Transgender Survival Guide

I'm now approximately two and a half years into my transition, and so have decided to put together a transgender survival guide to help others contemplating transitioning or struggling with gender-related discomfort. Please feel free to share this with others.

 

Disclaimer: it is both rather long, by necessity autobiographical, and aimed primarily at other female-to-male transsexuals, though I hope it'll be helpful to other transgender people and their friends and families. It will hopefully also be useful to those wanting to learn more about transgender issues.

What does 'transgender' mean?

'Transgender' is an umbrella term for a variety of experiences, from people who occasionally choose to cross-dress for pleasure or comfort (some use the term transvestites), to people who feel they are both male and female, neither of these, beyond gender or who experience gender as fluid (gender-queer), through to people undergoing social, hormonal and sometimes surgical gender reassignment or affirmation processes (transsexuals).

 

When we're born, we're assigned as 'male' or 'female' based on our genitalia (intersex people are those born with both male and female genitals or ambiguous genitals), and it is assumed that this decision based on these primary sex characteristics (biological) reflects the person's inner sense of who they are, the ontological. As we make culturally-grounded assumptions about how to treat someone and what's considered 'typical' or 'normal' behaviour based on the biological, this profoundly impacts the social aspects of our lives. Most of the time, the biological and ontological match up and there's no problem, though we may struggle with prescribed gender roles. However, around one percent of the population experience some degree of mismatch between the biological and ontological, which causes distress and leads to social assumptions being made about them which don't match up to the person's sense of their gender identity. This sense of discomfort, dysphoria, is called Gender Identity Disorder.

 

Check out this TED talk by comedian Sam Killermann if you want to think more about what gender, gender identity and gender roles are all about; it's very funny yet draws out the complex ontological, biological and social aspects and their interplay.

What causes gender dysphoria?

The GIRES website is very good if you want to learn more about the causes of transgenderism. No-one's one hundred percent sure, but it's thought to be caused by hormones in the womb not doing their job around the eight-week point when the foetus goes from having one sex chromosome (the mother's X) to two as the father's X or Y kicks into action. The body develops in one way but the brain in another, giving rise to gender dysphoria through there being a body-brain mismatch. One legacy of it having previously been understood as a psychological problem is that getting treatment means negotiating mental heath services.

How do you know things don't match up?

Like a lot of transsexuals, I realised at a young age that something wasn't right. Starting primary school was the first time I'd been around lots of other children, and I couldn't fathom why I was being told to dress like a girl, play with the other girls and act in a 'girly' way. It was profoundly distressing to me, and I think it's one of the main reasons I acted up a lot during my first months there; I didn't have the language to express what was going on, but felt it acutely. These feelings persisted, though being and looking incredibly tomboy-ish, and being able to 'pass'/'be read' as a boy if I wanted to, helped a lot. I used to like writing stories and illustrating them, and my little imaginary worlds were exclusively male domains. My cuddly toys were also all male, and apparently when presented with a doll on one occasion, it got banished to the wardrobe without a second look! I shrugged off criticism from teachers for not being 'ladylike' enough, and things weren't too bad.

However, when I hit puberty, things changed. I went from being flat-chested to a DD cup in little under a year, which meant I could no longer pass. Periods made me feel dirty and felt fundamentally unnatural. As I got older, I experimented with cross-dressing in the privacy of my bedroom, and the rush that gave me was both almost orgasmic and very confusing. I eventually came to the conclusion that there was something wrong with me (I had never even heard the word 'transgender' before, nor had any idea that there are others who felt like I did), so I determined to bottle these feelings up and repressed them deeply for a long time. In the fullness of time, though, with the support of my now wife, my friends and my then boss, I felt I could both acknowledge who I am really am and begin the process of transition, so that the biological will finally reflect the ontological, which will in turn mean the social reflects the ontological.

My story is not unusual; while some children do experience the kind of confusion I did when younger but things settle down as they get older, for me the discomfort stayed and it's only through transitioning that I've found any relief. Others begin to experience gender dysphoria in adolescence and others in adulthood. For some people, their feelings can be relieved through things like binding their breasts or selecting hair styles and clothes that give them a more androgynous appearance, For others, hormone treatment alone does the trick, and some may opt for surgery but no hormones; others like me go for both. It's important to stress that everyone is different, and pushing people down a route that isn't for them is wrong.

If you want to learn more about gender dysphoria and hear some other people's experiences, check out this page from the NHS website. There's also an excellent series in the Guardian by Juliet Jacques, who is a male-to-female transsexual, and it details her story from starting out to recovering from her surgery.

Could you not have just had counselling?

Nope! This has been tried in the past and caused a great deal of damage to many people. I did have some counselling around three years ago, but that was to help me deal with my fears about coming out as transgender and how people would react. There are world standards of care for transgender people which make it very clear that the best way to help transgender people relieve their gender dysphoria and feel comfortable in their bodies is by offering options for changing outward appearance in some form, perhaps as mentioned above through clothing and other external choices, or perhaps by hormones and/or surgery if that is right for that individual.

What did you do about it, then?

Well, not having the faintest idea where to start, I did some asking about among my friends in the LGBT community (before I came out as a transsexual man, I identified as a lesbian) and came across a local trans activist called Delia. We had lunch and she talked me through what was involved in the process of transitioning and the good and bad things about how the NHS handles it all. This did scare me somewhat, as many people have had bad experiences of the NHS, but I think has made me a lot more realistic about what the process involves and what I wanted to get out of it.

 

I decided to tell the outgoing boss of my team at work, on the basis that if he reacted badly, he was leaving anyway! As it turned out, he was great and suggested that his successor would be a great person to support me. I then spoke with the equalities person in HR, and between the three of us, we put together a plan to 'manage' my coming out. Around that time, I decided on a new name, Karl, and began to use it with my partner and certain close friends. In February 2012, I began negotiating the NHS 'care pathway', and came out at work and changed my name by Deed Poll a month later.

What about negotiating the NHS pathway?

The NHS refers to the treatment options as a 'care pathway', which sadly still strikes me as a bit of a misnomer, as the early stages at least seemed more diagnostic than caring. The first step was going to see my GP and asking to be referred to the local mental health team for an assessment. I think the need for a local assessment might vary from place to place. I'm also not sure whether for younger trans people, the first stop would necessarily be the local Child and Adolescent Mental Health team. Either way, I was pretty scared before my GP appointment, and wasn't sure how he would react to me; others have had bad experiences at the hands of GPs who don't understand trans issues or have shown blatant prejudice (if this happens to you, insist on your right to see another doctor). While he admitted that, like the majority of GPs, he'd never met a trans person before, he was supportive but needed telling what to do.

This highlights one of the problems I've found with the NHS - you have to be an expert patient. I went into the surgery that day - by the way, book a double appointment - armed with useful leaflets I got from the GIRES website, which explained what 'transsexual' means, what treatments I needed and what my GP needed to do to ensure the funding was put into place for these. Things have improved considerably in England in the last couple of years, in that the money now comes from NHS England, rather than the local Primary Care Trust, meaning someone transitioning is no longer tired down to one area while they go through treatment, which takes a number of years. Anyway, this meant I could give him some bedtime reading to do, and not have to worry about chasing up funding myself.

One thing the NHS isn't very good about is helping with the practicalities of everyday life in the intervening period before treatment starts. As there is a requirement (the 'real life experience') to live in one's preferred gender role for at least six months to a year before beginning hormone treatment for adults (see below for a note on teenagers and hormone blockers), this can create problems. I mentioned earlier that periods were very distressing for me; I asked for female contraceptive injections that would stop (or at least notably reduce) my periods at that same appointment. Annoyingly, I got passed onto a female GP who couldn't get her head around things and gave me a lecture on safe sex (despite my saying I have a long-term female partner), but I got them nonetheless. I needed to be the one asking for this; my GP wouldn't have thought to suggest it.

Getting through the local psychiatric assessment was pretty straightforward; I got grilled on my childhood and past relationships, as well as how the people around me were handling things. I think it helped that I come from an academic background and had already been grilled by supportive people with a knowledge of the issues, so I knew what was coming and didn't feel intimidated by the doctors. This highlights another issue: being educated and middle-class really helped when dealing with certain medical professionals. An acquaintance of mine, who found it harder to express what he was feeling, got quite a bumpy ride from the same people. One tip, therefore, would be to talk over how you feel with people you can trust and work out what you want to get across beforehand, so you can be clear and articulate. Be ready to be asked about some difficult things, and for it to feel like being put through the mill if the conservation goes to places you normally keep closed off; exercise judgment in what you say, and be gentle to yourself.

Eight months later, I finally got my first appointment at the gender clinic. Where you get sent will depend on where you live; I got sent to Charing Cross, which deals with London and surrounding areas. There is a useful list of the different clinics on the NHS website. Two psychiatrists have to agree on a diagnosis and the appropriateness of treatment, as well as one meeting the real-life experience requirements, to allow hormone treatment to commence. The questions were the same, but the tone was different. It came across as someone with a checklist and an agenda, and at times I felt pushed into simplifying my story and omitting certain things. For me, it's one of the problems with this model of treatment; the gender clinic staff are the gatekeepers of further treatment, and the resulting power dynamic, together with time constraints on the staff, can create tensions that might hinder honest conversations. I got past these hurdles, and started taking testosterone gel in September, and was referred for chest surgery at the same time.

Word of warning: Charing Cross have the worst administration of any organisation I've ever dealt with! I was supposed to take one 50mg sachet of Testogel each day, but was initially told once a week thanks to a clerical error, which is a bit of a difference - I'd wondered why it wasn't doing anything! I've also had to do a lot of chasing up if I've needed anything from them, such as help getting my hormone balance right. They also don't seem to have discovered the 21st century and e-mail seems quite beyond them!

How did you handle coming out at work?

As I've already outlined, my coming out at work was helped by having a supportive boss and HR department. Having already come out as gay, I was acutely aware of the differences; in one sense, nothing changed when I announced I had fallen in love with a woman and being attracted to women was part of who I am. This time, my name and the pronouns I'd be asking people to use would change, along with my appearance to some extent, though I'd long since given up any pretence to feminine dressing and wore a suit and tie to work. I was also nervous because people have been hounded out of jobs, and unemployment among transgender people is historically higher than among the general populous.  Having the support, therefore, was crucial to my sense of well-being during this time.

I work for Santander, and the equalities person from HR hadn't met a transgender person before, so once again I found myself having to be the expert. This guide for employers from Stonewall Scotland was particularly helpful. Again, though, what made this a good experience was the willingness of others to listen to my story and do their research to figure out how they could help me negotiate coming out. It was a pretty rocky time as my partner and family struggled to accept what was happening, and my boss really went above and beyond the call of duty in supporting me and keeping me on the rails during that time. When I'd seen my GP and felt ready, my boss was with me when I told my team, and then she told the rest of the department on my behalf so I didn't have to, which made it a lot less daunting prospect. HR had already sorted things so I could have a new e-mail address with my new name, and when I'd done the Deed Pool, I formally changed my details on the payroll, with my bank and other companies.
 

What about people in schools, youth groups and so on?

Again, Stonewall Scotland have some great resources for schools which provide advice on how to support transgender students, and there is a useful guide on the GIRES site for youth group leaders on making their group trans-friendly. There are also organisations like Gendered Intelligence which offer workshops for schools, resource-sharing sites like Schools Out, and many LGBT youth groups around the country. In my experiences and sadly that of countless others, being different in any way can make school a thoroughly shitty experience, and while I've not always got on too well with trans support groups, they can be a lifeline for both the person themselves and their families. It may well be worth having a trawl online and seeing what you can find, and there are some suggestions below. There is a Home Office guide on dealing with transphobic bullying that schools can access easily and should be putting to practice.

How do you change your name?

I used Deed Poll, which is one of two options; the other is to make a statutory declaration. People have gone for cheaper options and been fine, but I used the site linked to on the Passport Office website. It cost me £50, and involved sending for the form online, getting it signed and witnessed and then sending it back to get the final certificate. I've had no problems with using it to get a new passport (along with a letter from my GP saying the change is permanent and my gender identity is stable), or updating bank accounts, National Insurance and tax details, and so on. To change the gender marker on some paperwork (such as getting a new birth certificate) requires a Gender Recognition Certificate - see below.

 

Coping with everyday life: Friends and family

Telling friends and family is one of the most difficult bits of the journey in my opinion. As I've already hinted, it was hard for my now wife to come to terms with, as much as anything else because it created questions of identity for her: can she still be a lesbian if she's with a man? (Answer: of course!) My parents seemed alright at first and then exploded later when the reality hit them. Over time, things have got better, and in their own (unique) way my mum and dad now are great about it all, but they still find it a struggle. Some of my relationships with other family members have become strained, as they won't use Karl and misgender (refer to me as female) me constantly. That hurts like crazy.

Thankfully, things have been much more positive in terms of my friends; a couple of people did walk away, but everyone else has been really supportive, which has made such a difference. At our wedding last year, people I hadn't seen since I started transitioning came, and their acceptance of me just as I am was one of the things that made it such a special day. Work being safe has also helped, and I've not had any problems making new friends, in both professional and other settings, as a result of my transition.

One thing I hadn't expected was that some people, notably my partner, expressed a sense of grief when I started transitioning. They felt they were losing someone they cared about, and I found that incomprehensible at first, because for me it was a liberating experience. Having to be honest with each other and deal with painful stuff, as well as find language for what we were both experiencing, has brought my partner and I closer together, but has been very hard, with lots of tears shed along the way. It doesn't help that the NHS process focuses on the person, but there's not so much there for partners and family, especially if formal support groups aren't your bag. Thus, finding someone your partner/parents/other family/friends can talk to, who isn't you(!) about their feelings is important, in helping them come to terms with what, after all, is a big change.

 

Coping with everyday life: Support networks

On a related note, one thing I've learnt really helps is having people about with a bit of knowledge of the issues who are willing to listen, ask the hard questions and give hugs when they're needed. For me, one of those key people has been my minister at church, who is also a GP and has supported trans people before. She both helped me get to the point where I was ready to transition and dealt with curious questions from people in the churches I worship and lead worship in, meaning this part of my life (being a Methodist local preacher) has been able to continue perfectly happily since coming out. In addition, she led a naming ceremony for me in church when I wanted to reaffirm my commitment to God but use my new name, whereas when I was confirmed and first made that commitment, it was in my old name.

Coping with everyday life: Language and pronouns

Getting the language right is something that is very important, but can be hard for people. It takes time for people to change to using 'he', 'him', 'his' and so on, when they've been used to the female versions. Other people prefer 'they' or other neutral terms, and that seems to be quite beyond a lot of people to get right! One of the hardest things I found in the pre-hormones period was trying to live as a man but still sounding and looking female. It meant that even after binding my breasts and wearing a suit and tie, people got it wrong. Places that were very keen to affirm and welcome gay people were the worst - I think they assumed I was a butch lesbian! It's irritating, but you have to be patient with people, as it's very rarely borne from maliciousness. Now my voice has broken, things are a lot better, but it does take time for people to adapt to new language. Check out this TED guide for more on use of language.

 

Coping with everyday life: To disclose or not to disclose?

How to talk about my past is another question that arises: should I be open, or just not say anything that could give away that I'm a transsexual? It's a complex question, with implications for people around me too, which I've not fully resolved yet. For example, can I talk about childhood or teenage experiences that I wouldn't have had if I hadn't been assigned female at birth? I think each person has to make their own mind up on this one, and so far I've chosen to be open most of the time. However, there are situations where that can make life awkward, and I don't know what I'll do beforehand. As an example, I was asked while on a church placement about when I got married and whether it was in church. I really didn't want to go into the complexities and avoided the question, but other times have told the person what the deal is, so it depends on the situation. Perhaps ask me again in a year's time on this one!

It helps that my relationship has survived the process, so I've not got the complexities of dating to deal with. The only thing I would say is that I'd hope that, if something happens and I end up single again, I wouldn't want to have sex with someone I couldn't trust to tell I'm transgender. If they couldn't handle that or insisted upon thinking of me as a woman, I'd be out of there!

Coping with everyday life: Binding breasts safely

I started binding my breasts after coming out, mostly because I was worried about how to do so safely. I'd met people who use elastic that binds so tightly it restricts breathing and causes pain, which is obviously not good. I'd also come across full upper body binders, which given I'm a tad on the larger side seemed a recipe for sweating and discomfort. In the end, I settled on sports bra-style chest binders from a company called Peecock Products, which had to be shipped over here and cost around £30, but which when worn with a bra underneath provided a good degree of binding and gave me a much flatter chest, but still left the area below my breasts free to breathe. They didn't work for me without a bra; my breasts fell out! One of the disadvantages of wearing this was that the bottom curls up sometimes, and can crease shirts and other tops. They do show through some clothes, but I reckon just look like you're wearing a vest.

The important thing with binding is to do it safely. I met a trans man who bound his breasts day and night for years, and did so that tightly that he hyperventilated when he took the elastic off, because his lungs weren't used to so much air! As a general rule, if you're struggling to breathe or in pain, you're binding too tightly. Once I got used to the new binders, I found them really liberating, as having a much flatter (though there's only so much you can do with DD cups!) chest gave me the confidence to use the gents' toilets rather than the disabled loo, and to feel confident challenging people about using the wrong pronouns. Binding reduces breast size over time, so one's chest appears less feminine as a result, though having squashy breasts might be off-putting for some people. The downside is that even with ones that don't cover the whole chest, they do trap a lot of heat and can be very sweaty and itchy in summer.

Coping with everyday life: Toilets and other gendered spaces

Negotiating gendered spaces can be tricky at first, especially in the period before starting hormone treatment. I'd never considered how difficult going to the toilet could be before beginning transition. One thing to make clear is that you're entitled to use the toilets of your preferred gender or the disabled facilities as you feel comfortable; if someone tells you it's illegal then they don't know what they're talking about. In my experience, I didn't feel confident to use the gents at first, so I used the disabled loos wherever I could. This was hard in some places like some pubs, as it required having a RADAR key and I didn't want to have to explain to the people behind the bar why I wanted to use that toilet and not one of the others. It meant knowing where I could go that was nearby, or simply avoiding certain places. As time went on, I got more confident and started to use the gents regularly at work, and later in public places that felt safe.

Over time, this has got easier as I have been binding for a while and my breasts have shrunk, my appearance is more masculine and my voice has broken. However, changing rooms haven't yet become any easier, as when I take off my clothes I still have a female-appearing body, meaning using the gents is out, but the hormones have made me rather hairy, and especially with a deep voice, it means I can no longer just use the women's changing rooms and keep quiet about my gender identity. When looking for a gym to join, therefore, checking out the disabled facilities was important, as was letting the staff know the situation and that I would need to use these. I mention this as my gym has a notice on the door of the disabled changing room telling people it's just for wheelchair users, so it helps if they are aware in case, as has happened to me once, someone takes offence to you apparently breaking the rules!

Coping with everyday life: Shopping

One situation that can become more difficult when transitioning is shopping, not least because there's another changing room situation to negotiate, and while some stores have gender-neutral changing rooms, many don't and that can cause problems. Once, I was shopping for a new shirt and got told I couldn't use the men's changing rooms, so reluctantly went to the women's section. They told me they wouldn't let me in with a man's shirt. H&M lost £30 worth of custom that day! My worst experience was in BHS in Milton Keynes; I went into try on some short-sleeve summer shirts for the office, and after my experience in H&M decided to use the women's changing rooms. The women minding them reported me to security as a potential shoplifter, and I was then followed around the store! Again, as time has gone on, things have got better, partly because I 'pass' more readily and partly because we've found shops that are more transgender-friendly. House of Fraser, Marks and Spencer's and Hawes and Curtis in Milton Keynes have been great for clothes, and Schuh and Doc Martens for shoes.

Another issue that arises for me is to do with sizes. I'm 5ft 2 and have proportionally short arms and small feet! This means I have to get shirt and jacket sleeves shortened, and because most places stock men's shoes from size six upwards and I'm a size five, I buy gender-neutral shoes like Doc Martens. I did try junior shoes, but they looked like they were for kids, so wouldn't really work on a thirty-year old! Finding a place that will do clothes adjustments can really help, especially if like me you work in a professional occupation and are expected to dress smartly. Learning what your size is when you start transitioning can be tricky; be willing to do a certain amount of trial and error until you get it right, and don't be afraid to ask for things in smaller sizes if you need them.

Coping with everyday life: Getting hassled

Sadly, being perceived as 'different' in some sense can put one at risk of harassment when out and about, and as transgender people challenge people's often rigid ideas about what is socially acceptable for males and females, simply by being ourselves and not hiding away, we often come in for more than our fair share of hassle, particularly trans women. I think my experience hasn't been too bad partly because I've often been viewed as simply a butch woman, and there's far more freedom for women to appear masculine then men to appear feminine in our society, something I think it is bond up with misogyny, homophobia and transphobia intersecting. However, I've nonetheless had to develop a thick skin.

Just to tell one story to illustrate: I was out for a lunchtime walk in Regent's Park, which is near work, a few weeks ago and wearing a suit and tie. I thought I looked pretty dapper for what it's worth, and was just enjoying my stroll. There are some benches by the lake, and that day they were full of French school kids. The children on the first bench pointed at me, laughed and started loudly speculating about my gender, which encouraged all the rest to do the same. One lad openly stared open-mouthed at me, and then nudged his friend and got him to do the same. I felt like a zoo exhibit! I've also had abuse (both homophobic and transphobic) shouted at me, been threatened and pushed about, chased and spat at, and one guy tried to punch me in a pub toilet. Thankfully he was drunk and he missed, but it was scary.

If you do experience harassment - verbally, physically or sexually - then please do report it rather than suffer in silence. Most councils have hate crime officers, and the police do want to help in my experience. It may help to get to know officers working with the LGBT community, as they've had specialist training in things like transgender issues. In Milton Keynes, we've built up good links with Thames Valley Police, and they've sent officers along to community events such as Pride and the Transgender Day of Remembrance. Employers also have a duty under the 2010 Equality Act to deal with discrimination against transgender people, and it is illegal to fire somebody for intending to, going through or having been through gender reassignment; it's worth getting to know your rights.

What about teenagers and hormone blockers?

Hormone blockers can be very useful for teenagers, in that they can stall the process of puberty and give the young person breathing space to work out what (if any) treatment they want to have as they get older. If you want to learn more, check out this guide on the GIRES website, or have a look at my previous blog post on the subject. Additionally, there is a great TED talk by Norman Spack, who has helped young trans people for years, which is about hormone blockers.

 

What happens when you take testosterone?

After negotiating my way through the NHS system, I eventually started taking Testogel at 50mg once a day. I began in December 2013 and have noticed significant changes, despite transitioning with gel being slower than injections. I'm scared of needles and didn't want the aggression after an injection and the gloom in the run-up to the next one. The most notable change is that my voice has broken, and after going through a phase of being squeaky, has settled down to a nice, deep tone. It does crack and squeak still while singing, so someone concerned about this might want to do voice exercises like singers do a little more diligently than I did! This has been really liberating for me, as now I don't get misgendered over the phone or anywhere near as often in person, and I feel more confident in handling gendered spaces and social situations.

Other changes have thus far included development of muscle mass, particularly in my legs and shoulders, increased stamina, growth of body hair on my legs, arms, back, chest and shoulders, the beginnings of facial hair, being more (but not hugely more) short-tempered, increased sex drive and an enlarged and more sensitive clitoris, increased sweating and spots. I think my face looks more masculine, and my skin is a bit tighter around there. The spots have been easy to deal with, but the sweating harder. I occasionally get hot flushes, and feel like a teenage boy crossed with a menopausal woman! My periods had stopped but have recently restarted, which has been quite distressing, so it evidentially takes time to get the level of testosterone right. One thing that hasn't happened is that I haven't suddenly become really aggressive, something I was worried about beforehand; I'm still just a weedy mathematician!

Overall, I have found taking hormones to be a good experience, though one thing that has taken a bit of getting used to is how my sexual orientation has shifted. I'd now say I'm bisexual but still much prefer women to men. I'd heard this could happen, but it's taken me a while to get used to it. Taking hormones does mean needing regular blood tests, as cholesterol levels can shoot up, and increased red blood cell count can cause problems, among other issues. I dread these, as it's not easy to get blood out of me. I'm told I have bendy veins! Hormones are something I'll need for the rest of my life, as without them, certain characteristics (such as facial appearance) will begin to regress, and  because I'll need them to maintain a healthy body when I've had my hysterectomy - see below.

If you want to know more about how the hormones work and what the risks are, check out this NHS guide.

What surgical options are there?

I have decided to have what's commonly called 'upper surgery', which means having my breasts removed and a male-appearing chest constructed in their place. As I noted earlier, I've been stuck with DD cup breasts since around twelve years old, which has been a source of great distress to me. Even if the world around me was more tolerant of gender variance, I'd still have to look at them every time I take my clothes off. I'm really looking forward to the surgery (hopefully in October 2014) and have been working hard to lose weight so I can get good results from it and recover more quickly.

I've elected not to have any lower surgery (penis construction) because to my mind, the dangers outweigh the benefits by quite a way. I'm told around 5% of trans men opt for this treatment, which involves using arm tissue to construct a phallus. I will need to have a hysterectomy, though, as otherwise the thickened womb lining caused by the testosterone can give rise to problems, and there's an increased cervical cancer risk. I'm quite nervous about that operation, to be honest, but at least it means I'll never have another period.

 

If you want to know more about what it's like to go through chest surgery, check out this Guardian article by a trans man called Fred McConnell, or the ever-helpful GIRES website again, which also talks about options for lower surgery.

What is a Gender Recognition Certificate?

The Gender Recognition Act 2004 allows someone who has transitioned to obtain a new birth certificate with their new name and the correct gender. It also affords the person extra legal protections, and it is illegal for someone to 'out' someone as having a gender history. To obtain this, one has to have lived in one's preferred gender for at least two years and have changed appearance sufficiently. It has implications for marital status: someone in a civil partnership will have to transfer to a marriage before obtaining a Gender Recognition Certificate (GRC). Everyone will have to have written confirmation from the partner, sworn before a solicitor, that they are happy to remain married. This is called the spousal veto, and has the potential to cause issues when nasty break-ups occur...

For more information on the Gender Recognition Act, check out this guide to the process of obtaining a GRC.

Where can I go for support and advice?

There are various websites worth checking out if you want further help and advice. One very good list has been compiled by Juilet Jacques in the Guardian. There is also a new book called 'Trans Bodies, Trans Selves' which may be worth a read, and there's an associated website to check out. Finally, there are local groups out there, so have a hunt around the internet and ask about.