Elements of Transition for Male to Female Transsexuals

Transition for the Male-to-Female (MTF) Transsexual

Originally written around 2006 – Rewrite August 11, 2013

Male to Female Transition To Do List

The MTF To Do List

The average person probably thinks that a transsexual gets up one morning and says, “Today I’m going to do it”.  They phone up a doctor and go in for a “sex change”.  This about on par with NASA getting up one morning and saying lets go to the moon.  What you don’t see are the years of planning.  In reality, the actual “sex change”, actually called SRS (Sex Reassignment Surgery), happens only after years of personal struggle and countless other processes and procedures.  By the time some transitioning from Male to Female (aka a Transwoman) gets to that point they have been living as a woman for at least one year.  The SRS operation, although major surgery, (and technically cosmetic surgery) will mostly seem like just a detail.

Transition is a very personal journey and will be different for everyone.  I will describe transition, not as the right or wrong way, but simply as it makes sense to me.

Elements of Transition

Transition can be broken down in to two general sections

  • Mental
  • Physical

Mental:  (Including anything that does not change a person’s appearance.)

Long before you see any physical changes in a person, they will have gone through years of emotional struggle.  For most of us this is something that has been nagging us for as long as we can remember.  Transition usually starts for a person by dealing with the metal side:

  • Emotional:  I have always know I was TS (a transsexual).  Long before the words were there, I knew that I didn’t match somehow.  There becomes a point at which you understand that you can do something about it.  For me it was reading a book that showed there was some hope for me.  When discussing this, a good friend said to me, “Just ask your self if doing this will make you happy.”  This is exactly what it is about.  If you could just do it, would you be happier?  From the sense of self, appearing and interacting to the world in a way seems congruent to who I am.  This is exactly it.  There is no question that I would be happier.  It is the reaction from the world that changing genders could take that all away.  Most people are prepared to lose it all when they transition.  For me I have always been aware that I am very lucky and have much to be grateful for.  If only I could change that one thing.  The emotional transition starts with the courage to move forward.
  • Legal:  The legal aspects of transition often center around one little letter on your birth certificate or drivers license.  The F or M.  It seems funny to me that you can ask people about this.  But yet it is tied to every aspect of our physical existence.  Why don’t they have a box for race or religion.  (Imagine if your drivers license said “Bob Smith, white, Catholic”!)  People that transition usual get very excited about changing their name but especially changing that one letter.  In British Columbia, any person can change their name quite easily.  Changing the letter on your drivers license requires a letter from your doctor.  The letter must include information to support a reason to change your gender.  To have your birth certificate changed you need to have first had SRS.

The one aspect that didn’t occur to me, what the legal status of our marriage after transition.  There are places in the world were same sex marriages and not legal.  There is one American state that goes so far as to make wills illegal for same sex couple.  Is it possible that, at the hand of some future government, Brenda would not be able to collect a widow’s pension?  Could I lose custody of my kids if Brenda died?  Would I not legally own my house?  There are many questions that have to be answered before you transition.

  • Spiritual:  The spiritual aspect of transition is something we all have to work through.  Is taking hormones playing with mother nature?  If you are religious, do you view this as a sin?  What is the sin, becoming yourself?  In the same way that God makes one person blind and another a genius, he also makes transpeople.  Like a Gary Larson cartoon with God making people, “Hey, let’s put the girl brain in the boy’s body!”  Does it become a sin to take the challenge life has given you try to rise above it?  In the past transpeople have lived with much shame and lived in a world were they must repress who they are.  In many ways this may look like the type of oppression suffered by countless minorities in history.  Like the Jews or even left handed people.

So many transpeople find themselves in a kind of spiritual awakening, before transition starts.  A few years before, I had started to do yoga as a means of improving my health.  What I didn’t know going in to it was that what we know in the western world about yoga is that it is a means of exercise.  However the “Asanas” or postures of yoga is only one of eight limbs of yoga.  There is very much more to it and it seems to be quite “wired-in” to Hinduism.  The result for me has been a lot of introspection.  Many spiritual people will ask questions like, where was I before I was born and where will I go after I am dead.  I find myself adding questions like, am I truly female?  Does the soul have gender?

  • Reality:  After all is said and done, will I be a woman?  The reality is that I won’t.  I will not have a period or have the ability to conceive children.  But there are many woman that for a variety of medial reasons can’t do that either.  Are they men?  If you do a blood test on a transperson or look at their cells under a microscope what will you find?  Does the fact that I grew up as a boy, prevent me from being a real woman?  Maybe. The reality is that before and after transition , I will be a transsexual a transwoman.  To deny that is to deny who I am and to deny the journey I must endure to get to a place that makes sense for me.
  • Counselling:  Before anyone launches in to transition it is very important to have some level of counselling.  Many people will start into hormones on there own.  Without having a doctor on their team.  In my view this is a huge mistake.  Finding a doctor that understands trans issues can be hard.  I was lucky to find one that has made a specialty of it.  He has been trained in both trans assessment and endocrinology.  Many us know long before we ever go to a doctor what is going on.  Nevertheless, It is good to get an acknowledgement from a professional that you are on the right track.  In my case, my doctor also works with another doctor that provides a second opinion before hormones start.  I also attend a support group of my peers.  Some are just starting out.  Some transitioned decades ago.
  • Restrooms:  (I just had to include this somewhere.)  Something as simple as peeing can become a problem while you are transitioning.  If you are man dressed as a woman, where do you pee?  You can’t use the men’s room and if a woman figures you out in the ladies room, she’ll likely call the police.  MTF’s have to use the ladies room, pee sitting down and don’t hang around to chat.  I’ve been washing my hands and had a woman strike up a conversation.  I found myself trying to politely finish and leave.  My doctor provided me with a letter that I can use if needed.
  • Hormones:  See below (anti-androgens and hormones) for the physical side.  You can see the physical effect, but the emotional side of this is both profound and subtle.  After taking hormones for some time I feel that although I am the same person, emotionally I am quite different.  These differences are hard to explain but I think they are noticeable.  When I first started taking estrogen I found myself crying a lot.  The question is: Is it the hormones or the deep emotional release of starting to transition?  I’m not really sure.

Physical: (including esthetics and medical proceedures)

  • Painted Nails:  The thought of a man with painted toe nails has often been the but of jokes.  Including M. Frank Burns on TV’s H*A*S*H. For many women having their nails done gives them the feeling of being groomed and a bit more feminine.  For me keeping my toes polished and fingers well shaped and with clear polish is just one of those things that make me feel good.
  • Ear Piercing:  These days men with pierced ears is not too unusual.  For me it was just another important step in femininization.  Mostly I just wear my silver studs.
  • Hair:  If you know me, you know that having a full head of female hair just ain’t gonna happen.  I did look at Hasson and Wong but it appears that the cost for me would be about $25K.  Also, it appears that the process they use moves hair around and does not create new hair.  I have not been for a consultation so this only my estimation.   I have purchases wigs on-line, which I do not recommend.  Also, I have purchased a number of wigs from Abantu.  I found their staff was great and the product was reasonable.  I purchased synthetic wigs and no matter what the style or colour was, Brenda still complained of their wiggy appearance.  Later I purchased a custom human hair wig from West Coast Wigs.  Which is what I wear everyday.  Sometime its looks a bit messy and damaged, but nobody has ever thought it was a wig.  I’m very happy with it, but it was insanely expensive, so it will have to last a long time!
  • Skin Care: In the past I have had fairly bad skin.  Over the past few years I’ve been taking care of my skin more actively.  I use a (should be twice) daily three step, cleanser, toner, moisturizer from Mary Kay  (Brenda sells it, if you need any.)  Also, I use a weekly home Microdermabrasion kit.  Whether it is the skin care or the hormones or just that I am so much happier now, my skin is much healthier now than it has ever been.
  • Makeup: The challenge for any transwomen is to wear enough makeup to hide the maleness.  While trying to keep it subtle, appropriate and not being gaudy.  You’ll have to tell me if I’m doing ok.  Most of my makeup is Mary Kay (ask Brenda for a catalogue)
  • Laser Hair Removal:  Laser is a quick way to remove hair from your body.  For an entire face a procedure takes about 5 mins, but must be repeated several times over a number of months.  There is some doubt that it is permanent.  Also as light energy is absorbed by dark colours but not by light colours.  My beard was dark blonde and white (grey), so the dark was removed by the grey remained.  This must be removed by electrolysis.
  • Electrolysis:  Electrolysis is the one-hair-at-a-time destruction of the hair folical.  The process hurts about as much as an insect bite.  But during the course of multi-hour procedures having thousands of these of these little bites can make you crazy.  Before a procedure you need to let your beard grow out a bit.  This is not very desirable for a transwoman.  During and after a procedure your skin can bruised and swollen and often gets very scabby from the needle pricks.  I’ve probably had forty hours of electrolysis which is only a fraction of what is needed.
  • Anti-Androgens:  These are a type of drug that blocks the bodies cells from utilizing testosterone.  (Often called T-Blockers)  For a transwomen the effect is the loss of male sexual function
  • Female Hormones:  Taking estrogen has the the physical effect of making your skin softer and making your body more fatty.  The hope is for hip and breast development.  However transitioning after about the age of thirty greatly reduces the amount of breast tissue that develops.  One annoying thing is that the extra weight goes to your belly.  I’ve always been quite boney.  Now, when in front of a mirror, I find myself sucking “it” in.
  • TCR (Tracheal Shave):  The proper name is Thyroid Cartilage Reduction.  Men typcially have an protruding “Adam’s apple” at the front of their throats.  A TCR is the surgical reduction of “the bump”
  • Voice Therapy:  Having a male voice and trying to train it to sound female can be quite a challenge.  I have used two audio programs,  (One from Melanie Anne Phillips and one from Andrea James) to help correct some of my male speech habits and to raisi the pitch.  I also took a course with voice therapist Shelagh Davies. Shelagh’s is a wonderful lady and her course was great.  But, I found that habitually, my voice dropped in pitch during conversations.  In the end I decided to have voice surgery.
  • Voice Surgery:  Voice surgery can be used to increase the pitch of your voice.  My surgery was performed by Dr. Murry Morrison on the Pacific Voice Clinic  The procedure was done at the same time as the TCR (above).  The procedure is minimally invasive and probably took fifteen minutes of actual surgery.  See voice surgery   After it all, I think people that know me think I sound the same.  But at the same time I think that it is androgynous enough now to get me past.
  • FFS: (not done)  FFS is Facial Feminization Surgery.  Dr. Douglas Ousterhout is well know for making male faces look female.  This procedure is more expensive SRS and augmentation together.
  • Breast Augmentation: (not done) This is the same procedure that is done on natal women.
  • SRS/GRS: (not done)  Sexual Reassignment Surgery or Gender Reassignment Surgery for transwomen is called vaginoplasty  This is where they make an “outy” in to an “inny”
  • What you can’t do: There are lots of things that you just can’t change.  For me I’d rather be about four inches shorter.  It’s not going to happen.  You can’t make your feet or hands smaller.  You can’t make your vocal chords small again.  Basically anything that happened through puberty to make your body larger or stronger are here to stay.  HRT does result in less muscle density and the soft skin helps too.

If I’ve missed anything let me know.


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