You did some introspection and realized you might be trans. Maybe you want to try micro dosing or full dosing hormones to discover more about yourself; but, what are the first steps?
1. Thinking out loud
If you have a therapist, gender therapist, or psychologist, you should probably tell them your feelings and see what their thoughts are. This doesn’t mean whatever they say is what you need to believe, but having someone impartial to bounce ideas around with is always helpful. Keep in mind that even an “impartial” 3rd party still has their own beliefs and are just as biased as everyone else in their own way.
2. Thinking about your partner
After thinking out loud to yourself and maybe a 3rd party, you still want to find out more about being Trans. It’s time to let your significant other know your feelings. Don’t spring this on them all of a sudden; rather, talk about your feelings and what you’ve been thinking and going through. Find out what their boundaries are and what they might be open to long term. For example if you’re trying to have kids with your partner, hormones can be a deal breaker. Note that many people have successfully become fertile again after stopping hormones, so it’s not an absolute… but it is a painful process to de-transition temporarily.
You also need to ask yourself if whatever boundaries your partner has set are OK with you. It’s not uncommon among trans people to lose their family and much of their previous support network. For example if you want to present hyper feminine and your partner is only attracted to masculine people, that could be a major ongoing conflict that will be painful for both people. If your partner is OK with some minor level of presentation, are you also OK with that boundary?
For insight and support for yourself or your partner, the My Partner is Trans community can be helpful:
3. Thinking about the future
Your partner is cool with it or you have no partner. Ask yourself who you might want to be in the future – do you want to have biological kids? It might be time to bank sperm if you are AMAB (Assigned Male at Birth). Search the internet for Sperm Banks – there are many where the whole process can be done at home and shipped. Or if you are worried about reliability you can ask your local fertility clinics, universities, or healthcare network. If you are paranoid you can also use multiple banks for redundancy.
There is no guarantee whether you can de-transition and become fertile again, but if you are able to, keep in mind it could be a 6 month process where you struggle with your appearance and psychological changes every single day. Many choose to bank simply to avoid the possibility of de-transition for the purpose of having biological children.
4. Getting started with HRT
HRT (Hormone Replacement Therapy) is often the first step in transition, though not always. Some people choose to, or are required to live as their desired gender outwardly for some period of time before starting hormones. At least in the USA, all you need to do is find an informed consent clinic. ANY doctor can prescribe HRT, but many are uncomfortable.
In the USA you don’t need any endorsement letter to begin HRT or to find a doctor who can prescribe HRT. Here is a comprehensive list of Informed Consent Clinics:
Erin’s Informed Consent HRT map of the US
References to Hormone Therapy Guidelines:
- A basic starting point: https://transfemscience.org/articles/transfem-intro/
- Major list of hormone guidelines by region: https://transfemscience.org/articles/transfem-hormone-guidelines/
- If you want a single USA guide as a starting point, this one is decent: https://www.lgbtqiahealtheducation.org/wp-content/uploads/COM-2245-The-Medical-Care-of-Transgender-Persons-v31816.pdf
If you’re getting started and don’t want to leave your house, you can also try a service called Plume. Note that Plume has some limited options for HRT prescriptions, but is still a great way to get started and it can be your sole Trans medical provider long term if what they’re willing to prescribe meets your needs.
If Plume is a bit pricey you can save some cash using Folx:
If you want to try DIY (Do it yourself) Transition, you can; however, the DIY route is often dosed too highly which is dangerous and can prevent a good transition. Primary puberty takes around 10 years and secondary puberty will also take a long time for a good result. Whenever possible I would recommend having a doctor prescribe your medications. When you order medication without a prescription it can be illegal and dangerous since there is not quality assurance built in necessarily. You’ll also have to manage your own schedule and dosage.
The DIY route is certainly not a deal breaker and may be the only option in certain countries or financial situations. You can find a comprehensive supplier list at hrt.cafe:
For some guidance check out TransfeminineScience (if transfeminine), Reddit also has a massive trans community:
- https://transfemscience.org/articles/
- https://www.reddit.com/r/TransDIY/
- https://www.reddit.com/r/estrogel/
- https://www.reddit.com/r/MtFHRT/
- https://www.reddit.com/r/MtFHRTsuppl/
5. Thinking about insurance
In some states in the USA, or some countries, Transgender doctors, prescriptions, and surgeries are covered by insurance or employers. California, USA is a good example.
For financial and social reasons it is very important to think about moving for your own happiness if necessary. There’s a good chance if you stubbornly stay in one place, your social support network and transition accessibility will be limited in the long term.
Try finding an insurance provider on HRC if interested:
6. Thinking about medications
What HRT prescriptions should you start with? Almost universally for transfeminine people start with Oral Estradiol (Estradiol is a form of Estrogen), which is typically taken Sublingually (absorbed by holding under the tongue until dissolved, usually about 10 minutes). Many doctors will start a person on 2mg for at least the first month. Some people start with only Anti-Androgens (blockers) and some start with blockers and hormones. Note that Spironolactone may correlate with premature breast bud fusion, limiting development of full breasts. There is very little study behind this correlation unfortunately.
For transmasculine, testosterone tends to be done via injection.
Going deeper into the details of prescription options is beyond the scope of this article.
7. Thinking about labs
Labs are blood draws to measure hormone levels and liver function typically. Cholesterol is also an important consideration since hormones can impact cholesterol levels. If your insurance isn’t covering labs or the lab your medical provider wants to use is far away, you might consider an online lab purchase which is then drawn in-person. Health Labs is a good option and relatively affordable:
https://www.healthlabs.com/transitional-hormone-wellness-panel
8. Thinking about surgery
Are you planning to have “top” (breast) or “bottom” (genital) surgery? This is essentially taking transition as far as it can go, and is fully permanent. It is perfectly valid to never have any Trans surgery also. This is a personal choice.
Other common Trans surgeries are FFS (Female Feminization Surgery), Hair Transplants, and Body Sculpting (moving fat around).
Note that even with surgery, it does not add the reproductive aspects of genitals. For example a transwoman cannot get pregnant and a transman cannot produce sperm. Obviously in the case of a hysterectomy (removal of cervix and ovaries) or orchiectomy (removal of testicles), the person is permanently reproductively sterilized.
Functional reproductive genitals may change to some extent through organ transplants in the future; however, from a DNA standing the eggs and/or sperm would not contain genetic material of the host; rather it would contain the genetic material of the donor. In fact the DNA from organ transplants may even modify the DNA of the host over time (this topic is outside the scope of this article).
If you want to see how transition has worked out for others, check out these Trans communities on Reddit:
- https://www.reddit.com/r/transtimelines/
- https://www.reddit.com/r/transpositive/
- https://www.reddit.com/r/Transgender_Surgeries/
- https://www.reddit.com/r/transpassing/
9. Thinking about the end
Trans people have higher suicide rates than all other conditions combined. Also depending on the age transition begins, results may be limited. Transition after age 25 is considered “late” by many due to the limited changes – particularly in skeletal / bone structure. Primary puberty is typically “done” around age 25. Even with that said, the average Trans person is in their 30s when they begin to transition.
This doesn’t mean an older person can’t transition; but, as a person gets older, the physical changes are increasingly limited and the transition becomes more of a mental experience. Even so, there are cases where a person is already masculine or feminine enough that an older transition is highly effective for “passing” as the desired gender. Passing means that people cannot easily tell a person was not born the same gender they are presenting as.
You also absolutely do not have to “pass” as a particular gender. The non-binary gender category is vast and increasingly as a society we are moving towards a gradient of gender expression. There isn’t any valid reason for clothing or makeup to be gendered to begin with and the lines between gender expression are increasingly blurry. Just be yourself and do what makes you comfortable.
If one of your primary concerns is finding a life partner, keep in mind that people have a wide range of attractions and presentations. If you look like “a man in a dress” for example, it doesn’t mean you can’t find an ideal life partner who loves you for who you are.
It’s important to recognize that as a society we all support each other and that we are all human with the same needs and desires. If you live in a highly isolating area without much transgender support, you should also seriously consider moving.
If you are planning suicide, please keep in mind that suicide is an absolute last resort and that everything and anything else is better than suicide. Have you really explored every other life possibility? Have you travelled to other places where people think and behave differently? Have you moved to a new location that is more supportive? Have you made new friends in the Trans community to support you? Have you changed jobs to find one with more meaning and better Trans support? Have you dropped the toxic people in your life who are more interested in their own happiness than yours?
While in a dark place, everything feels pointless, but there is a lot to try before giving up. Make small goals and take baby steps towards providing your future self a better life.