eader image courtesy of No But Listen.
Transitioning as an adult can be intimidating – you might feel like you’re behind the curve, or like you don’t even know where to start. Luckily, there’s no right or wrong time to transition. To help you get moving, we’re here to give you some tips on:
- Transitioning physically
- Transitioning socially
- Transitioning legally
Of course, you can mix and match these things however you want – if you want to transition socially but don’t want to start hormones or get surgery, you can most certainly do that. If you want to quietly start hormones without telling anyone, power to you!
Note that when it comes to our suggestions on legal and medical transition, we’re approaching from an American standpoint – if you’re outside of the U.S., processes may differ. Additionally, laws in the U.S. tend to vary by state, so make sure to look up information specific to where you live.
Transitioning Physically
Surgery, Hormones, And More
There are a lot of different ways you can transition physically, and a lot of things to consider. We’ll try to touch on all the basics.
1. Hormones
Chances are, since you’re transitioning as an adult, you might not have used puberty blockers growing up – maybe you didn’t know yet that you wanted to transition, or you couldn’t get parental permission. Luckily, while puberty blockers are certainly helpful, they aren’t the end-all be-all, and you can successfully meet your transition goals even if you went through a different puberty first (I started testosterone years after my initial puberty, and people are often genuinely surprised when I tell them I’m not a cisgender man).
As a brief overview, hormone replacement therapy (HRT) is a treatment that changes your hormonal balance, making your endocrine system either more estrogen-dominant or more testosterone-dominant. This can result in a lot of outward (and inward) effects, such as body fat redistribution, breast growth (on estrogen), body and facial hair growth (on testosterone), changes in mood and sex drive, etc. Your doctor will make sure you’re well-informed on all of the effects, but it’s a good idea to read up on them ahead of time. That way, you can bring up any potential questions or concerns.
The easiest way to access hormones is through an informed consent clinic. An informed consent clinic gives the patient the freedom to make their own choice – they just provide you with the information relevant to your decision, such as the benefits, risks, and any alternatives that might be available. When it comes to HRT, Planned Parenthood is probably the most common informed consent clinic, but not all of their locations provide gender-affirming services, or HRT specifically. It’s easiest to call and ask if it’s a service they provide, but you may also be able to find the information on their website.
Once you’ve got your appointment made, you’ll be able to go in and speak to your doctor. You’ll be informed ahead of time of anything you might need to bring, like your insurance card (thankfully, Planned Parenthood locations often use a sliding scale payment system, meaning they won’t charge you more than you can afford – make sure to ask about this if you’re worried about your ability to afford gender-affirming services). Your doctor will ask questions about your identity and transition goals, and tell you your available options, such as what exact medications you might be taking (pairing your estrogen with an anti-androgen, for example, or choosing between testosterone cypionate and testosterone enanthate) and in what form you’d like to receive them (injections and pills are the most common, but gels, creams, and/or patches may be available to you). Your doctor may have you take a blood and/or urine test before you begin HRT.
After you’ve started HRT, your doctor will want to check in with you every now and then. They’ll ask about the effects you’re experiencing, how you feel about them, and they might do some routine testing to make sure your body is responding to it properly (e.g. your cholesterol isn’t jumping out of control). If you want to switch things up, such as trying a new method or raising/lowering your dose, don’t be afraid to ask – your doctor is there to help you.
2. Surgery
Getting surgery is a deeply personal decision – not everyone wants it, and that’s okay. And just like everything else, it’s perfectly okay to mix and match things. Depending on your goals, different surgeries will be available to you.
For transmasculine folks, you’ve mainly got top and bottom surgery available to you (though there are other surgeries you can get, like enhancing your Adam’s apple). Top surgery may include reducing or removing the breasts, while bottom surgery may include the removal of the uterus/ovaries through a hysterectomy and/or an ovariectomy, and/or the creation of a neopenis through a phalloplasty or a metoidioplasty.
If you’re transfeminine, you have some options, as well. Because HRT doesn’t stop the growth of facial hair, some trans women opt for laser hair removal. If you’re dysphoric about your facial features, you may also be interested in facial feminization surgery. There are also top surgeries available to you (if you’re not on HRT, or haven’t experienced the breast growth you’d like), and bottom surgeries, such as the creation of a neovagina and the removal of the testes.
Generally speaking, gender-affirming surgery has more hoops to jump through than HRT does – while the specifics may vary, most surgeons will require a letter from a therapist, and proof that you’ve been living as your preferred gender for at least a year (such as being on HRT, or presenting publicly as your gender). Additionally, many insurances consider these surgeries cosmetic rather than gender-affirming, which means that even if they cover other gender-affirming care like HRT, they may not cover your surgery.
If you’re considering surgery, make sure to carefully research your surgeon (if you’re in the DC area, I can’t recommend Dr. Ramineni at District Plastic Surgery enough – he’s extremely kind and professional, and very experienced in working with trans patients). Ideally, they should have a gallery on their website with before and after photos, so you can determine if their work is right for you. It’s also a good idea to read their reviews and, if possible, speak to other people who’ve seen them (Reddit and other forums are a great way to research local surgeons), to find out how their bedside manner is. Don’t jeopardize your surgery results with a rude or dismissive surgeon.
3. Voice Training
A lot of trans people pursue voice training – typically transfems, as estrogen doesn’t raise the voice, but it’s also a good option for transmascs who aren’t on testosterone (if you’re transmasc and like to sing, it may be good to pursue voice training if you’re on T anyway, to preserve your vocal range). Services exist to provide voice coaching, such as TransVoiceLessons, but many guides also exist on Reddit and YouTube.
If you’d like to have different physical characteristics (such as a larger or flatter chest), but don’t want or aren’t ready for something more long-lasting like HRT or surgery, there are a lot of other methods you can use to achieve this.
Transitioning Socially
How To Make Your Gender Known To Others
Social transition can mean a lot of things – the workplace, family, friends, college or graduate school, even just going out and about. Being out in one place doesn’t mean you have to be out in another, but it’s important to note that sometimes the lines between these things might blur (e.g., a friend who you’re out to might ask for you at work by your preferred name, not realizing you only go by your birth name there). If there are people you’re not out to, make sure the people you are out to know that there are situations where using your old name and pronouns is more appropriate.
Of course, keep your safety in mind – you don’t have to come out to anyone you don’t want to, but especially don’t feel obligated to come out to someone you feel would create an unsafe environment for you. If you weigh your options and decide it’s necessary for you to come out to them, make sure you’re in a safe environment (for example, if you’re worried about them having a volatile reaction, aim to have the discussion in public) and have people that you can rely on if the situation turns sour.
That being said, we’ve laid out some tips for a smooth social transition:
1. Coming Out
Coming out is difficult – even if you know someone is (or would be) accepting, it can still be a lot. How you go about it is up to you, in the end. Whether you sit someone down and explain your feelings in depth to them, or just say, “Hey, I’ve figured out I’m a girl. My pronouns are she/her now, and I’m going by Maeve,” or even go big and throw yourself a gender reveal party. You might tackle it one person at a time, or send out a mass email (heck, when I got tired of contacting people individually, I just made a new Facebook profile and let people come to their own conclusions). Whatever works for you! Just remember to set clear boundaries, such as if you’re going by a new name and/or pronouns, if there are people you haven’t told yet, and whether or not you’re open to questions about your identity at the moment. If you’re someone who’s shy, check out our tips on how to communicate with confidence.
If you’re feeling intimidated (or just overwhelmed by the sheer amount of people you want to come out to), don’t be afraid to ask others for help – while I came out to my immediate family and friends myself, I asked my grandma to tell my great-grandpa for me, for example. If your workplace has an HR department, you can ask them to send out an email updating everyone on your new name and pronouns.
Also, if you plan on being out to everyone you interact with, make sure to update your social information accordingly – display names, email signatures, voicemail, etc. This will keep everyone on the same page, and prevent yourself from being accidentally outed to new people you may meet later in your transition.
2. Correcting Others
Even if they’re well-meaning, people can make mistakes. While it can feel tedious, it’s recommended to correct people whenever they use the wrong name or pronouns – otherwise, they might get into the habit of using them because they think you don’t mind.
Some people might spiral or degrade themselves when you correct them – often, they mean well, but it can be a bit grating, especially when it veers into self-victimization. Try and handle them with compassion, but don’t be afraid to be firm and move the conversation along. If they start over-apologizing, it’s best to simply reply with something like, “It’s okay, I’m not mad. I’m just reminding you. Anyways…” and carry on where you left off.
If you feel comfortable, asking friends or other allies you may have to help correct people is a good way to reinforce things without overextending yourself. If someone misspeaks, another person stepping in with something as simple as, “Oh, you mean Tyler?” or “Yeah, I think her art is great,” can work wonders, especially as it can show people who are more resistant to gendering you correctly that other people aren’t on their side.
Transitioning Legally
Name Changes & Gender Markers
Legal transition can have its pros and cons – obviously, having a driver’s license with your preferred name is great (especially if you don’t want people knowing your deadname), but it can be a pretty tedious process, so some people tend to either delay it or forgo it altogether.
A legal name change can vary a lot by state, and even by county – it’s best to look up your county’s name change proceedings, but generally, if you go to your county courthouse, they’ll walk you through the process. Typically, they’ll have you fill out a name change form, and assign you a case number and hearing date. Your case file may be public by default, but the court may allow you to make a motion to impound (make the file private). You’ll go to the court on your hearing date and speak to the judge, who will approve or deny your request. Once your request is approved, ask for copies of your Order For Name Change. Nothing changes automatically, so you’ll have to go through the process of individually changing your name on your Social Security card, driver’s license, and so on. These might come with a small fee.
Note that some places require your name change to be publicized – i.e., they’ll print it in a newspaper. If you feel that this would put you in danger, make this known to the judge, and they may be able to make a compromise with you.
Gender reassignment can be a little trickier – some states, like Illinois, allow you to simply change the gender on your birth certificate by signing a statement affirming your gender, while other states require a signed statement from your healthcare provider asserting that you’ve undergone clinical treatment for gender transition. If you’ve already gotten your name changed at this point, you can often submit your Order at the same time, and they’ll be able to issue you a corrected birth record.
Note that changing your legal gender can make certain medical procedures more difficult – for example, some insurances may deny someone who is legally female coverage for a prostate exam, or deny those who are legally male prenatal care. Make sure to take this into account when considering changing your legal gender.
That’s it for our guide on how to transition as an adult. Good luck out there!
