What is Transitioning?

You’ve probably heard the terms “top surgery” or “transition” or “T” if you’re interacting with trans* people. So if you’re trying to educate yourself on a transmasculine experience, you’ve come to the right place!

Lots of transgender people feel something called “gender dysphoria,” which is a discomfort of varying intensities with one’s body, physical attributes, behaviors, etc., due to a disconcordance of biological sex and gender identity. So, basically, it’s when your mind tells you your body should look one way, but your body looks another. (In my case, my mind believes I’m male and therefore my body is as well, but when I look down and don’t have a penis, have 36DD boobs, and a curvy body, I get upset and I feel like my body is somehow wrong.) Trans* people experience dysphoria in all kinds of ways. Some people feel dysphoric about their voice, about their emotional reactions to life events, about their hips, about their chest, etc.

Transitioning comes in two main forms:

  1. Social transitioning
  2. Medical transitioning

Social transitioning involves telling people that you want to be referred to with different pronouns or a different name. It can involve a wardrobe change — for me, social transitioning meant buying men’s jeans, ties instead of dresses, buying a binder, and asking people to refer to me with he/him/his pronouns.

Medical transitioning for transmasculine individuals can involve any or all of the following: (I am comparatively quite ignorant on male-to-female transitioning but I’m working on educating myself and so hopefully sometime in the near future there will be a section here about MTF transitioning. My apologies for now.)

  1. Hormone Treatment: this entails taking testosterone (commonly abbreviated as “T”) in various forms (see below) which causes a person to essentially go through male puberty — your voice drops, muscle growth is enhanced, hair growth increases, acne increases for the first year or so, etc.
    1. Topical — comes in either gels or creams that you spread on your body, typically daily. The main risk is that it’ll get on someone else (ex. a female partner) and most other people don’t want excess testosterone, especially women. The results are also slower, typically, and so you can ease into it.
    2. Injections — probably the most common form of testosterone usage. Injections can be weekly or bimonthly or even (with a more recently developed long-lasting shot) every few months.
    3. Pellets — a doctor surgically inserts a few pellets of testosterone every 5 or so months that slowly dissolve in your body, releasing testosterone over time. It seems that people typically start this after having been on injections for a while.
  2. Top Surgery: a double mastectomy and chest masculinization
    1. Double Incision — this type of mastectomy involves two incisions generally along the line of the pectorialis major muscle, as well as two free nipple grafts taken from the patient’s original areola and nipples. The surgeon removes all breast tissue and most of the excess fat from the chest. Nipple sensation post-surgery can come back in full but pleasurable sensation is physiologically impossible, although some people claim to experience it. The scars along the pec line will never disappear completely.
    2. Keyhole — the surgeon makes semi-circle incisions along the base of each areola and removes breast tissue and fat through liposuction. Sometimes, the areolas are resized. This procedure is for smaller chested individuals, (typically A-cup or smaller,) and it preserves the nipple nerve stem, therefore preserving pleasurable nipple sensation.
    3. Peri-Areolar — incisions are made surrounding the areola so the surgeon can resize the areola and nipple
    4. Every surgeon has a slightly different technique but these are the two main ones. There is also the T-anchor surgery which includes a vertical scar extending down an inch or so under each nipple. This preserve nipple sensation when paired with the Double Incision technique. On it’s own, as a similar surgery to Peri-Areolar, it can aid in getting rid of excess skin and fat that gathers under the nipples.

      T-Anchor Double Incision vs. just Double Incision

  3. Middle Surgery: essentially a hysterectomy; the removal of one’s reproductive organs. Many people undergo this because it is a sort of spiritual release of one’s original assigned sex, but it also can chemically aid in one’s medical transition because female reproductive organs produce estrogen that competes with the prescribed testosterone. So some people experience better results from the testosterone once their reproductive organs are removed.
  4. Bottom Surgery: the reassignment of one’s genitalia, can include a vaginectomy (removal and sealing of the vaginal cavity), addition of a penis, and testicular implants. One of the leading bottom surgery surgeons is Dr. Curtis Crane in San Francisco so check out his website for more information: http://brownsteincrane.com/ftm-surgery/
    1. Metoidioplasty — creates a phallus from a hormone-enlarged clitoris, the urethra is lengthened so one can pee standing up, some people have testicular implants using the vaginal labia. The penis is small and will not be able to penetrate.
    2. Phalloplasty — the construction of a penis using a large skin graft from the patient’s forearm, thigh, or abdomen. This can be a lengthy series of surgeries that are pretty risky, as well. It is not uncommon for infections to occur and parts could die or have to be removed. It is also very expensive.

IMPORTANT: Medically transitioning isn’t something everyone chooses to do. And those that do choose to medically transition don’t all choose to go through every part. For transmasculine people, it is very common to take testosterone and get top surgery and never undergo bottom surgery. A trans* identified person who hasn’t gone through any or all of the surgeries or isn’t on hormones is not any less of the gender they identify with. Surgery and hormones are a personal choice and do not define one’s gender.

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