- Change your name, pronouns, and wardrobe to reflect your true self.
- Start hormone therapy to give you some curves and smooth out your skin.
- Consider getting gender-affirming surgery if it’ll make you feel more confident in your body.
- Insurance will pay for most gender-affirming care if your doctor prescribes it.
Hormone Therapy
Find out what your insurance covers. Because of Federal laws, insurance plans are supposed to cover medical care for transgender people. However, some plans require you to send in a letter from your doctor stating that your treatment is medically necessary. Check your insurance benefits or talk to your insurance provider to find out what they cover. If your insurance requires pre-authorization, ask your doctor to fill out the template, then send it into your insurance. If you get insurance through work or school, you may need to ask your employer or school to remove exclusions against transgender treatments before you can get coverage. Send this letter to your employer or school if you need to get your medical treatments added to your insurance benefits.
Make an appointment with an experienced doctor. Look for a doctor who’s treated trans patients before or who regularly prescribes Hormone Replacement Therapy (HRT). Check the doctor’s website if they have one to see if they help people transition. You could also look up their medical license on the Federation of State Medical Boards. At your appointment, talk to your doctor about your health history and your fertility concerns. Your doctor will explain all of your options to you to help you pick the right treatments for you. Medically speaking, you can start hormone therapy as young as 16 years old.
Ask for a diagnosis if you need one for treatment. Some doctors only provide gender-affirming treatment if you have a diagnosis of gender dysphoria from a psychiatrist. To get a diagnosis, visit a psychiatrist with experience treating LGBTQ+ individuals. Then, you can take their recommendation to your primary doctor or endocrinologist. Gender dysphoria does not mean that you are diseased or broken; it simply means that you are not content with living as your assigned sex. HRT's purpose is to make you more comfortable with your body. The hormones will alter your body to align with your gender identity.
Freeze your sperm if you plan to have biological kids. Hormone therapy may reduce your fertility or cause infertility. Even if you stop hormone therapy, your fertility may not return. Fortunately, you can still have a child if that’s important to you. Talk to your doctor about freezing some of your sperm so that you can have a child when and if you’re ready. This process is called sperm cryopreservation. It’s a super easy process where you masturbate to produce sperm. After that, you’ll pay about $100 to $500 a year to keep your sperm frozen.
Choose which type of treatment works best for you. HRT for MTF transitions includes exogenous estrogen to enhance feminine features and anti-androgens to reduce masculine features. You have several options for undergoing HRT, so pick the one that’s right for you. You’ll pick whichever option is easiest for you to use. HRT comes in the following: Pills Creams Patches Injections
Expect changes to your skin, hair, and body shape in 3-6 weeks. After you start HRT, your skin will feel smoother, and your body hair should start thinning out. Additionally, you’ll start to grow breasts and develop a curvier physique. At the same time, you might notice your testicles shrinking, and you could have erectile dysfunction. Look for changes in about 3 months, though the full effect will take 1 to 3 years. There are some risks to HRT, including blood clots, gallstones, weight gain, elevated liver enzymes, heart problems, high triglycerides, high blood pressure, and diabetes. Whether and when to take HRT is a deeply personal choice. Take hormones once you've fully researched your options and feel that hormones are a positive next step for you. Additionally, make sure you’re okay with the fact that the effects may not be fully reversible.
Work with a therapist who can support you through the process. Transitioning isn’t always a smooth process, but you don’t have to go through it alone. A therapist can help you cope with difficult moments and decide which treatment options to choose. Pick a therapist who validates you and who makes you feel comfortable enough to open up. Most therapists include their specialties on their websites, so look for a therapist who lists LGBTQ+ issues as a treatment option.
Surgical Treatments
Find a reputable surgeon to help you transition. While surgery could really improve your life, it also comes with big risks. Play it safe by going to a qualified surgeon. If you can, visit a hospital that has a Gender Services Program with surgeons who focus on gender-affirming care. If that’s not possible, find a board-certified physician for each surgery you plan to get. You can check board certification here. TransHealthCare.Org has a database of gender affirming surgeons that makes it easy to find a reputable surgeon near you.
Consider voice feminization surgery if it’ll help your confidence. Your voice probably sounds great, but it might not be how you envision yourself sounding. If that’s the case, a surgeon can shorten your vocal chord to give you a higher pitched voice. Before the procedure, your doctor will ask you to work with a vocal coach to make as much progress as possible without surgery. This procedure usually costs around $7,000 and is usually not covered by insurance because it’s not medically necessary. It takes about 6 months to recover from voice feminization surgery. The main side effects of vocal feminization surgery are the shortening of your airways, which can make it harder to take deep breaths.
Have a tracheal shave if you want to reduce your Adam’s Apple. During a tracheal shave, a surgeon will numb your neck, then gently remove some of the cartilage that makes up your Adam’s Apple. You’ll be awake the whole time, but you won’t be able to feel it. After your procedure, stay upright as much as possible for the next 3 to 4 weeks so that your neck heals properly. A tracheal shave typically costs between $3,000 and $4,000, and it’s usually not covered by insurance. Your swelling will improve after about 3-4 weeks, but it usually takes about a year to see your final result. You don’t really need a tracheal shave to be a woman, but it might make you feel more confident. You could experience some side effects, including swelling, bruising, scarring, infection, voice changes, and changes in swallowing.
Feminize your face if it boosts your confidence. During facial feminization surgery, a doctor will smooth and reshape your forehead, brow, chin, and jaw. Additionally, they’ll do a tracheal shave to reduce your Adam’s Apple and may lower your hairline. Afterwards, your face will have traditionally feminine features. Expect your surgeon to put you under general anesthesia, and you’ll likely stay in the hospital overnight. Some insurance companies will cover facial feminization, but it’s usually not medically necessary. Without insurance, it starts at around $8,500 but often costs more. It usually takes 2-3 weeks to recover from this surgery. Hormone Replacement Therapy (HRT) generally facilitates around 70% of the feminization process. However, due to the aggressive impact of testosterone on the facial bones, surgical intervention may be advisable to reverse features such as a prominent brow bone, closely positioned eyebrows, and a strong jawline. Although some women naturally have these features, transgender women often face greater challenges to pass as female after exposure to testosterone.
Get a breast augmentation if you want bigger boobs. Breasts come in all shapes and sizes, so there’s no need to get implants. At the same time, you might feel more confident with a curvier physique. Visit a plastic surgeon if you’d like to get breast implants. Typically, your surgeon will perform your surgery under general anesthesia, and you’ll get to go home the same day. Breast augmentations are usually covered by your insurance, as long as your doctor confirms it’s for gender-affirming care. If you don’t have insurance, it starts at around $2,000 but could be higher. After top surgery, you may experience pain for 4 to 5 days, and it’ll take 2-3 weeks before you’ll be able to lift your arms more than 90 degrees. Although the procedure is generally safe, no surgery is without risk. After a breast augmentation, you might experience discomfort, scar tissue, changes in nipple and breast sensation, infection, changes in implant position, or implant leakage or rupture.
Get your testicles removed to fully stop testosterone. During a procedure called orchiectomy, a surgeon removes your testes and leaves your penis intact. Once your testes are gone, your body won’t produce testosterone anymore, which can make it easier to transition. Your surgeon will give you a choice between general or local anesthesia, and you can usually go home the same day. An orchiectomy is typically covered by insurance. Out of pocket, it usually costs between $5,000 and $8,500. It takes 2 to 3 weeks to recover from an orchiectomy. While it’s generally a safe procedure, you might experience some side effects. These include low sex drive, low muscle mass, fatigue, depression, hot flashes, erectile dysfunction, and osteoporosis.
Decide if vaginoplasty is right for you. For some trans women, it’s empowering to have a vagina. During vaginoplasty, a plastic surgeon transforms your penile and scrotal tissue into a vagina, clitoris, and labia. You’ll be able to have sex and orgasms after your surgery, but it’s not reversible. If you decide surgery is right for you, expect your surgeon to do it under general anesthesia and plan to stay in the hospital for at least 3 days. Fortunately, a vaginoplasty is typically covered by insurance. If you pay out of pocket, it usually costs between $6,000 and $9,000. It’ll take about 3 months for you to fully recover from your vaginoplasty. There are a few risks to having vaginoplasty. You might experience nerve damage, vaginal stenosis, a short vaginal length, or a fistula. Additionally, you might not like the appearance of your new vagina.
Coming Out
Tell family and friends you trust. How and when you come out as transgender is totally up to you. When you feel ready, open up to someone you trust to be supportive. From there, you can start telling friends and family as you feel ready. It’s totally okay to tell some people and not others. Do what feels right to you. “I have something I’ve been wanting to talk about. You might have noticed how I’m really into fashion and love hanging with the girls. That’s because I’m really a girl, and I’m ready to start my transition.” “I feel like I can really trust you, so I wanted to tell you something really personal. For a long time, I’ve known that I’m really a woman. Now, I’m ready to start presenting my true self to the world, and I hope you’ll be there for me as I transition.”
Give people time to accept your truth. We know that you’re amazing, and your friends do, too. At the same time, they might need some time to adjust to the changes up ahead. For some people, it might feel like they’re losing the old you—at least at first. In time, they’ll hopefully realize that this is who you’ve always been on the inside. Spend more time with the people who already accept you so that you have support. Sometimes, people just need time to think. You might be surprised by how supportive your friends and family become after they’ve had time to process everything.
Make friends in the LGBTQ+ community. There’s one place where you can always find someone who understands you—the LGBTQ+ community. Connect with people online, or attend local meetups to meet people in person. Lean on these friends when you need advice or when you want to celebrate being awesome just the way you are. If you’re still in school, see if there are any clubs for LGBTQ+ folks and their allies. Try meetup.com for groups that meet in your area.
Build yourself a support system. Even though transitioning is exciting, it’s also hard at times. Unfortunately, you’re probably going to have to deal with people who aren’t accepting of you, and you might even lose some friends. You don’t have to go through any of these things alone, though. Ask the people who love you most to be there for you when you need support. Sometimes your chosen family is more important than the one you were born into. Losing friends is painful, but you’ll make new friends as you transition. Best of all, these new friends are going to love you as you are.
Come out at work when you feel ready. Start by talking to a trusted coworker who can act as your ally. From there, talk to human resources and your supervisor. As you feel comfortable, tell your coworkers one-at-a-time or in small groups. Remember, you don’t have to tell someone if you don’t want to. If you start a new job after your transition, you don’t have to tell anyone that you’re trans unless you just want them to know. If your deadname is still your legal name, HR will need it for payroll and taxes, but they’re supposed to keep that confidential.
Social Transitioning
Change your name if you want. You might like to keep your current name, and that’s totally alright. At the same time, a new name might better reflect your gender identity. Choose a name that fits your personality and feels right for you. You might draw inspiration from your family names, or pick a name that starts with the same letter as your current name. Gender neutral names like Alex, Sam, Taylor, Blair, and Harper might be comfortable if you’re more androgynous.
Ask people to use your correct pronouns. You probably prefer she/her pronouns, or possibly they/them. Tell people which pronouns they should use for you so you’re correctly gendered. If people make a mistake, remind them of your correct pronouns because it’s not okay for people to misgender you. “Hi, I’m Amy, and I use she/her pronouns.” “I’m Alex, and my pronouns are she/her/they/them.” “Actually, it’s ‘she’.” “It sounded like you said, ‘he’. My pronouns are she/her.”
Wear outfits that make you feel confident. It’s time to wear clothes that express who you are. There are so many ways to be a woman, so throw out any “rules” you think you have to follow. You might be a woman who wears dresses and heels, or you might be a woman who prefers slacks or T-shirts. Pick clothes that make you happy. Look at what girls or women your age are wearing to get inspiration for your own looks. Wearing a padded bra can help you have a curvier figure.
Pick a hairstyle that fits your personality. Getting a great haircut can help you really feel like yourself. Remember, women can have any hairstyle—short, long, curly, straight, textured, shaved—anything goes. Show your stylist pictures of the haircut you want so they have an idea of how you want to look. Then, rock your new ‘do! If you prefer short hair, you might get a pixie cut or bob. If you’re growing out your hair, bangs or layers can make your style look more feminine.
Wear makeup if it makes you happy. Many women enjoy wearing makeup, and you might be one of them. If so, try out different colors and products to see which ones you like. Additionally, try these makeup application techniques that work great for trans women: Opt for matte foundation and powder because they’ll create a more even texture. Apply peach or orange concealer on dark spots and over your beard shadow. Use highlighter under your eyebrows and on the sides of your nose for rounder features. Pick a shimmery blush to add a little glow to your skin. Blend an eyeshadow the same color as your hair around your hairline to round it out.
Change the pitch of your voice to sound feminine. Experiment with your voice to find your feminine pitch and tone. To do this, speak in the highest voice you can, even if it sounds squeaky at first. Practice talking in your highest pitch to train your voice and change your vocal range. If you can, work with a vocal coach to change your pitch and communication style so you sound more feminine. Try these free voice exercises to help feminize your voice! Altering your voice takes patience and practice. It could take years to get the tone and pitch you want, but you’ll definitely see changes along the way.
Update your ID and legal documents if possible. Your legal options depend on where you live, but you likely have options for changing your name and possibly your gender marker. Check the laws in your area to find out what you can do. Then, start the process of legally changing your documents. If you live in the U.S., LGBT MAP can tell you the policies in your area. If you can’t afford to change your name, the Transgender Legal Defense & Education Fund may be able to help. They provide free legal assistance to low-income trans and non-binary folx.
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