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Male-to-female transition: Primary considerations
The following items are the most important areas to plan when figuring out a general transition timetable. (Women who transition early in life have a few slightly different issues, but the following basically applies to anyone.)
Note that only about half the things are physical aspects. Many make the mistake of thinking transition is about a physical change. That is only a small part of it.
Research is essential. The more you know, the better you'll do. That's why I've done this whole site. Look into as many books and films as you can. Get information from gender organizations. Look through the Standards of Care (SoC) which many helping professionals use when treating women in our community. Get advice from those in your area who are successful. Write letters to people whose websites or newsgroup posts impress you. Knowledge is power.
The internet has been one of the most important developments in the history of our community, by offering an easy way to collect and disseminate information from a scattered population. However, it's important to consider internet safety issues that can lead to your being outed or can come back to haunt you many years after you've completed transition.
Self-acceptance is the most difficult part of transition, and the first thing you must begin working on. Many women find therapy can help them sort out their emotions and accept them. It will help you determine how important this is to you. Most women have fantasies or misconceptions about transition at the onset. Therapy can help you prepare for the realities of transition, and how to handle both the pleasant and unpleasant parts. The key to all of this is feeling good about yourself. You are going to take a lot of blows to your self-esteem as you transition. You must have a way to deal with these. Starting a therapists relationship early will also make it easier to get an therapist's letter when you are ready. You may also need to work out how your spirituality and religion fit with your feelings.
Coming out to family and friends is an extremely personal issue. Everyone will have different challenges with this, and it's important to think very carefully about when and how to tell people about how you feel. For young women who live at home or are financially dependent on their parents, this is the most critical step in your transition and must be planned out very carefully. For older women, it's still important to do this early on, I feel, especially if you are married or in a serious relationship. You owe it to your partner to let them know what's going on. You may lose them because of this. Some women do, but certainly not all. However, despite the fear of losing your partner, it's unfair to them to keep something like this from them, since it will affect their lives almost as much as yours in some cases. Talk with your therapist about your specific family issues.
Employment is an absolute must. You must decide early on if you will transition in place or not. I believe the best thing to do is transition at a job or in school, and if you want to move or leave, do so after all your legal and financial records have been changed. You can basically start with a clean slate, and you don't have to deal with all of that as well as moving and interviewing. If you work in a position historically known for firing women in our community (i.e., military or schoolteaching), you may want to leave NOW for a job at a more accepting company. The key is to maintain enough revenue to cover transition costs, no matter what. I recommend not coming out at work until absolutely necessary.
Financial issues: Transition is very expensive. Most women spend tens of thousands of dollars by the time they're done with everything. For this reason, your timetable must be made after carefully laying out your spending plan. Insurance can be of help, but there are often limits to what is covered by your policy. You must have a realistic financial plan in place.
Legal issues: You will need to start looking into this sooner if you're married or own a business. You may be facing a divorce and/or custody case. If you work for a company, I recommend discussing your employment situation with a good anti-discrimination lawyer prior to starting. This can give you a good idea of how to ensure against being fired or help you gather evidence if you're forced to file a wrongful termination suit. Keep in mind many transsexuals lose such suits if they're based on discrimination, so don't count on a big settlement to carry you through if you're fired. Seeking legal advice should be done as a way to avoid being fired. I also recommend getting your legal name change and Social Security switched immediately before coming out at work. This will allow them to process your name change quickly after you come out. Often they won't begin until they have certain types of legal documentation.
Choosing a name may sound like a pretty easy thing, but it's something you need to consider carefully before committing to it legally. Your choice can affect your ability to be accepted as female and can even make it easier to be outed long after you're done with transition.
Hair removal, particularly facial hair removal, is one of the most time-consuming, and in some cases the most expensive, parts of transition. It is vital to begin as soon as possible in transition, and those who desire to be accepted as female should consider permanent hair removal rather than temporary methods. I strongly urge you to have as much permanent facial hair removal as possible completed prior to going full-time. At the very least, you should be clearing your face with one weekly session that can carry you to the next session. Once you're full-time, it gets harder and harder to deal with facial hair. Ask anyone. They'll say they wish they started sooner.
Voice is one of the most neglected parts of successfully blending in as female. I am constantly amazed how few people have decent female voices. It's such a dead giveaway. Luckily, getting a voice down can be quite cheap. I spent under $100 on voice stuff, and I never get clocked on the phone. Voice practice is time-consuming and requires a serious commitment over about 6 months. You may require work with a voice therapist for adequate results. However, it's something you can do well in advance of transition without affecting your old voice whatsoever.
Hair (the kind on the top of your head) is something you also may need to think about. If you don't have recession, you should begin growing it out as soon as possible, since it takes a long time. If you have some recession, you may want to consider correcting it surgically. If your hair loss is moderate to severe, you must determine how to deal with that through wigs or hair systems. If you decide on a hair replacement system, spend the extra money for the highest quality.
Hormones tend to be overrated in terms of the ability to help you be accepted as female. Most of the effects are welcomed: better skin, redistribution of body fat and softening of facial features, emotional changes, stoppage of scalp hair loss, reduction of body hair. However, most of these are gradual and basically subtle. Hormones aren't a magic pill that will transform you. They will not improve your voice or lessen existing facial hair. The key is hair removal, voice, and face. You should carefully consider your reproductive options prior to getting an orchiectomy or starting hormones, since they can both render you permanently sterile.
Facial feminization surgery (FFS) can be expensive, even more than vagninoplasty, but it can make much more of a difference in your daily existence than genital work ever will. Vaginoplasty will do nothing to help you be accepted as female on a daily basis. If your face or hairline is too masculine to allow you to blend in as female, I would strongly urge you to consider facial surgery before even thinking about vaginoplasty. Having a female face will make a major difference in the quality of your life. It will improve many aspects, from walking down the street without getting clocked, to employment issues, and in social/intimate situations. In my case, I feel face surgery was easily the most important investment of my entire transition.
Accessories: Earrings, long painted nails, makeup, and feminine clothing shouldn't be done until you're full-time. It will not make people more accepting of you to give them hints like this. Wait until you're ready to go full-time. People will notice, and you may get outed sooner than you're ready. It seems as if people who do those things early on want to get busted. This is a very risky thing to do unless you're ready to face the consequences.
Full-time is usually most successful when you've done as much preparation as possible (i.e., everything above). It also makes it easier for others to accept if you've obviously put thought and effort into transitioning.
Vaginoplasty shouldn't be a major concern until you're full-time. While it's wise to research this before going full-time, you will need to be full-time (and probably employed) to get therapist's letters and pay for the procedure. Genital electrolysis is often recommended for vaginoplasty. Once you've decided on a surgeon, you should check about whether it's needed in your case. This should be started one year before surgery if possible. Labiaplasty is a second part of the procedure used by some surgeons to complete the shaping of the genitalia after surgery by adding inner labia and a clitoral hood, and sometimes making minor cosmetic and functional repairs to the urethra and clitoris. While some surgeons and patients do not feel this step is necessary, others felt they needed to do it.
Breast augmentation is an option some choose, though it is not necessary. There are significant risks you should consider while deciding if it's right for you. Again, this is best dealt with after going full-time and after seeing how much hormonal development you have.