This post is part of a series related to Transgender Awareness Week, click here to see the list of all topics I plan to cover.
Before I begin, I want to preface this post by stating that there are numerous ways to transition and it isn’t a one size fits all approach. Hormones and surgery (or both or none) may be right for someone, but not for another. Just because a person doesn’t want to or is not able to medically transition in the same way as another it doesn’t make them any “less trans” than anyone else. Everyone needs to find their own path in life.
Once I was able to sort through those mental/emotional reservations about making such a difficult decision, I was finally ready to plan my transition. There are many aspects to such a complicated process so today I’ll focus largely on the medical aspects of transitioning. I’ll also focus on several physical changes I went through that are not necessarily medical in nature, but they all had the primary goal of helping my body to match my soul. This might have been my favorite part of the transition to plan out and execute, as it was easy to incrementally see the impacts of my hard work and energy paying off.
Below you can see a timeline of my physical changes over the course of 1.5 years (May 2017 to Nov 2018). Each picture is roughly 6 months after the previous picture. Read on to see how I was able to make these changes happen! (FYI – the below is mainly a reflection on the Male to Female process as that is what I have experience with).
Hormone Replacement Therapy (HRT)
There are many ways I sought to change my physical appearance, but the most significant of which would be hormone replacement therapy (HRT). HRT is the process by which we as transgender people can make our hormonal state match that of our preferred gender. I like to compare it to a car that is at long-last getting the right kind of fuel it needs to run properly.
When trying to figure out how my body would take to HRT, the phrase “your mileage may vary” could not be more applicable, both in terms of the dosage that is right for my body and in terms of the results I could expect. HRT is administered in pills, patches, or injections; I take the pills myself because I feel like it helps to balance out my mood swings more evenly (keep in mind I am literally going through a second puberty). I take two pills, one is to suppress my body’s levels of testosterone and the other is for estrogen.
There are a wide variety of changes that come with HRT that all start and stop at various times. When taking HRT, on average, some of the first mental changes occur within the first few weeks and subtle physical changes occur in the first 3 months. I didn’t start to feel like I looked feminine until the 6 month mark, and closer to one year is when I started to feel more comfortable “passing” out and about without makeup on. More changes are expected over the course of 3 – 5 years, so I still have a way to go!
This process is not experimental in nature and guidelines are published by the World Professional Association for Transgender Health (WPATH). These guidelines are referred to as the Standards of Care (SOC) for the health of transgender & gender non-conforming individuals and they were written to ensure that every trans person gets the proper and consistent care that they deserve.
In order to start HRT I consulted with my primary care provider to ensure it was administered properly and at the right doses (FYI – if in the Philly area I cannot recommend the Mazzoni Center enough, they have a transgender care team inclusive of medical, emotional and legal support to use as needed).
Weight Loss
When I called last August to schedule my intake appointment with my new PCP, they told me the waiting period was 3 – 4 months and I would not be able to have the psychiatric evaluation and Dr. consultation until October 2017. Obviously, I wanted to start ASAP but there were plenty of other things I could work on in the meantime, first and foremost was my weight.
At 190 lbs I was the heaviest I had been in my entire life and I desperately wanted to lose weight before starting HRT. Fun fact about testosterone, while I consider it a “poison” to my body, it is remarkably good at burning fat (ever wonder why it’s so easy for men to lose weight but it is much harder for women? – testosterone). And so, while I still had T in my body I was going to make sure to get the most out of it. I had made a challenge with myself that if I couldn’t commit to losing 30 lbs by the time I was to start HRT then how the hell was I going to commit to everything else that came with transitioning?
This challenge was all I needed, I had NEVER been more motivated to work out in my entire life. I was doing yoga every morning (this helped with the mental aspects too), I was running after work, sometimes biking after running, and occasionally would practice yoga at home after all that. I am not suggesting that you go crazy like I did, I’m just showing you what worked for me, as I was able to lose 30 lbs in 4 months with minimal change to my diet. Not only did this give me an AMAZING sense of accomplishment and confidence but in my mind, I had “earned” the hormones I needed so badly. It is also recommended to not be overweight when you plan to transition from Male to Female, as the estrogen medication can increase your risk of blood clots (for this reason you should also definitely not be a smoker if you wish to transition from MtF).
Hair growth
Another aspect of my transition (that required nothing but time, and LOTS of it if you’re a curly girl like me) was to grow out my hair. I had been growing it out since February 2017, around the time when I decided to book my initial therapy appointment. My thought process at the time – if I was going to end up transitioning then I may as well have gotten a “head” start growing it out (I regret making this pun already). And if I was to not transition then there was nothing a simple cut couldn’t fix.
Growing out my hair has been such a wonderful experience, I had always wanted it longer but like most things considered feminine I previously would never “allow” myself to do so. So the fact that it was curly was a shock to me. I had always kept it under 1” – 2” where it showed no signs of curliness (see prior post). There were awkward months and weird cuts and I hated it for a long time, especially when I couldn’t style it in a feminine way. But like everything else in this process it is a marathon, not a sprint.
Laser Hair Removal (LHR)
Towards the tail end of my training and with my HRT date rapidly approaching, I also sought out laser hair removal (LHR) to ease the immense dysphoria I had with my beard (and basically all body hair). Estrogen, while a miracle drug, does not make your facial / body hair go away. It can thin it out and make it lighter but only through LHR or electrolysis can you hope to rid yourself of the 10,000 tiny little hairs that comprise each beard.
One thing to note about LHR – it works by targeting pigments and is most effective when used on people with fair skin and dark hair. It is best to avoid the sun for about 2 months prior to starting treatments so your skin is as pale as possible. Also, sorry to those with fairer hair as LHR is ineffective when used on blonde, red, or grey hair. For that you’ll have to seek out the more-painful, more expensive and more-time consuming method of electrolysis (I’ll need to start electrolysis myself to rid my face of the blonde stragglers I have left over from LHR).
These hair removal treatments are expensive, and they are never covered by insurance, although I would absolutely make the argument that face treatments for MtF’s are 100% medically necessary and should be covered by insurance. Because of this, I wanted to get the most for my money and target the areas that would help me rid myself of as much dysphoria as possible (for me, that meant starting just with my face and chest). Over the past year I have been able to save up money and pay for other treatments, but face and chest were absolutely my priority.
Surgical Procedures
This seems to be the first place everyone goes to when they find out I am trans, and it seems like some people think transitioning solely involves getting a few surgeries and then back to life as normal. Personally, I have not had any yet and I view surgeries as my last resort and only to be needed when HRT cannot do what I need it to do. HRT is a wonderful process, for MtF’s it can help you develop breasts and hips, round out your eyes, soften your skin, lighten your hair and redistribute fat all over your body, even change the way you smell; but it cannot change the structure of your bones (or your genitals). To do that is where surgery would be needed.
The three main categories of surgeries for MtF’s are Facial Feminization Surgery (FFS), Breast Augmentation (BA), and “bottom” surgery (inclusive of vaginoplasty/orchiectomy). I’ll skip BA as that is pretty self explanatory and is only used if HRT doesn’t give you the results you desired.
FFS is used to soften the normally hard/jagged facial features present in males, such as the protruding brow ridge, adam’s apple, jawline, and a wider or larger nose. The process for this is graphic so stop reading if you get squeamish, but this is done by making incisions in hard-to-see areas (like hairline and under your jaw), lifting the skin off the face and shaving or grinding the bone down to the proper shape and proportions. It’s gruesome I know, but this is what is necessary for some people to relieve dysphoria or even just to pass as their preferred gender. Surgeons cannot work magic to make a brand new face, but it will certainly be a feminized version of the one before.
For many people the last surgery to get is the bottom surgery (Vaginoplasty for MtF’s) as this is the one with the most “gate-keeping” involved. And with so few qualified surgeons to perform the procedure the waiting list can be very long, I personally am waiting until mid-2019 just for a consultation. Since I am in the process of learning more about this surgery I’ll share more information when I get to that point as I don’t want to communicate inaccurate information.
I hope the above information on my medical process/experience was helpful! If you have further questions or want to comment please feel free to do so, you can also sign up for my mailing list to the right. Tomorrow I’ll be switching up the originally planned schedule and will talk about Social/Professional Awareness, as this was next in my personal journey and was completed shortly after starting HRT.
Erin Appelbaum says
Hi Erica. Let me say that I think you’ve transitioned remarkably well. You look great (oh to be young again). Your blog is fabulous and informative.
Erica says
Thank you very much! It feels so good to be able to help others through this