FAQ: Transition Basics

Welcome to the first of our FAQs series of posts. We’ll be covering various topics in these, trying to give you the most information about a particular subject as we can. You can always find all of the FAQs by looking in the FAQs category.

Anyways, today I’ll be talking about the basic steps of transition for both transgirls and transguys. I should note that this is how it is done in the USA, and other countries may differ from this in some ways. This is a process that will consume a lot of time and money. It can cost you heavily both emotionally and physically. But if you truly are transsexual, it might be the only way out for you, the only way to safely move on in your life. So let’s go on a journey, and check out what you will most likely encounter.

The Beginning

So you’ve realized that you are transsexual, eh? Well, that’s certainly a good start, it gives you a path to follow and all, but what do you do with that realization? Well, the first thing you will want to do is find an understanding therapist. Before you can actually begin hormone replacement therapy (HRT), you will need to have been seeing a therapist for a number of months.

I am pretty sure the requirement in the USA is for transgirls to have at least three months of therapy, and transguys six months. The reason for this is that testosterone produces permanent results faster than estrogen/progesterone. They want to make sure transguys are really sure they want to go through with this. The same applies to transgirls, but it takes longer for the female hormones to start showing permanent changes, which is why they can start earlier.

Your therapist might make you wait longer, depending on what they think about your situation. For instance, my therapist would write me the letter to get hormones, would have a while back, but because I currently lack a job, she doesn’t want to do so. She wants to make sure I can afford to pay for them before she will OK them.

Hormone Replacement Therapy

So you’ve been seeing your therapist for awhile now, and s/he finally has written you a letter approving you to start HRT. What’s next? Well, you will need to find yourself a qualified endocrinologist. This is one of those things where quality trumps price. Hormones, if done wrong, can kill you, so you want to make sure you are seeing someone who has plenty of experience. It is best to find one who has experience with transsexual patients, if you can. Not everyone will be able to of course, but if you can’t, then just find the best endocrinologist you can find. This is also why you don’t want to self medicate with hormones, because it is something that needs to be carefully administered and monitored by a professional.

If you are a transguy, odds are the only thing you will be put on is testosterone, which is a potent male hormone. This will be given to you through injections. You can either self-inject or go to a doctor to do it for you. Transgirls are a little more complex when it comes to HRT. For sure you will be on estrogen, which can be given to you in a variety of ways. Injections and pills are the two most common ways. You may also be put on a progestin/progesterone. And finally, depending on what hormones you are already taking, you may be put on an androgen blocker, to help block the effects of testosterone.

I should add that after you remove your primary hormone producing organs (testicles or ovaries), you will need to be on hormones for the rest of your life. Your body will not produce enough hormones on its own to keep you nice and healthy. Of course, after a few years on the hormones, you will be dropped down to lower dosages, so it will get a little cheaper for you.

Voice

Now, for transguys, this is a very simple task. They sit back and relax, and let the male hormones kick their voice into guy mode. The vocal cords will thicken up and they’ll probably have the joy of a cracking voice for a bit of time.

Transgirls have a bit more complicated set of steps to do. Female hormones will do nothing for your voice, so you have to train yourself to have a feminine voice. This process will take time, probably at least a year. You will have to train yourself hard, and this might end up being the hardest part for you to do. If you have had any type of voice training, be it singing or other things, you will probably have an easier time doing this.

Now, there is a type of benefit from this, at least for some people. You will now have access to both a female and male voice. This would be great for a voice actress, being able to do both genders with ease. For most people though, you will probably eventually forget about your old male voice, leaving it to wither inside you.

Electrolysis (transgirls)

This is the first surgical procedure that transgirls will get to help them pass. This is the only procedure the FDA has approved as being capable of permanently removing body hair. Some people can just get away with laser removal, while others do laser and clean up the remainder through electrolysis. Facial hair will not be affected by the female hormones, other than to possibly slow down the growth rate. So electrolysis will help remove that hair from your face, which will greatly aid in passing as female.

Depending on how much body hair, particularly on the chest and back, that you now have after the female hormones, you may need some electrolysis there as well. While I am at it, you might also need to have your pubic hair cleaned up to a degree. The biggest part would be the hair on your scrotum, which is good to remove before you get the genital surgery. The reason is the scrotal tissue will become the labia, and you don’t really want hair growing all over the place there. If you don’t do it, the surgeon will probably scrape the hair follicles out when s/he is working down there, but it would make things easier on the surgeon if you took care of it beforehand.

Chest Reconstruction Surgery (transguys)

This is the first surgical procedure that transguys will get to help them pass. Now, as a transgirl, I only know a little bit about this, mainly from my friend Roger. Basically what happens is they go in and remove enough breast tissue and skin to flatten out the chest. According to my sister, they will cut the areola and reshape it, making it appear more masculine. Finally, they will move the areola and nipples into a new, more masculine position.

Real Life Test

You’ve been taking your hormones for awhile now, your voice is passable, your look is passable. Everyone around you sees you as the proper gender now. So what’s next? Well, you will begin your Real Life Test (RLT), which is where you live in your desired sex 24/7, usually for about a year or so. You will present as your internal gender all the time, to anyone and everyone. You will have to accomplish this before you will be allowed to get your final surgery.

Name / Gender Change

Before you start your RLT, you will probably want to get your name legally changed. Generally this is a simple and cheap process. The process and costs will probably differ depending on where you live, but it should be pretty easy to find out.

The gender change is a little more complicated. Some states are really a pain about it, while others are more understanding. In some places, you might need to go all the way through with the final surgery. In others, you just need to prove that you either plan on doing the surgery, or that you plan on living in your target gender forever. This is more complex than a name change, and therefore will probably cost you more as well.

It would possibly be a good idea to get a lawyer to help you out with it, to make sure things go as smoothly as can be. Some states actually might require you to go to court to explain why you are doing it, while others might be pretty simple. Of course, a lawyer familiar with gender changes could be of some good use to you, if you have the money to spare for one. Otherwise, just make sure to do some heavy research about the requirements in your state or country.

Final Surgery

Here it is, the final surgery. You’ve spent years jumping through hoops, spending thousands of dollars, but you have finally made it here. Most transgirls will likely get the genital surgery, which uses the penis and scrotum as raw material to make the vagina. Doctors have been getting more skilled at this type of surgery, and can pull off some amazing results.

Transguys on the other hand just might choose to wait. They will probably go and have their internal sex organs removed, but still leave the vagina intact. The reason for this is that the two available types of surgery to create a penis are… lacking. One method gives a penis that can get erect and have all kinds of sensation, but is basically miniature in form. The other gives a more naturally sized penis, but it can’t get an erection and from what Roger says looks kind of weird as well. He calls it the Zombie Penis. In addition, the costs may be prohibitive for a transguy, as the surgery costs far more than a transgirls does. Until the surgery gets perfected some more, a lot of transguys just might decide to hold off on that goal.

Congrats / Costs

Congrats! You’ve made it to the end of your goals, and are hopefully integrated nicely into your chosen gender role. So what did all this run you? Well, it cost a lot, that is for sure. Emotionally, physically, and financially. The emotional costs can’t be calculated, as they can vary wildly from one person to the next. The physical costs are also hard to pin down. What can be easily figured is both the financial costs and the time spent working towards it.

I’ll give a breakdown for transgirls and transguys, with an estimated total as well. Of course, this number can vary quite a bit as well, but it will give you a rough idea. The time spent will be roughly the same for each gender. For a lot of people, you are probably looking at three to four years, at least.

	Transgirls	Transguys
Clothing / Makeup	$500 — $1,500	$500
Doctors	$10,000+	$10,000+
Hormones	$5,000 — $7,000	$5,000 — $7,000
Electrolysis	$10,000 — $20,000+
Chest Reconstruction		$5,000 — $10,000
Lawyers	$5,000	$5,000
Genital Surgery	$10,000 — $20,000	$30,000 — $100,000
Final estimated costs over four years	$40,500 — $63,500	$55,500 — $132,500