healthcare

In vaginoplasty, which may require multiple surgeries, depending on the surgeon’s preference and your case, your existing genital tissue is creatively recycled into a vagina, set of labia, and a clitoris.

If you’re equipped with a clit and some labia and you’d like a penis (with or without testicles), you’re looking at either a phalloplasty or metoidioplasty. The procedures have different advantages and disadvantages that you’ll want to consider before making a decision.

In this procedure, the surgeon removes the testicles with or without the scrotum. This procedure stops the production of testosterone, which allows patients to adjust their doses of anti-androgens and estrogen.

If you’ve got a uterus and you don’t want one, you’ll be spending some personal time with a gynecological surgeon.

Fun fact: While top surgery is often described as a “mastectomy,” that’s actually usually inaccurate. Many surgeons perform a “subtotal mastectomy,” which involves removing most, but not all, of the breast tissue. This prevents a sunken or fallen appearance after surgery, and makes it look like you have a sweet set of pecs (if you aren’t already sporting them).

After about two years of estrogen, your body will be pretty maxed out in the boob department. What you see is what you get...but if you’re not happy with the look and feel of your breasts, you can explore breast augmentation. There are a huge range of procedures available, broken down by type of incision and implant, and your best option depends on the preferences of your surgeon, your body, and your desired outcome.

Depending on how old you are, where you live, and the specifics of your situation, you may start with “blockers,” also called puberty blockers or puberty inhibitors (or, more formally, GnRH agonists). These drugs do pretty much exactly what it sounds like they do: they block the release of hormones from the pituitary gland, thus putting a pause on puberty.

If you’re a little older, or you feel confident and ready to transition after being on blockers and your doctor thinks it's reasonable to do so, you may start taking estrogen and an androgen blocker if your body would otherwise naturally produce testosterone. You may hear estrogen referred to as a “feminizing hormone” or “female hormone,” which is a term I dislike because you may not necessarily be taking it to achieve a “feminine” body if you’re nonbinary or otherwise gender nonconforming, and lots of people who aren't women produce estrogen naturally. You can just call it estrogen!

If your body is longing to pump out some estrogen and you’d rather it didn’t, your doctor will start you on testosterone therapy. Estrogen blockers are also available, but they aren’t widely used — usually your testosterone will be enough to do the trick. You may also hear testosterone discussed as a “masculinizing” or “male” hormone, but it doesn’t have to be either of those things for you unless you want it to be.

After social transition, many people face the question of whether they also want to pursue medical (hormones) and/or surgical transition. In this post, we’ll be discussing hormones — our following post will delve into the nitty gritty details of “the surgery” (starting with the fact that there’s not just one).