The Girl's Guide to Changing Your Gender
A chill primer on estrogen, breast augmentation, skirts, and other things a trans girl might consider on her trek across genders.
Collage by Michelle Thompson
The steep climb out of manhood can be daunting to the uninitiated trans girl, but look on the bright side: Before you came along, countless others have made that same hike, and they’re doing just fine.
This is a guide for trans women, so I’ll stick to addressing a few things that I’ve found useful based on my specific experience as a male-to-female trans woman. My advice might be helpful, but you deserve actual medical and mental health care providers to ensure you’re being cared for. (Recommendations on finding them are forthcoming.)
Not all transgender people transition, and transitions look different for all kinds of people. They can be fast, or slow, and include lots of different kinds of treatments. Whatever your identity is, some things are true of transitioning across the board. Chief among these: Transition is not one-size-fits-all. You may be comfortable altering your gendered existence without hormones or surgery; other people will feel those kinds of physical transitions are necessary for their survival. There are lots of tools at your disposal, like changing your pronouns, your name, or what you wear. Whatever you’re looking for in your quest, trust there’s something out there for everybody.
How Can I Be Sure I’m Transgender?
This is a popular question among early transitioners. Some people know that they’re trans when they’re toddlers, and others don’t figure it out until later in life—some people don’t connect the dots until they’re middle-aged or older. Whenever it is that you realize you’re transgender, it can be difficult to accept this about yourself, especially when politicians and transphobic faux-feminist TERFs regularly attempt to undermine or compromise our existence in public forums, whether that’s in The New York Times or the highest levels of government.
I realized that something about my gender felt mismatched when I was a teenager, but I convinced myself I was wrong because I was ashamed of admitting that I wanted to be a girl. No one had ever told me that those sort of feelings were valid. Rather, I was constantly called a girl as an insult to my masculinity, and my bullies used my femininity to degrade me on the basis of my assumed male gender. I was gay, according to every source at my disposal. It never crossed my mind that I had a choice about my body, my name, or that I could self-identify gender.
If you think about transitioning all the time, you’re probably trans.
When I first came out as trans when I was 23, I struggled to accept whether my experience was authentic. Society fucked me up in that regard—there were so many subliminal and overt messages that undermine the fact that being trans is even possible, or “real.”
In those early days before I made the dive into transition, I called a trans woman I knew and talked to her for two hours, trying to explain why I wanted to transition—as if I needed to justify the decision. Really, I was trying to convince myself that I was making the right choice. After I vomited up my insecurities, she sighed and told me this: Men don’t think seriously about becoming women and taking estrogen. If you think about transitioning all the time, you’re probably trans.
Where to Go for Transgender Information and Resources
If you live near an LGBTQ community or health facility, it may become your greatest resource. LGBTQ centers specialize in issues related to the queer community. It was this sort of facility that helped me when I began transitioning six years ago. Working with a doctor and a therapist with experience treating trans clients made the process feel less scary, and it was a relief to know that my physician had done all this before when, for me, it was totally new.
In large cities like New York, Los Angeles, and Boston, there are major gender identity clinics that provide rapid, affirmative transition care. Many places, like Callen-Lorde in Manhattan, will treat patients regardless of their insurance status or ability to pay. Planned Parenthood also offers transgender medical care. Try searching online for the words “transgender clinic” plus the biggest city near you, and see what pops up.
Working with a doctor and a therapist with experience treating trans clients made the process feel less scary.
If you’re not near a big city, talk with a doctor you trust. It can be tricky to find someone, but there are resources that could help you. Psychology Today offers a search engine for mental health providers who list care for transgender people as a speciality, and sites like Trans Health and MyTransHealth offer lists of gender-affirming and trans-focused medical care. The National Center for Transgender Equality has compiled many similar resources for people seeking help.
Wherever you go for help, make sure the people you’re talking to understand gender dysphoria as defined by the American Psychiatric Association. (Start here in case you don’t know what gender dysphoria is.) If you have gender dysphoria, transitioning may be the right choice for you, and you deserve to talk with someone who is both knowledgeable and compassionate as you make that serious decision. You do not want to be met with hostility or skepticism because a provider disagrees with gender transition or isn’t up to speed on the proper treatment of transgender patients.
Transition is notoriously expensive, and for most trans people, many of our basic medical costs are prohibitively expensive. Surgery, hormones, clothing, name changes—they all cost money, and while there are ways to get these things paid for through insurance or with the aid of nonprofit programs, you may find yourself in a situation where you can't afford everything you need. That's one reason that knowledge is so powerful during transition—we need to know what our options are in order to take care of ourselves. Otherwise, the whole thing can be overwhelming.
How Do I Tell People I’m Transgender?
It’s so messed up that LGBTQ people have to come out. The only reason we do is because heterosexual cisgender society pushes us into invisible subcultures, then feigns shock when we wander out of the underground. Nonetheless, you’re probably going to have to come out as trans in some capacity.
Telling my parents I’m trans was scary. They’d always accepted me when I was a total sissy, so I knew they were allies of the LGBTQ community—but, for many, changing your sex is much more taboo than wearing a feather boa to middle school. Just one day after I realized I was trans, I decided to call and tell them anyway. Fortunately, they totally accepted me, but not everyone is so lucky. I know girls who’ve been disowned, and others who are somewhere in between. This is really personal, so work with people you trust to figure out how to best navigate coming out. Be safe, take care of yourself, and know that part of taking care of yourself is being informed.
No matter what you look like, your gender is real.
In getting ready to tell my family I am trans, I found it useful to do a lot of research, ingesting articles, forum posts, pamphlets, and books about transition. Many trans people I know have benefited by sharing these resources with their parents. PFLAG is one organization that is known for helping families of trans and other LGBTQ people be supportive of their loved ones—they have reading lists, movie lists, and more. The Human Rights Campaign has also compiled resources for people who have a transgender person in their lives. You are not alone, and there are more public organizations and people out there who want you to succeed than any time before in our nation’s history.
How to Legally Change Your Gender and Name
Lots of trans people change their name and their legal gender marker. Sometimes, that name change happens a few times—I went through, like, three names before I chose Diana. (One of them was “Dragyn.”) So: Take your time. Ask people to be patient with you if you’re out, but not sure what name you want to choose. Sometimes you don’t know if you’re going to be into a name before people use it—and you don’t even need to change your name if you don’t want to.
Changing your name and legal gender ID marker is easier in some states than others. The National Center for Transgender Equality has a superb search engine to figure out what your local laws are around document alteration. It can be a bit expensive to change your name, but that also varies by state. The Name Change Project by the Transgender Legal Defense and Equality Fund (TLDEF) provides free legal aid to do name changes for clients who can't afford it, and they help people in multiple US cities.
On your own, you’ll need to go to court and petition for a change of name. That sounds pretty intense, but it can be easier than it might seem. The court will then give you a legal order of name change, which you can present to places like the DMV to make them update your ID. These documents can be incredibly empowering as you move forward in your life, as they’re legal evidence that your identity is recognized by the state.
Ask people to be patient with you if you’re out, but not sure what name you want to choose.
If you’re going to make the trip to the DMV for a name change, you might as well do your gender marker at the same time. You usually need medical letters to get your gender marker altered. (You can look into this process using some of the resources mentioned in the section above about where to go for help as you transition.) After the DMV, you’ll go to the Social Security Administration for a new social security card. Then you have the joy of visiting the bank, or whatever else has your old name on it. (Good luck trying to get PayPal to do it. Good luck.)
When I had my documents changed, it was really rewarding. Seeing my chosen name and true gender on government issued identification made the whole thing feel real on another level. (And it was a big fuck you to boring cis society, which is always a plus in my book.) It was a lot of work, but it didn’t really feel like work at the time because it was so important to me. Learning that I could change all this stuff felt like I’d stumbled upon the best lifehack ever, and I loved the idea of changing my identity. I wasn’t sad to see the boy’s name, the “male” gender marker, or the old photo go away—those were other people’s inventions, not my own. For a lot of us, the whole thing can be really triggering and difficult, but the results are often surreal and validating.
As with all of this, you may encounter ignorance out there. If you meet some asshole at court or the DMV who doesn’t want to make your legal transition a seamless breeze, remember your rights, and remember that this is just the beginning of your journey. Bring a friend to make it less scary, and don’t ever take other people’s judgement’s personally.
What Is Hormone Replacement Therapy Like?
Hormone replacement therapy (HRT) is closely associated with the healthcare of transgender people. It is exactly what it sounds like: replacing the hormones that are currently dominant in your body (if you’re a trans woman, this is very likely testosterone) with hormones that are typically more prominent in the opposite sex (estrogen). For trans women, HRT typically comes in two parts: A medication to block testosterone in your endocrine system, and estrogen to replace it.
In case you didn’t know: Estrogen works within the body whether you have a penis or a vagina. “All bodies, regardless of sex assigned at birth, have the potential to react to hormones,” says Dr. Andrew Goodman, associate director of medicine at Callen-Lorde Community Health Center. “Estrogen will stimulate chest or breast growth in all bodies. Testosterone will stimulate muscle mass and facial/body hair growth in all bodies. The degree of change, however, is different for every person.” Dr. Goodman also says that penises tend to reduce in size once a person is on estrogen.
(In case you want more evidence that biological sex is big old myth: Even our “male” genitalia bears traces of a previous sex: There is a scar going down the middle of the testicles. This scar is typically darker in color to the surrounding skin, and runs like a seam all the way toward the anus. It is called the perineal raphe, and is where the urogenital swellings fuse together in utero after the production of testosterone. If they hadn’t fused, that tissue would be your labia; we’re all female until we aren’t. So, you see, regardless of our “biological sex,” our bodies are produced from the same basic form, and they carry scars from long before birth to remind us of that.)
All bodies, regardless of sex assigned at birth, have the potential to react to hormones.
HRT began to redistribute my body fat around four months into taking hormones, starting with my face. I noticed subtle, but profound changes that altered the way the public was reading me. Over the following months and years, more fat kept moving around, making my legs, hips, chest, and arms, all look different. It effectively restructured my body from one that looked masculine to one that looked feminine.
There is an adage within online trans communities, especially when it comes to HRT: Your mileage may vary (YMMV). YMMV means that HRT doesn’t affect everyone in the same way, and it can be difficult to predict the changes you may experience if you undergo the treatment. YMMV is intended to help newly transitioning people have a realistic perspective on what hormones can accomplish. Sometimes big changes happen, other times, the changes are less pronounced. Dr. Goodman agrees: “This is why it is so important for all people who need hormone therapy to have access to supportive and knowledgeable medical providers who can guide them through individualized hormone therapy.”
In some cases, the younger you are, the more effective HRT can be in transforming your external secondary sex characteristics: “Hormone therapy usually achieves more masculinization or feminization if started earlier in puberty,” Dr. Goodman says. “Once a body has been through puberty, there are often changes that hormones may not be able to completely reverse." For trans women, these might include a deepened voice, facial hair, and masculinized facial bones. Nonetheless, HRT can have significant results on people well beyond puberty, including effects like breast development and fat redistribution.
Cross-sex hormones saved my life, and are one of my forms of body modification. That said, it was fucking terrifying going on HRT. I knew I wanted it, but before you’ve taken hormones, you’ve never taken hormones , so no matter how confident you are, it can be really nerve-wracking. It’s normal to be scared of going on hormones for the first time. As with any medication, only pursue it if you honestly believe that HRT can improve your quality of life. In my case, a few months after I started HRT, I felt better about myself even before any physical changes occurred. It felt empowering to take control over my body after many years of feeling like I was its victim.
MTF Breast Growth Stages When You’re Transitioning
Breasts are so fabulous they deserve their own section. One of my favorite odd-corner-of-the-internet resources for trans breast discourse is Second Type—a relic on the transgender web, with data mostly written in the year 2000. The website has a great breakdown of the development of breasts in AMAB trans women, explaining the different stages that both breasts and nipples go through at different points in HRT. This is the most common process of breast development for cisgender women, too. Some trans women grow large breasts, others don’t—just like cis women. Since those of us who undergo HRT literally have a second puberty, things are a bit different. Check Second Type out—there are anecdotal notes and photos taken of trans women’s breasts at various points in HRT treatment.
Breast development can be one of the quickest changes to occur during HRT. Two to three weeks after taking my first estrogen pill, I woke up and noticed my nipples looked and felt different—they were softer and more sensitive. Within a month or so, the breast “bud” grew underneath them, and I was on my way.
You can get breast augmentation if you want it and it’s accessible to you. The Trump administration is threatening Obama-era protections that mandate transgender medical care be covered by insurance, but it is still possible to get transgender-related procedures covered for the time being. If you’re on Medicaid, some states will pay for your new breasts. Call your healthcare provider to find out if they’ll pay for it. (It seems only fair to me that they should—after generations of the criminalization, pathologization, and repression of transgender people, this country owes us free breast implants, at the very least.)
MTF Clothing and Beauty Tips
The way you look does not make you a woman or a man.
You can wear whatever you want when you’re a woman. A lot of trans women, myself included, go full-throttle femme in the beginning of transitioning. After years of suppressing your femininity, the desire to celebrate it can be powerful. That’s why you see some early transitioners wearing spaghetti straps and leopard-print miniskirts in any and all situations. That’s cool—who the fuck cares where or when you want to wear spaghetti straps?
I looked exceptional when I was in my early stages of transition, often wearing enormous platform heels and lingerie around in public just because I could—I had a lot of pent-up femininity that wanted to express itself. Lots of people looked at me weirdly, but the public had always seen me as a freak anyway—I was grateful to finally be accepting myself. It would have been fine to live in that lacy, foot-achey stage forever, but that was just one stop on my journey.
The physical changes I experienced because of HRT made it easier for me to make decisions about clothing that were more related to my personal style than my need to express my gender identity, because now my body expresses my gender identity. These days, I wear a contrast of oversized menswear and tiny thot clothes. The more feminine my body has become, the more comfortable I have been in wearing whatever the hell I feel like wearing.
If you’re not sure where to begin, consulting other trans people may be a great help to you. In some places, there are even transgender clothing swaps, which is a really good idea. Back when I first transitioned, I remember seeing trans guys on Tumblr offering their girl clothes to trans women, and vice versa—and it looks like that’s still going strong. I remember throwing away all my “male” clothing when I came out as trans. It was empowering to purge any relic of my former self. I don’t regret doing it, because it’s what I needed at the time. But I definitely miss some of those chic clothes that I used to think were just for guys.
When it comes to another element of the way you present: Facial hair can be so triggering and frustrating, and not easy to get rid of. Hair removal is one of my least favorite things. When you've got facial hair and you don't want it, for permanent relief, you can have laser hair removal or electrolysis. But both of those cost money. Laser isn't considered to be as long-lasting as electrolysis, but it is cheaper. Electrolysis involves the tedious insertion of a needle into your hair follicles, followed by an electric shock that destroys the hair follicle itself, preventing growth. It's painful, and can require hundreds of hours of treatment, which can mean thousands of dollars. You may find a program, like this one, that will pay for your hair removal! If you're interested in depilating by way of laser or electrolysis, create a financial game plan for getting rid of your unwanted hair and look for hair removal specialists that have worked with trans patients before.
Again: No matter what, the way you look does not determine your gender. Only you know yourself well enough to decide that. Life is complicated—we grapple with gender norms, passing, and the desire to be seen by the world as your self-identified gender. But you need to focus on what you can control, and trust that no matter what you look like, or what you wear, you’re exactly who you say you are.
What Kinds of Male to Female Surgery Can Be Part of a Transition?
Surgery is really cool to me. It’s also super serious and definitely not something I can advise you on. Only you, slash you and a therapist and/or medical professional, can determine if you should have surgery. Society has sensationalized trans people for a long time, fixating on whatever surgeries we may have had—and that’s fucked up. Don’t let cis people control your narrative. If surgery is part of your story, that’s just fine. If it isn’t, that’s fine, too.
For trans women who are interested in surgery, there are lots of procedures a person may opt to undergo. Cisgender people tend to think about vaginoplasty (which is colloquially called bottom surgery) a lot, but in my experience, this is one of the less common procedures. (One new study shows that it’s on the rise, however!) Obviously, people do undergo it, and according to that study, this may be linked to the fact that many private and public health insurance providers now pay for it. Personally, I spend more time talking to my girlfriends about face work and breast augmentation than getting a vagina—but to each her own.
Some people want facial feminization surgery (FFS). Essentially, FFS is any surgery or combination of surgeries on the face that are performed in an effort to make your head look like it never went through testosterone-induced puberty. At puberty, testosterone transforms otherwise androgynous faces with secondary-sex characteristics typical to men, like how it causes bone growth at the orbitals around your eyes, and often creates a ridge there, which is one of the most gender-specific facial bones.
There is nothing wrong with your face or your body.
If you aren’t comfortable with the way your face looks, you can change it. To quote Christine Jorgensen, a hugely famous trans woman from the 1950s who spoke with Newsday in 1979: “If you can improve on nature, why shouldn’t you?” If you're going to get your face feminized through jaw and chin recontouring, a sliding genioplasty, a Type III forehead reconstruction, burring down of the orbital bones, a scalp advancement, an eyebrow lift, a face lift, a nose job, a lip lift, or cheek implants, make sure you go to someone who actually knows what they’re doing.
Same goes for any surgery related to transitioning: Whoever you go to should specialize in transgender procedures. If they do face work, they should also be a bone surgeon, because the most impactful facial surgeries (like the Type III forehead reconstruction, which sets a protruding brow bone backward, into the sinus cavity) involve complicated restructuring of your skull. It’s not the kind of thing any old plastic surgeon can do.
“For facial feminization surgery, the best doctor would be someone who has extensive surgery in the face, along with extensive experience with cranioplasty,” says Dr. Jeffrey Spiegel, one of the world’s leading facial feminization surgeons. “Cranioplasty deals with reconstructing the bones of the skull,” so, he says, your generic plastic surgeon isn’t going to be the best choice. Spiegel says they need to have undergone specific training to perform FFS.
There are a lot of resource directories about surgery for transgender people out there, but, sadly, a lot of the best information for surgical care comes via word of mouth. I learned about FFS and found out who the leading FFS surgeons in the world are through trans people on the internet. If you want more information to consider (with the caveat that it largely isn’t vetted by professionals): Join a trans group on Facebook. Sign up for the legendary trans message board Susans. I got my start on Susans, and so did a lot of other trans women. For many Susans users, the site is a place to ask questions that like, “Do I pass?” and, “Who does the best foreheads?”
The site does tend more toward the binary side of things. In my experience, a majority of the posters there concentrate on crossing the gender binary to become women in a more traditional sense; they’re concerned about passing well as women, and focus a lot of energy on figuring out how to do that. But if that’s not your cup of tea, maybe you can take what works for you and leave the rest.
Finally, please don’t think you need to get surgery. There is nothing wrong with your face or your body. Only you can know if surgery is something that you need. It’s hard to be misgendered by the public, or to see attributes that you think of as “male” in the mirror. But the truth is that women look like everyone. There’s no one way for women to look, and there are plenty of cis women who would be eligible for the same surgical procedures we tend to think we need in order to “pass” as female. Let your transition be about you, not the world.
Looking like you’re trans is sometimes considered negative. I wish it weren’t. Trans bodies are beautifully diverse. No matter what you look like, your gender is real, and people who “pass” as cisgender aren’t more authentic or worthy of care than anybody else. Personally, I hope that we can all become more comfortable residing somewhere outside of a “male” or “female” designation. That way, we can make decisions about what we want for our bodies without being burdened by what society suggests we should look like in order to “qualify” to be a certain gender.
How Do I Live?
You can take every trans pill and undergo every trans surgery known to man, but if you’re not on good terms with yourself, treatment for gender dysphoria can only do so much. Transition made it easier for me to love myself because I wasn’t so distracted by the weird situation of living as the wrong gender, but I needed to do a lot of work to accept myself for exactly who I am.
I will never be a cisgender woman. I don’t even care that much about gendered labels. I care about feeling comfortable in my body. For me, body modification had a profoundly positive effect on my psychological and spiritual experience of life on this planet. What really matters is that we all find ways to love ourselves not in spite of being transgender, but because we are.
“People experience dysphoria in many different ways and to different degrees, but feeling stress and discomfort are common,” says Dr. Goodman, explaining that many patients suffer from depression and anxiety as a result of gender dysphoria. I sure did! However, transition can help alleviate those symptoms. I still live with depression and anxiety, but it’s much more manageable today.
Goodman explains that while medical care is important, it can also be complicated when your identity gets medicalized. “Many patients also reject the idea of a diagnosis of gender dysphoria, feeling that the medical community is creating a mental health diagnosis to describe an identity,” he says. “Any treatment for gender dysphoria should focus on supporting a person’s identity as they see it.” There are a lot of issues associated with gender dysphoria, but there are so many more beautiful things about trans people, and you deserve to get the help you need—and to be happy.
The body is impermanent, and society is totally fucked. We’re never going to look “perfect” or force everyone to believe that we are the gender we say we are. But things are improving, and the medical world has come to understand that we can’t stop being trans: “Therapies focused on ‘correcting’ a person’s gender identity to match their sex assigned at birth are ineffective, harmful, and thankfully, outlawed in many states,” Dr. Goodman says. Together, as a society, we are beginning to accept that self-identification is paramount in our own lives, and we need to keep working to make this world more accepting of gender variance in general in order to significantly reduce social issues that are harmful to trans people.
In the meantime, remind yourself that you are worthy of love. Don’t be harder on yourself than you would be with someone else. It’s easy to get overwhelmed living in this world as a trans person, but we are here now, and we can live every day to its fullest by celebrating our uniqueness instead of longing for conformity.
I think about that little boy I used to be—how scared he was of life, and how lost he was. It’s been helpful to compartmentalize my identity in this way; that kid needed help, and I couldn’t get it to him for a long time. When I finally did, Diana stepped in, and now he gets to sit this one out. I try to take care of that kid every day, even when I don’t think I deserve it.