and prescribing them would lead to a dangerous situation.” Nyko stood as she continued her offhand rambling about the intricacies of the morality and legality to prescribing such important medications. 

“Well, of course, I want to take them if I have the choice.” 

Lexa tensed and held Clarke closer, scared of what could possibly come from this if Clarke ever relapsed; even more, she was terrified when it further dawned on her that she had absolutely no experience in the way of alphaisms in this context and how being an alpha related to drinking. “Is- is that-” She was quickly overwritten. 

“I don't care, I will be fine, I’ve quit twice and I am not going back.” Clarke’s words were far from the ringing self endorsement that she thought they were. 

“Hmm, well, it is certainly something that I would like to keep monitored if things go well and we do have the opportunity to prescribe alpha hormones. If we can do this, I think it would be important to have a standing weekly appointment as a check-in. I don't care if it is here at my office or with a therapist of any sort, I just think this is important to ensure nothing gets out of hand.” Nyko suggested as she pulled out a blood pressure cuff and her stethoscope. 

“I like that idea as well.” Lexa agreed, worried if she didn't speak in affirmatives she might be lost in Clarke’s anxious excitement. 

“Of course, that would be more than understandable. 

“Your arm Clarke?” Nyko requested. 

“Oh of course.” Clarke surveyed herself, noting that she had calmed significantly. 

“Ok, deep breaths just like last time. We have let a good amount of time passes, and now I think we are ready to try this again.” 

“Thanks.” Clarke began with her deep self-soothing breaths. 

“Of course Clarke. We will work something out. Everything will be ok.”

“Yeah, it will all be ok baby.” Lexa kissed Clarke’s cheek supportively. 

“Thanks.” Clarke repeated, the cuff squeezing her arm almost painfully tight. 

The following several seconds trudged onward, everything taking a small millennium to occur as Clarke held her breath. She felt an abnormal weight to the test as if it were of much more imperative importance than Nyko had openly admitted to. Unsure where the weighted feeling originated from, Clarke fought to calm herself back down by looking over the fliers once more. Informed consent and its advantages, the risks of online hormones, and a much less attention-drawing flyer suggesting how to bring up the idea of being trans dynamic to a therapist.  

“Ok.” Nyko pulled away, deflating the cuff and slipping it off of Clarke. “Good news”

“Good news?” 

“Good news?” Clarke’s voice followed but a moment after her mate’s. 

“Good news girls.” Nyko removed all but the final page of papers from her clipboard and handed it off to Clarke along with her pen. “Good news.”

End of Chapter 54

Author’s note: The medical transition in this story is not a one to one comparison to real life. I have drawn from my own personal experiences, the experiences my friends have endured, and drawn inspiration from FTM medical transition, but again it is not the exact same. If you are struggling with gender dysphoria, Informed consent is a real thing, and so is attending a therapist in order to get a referral letter. I personally started my MTF hormone transition over three years ago through informed consent at the Mazzoni Center in Philly. Again this story is not the exact same as our real-life system, but it is similar and based upon it. There are a multitude of resources available online and in many areas, there may be a local LGBTQ+ welcome center or something of the sort that you can use to get information.