After reading part one, you may be wondering what exactly goes into transition. Well, as it turns out, a lot – and while it is a time and energy consuming process in the extreme, the results can be nothing short of astounding.
Popular media might have you believe that getting a “sex change” is a single procedure- you walk into the hospital male, and walk out female (or vice versa). Alas, if only it were that easy.
The truth is that transitioning has a number of components to it (including hormone replacement therapy (HRT), changing names and pronouns, dressing differently, and surgeries, amongst others), and often takes years before completion (however that’s defined by the trans person in question). The nature of the transition reflects the identity of the trans person – whether they identify as male, female, both, neither, or something else all together. Furthermore, which components a trans person includes in their transition varies widely – many, for example, may just take HRT and socially present as their identified gender, and eschew surgery (whether it’s because they can’t afford it, aren’t satisfied with the results, or simply don’t feel it’s necessary for them to be happy). The order often varies, as well – some going on HRT and then changing their social presentation, while others do the reverse. Excluding one or many of these components doesn’t make the person any less trans- ultimately, it’s their body, and their decision.
Here are some of the common elements of transitioning:
While not all trans people feel the need for counseling, it can be helpful to many of us. After all, you usually don’t spend years or decades trying to be something you’re not without developing a few issues- not to mention having to cope with a culture that, while it’s gradually improving, is still often hostile to trans people. Additionally, some doctors require a note from a mental health professional before administering transition-related procedures, though there has been a movement away from this “gatekeeper” model towards one based around informed consent, at least when it comes to hormonal treatment (surgery still requires letters from not one, but two therapists, one of which must be a licensed psychologist with a PhD, who certify that you’re mentally fit for the procedure, and that you’ve been living as your target gender for at least a year prior- it’s quite a number of hoops to jump through).
Many trans people seek to transition medically- that is, to modify their bodies to reflect their identity, and so that they can (quite literally) be comfortable in their own skin. Hormone replacement therapy is the keystone of transitioning medically and results in dramatic and pervasive changes.
In my case, I was put on the standard HRT regime for someone transitioning from male to female, as I felt I would be most comfortable in a female body. This typically includes estradiol (a form of estrogen, which can be injected, absorbed through the skin via adhesive patch, or dissolved under the tongue in pill form). However, since testosterone “competes” with estrogen for binding with cell receptors and will overpower it, the regimen usually includes one or more testosterone-blockers, which prevents testosterone from binding. Additionally, estrogen, once it reaches sufficiently high levels, will greatly lower testosterone production.
Some of the effects of my HRT treatment have included:
Probably the biggest and most visible change, and honestly, the one I’ve enjoyed the most – watching myself go from being completely flat-chested to a C cup (and still growing!) has been rewarding on a deeply visceral level. As a side note, with the right hormonal treatment, lactation can be induced, allowing me to breastfeed – something my fiancée and I plan on doing when we get around to having a kid, so we can split the midnight feeding runs.
Reduction in body hair
My body hair has thinned considerably, and what’s left is much finer and lighter colored. I still have a bit more than I would like, though, especially on my chest. I’m hoping that’ll eventually thin out, too.
My skin is a lot smoother, softer, and clearer than it was before. Oddly enough, this- along with my change in scent- is one of my fiancee’s favorite aspects of my transition.
Body fat redistribution
This is a subtle, yet extremely powerful effect of HRT. Not only have I started to develop curves (previously, I was basically a rectangle), my facial appearance has changed as well- my cheeks have filled out and become more prominent, my lower jaw has thinned a little, and my face overall is now much softer and rounded.
Reduction in muscle mass
My overall figure looks more feminine now as a result, though my stamina and strength have definitely taken a hit. I can still open most jars, though.
Increase in my sense of smell
While I’ve never had a particularly strong sense of smell, I do notice scents more than I used to. This, apparently, is widely reported amongst trans women, with many experiencing a much greater enhancement to their olfactory acuity than I did.
While I was always pretty emotional, the speed at which my moods change has greatly quickened (in technical terms, I have higher emotional lability). While previously it might take me a bit to get angry, sad, or joyful about something, now it feels like my moods go from zero to sixty in milliseconds. I also occasionally have to deal with mood swings, which took some getting used to. With that said, overall I feel much calmer and confident, and far happier than I ever could’ve imagined- in fact, I’m not sure I really knew what happiness was before I transitioned.
I should note hormones don’t do everything- they can’t change your skeletal structure, for example. Nor, in the case of trans women (but not trans men!), do they really affect the voice – I had to go through eight sessions of voice therapy and months of practice to be able to speak with a female-sounding voice (I also recently started taking singing lessons, which has also helped). And while my beard grew in more slowly, to actually have it removed I’ve had to undergo numerous sessions of laser hair removal and electrolysis (which, somewhat frustratingly, is still ongoing- though I have gotten to the point where I no longer need make-up to hide my beard shadow).
Social and Legal Transition
This is a fancy way of saying of changing how you dress, act, speak, and so forth, as well as having your legal documentation updated to reflect your identity. In my case, once I had been on HRT for a few months, I gradually started dressing more and more androgynously, until I switched over to wearing women’s clothing completely. My style remained somewhat androgynous for a few months after I started living as Tessa full-time, but over time I’ve gotten more femme (I heart sundresses! And sweater dresses!).
Getting your legal documents updated varies from state to state- I was lucky to live in a state that all was required for changing the “M” on my driver’s license to an “F” was a note from a doctor verifying that you are receiving the “appropriate treatment” (as deemed by the doctor) for your gender transition. The Social Security Administration and the State Department (for passports) have similar requirements. Other states, however, require that you’ve had surgery, and in some cases, when it comes to birth certificates, won’t let you change them at all. Which is horrible and those states should feel bad about themselves.
There are actually several surgeries available to trans people – some trans women elect to have facial feminization surgery to make their facial appearance more womanly. Breast augmentation/removal is another, and voice surgeries and Adam’s apple reduction are also an option for trans women.
The one that gets everyone in a tizzy, however, is referred to variously as sexual reassignment surgery (SRS), genital reassignment surgery (GRS), or simply “bottom surgery”. For trans women, the results are often highly satisfactory, in terms of sensitivity (many surgeons boast that 90% or more of their patients are orgasmic post-surgery), function, and appearance; the resulting vulva, clitoris, and vagina can often only be distinguished from that of a cisgender woman’s by a gynecological exam. For trans men, unfortunately, the results are often less satisfactory and require painful skin graphs; consequently, most trans men elect not to get bottom surgery
A caveat: asking a trans person their surgical status (if they’ve had it and/or if they plan to) is considered highly offensive (since it’s basically a roundabout way of asking what’s in our pants). While I’m pretty open about such things, it’s often best to just not ask.
With that said, I personally haven’t had surgery yet, but I’m currently scheduled to in July 2017. I can’t say I’m looking forward to the surgery or the recovery process itself (which includes three months of convalescence and activity restriction, plus another three to nine months of healing before you’re fully back to normal, as well as daily maintenance  for the first year or so), I am definitely looking forward to the end result.
So far, transitioning has been the most audacious, scary, exciting, demanding and ultimately rewarding thing I’ve done in my life. While it’s a little mind-boggling to think how much I’ve changed in such a short time (three years ago, I was still convinced I was a straight dude), I wouldn’t have it any other way.
 Apparently, I smell way better than I used to. Make of that comment what you will.
 If you’re morbidly curious as to how this procedure works, there’s an excellent (and bloodless) CGI animation of it here.
 If you’re not up on the vernacular, cisgender (or simply cis) is how you refer to someone who’s not transgender.
 Specifically, you’re required to do what’s called dilation. You know how when you get your ears (or other body part) pierced, you have to at least periodically leave the ring or stud in so the body doesn’t treat like it a wound and heal it shut? Yeah, same idea, except with what are essentially medical grade dildos instead of piercings. Thankfully, like a piercing, over time, you have to dilate less often, first multiple times a day, then only once a day, then only once or twice a month.
Tessa is a 28 year old PhD student, and perhaps the world’s only queer trans astrobiologist. A nerd going way back, her interests include science fiction, space exploration, sustainability, science communication, and feminism and gender. Her hobbies also include horseback riding, playing the flute, social dancing, knitting, and occasional attempts at writing fiction. She currently resides in Tempe, AZ with her even nerdier fiancee and a mastiff mix who thinks he’s a lapdog. She tweets occasionally @spacermase.