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How to Get Started

Considering Gender Transition?

Transitioning from male to female, or from female to male, is a unique and very personal experience. It's important to understand that there is no "right" or "wrong" way to transition. For example, some trans people undergo Gender Reassignment Surgery (GRS), some find that Hormone Replacement Therapy (HRT) is sufficient, and others still seek no medical treatment. Regardless of the path taken, gender transition is a long and often difficult process that requires a lot of patience and resilience, but one that ultimately can bring great personal reward.

While everyone transitions in their own unique way, this quick start guide can help you identify your next steps.

Preparing to Transition
Finding Support Groups,
Educating Yourself

Coming Out
...to Family & Friends
...in the Workplace

Financing Your Transition
Insurance, Medicare & Medicaid,
Saving Money

Finding a Therapist
Reasons for Getting a Therapist,
What to Look For

Gender Presentation
Changing Your Appearance,
Gender Affirming Products,
Real Life Test?

Changing Your Name & Gender Marker
Legal Name Change,
Updating Your ID,
Gender Marker Change

Starting Hormone Therapy
HRT Basics,
Finding an Endocrinologist

Non-Surgical Treatments
Hair Removal,
Vocal Training

Transgender Surgery
MTF Surgery,
FTM Surgery

Preparing to Transition

You reached this page, so the notion of transitioning is likely much more than just a passing idea to you. (Pun intended!) Prior to seeking medical treatment, spend plenty of time quietly reflecting on your decision to transition, and consider keeping a personal journal or private blog to work out your feelings. Get out of your head too: Find someone that you can confide in and bounce ideas off, whether that be a close and understanding friend or someone from a local or online transgender support group.

To help you make an informed decision, educate yourself about the transition process and the benefits and risks of transitioning. The Internet puts a staggering amount of information available at your fingertips, with searches for "male to female" and "gender reassignment" turning up thousands of results—some more accurate than others—but don't limit yourself to just the web. Your local library, bookstore or LGBT center may carry some helpful books, and support group members are tremendous assets to noobies with questions. Ask away!

Coming Out

How and when you come out as trans to those closest to you is a very personal decision, and the experience can be very stressful. Truth is, you may face some negativity. It is important to remember that your friends and family also have to "transition" to some degree to come to terms with your gender change. Be patient and give them time to come around. You may find it helpful to discuss coming out strategies with a gender therapist.

Coming out in the workplace must be navigated carefully. Start by researching your employer’s equality/diversity/inclusion policies, and brushing up on your knowledge about your local jurisdiction's anti-discrimination laws (if any.) At some point, you will want to meet with your supervisor and/or a HR rep to discuss the changes you are making. Again, talking with a gender therapist about workplace issues is recommended.

Financing Your Transition

Unless you have excellent, inclusive health insurance gender transition can get very expensive. Costs add up quickly: therapist fees, new clothes and gender affirming products (packers, breast forms, etc.), name and ID change fees, pre-HRT lab work, HRT, and expenses associated with surgery and recovery.

If you have insurance, review the fine print of your policy and look for exclusions and limitations related to gender reassignment. Next, call your insurance company and ask about surgeons in-network, out-of-network benefits, and deductibles.

Also, take note that U.S. Medicare and some state Medicaid plans are covering medical expenses related to transitioning.

Coming up with strategies for saving money is important because unfortunately the time it takes to transition is often determined by finances. Research your potential transition expenses and devise a savings plan.

Finding a Therapist

There are a couple of reasons why you will want to add a therapist to your transition team: 1) Transition is stressful and having a safe space to talk about your problems and feelings is extremely helpful, and 2) you will most likely require an assessment and letter of recommendation from a therapist before you can proceed with HRT and/or surgery. While some surgeries can be done on the basis of informed consent, such as Hysterectomy and Top Surgery, most surgeons will not perform genital surgery on a patient without the recommendation of a mental health professional.

Seek out a therapist who has experience working with transgender patients and is someone who you feel you can confide in. Before engaging a potential therapist, make sure they have written letters of recommendation for HRT and/or surgery before, and find out how many sessions they typically require to provide the letter. (This can vary widely: some therapists require a set number of months for therapy, while others will write a letter after a single session.) There are a number of web pages that list reputable gender therapists. You can also ask friends in your support group(s) and other members of the trans community.

Gender Presentation

As you make progress through your transition, you will begin living in the gender role congruent with your identity. These changes in your gender presentation typically involve clothing, shoes, hair, makeup, and may also include the purchase of gender affirming products like packers, gaffes and breast forms. This may also be the right time to initiate non-medical treatments like hair removal and vocal training, or HRT.

Your gender presentation will require more than just changing outside appearances. There will also be social adjustments to make as you make yourself known at work and family functions, and in your community.

While the dreaded term “real life test” or “experience” has been removed from the WPATH Standards of Care, 12 continuous months of living as your preferred gender is required before proceeding with genital surgery. (U.S. Insurance companies may have their own "real life experience" requirements.)

Changing Your Name & Gender Marker

Unless you were given a unisex name at birth, changing your name will probably become a priority early on in your transition. Once you've selected a name that you identify with, you'll want to get a legal name change, the process and cost of which varies depending on where you live.

After you obtain your name change certificate, update your identification (driver's license, social security, passport etc.), banks and credit cards, utilities, etc. with your new name. The process takes time, and like many aspects of transition will require some patience and perseverance.

Many, but not all, transgender people are able to get their gender marker changed on their birth certificate, and subsequently other identification documents. Changing your gender marker on your birth certificate is done in the place where your birth was registered. Depending on regulations there, Gender Reassignment Surgery—Vaginoplasty for trans women, or Metoidioplasty or Phalloplasty for trans men—may be required. There are still many countries as well as U.S. states that don't permit gender marker changes on birth certificates.

Note: In some jurisdictions, you can change the gender marker on identification documents such as a driver's license without changing the gender marker on your birth certificate.

Starting Hormone Therapy

Hormone Therapy, or HRT for short, involves taking oral, injectable or topical hormone formulations to align one's physical traits with their gender identity. Trans women are prescribed an estrogen regimen while trans men are prescribed testosterone. In most cases, HRT should be continued indefinitely. While HRT has been proven as a safe and effective treatment for gender dysphoria, it's important to note that it causes some permanent changes to your body and you will want to become fully informed before committing to HRT.

HRT is usually prescribed and managed by an Endocrinologist, though there are also many general practitioners now who are experienced with trans health and can provide this care. Multidisciplinary transgender health clinics are also available in some urban centers. Either way, your HRT should be monitored by a medical professional.

Non-Surgical Treatments

Many transgender individuals seek out non-surgical treatments to improve their gender presentation or prepare for surgery. For example, many trans women have more than 300 hours of laser hair removal and/or electrolysis to remove a beard or body hair. Similarly, trans men who undergo Phalloplasty surgery also have extensive hair removal done on the area where the donor graft will be taken from. (Most surgeons require trans women to have hair removed from the genital area in preparation for Gender Reassignment Surgery, but Dr. Rumer's Vaginoplasty technique does not require hair removal—and there is no regrowth!)

Voice/Speech Therapy is sometimes sought out by trans women who wish to feminize their voices, because feminizing hormones do not change vocal pitch. Conversely, it is precisely because female to male HRT does change vocal pitch that many trans men also seek voice therapy, to adjust to the changes in the larynx caused by Testosterone. You can find Speech Language Pathologists who have experience working with transgender people, consult many online videos with trans vocal tips, or take part in the occasional vocal training courses offered at trans health clinics.

Transgender Surgery

Not all transgender people choose to have surgeries, but for those who do it's a life changing—and often life saving—experience.

For trans women, transgender surgery can be broadly grouped into three categories: Facial surgery, top surgery and bottom surgery:

While facial surgeries are also available to trans men, the majority of surgeries accessed fall into the top surgery or bottom surgery categories:

Body Contouring aka Body Sculpting, is also becoming popular for both trans men and women.

While undergoing surgery can ultimately provide great relief for those experiencing gender dysphoria, the emotional toll and amount of support required to get through the experience can be high. Surround yourself with supportive people during this time, and develop a plan for preparing yourself both physically and mentally for surgery. Many trans folks don't have people in their lives who can understand the need to have transgender surgery, but in-person and online support groups can help fill this role.

Learn more about MTF Surgery and FTM Surgery.

If you would like to arrange a time to speak with Dr. Rumer about Gender Reassignment Surgery, please contact us.