After a person has started HRT, he will have a host of other things on his agenda. Of the items discussed today, the first and the final often are the first and the final. The rest, if they utilized, do not come in a particular order.
MTFs have a high desire to get rid of their beard. If their hair is dark enough, or has not grayed, laser hair removal can see them with a cleared beard in as little as eight to twelve once-a-month sessions. For others, the only route is electrolysis, which is vastly more labor- and time intensive. Expect a minimum of 120 hours to have each hair follicle pierced and the hair plucked, one at a time. Both processes are painful, expensive, and time-consuming.
Before either MTFs or FTMs can get a therapist’s second letter of recommendation, to have sex reassignment surgery (SRS), also called bottom surgery (and gender reassignment surgery, and gender confirming surgery), they must pass the Real Life Test (RLT). During the RLT, the person lives full time in the desired sex. The purpose is at least twofold: to see if a person can succeed as the opposite sex and for the person to recognize if this is what is needed. In the past, the RLT had to be a minimum of a year and perhaps two years, and required letters from two therapists. Now, it generally is one year but I have read that some have only been required six months, and that only one therapist’s letter is required.
There are several legal issues involved in transitioning. If, during the RLT, the person decides this is permanent, a decision will be made to legally change one’s name. State laws vary, but generally a person may get a name and gender marker change at this point, which allows for things like drivers licenses being changed, but a birth certificate can only be changed after sex reassignment surgery (SRS).
Besides the problem of facial hair, the male facial bone structure varies greatly from a female’s. To gain a more female appearance, MTFs might make use of facial feminization surgery (FFS). Typical procedures in FFS are rounding of the chin, reducing nose size and perhaps shaping it, and trimming the brow line and raising the eyebrows. Other things common for facial plastic surgery patients might also be in order, like raising cheekbones, and tightening a sagging neck.
Money is a huge issue for folks in transition. One can spend from $50,000 to $100,000. Until recently, you were on your own. Now, more and more insurance plans cover therapy, HRT, FFS, facial hair removal, top surgery, breast augmentation, and SRS. There is a Catch 22, however. In order to successfully pass as the opposite sex, many in transition desire things like FFS, yet their insurance plan says they must successfully pass their RLT before insurance will cover any surgery.
For FTMs, before top surgery they must bind their breasts. For MTFs, they likely use artificial breasts, unless HRT does quick and satisfactory work. FTMs ultimately want their breasts removed for a male-like chest. MTFs might have breast implants to achieve the desired female figure. Less common are procedures on the buttocks and hips to acquire the longed-for shape.
The ultimate surgery is what commonly is referred to as the sex change, SRS. As has become obvious from this and the previous discussion, genital surgery is hardly the be-all and end-all of transitioning. Indeed, many opt never to have it. Having reached a level of contentment—the effects of HRT, now living as their desired sex, and the like—they do not feel the need. Also, it is very common for it to be put off, or never done, because one cannot afford it. Insurance coverage would provide a grand assist in one making this decision. While there are a number of doctors performing the surgery in the USA, Thailand has become a popular destination as numerous surgeons are highly skilled at SRS and the cost is significantly less than in the USA.
I won’t go into all of the details of SRS. If you are interested, the Internet is filled with sites that walk you through either type and YouTube videos with folks describing theirs. SRS has been so perfected that doctors, who are unaware their patient is trans, often cannot tell the person is not a genetic male or female.
Undertaking each and every step in transitioning demonstrates the seriousness of gender dysphoria. This is why I wanted you to know the process, so that you appreciate that transgendered people are not acting on a whim, or playing out a fetish, or just a bit confused. For the person with gender dysphoria, this is the stuff of life and death.
As I have considered the topics on which I would write, it did not occur to me that the steps to transition would be one of them. It is not a topic which garners a lot of conversation, but I hope it is informative and helpful. In coming days, I will discuss things more likely to generate conversation as I get into some of the issues of the Christian faith, and address some of the questions and comments that continue to arise.