Transitioning: part one

Changing one’s sex is a long, methodical process. At the very least, transitioning takes nearly two years. It is not unusual for a person to spend several years making the passage.

As I lay out what is involved for a person to transition, the purpose is not to offer opinions or debate any aspect. For example, I will not discuss how a person might want to see a therapist whose goal it will be to keep the patient from transitioning. That is another topic for another time.

While few are familiar with the path of transitioning, more and more have a relative, friend, or know someone who has or is transitioning. This is why I am presenting the facts of transitioning, as I have become familiar with them. My aim is to inform, not to influence.

Virtually universal are the first two steps, seeing a therapist and taking hormone replacement therapy (HRT). While it is possible to get HRT without seeing a therapist, one has to go outside of the World Professional Association for Transgender Health (WPATH) guidelines. The WPATH serves as a resource for both healthcare professionals and patients.

Qualified therapists carry an array of credentials. The gender dysphoric person seeks one who has experience with the condition. As the saying goes, “The transgender experience is highly individualized,” so the patient values the more knowledgeable and experienced therapist.

Simply engaging a therapist often is a huge step. It is not unusual for a therapist to be the first person whom the patient is telling about his gender conflict. Whatever the background of the patient, the therapist will assist the patient in coming to an accurate understanding of himself, which will give the therapist what is needed to make a diagnosis.

Because of the WPATH, therapists are often called “gatekeepers.” Depending on one’s perspective, that can be seen either positively or negatively. In no other condition or disease or illness, where a person seeks medical care, is a person required to have a therapist’s letter of recommendation. (For example, a person can have facial plastic surgery without seeing a mental health professional.) The purpose of the therapist as gatekeeper is not to slow down or hinder the patient. Rather, the role of the therapist is to ensure success in what is as major a life-change as exists.

In most cases after a person is diagnosed the next step is to go on HRT. The therapist writes a letter of recommendation which the patient takes to a qualified doctor, perhaps an endocrinologist (hormone doctor). As family practitioners become familiar and experienced, one might see his own doctor for a variety of reasons—for one, they already have a relationship; for another, being able to get an appointment much sooner than with a specialist.

HRT is sought for, and will accomplish, a host of things. For many, the first goal is to receive the emotional benefit. For the male transitioning to female (MTF), this is from estrogen. For the female transitioning to male (FTM), this is from testosterone. Part of the affect is physical—reversing one’s hormone make-up creates sort of a second puberty. Part of the affect is emotional—many people report a calming effect. MTFs report being more emotional, crying easier. FTMs comment that they find themselves more aggressive. In both, one commonly hears, “I finally feel like who I am.”

HRT is administered by pill, patches, or injection. Generally, the younger the patient, the quicker and more dramatic the results. In young FTMs—say, late teens and twenties—HRT can create visible changes in weeks. For MTFs, visible changes tend to take a bit longer to become striking, mostly because of the type of changes. In older adults, everything—time frame and impact—lag far behind.

FTM: Testosterone usage has some desired affects which are permanent. The voice deepens. Facial and body hair grows. Fat deposits shift to typical male areas (which might not remain should the person cease HRT). There are some less-than-desired affects, like male patterned baldness when one is genetically prone. I have met several FTMs and found their facial hair impressive and their voices sounding just like a cisgender guy’s. (Cisgender refers to a person who identifies with the sex assigned at birth, as in “it’s a girl!”)

MTF: Estrogen is supplemented with one or two other drugs which block testosterone production. Where the FTM’s facial hair grows, the MTF’s facial hair does not stop growing. Where FTM’s voices deepen, the MTF’s voice is unaffected. Body hair becomes lighter. Skin thins. Fat deposits shift. The face will change some, but hormones cannot alter bone structure. Breasts development can be minimal to full. When less than desired, progesterone might be introduced or a person could opt for implants.

There are undesired possible side-effects for both FTM and MTF. As body chemistry changes, so do potentials for things like breast cancer for the MTF.

There are some transgendered folks who never take HRT, finding their way without it. (Once again, the transgendered experience is highly individualized.) The high percentage taking HRT find the affects to be what they desired and needed. The mind, which has perhaps been in a two-person war, is confirmed in the desired sex. The body, which has often felt wrong on the person, now looks and feels correct.

This is a major step, to engage a therapist, be diagnosed, and take HRT, but several major steps await. Among the generally utilized things are electrolysis and laser hair removal, facial feminization surgery, top surgery for MTFs, and bottom surgery for both. Toss into the mix what might be considered the biggest step of all: changing one’s outward life: the Real Life Test, where the person undertakes living in his or her desired sex.

I will address those things in part two.

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