My last blog post was about how I got to where I am today. This blog post is all about what lies ahead for me. It’s less reflective and more factual, and is very much about the physical process of transition and what that involves. I tried to keep it fairly general and not too personal. I hope I got the balance right.
What’s next for me?
I saw my GP in September and requested a referral to a Gender Identity Clinic (GIC). The nearest one to me is in Exeter, so I was referred there.
The NHS services for transgender people are massively overused, so the waiting lists are long. I would have had to wait over a year to even have a first appointment with the GIC in Exeter. After that, it would probably be at least two appointments and another six months before I’d even be able to get started with physical transition.
For this reason, I decided to seek private care in parallel to the NHS so I can get out of my current limbo more quickly. I’m fortunate that this is an option for me financially, and I’m happy to report that I have my first appointment at a London clinic in January.
At that appointment I will hopefully be prescribed hormone therapy, specifically testosterone (usually referred to as T for short—I must do a transgender glossary post at some point) and will be able to start that fairly soon after the appointment. T is usually taken in the form of regular injections, although can also be administered as a gel that is rubbed into the skin.
T will make me go through male puberty. You can google for the specifics of how T changes a female body into something approaching a male one, but the most obvious changes to people who know me will be my voice breaking, and just starting to look generally more masculine (hopefully). I find it totally bizarre and hilarious that I will be going through puberty again at the age of 45, but hey—it’s an original way to sidestep the menopause.
People often ask trans people if they’re going to have ‘The Surgery’. When I get that question I just laugh and say, “Which one?” The process of total gender reassignment from female to male involves a number of surgeries. Also, FYI, most trans people aren’t too comfortable being asked this question—I’m sure you can imagine why if you think about it for a moment. If you’re a close friend or family member you might be able to get away with it, but caution is advised.
The most common surgery for transgender men is top surgery: the removal of the breasts and reconstruction of the nipples/chest to give male contours.
This is the only surgery I know I definitely want, and I want it sooner rather than later, hopefully next year sometime.
Another common surgery for transgender males is a hysterectomy (also referred to as hysto). Once the body is running on testosterone there is little benefit to keeping the female internal equipment. For this reason many transmen have a hysto a few years into transition, if not before.
I’m neutral on this one. I don’t need my uterus anymore. Its work here is done (literally—I have two wonderful humans as living proof). But having it still there isn’t currently a source of dysphoria for me so I will see how things go.
Genital Reassignment/Reconstruction Surgery:
(Also often referred to as ‘bottom surgery’ or ‘lower surgery’)
This is the one that fascinates everyone. I can see why. I mean, how can you make something out of nothing? It’s easier for the uninformed to imagine how you might remove a penis and construct a vagina. Unfortunately the process of constructing male genitals is a lot more complicated, and usually takes not one, but several surgeries. There is more than one method. I won’t go into detail here but it’s a long and difficult process. If you would like to know about the options available the terms to search for are metoidioplasty and phalloplasty. But no surgery will ever create a fully functional penis. The technology doesn’t exist for that yet.
Being transgender involves compromises, but that’s true for life in general. I have to accept that I will never have the body of a natal male. It’s often hard for people to grasp that gender isn’t about what’s between your legs, it’s about what’s between your ears. Masculinity and femininity aren’t defined by body parts. Some transmen choose to have this type of surgery, but many others find peace with their body without the need for more intervention. So here again, I’m keeping my options open and will wait and see how I feel further down the line.
I’d like to finish by pointing out that some transgender people choose not to take hormones, or have any kind of surgery. It’s important to realise that this decision doesn’t make them any less trans than someone who does choose the medical route.
Thank you for reading if you made it this far. I’m glad you’re interested in my journey.