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How can I help my trans partner with a medical transition?

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myself5 asks:

Okay, so I'm a female high school junior. There's this girl (sweet, geeky, smart, funny, the works) that I may soon be starting a sexual relationship with. She's trans and just started taking hormones. Currently she's male, but eventually, her "outie" will become an "innie," so to speak. I've heard mixed things about this surgery, and I don't know if she'll be able to feel things the same way afterward. She's very sexual, and obviously I want to be able to do stuff with her, so this is a big concern. What will the aftermath of the surgery be like? What are the risks of the procedure? What can I do to help her get through this?

Heather Corinna replies:

Our sexuality is about so much more than our genitals. Our genitals are actually one of the smallest parts of our whole sexuality and our sexual response and experience, believe it or not.

Without our brains (and everything that goes on in them), our neurological, cardiovascular and endocrinological systems, our genitals would be a non-issue when it came to sex. The sexual effects we feel in our genitals are because of what's going on with the larger systems of our body and in our minds. Our sexual response and our experience with sex is also very strongly influenced by our emotions and our psychology: by how we feel about ourselves, our sexuality and ourselves and our sexuality in relationship with others, gender identity absolutely included. Male, female or intersex genitals also aren't really as different as most people think: they have similar drivers and in utero they were even the same for a many weeks. All of our parts started from the same stuff, they just developed differently. But whatever our genitals and whatever our gender the central systems that drive our sexuality are very similar and are primarily not genital. People also feel differently about their body parts, and so there's no one thing that every trans person (or any cisgender person) will like, want, dislike, or not want.

For trans people who are physically and/or mentally transitioning their bodies, the closer they get to an embodiment that feels more true to their gender identity, the more comfortable they usually feel in their sexuality in the long run. The feeling of right embodiment carries more weight than physiological changes which occur via genital surgery. It's just that the long run can be a really long run.

Hormone therapies, counseling, coming out to friends, family and community about being trans, voice coaching, hair removal, physical surgeries (like orchiectomy, vaginoplasty, clitoroplasty, facial feminization and breast augmentation surgery), managing the tremendous financial cost of a transition (especially if at some point her parents are unwilling or unable to pay for those costs) and the whole process of medical transition is a seriously long haul, and in many ways is not at all easy. You can be sure that most likely her experience of her body, sexuality, and sex will change throughout her transition. Many people feel a sense of relief as their bodies, minds, and attitudes change, but they still need to, in many ways, relearn their bodies and figure out what they want and like, both for themselves and with any partners. In other words, it's often a mixed bag, especially while all of a transition is in process, and it's a long process.

If she enjoys sex and her sexuality now while she still has male embodiment, then if she is trans feminine she's likely to still enjoy it after her medical transition. Potentially she may even enjoy it more. If medically transitioning is the right thing for her, she is most likely to experience it as a positive in all areas of her life.

If she has just started hormone therapy, she's a long way off from genital surgery. Many trans people also never have or choose genital surgery, so this may or may not even be an issue for her. I'd say that right now, you're putting the cart before the horse, and perhaps don't realize that genital surgery will not be the only thing which may or will likely impact her sexuality.

The best way to be an ally and a support to anyone often starts with questions like "How can I support you?" or "What do you want and need from me in this?" Then you listen to the answers and respond accordingly. It's also a good idea to try and be prepared even for answers you might not expect, or might need to process yourself. For instance, she may say that one way you can help is not to focus on her transition this much or to focus on what her transition means for her genitals or for what you want in terms of her sexuality. Her answers may challenge you in ways that could show that some of how you can help isn't so much by being there for her, but by adjusting your own thinking or working through your own feelings and fears. Those are also questions you keep on asking, since the answers may well change, and continuing to ask lets someone else know you're continually receptive.

There are many stages of transition which you two are going to be dealing with if you're a couple, all of which can or may impact her sexuality and your sexual life together: it's not like genital surgery is the only thing which will potentially bring about changes. Andrea James has a transition timetable on her site here that can give you an idea of what I'm talking about. She also has a link to the current standards of care for transitioning here. We also have a piece at Scarleteen on the whole sphere of transitioning here.

For example, hormone therapy is no walk in the park. Many trans people describe hormone therapy and much of their transition as feeling like going through puberty all over again. While that is a wanted process, that doesn't mean it's a comfortable or pleasant one. As a young person, you're still in puberty, so I don't need to remind you what that process can feel like. Her estrogen and/or anti-androgen therapy will likely have an impact on her sex drive or how she's sexual (both do often decrease sex drive), but it's tough to say what impact it will have or to talk about that impact as "feeling" more or less. It may make her feel less sexual, especially on days when she just doesn't feel well from the side effects. It may make her feel more sexual. When it comes to physical sensation, things will probably feel different (rather than more or less) in some respects, but it's tough to say how because that's so individual. Any of those changes are possible and may be constants or shift from day to day. One thing about the process of medically transitioning is that there are effects from the hormones, but then each person's brain will respond to them a little differently. Hormones can also affect how people's genitals respond and work sexually, so often times people will need to learn their bodies all over again for themselves, along with how they want to interact with any partners they might have. As well, ash she continues with hormones, how the different hormones make her feel about herself -- not physiologically, but psychologically - can create all kinds of changes, including with sexuality.

Before genital surgery she will also deal with the social and interpersonal parts of transitioning: that's no less huge than surgery. Beyond managing reactions from family, friends and others, given that there are certainly some downsides in our culture to being seen as feminine she may also start to experience some of the not-at-all-beneficial parts of being female -- like being objectified, hypersexualized or sexually harassed or threatened -- that may impact her sexuality, too.

Rather than putting your focus on what things might be like many steps down the road (potentially even after you two are no longer an item), I'd suggest keeping your concerns in the now. How is she feeling with the hormone therapy now? How is coming out going for her? How is she feeling about her sexual identity and sexual orientation? If she's dating you, she may just now be identifying as lesbian or bisexual and experiencing how others can treat you when you do, especially when you're also trans. How is she feeling now about her penis? For example, some trans feminine women are okay with their penis being treated as a penis, while others aren't okay with that. Some won't want to engage their male genitals in sex at all, others will want partners to treat it them as if they were female genitals. What does she even like a partner to call her genitals or other body parts right now? How we name our body parts and think of our body parts can make a huge difference in how we experience ourselves sexually, either solo or with a partner. And how she feels about things like this may be one way this month, but a different way the next.

Communication is important in any relationship, but since she's going to experience a whole host of changes -- physical, psychological, emotional -- it's even more important for you two to stay in good communication. If you two do become sexual partners, the way that she is sexual with you next week may not be the way she wants to be sexual with you next month or next year, and that will likely have more to do with how she feels as a person and how she feels about her gender identity than about the results of genital surgery.

Just so you know, if she has genital surgery and it is done by a competent and skilled surgeon, she is likely to leave that surgery with genitals that are fully sexually functional (though not reproductively functional). Surgeons all vary in their level of skill, and people also all heal differently from surgeries. Horror stories you have heard about genital surgery have likely either been based in bias about trans, or may have been addressing a lower quality of genital surgery than is ideal. Not everyone can afford or access a great surgeon or quality healthcare, after all, and some trans people will feel that a possibly substandard surgery beats no surgery at all.

ANY surgery of any kind carries risks, all of it requires time for healing afterwards, and error can always be made. But I'd not frame SRS or genital surgery differently in your mind than you would any other. For sure, the body parts being operated on may feel more personal than, say, having your appendix out. But surgery is a process, so trans people who are seeking out surgery have a lot of time to do research, consider their options, learn about the risks and benefits, and also just think for themselves about the bodies they want and need. She may have sexual side effects from surgery, or may experience her body sexually much differently than she did before surgery. But, again, our sexual experience does not tend to primarily be about our genitals alone.

It's tricky to look at studies on the sexual outcomes of SRS, and relatively little study has been done in the first place. Much of it which has is very heterocentric and phallocentric (often defining sex as penis/vagina intercourse only), doesn't tend to address patients' sexual experiences before surgery, and can sometimes seem to be trying to simplify sex to nothing but the physical, which we just can't accurately do when addressing sexuality and sexual experience.

But what we do have to look at shows us that despite a wide range of outcomes, overall, most who have had SRS report they are happy with their SRS results and feel that SRS has greatly improved the quality of their lives. Few regret their surgeries. Many trans women are able to reach orgasm and enjoy sex post-operatively in time. In the data I've seen, the percentage of trans women post-surgery who report being unable to reach orgasm through intercourse (again, this is usually the sexual activity they're asked about) is about the same or greater as the number of cisgender women who have never had genital surgeries who can reach orgasm that way. In these studies (Green, 1998, Lawrence, 1999, Blanchard et al, 1987) when patients have been anorgasmic (unable to reach orgasm), they usually attributed that to body image issues, rather than to functional problems with their genitals. And even when patients had trouble reaching orgasm, they often reported an increase in sexual satisfaction. Orgasm isn't all there is to being sexually satisfied, after all, just like the genitals aren't all there is to sexuality.

Whether or not sex is satisfying for trans women post-SRS clearly just has more to do with psychological issues -- and may also involve the impact of hormone therapies, which will need to be continued -- and with the whole sphere of who they are than the physical results of surgery as far as the function of reconstructed genitals. As well, these surgeries are improving with time, so I'd expect a study done on patients in 1987 to net different results than one done on patients from 2007. In addition, younger trans people tend to have an easier time of all of this overall than older trans people do.

My experience is also that trans individuals can be better than the rest of us at working out mutability when it comes to sex, gender and the body. To be clear, many trans people often have figured out how to have a sexuality and a self within a body that doesn't feel right to them, which is more than we can say, for instance, about a lot of cisgender women with body image issues. I think it's safe to say that many trans people are better at evolving in many ways than those of us who aren't trans. That isn't to say that those trans people they have usually felt as good as they could have in every stage: rather, what I'm saying is that most are already used to making many adaptations in their lives and the way they think about themselves and their sexuality and are often better equipped to handle a big change to their sexuality and body than most of us who have not experienced life as trans.

It sounds to me like you're all set to be a supportive partner to her, which rocks. Lacking care and support is something that is FAR more likely to result in big negatives than hormones or surgery.

Just know that it's also okay for you to have your own issues, which you probably will. Make sure you're taken care of in this, too, especially if your relationship becomes serious. It's important she feels supported, but the same goes for you. Be sure that you have other supports besides just her. After all, during some stages of her transition, since she's the one directly impacted and this is ultimately (and needs to be) about her, she just may not be able to be fully there for you. So it's also vital that you have other means of support outside this relationship, just like it is in any relationship, especially when big changes are afoot.

Considering being with someone through a transition is a pretty big deal. Partners of trans people sometimes need support, too, as they're supporting their transitioning partner. So many changes happen on so many levels -- emotionally, physically, sexually --that it can sometimes feel like a lot to take in or try to understand and support. It can be pretty emotionally loaded for everyone involved.

I think it's important -- especially as someone young, for whom this and all romantic/sexual relationships are new -- that you recognize both of you also have the right to consider this relationship just like you'd consider any other. In other words, you still get to figure out over time if this is a romantic relationship you want to be serious and long-term or not. It doesn't sound like you've even started the sexual part of your relationship yet: not everyone is sexually compatible (regardless of sex, gender identity or orientation) and not every two people who want a sexual relationship find that that's the right one for them to be in together once they give that a whirl. And if you find that you two aren't a good fit in that way, it may well have nothing to do with her gender or her transition at all.

You both still get to feel the whole of your relationship out as it goes, based on all its merits, and see how it fits you. You both still get to make any adjustments you may need to as time goes by. I say that because if and when either of you has conflicts or issues or if the relationship as a romance isn't turning out to be what you each want, you (or she) might feel like considering not being in a romantic or sexual relationship means a rejection, an abandonment, or a bias. But it doesn't have to be that way, and just because she's trans and is starting her transition, that doesn't mean every or any issue you may have in your newly-growing relationship is, will be or must be about her being trans or about her transition. And if you do have issues or conflicts, it'd be wise for both of you to do your best to bear that in mind.

I know I've given you a lot of information here, and talked a lot about the challenges you both may face. But I also want to make clear that most young adult relationships of all stripes tend to involve some big transitions: after all, people of all genders tend to go through big identity changes in their teens and twenties, and most young adults deal with huge changes in relationships or the people they're in them with one way or another. In some ways, this is likely to be easier on both of you than it would be ten or twenty years from now. It sounds like you really like this girl, and also sounds like you're open to and supportive of her transition right from the start. That's awesome. You walking into a relationship not only at a time in your life when change is a constant no matter what, but with her transition a given at the gate are both likely to be big boons for each of you. I hope whatever develops with this relationship over time, or whatever it develops into, that it's great and beneficial for her and for you.

I'm going to leave you with a few more links, both at the site here and elsewhere. All my best to you both!

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