The Wrong Sex Characteristics
Every two weeks, I stick a needle in my ass (upper outer quadrant of my left cheek, to be exact) and inject myself with 1cc of testosterone. That's because I, like other trans men (Female-to-Male transsexuals, or FTMs), was born with a body that didn't match up with the gender presentation which I felt inside. My proverbial sisters in arms, women who were born with male bodies (Male-to-Female transsexuals, or MTFs), are in similarly dire straits.
Trans people often don’t feel comfortable with the sex organs (penis, vagina) with which they were born or the secondary sex characteristics (facial hair, breasts) which developed at puberty. They therefore choose between a variety of actions, including medical and non-medical options, to change these things. Before any medical treatments or legal changes (e.g., sex change on a birth certificate) can be started, a trans person must meet with a therapist until the therapist feels confident that that medical change will be beneficial to the trans person. The trans person will sometimes be asked to live in the societal role they are adopting temporarily to provide a test run for living in that gender.
While these requirements, called the Harry Benjamin standards, were developed with the intention of protecting trans people from unscrupulous, exploitative physicians, many trans people today feel that they are unfair because of the costs of therapy, absence of trans-friendly therapists and potential dangers of living in the world as one gender while appearing to be another. Nonetheless, the majority of trans people undergo at least a few sessions with a therapist before starting hormone treatment or surgery.
Let’s take a look at the hormonal and surgical options as well as the non-medical alternatives available to trans folks looking to change their body or presentation.
Packing, Binding, Girdles and Garments: Non-Medical Options for Modifying One's Gender Presentation
The road to presenting a different gender isn't all doctor visits and prescriptions. Some people want to modify their gender presentation but don’t have access to medical options. These people, and others who simply don’t want to use medical options, can change their presentation in various other ways on a daily basis. The benefit to non-medical modifications is that they don't require a therapist's approval, are relatively cheap and are temporary (especially nifty if the person isn’t out in every aspect of their life).
Women:
When trans women transition, they join the ranks of the rest of the women who are taught by our society to be hypercritical of their bodies and appearances. Though unfortunate, this does mean that trans women have a plethora of products available to enhance the chests and hips. The trans woman's choice of product depends on what her body looks like to start with. Women with more natural breast tissue can use a girdle or a push up bra to create the appearance of breasts. For those women without as much natural breast tissue as they'd like, foam and silicone pads are available which can be held in place by specially made bras. To create hips, women can cut strips of foam to be slipped into the sides or seats of jeans. Lingerie stores on the internet and locally sell a variety of padded underclothes which can shape and lift the butt. These can be accompanied by waist cinchers, thereby accentuating the newly created curves.
Trans women can buy wigs if their natural hair doesn’t grow as long or as lush as they’d like for it to. They can also shave their faces and shave or wax their armpits and legs to be as smooth and hairless as is expected of women. On the subject of hair, one additional option for trans women is electrolysis, which is a treatment that permanently removes hair by targeting the hair follicles with tiny jolts of electricity.
Men:
Where trans women want to put it on, trans men want to cover it up. The big issue among many trans men is having a flatter chest. One of the oldest ways devised to do this is by wrapping ace bandages or strips of cloth very tightly around one's chest. Unfortunately, ace bandages, though cheap, are incredibly uncomfortable and pretty bad for a person's ribcage, much as girdles were back in the Victorian era. Guys who can afford it will often buy very tight sports bras or a shirt-like garment called a binder. Binders are worn like shirts but provide compression that flattens out the chest without being as painful or dangerous as ace bandages (though they're no cup of tea, especially in heat--imagine being wrapped in plastic wrap!).
Some guys also want to present a semblance of a penis and do this in a variety of ways other than the sock-in-the-pants gag that we all know about. Some guys will choose to buy packers, which are products (often made of silicone or silicone composites) in the shape of flaccid penises. Products like “Mr. Right” even have special jock strap attachments which go around the guy’s waist and suspend the packer in a position similar to that of a penis. Other guys will make their own packers, using hair-gel filled condoms and panty hose to make a convincing dick-fascimile.
Magic Pills and Injections: Hormone Treatment for Trans Folks
Women:
Trans women use estrogen (generally in pill form) to alter their bodies to be more female. Others use androgen blockers to change the balance of hormones in their body to be less testosterone dominated. Effects include reduction in sperm count, sex drives, erection sustainability and intensity, body hair amount and darkness, and musculature. Trans women show increases in breast size, often with a final result of measuring 1-2 cups smaller than close female relatives. Body fat is redistributed to the hips and butt, skin becomes thinner, softer and sometimes drier. Body odor and sweat production may change, as well, and they may experience a slow down in any progression towards male pattern baldness. Trans women are often frustrated with estrogen therapy because it is slow acting and does not raise their voices or produce smaller, more feminine facial features (though it does cause fat to migrate, creating a more feminine face shape). Some women choose not to use hormones at all if they’re comfortable with their body’s presentation or if they aren’t looking for the changes estrogen creates.
Men:
Trans men often use testosterone (most commonly injectable, but also available in pills, patch or gel form) to raise their own hormone levels to normal male ranges, showing effects in as little as weeks after beginning treatment. Effects include a deeper voice, increased facial and body hair growth, increased musculature, as well as migration of hair and fat to more male areas and patterns. A man’s scent or sex drive may change, his clitoris will grow in size, and his skin may become rougher or more oily. Finally, after a few months on testosterone, a man’s menses will usually stop. All these changes come together to create a much more masculine appearance and physical experience, with many men rejoicing over a deeper voice as they lament the developing bald spot they never wanted to inherit from uncle Bob.
Cut Me Up and Put Me Back Together Again: Surgery Options
Women:
Two different genital surgeries are available for women. The first, vaginoplasty, creates a vagina for the trans woman by salvaging as much tissue from the woman’s original genitalia. In this procedure, the penile shaft is split along one side and is inverted to make a vaginal sheath. The new vagina is then inserted back into the trans woman, with erectile tissue rescued and reconnected as a clitoris and the urethra rerouted to an appropriate location. Voila: Vagina. Often, surgeons will use this opportunity to create labia out of scrotal tissue, as well. Some women also get a bilateral orchidectomy in which both testes are removed and the paths to sperm production centers are sealed. This has the benefit of reducing testosterone production.
In addition to genital surgery, some women opt for a tracheal shave in which the trachea (Adam’s apple) is shaved down until it is less prominent. Others, who aren’t satisfied with the breast tissue that estrogen therapy has left them with, may opt for breast implants. Many more trans women get genital reconstructive surgery than do trans men due to the relative utility of the new vagina versus a surgically created penis, and the fact that the surgery has been around for significantly longer and has a higher rate of patient satisfaction. The beautiful reality of the surgically-created vagina is that it provides all the function of one present from birth, and most trans women are orgasmic post-surgery.
Men:
For trans men, chest surgery is more common than genital surgery owing to its relative cheapness and simplicity. In addition, many trans men are frustrated with the appearance of surgically-created dicks, feeling that they don’t approximate the real thing all that well. For the chest, though, surgical options are pretty solid and create very realistic male chests, though scarring can be prominent. Depending on size, men may opt to have one of two surgeries: keyhole surgery or a bilateral mastectomy. In keyhole surgery, excess tissue from guys with smaller chests is removed through incisions around the nipple while bilateral mastectomy removes tissue from more endowed guys through two long cuts across the chest.
For genital reconstruction, the main options are metoidoplasty and phalloplasty. Metoidoplasty procedures involve releasing the part of the clitoris which is inside the man so it can hang loosely and resemble a small but realistic penis (though not one that can be used penetratively, due to its size). In contrast, phalloplasty involves creating a larger penis out of tissue from the man’s arm, leg or stomach. In either case, the urethra can be lengthened so the man can pee out of his new penis. Whereas with the metoidoplasty, the man can achieve erection because it is made of erectile tissue, in the phalloplasty, a permenant rod or a pumping device must be inserted. Either of these procedures can be done in combination with the creation of scrotal sacs by closing off the vagina and turning the labia into the new scrotal sac. Once healing is complete, the new scrotum can accommodate testicular implants for an exceptionally realistic feel and appearance.
For the trans man, the decision of what dick to get depends on his priorities—whether he wants to just pee out of it, spring a boner, use it to penetrate someone, or all of the above…and he may even want to engage in the occasional sword fight with his new equipment!
Trans people may opt out of any of these choices for a variety of reasons including economic reasons, health reasons, or dissatisfaction with available options. It is important to remember that no trans person is “more” trans than another by virtue of having taken surgery or undergone a certain surgical procedure.
At the end of the day, the purpose of all the options in this brief article are to help the trans person feel more comfortable, and for them to feel better about their body and gender presentation. Although these are the major options available, trans people greet the world each morning after adjusting a million and one other things, from hair style to lipstick. There’s no right way to be a trans woman or man – it’s just the way each individual chooses for her or himself.