F-M Transsexualism.

The label of transgender male is not interchangeable with that of transsexual male (or female) although the two are often combined or mistaken for the same thing. The difference is that while transgender males identify with the male gender identity, transsexual males may intend to undergo physical changes to align their body with their gender identity. A transgender male is someone whose gender identity is male, but who does not necessarily want to change himself physically

Originally, the term "transmen" referred specifically to female to male transsexuals who underwent HRT and/or surgery. In recent years, the definition of "transition" has broadened to include theories of psychological development or complementary methods of self-acceptance.

Transsexual men may seek medical interventions such as hormones and surgery to make their bodies as congruent as possible with their gender presentation. However, many transgender and transsexual men cannot afford or choose not to undergo surgery or hormone replacement therapy.
Transitioning might involve some or all of the following steps:
Social transition: name change, wearing clothing seen as gender appropriate, disclosure to family, friends and usually at the workplace. Sex reassignment therapy: hormone replacement therapy (HRT), and/or surgery

How to succeed as a transsexual: I believe that the most successful transitioning is if you plan into the future. Plans will inevitably change but it helps to have specific targets.
• Any problems you have now must be faced and dealt with. If you go into your reassignment surgery with problems, then, they are still going to be there afterwards and you are less likely to be capable of dealing with them.
• Your hormones are going to be out of balance, you are going to be far more emotional, more prone to stress, often frustrated at how long things seem to take and the unfairness of it all.
• You are going through mental and physical changes and must be in a position to deal with that without the distraction of having to deal with problems brought forward with you. Look on it as going through puberty again and all the emotions that this brings with it.

From the day you start transitioning you should start planning every stage of your development.
• Your working future, can you carry on with your present occupation or will you have to look for alternative employment? Will you have to retrain?
• Have you told all your family and friends, if not have you thought of when and how you are going to tell them? The earlier you tell them, the more time they have to get used to all the changes that are going to be happening and in particular, the big day or days of your surgeries. Don’t expect too much and give them time.
• Have you told work colleagues? This is another important stage of your transitioning. How will they accept you and your new self? Do you turn up as your new self or do you tell them first? Do you speak to your boss before your colleagues or the HR department? The support of your employer is imperative.
• What about going out in public, such as going to your local shops?
• What about travelling, to and from work on public transport?
• What about Public Conveniences, do you look for unisex or disabled?

Once a person starts to live full-time as a member of a new sex, their name and other records, such as driver’s license, passport, etc. can be changed. This period, during which you are expected to live and work (or be a student) in your new sex, is referred to as the ‘real life test or experience’. Gender Specialists look on it as a test but I believe it is the period where you are learning to live, work and socialise in that sex and be accepted into society. You should be doing this for yourself and not to keep our ‘specialists’ happy.

Following the Gender Recognition Act 2004, individuals who satisfy the necessary evidential requirements, which include having lived in your acquired gender for at least two years, are allowed to apply for full legal recognition in their acquired gender. If successful, the law regards the applicant, for all purposes, as being of their acquired gender, including being issued with a new Birth Certificate recording your new legal sex. For more information on gender recognition, contact the Gender Recognition Panel. http://www.justice.gov.uk/tribunals/gender-recognition-panel It is important to keep records of your actions as the GRP will require you to furnish evidence for your GRC.

Being socially accepted as male (sometimes known as passing) may be challenging for transmen who have not undergone HRT and/or surgery.
Some trans men may choose to present as female in certain social situations (e.g. at work). After physical transition, trans men usually live full-time as male. The opposite applies to transwomen but again the same challenging situation. Being confident in yourself is half the battle. But to qualify for your Gender Recognition Certificate (GRC), you must live full time as a man for a minimum of two years, change your name by deed poll, change drivers license, passport, etc. Living two lives will not qualify.

Causes of and about Transsexualism.

Introduction: Gender dysphoria is a recognised medical condition. Those who experience the condition do not feel, on the inside, to be of the gender that their bodies appear to be. Many experience such intense and prolonged discomfort, that they must undergo a process of gender role transition in which they express their innate gender identities and, usually, obtain medical treatment to modify their bodies accordingly. They are regarded as having the condition termed transsexualism. In simplest terms; Gender dysphoria (transsexualism) is when a boy or a girl feels they belong to the wrong gender, are in the wrong body.

Transgender or transgendered is a broader term and includes those who temporarily change their gender and appearance, such as transvestites, cross dressers, drag queens but not transsexual people. Transsexualism is not the same as, and should not be confused as such. True transsexualism is a birth defect caused in the womb.

The term ‘Transgender’ was thought to have been first used by Virginia Prince, to cover ‘Transvestites’ like herself who have taken cross sex hormones, had facial electrolysis and normally dressed as a woman but did not want to have the re-assignment surgery. She wrote several books, including ‘How To Be A Woman Though Male’  taken from letters and articles published in her magazine ‘Transvestia’.

Transgendered is now used as an umbrella term, wrongly used to cover the whole spectrum. Unfortunately, this term has had the effect of leading many into thinking that we are all the same.

Males and females have both sex and gender. Sex is the genitalia of the body and gender is the identity of the brain female or male.

There is good scientific evidence that transsexualism is strongly associated with an atypical neurobiological development of the brain in utero. The condition should therefore be regarded as organic and congenital. This view is supported by the recent article in an international peer-reviewed journal, ‘The International Journal of Transgenderism 9(1), 2006’, which can also be found at the GIRES website, http://www.gires.org.uk. This article reviews the relevant science and is supported by 20 signatories which include many eminent clinicians, some of whom are world famous.
GIRES, (2006). Besser, M., Carr, S., Cohen-Kettenis, P., Connolly, P., De Sutter, P., Diamond, M. (chair), Di Ceglie, D.(ch & adol. only), Higashi, Y., Jones, L., Kruijver, F., Martin, J., Playdon, Z-J., Ralph, D., Reed, T., Reid, R.,. Reiner, W., Swaab, D., Terry, T., Wilson, P,. Wylie, K. “Atypical Gender Development – A Review”, International Journal of Transgenderism Vol 9(1).

Starting your RLE (Real Life Experience).

This is the most important stage of your transitioning and initially requires wearing the clothing of the sex that you want and need to live as. There is no doubt that this is easier for the F-M transsexual than the M-F. Women can dress in male clothes and in general will not attract attention; women have been wearing men’s clothing for years whereas a man wearing a dress will attract attention, mockery and possibly abuse. It is going to be much harder for the M-F transsexual.

Preparation is important. M-F have the problem of facial hair, yes, they can close shave and use a concealer but facial hair has the habit of re-growing and after a couple of hours may start to show. Not good. F-M’s do not have this problem, just the opposite but can use light make-up to improvise a 5-o-clock shadow.

Hair; in M-F’s many will have receded, quite considerably, even baldness, so the only answer is a wig, the better the quality and a style to suit you your face and age, so as not to draw attention to yourself. If they have been lucky and not receded then grow out the hair and have it cut and suitably styled. I was one of these, I had receded a little amount but grew my hair out and went to a good hairstylist. I later had a hair transplant. F-M’s will have adequate hair to get a male style.

Size; in general, men are bigger than women, this can impact on appearance when going out dressed. A 6’ 3” muscular woman is going to draw attention. A 5’ man is less likely to. However, looking like a man or a woman comes from the inside. It is how you act and behave, your gestures, posture, the way you talk and phrase things. How you dress is also important. There are many natal women with deep voices, masculine features, tall, fat, thin, etc. and visa versa, the physical divide between male and female can be very small and can even cross but you can still recognise them as male or female. Why is that? Confidence, attitude, being bought up male or female. These things are learnt from birth. Being a woman or a man is so much more than just looks. We have to learn this in a very short time. People will treat you differently and you will have to act differently. Men, in most cases will not hold doors for you; you will have to get in the habit of giving way to women, just a small example. Gender clinics will not teach you this, it probably has not even occurred to them. As far as helping you to get through your RLE, they will be as good as useless. I attended the wonderful Dr. Russell Reid, probably the best gender specialist that there has been but in this, he was of little help. I learnt by watching and helping my two daughters grow up.

As a man, I had similar size issues of the F-M transsexual; I was 5’ 3” tall with mostly feminine proportions but never really had problems. My voice only partially broke at about 17 and did not start to shave until about a year later. This aided me in crossing the gender divide. So as I said out the outset of this section ‘There is no doubt that this is easier for the F-M transsexual than the M-F’. However, there is also no doubt that this will be the biggest, hardest and most stressful thing that you will ever face and the hormone therapy will be harder to source (I will go into this in more detail) and the surgeries more extreme than that of the M-F transsexual.

Hormone therapy, is an important part of living in the opposite role. It will physically and mentally change you and there is no doubt that it makes living in that role, easier.

Do you start your regime before starting your RLE or during? Which way do you go? Will your GP prescribe? He can if he understands the condition enough. Do you go through a gender clinic? Do you go NHS or Private? Do you go the ‘self prescribing’ route? This is the riskier route owing to the source could be dubious and the hormones of unknown quality. The advantage is that you have full control over what you are taking.

If you decide to self prescribe then I would suggest that you find groups on line that is specifically for the F-M transsexual. You should also look for one that is based in the UK. Much of what information that is on the internet, is of dubious origin but there is also masses of information that is accurate and well researched. You will soon learn what is useful for you and what is not. Whether you decide to self medicate or not, it is still worth joining these support groups. Like the M-F support groups, they can point you in a safer direction.

Purchasing prescription medications, over the internet, is perfectly legal provided that you are buying for yourself and the amount is not more than 3 months supply. Most of these pharmacies are based in the USA. The package is likely to be opened by Customs and the contents will be subject to UK VAT.

I am not suggesting that you do self medicate, this is your decision and yours alone but if you do, consider the risks most seriously.

There are NHS guidelines on self prescribing and these say that your Doctor should take over prescribing as soon as possible. This is to protect you from the possibility of poor quality medications and from the risk of infections, etc. when injecting your Testosterone.

Whatever route you take you must seek the support of your GP and his practice clinic. You will need his support throughout your transitioning and onwards, for regular check ups and blood tests. The cross sex hormones are not just while transitioning but for the rest of your life. Your GP will be your most important medic.

Hormones and Hormone Therapy.

Hormone replacement therapy (HRT) for transgender and transsexual individuals introduces hormones associate with the gender that the patient identifies with (notably Testosterone for trans men and Oestrogen/ Progesterone for trans women).

HRT causes the development of secondary sex characteristic. While HRT cannot undo the effects of a patient's first puberty, developing secondary sex characteristics associated with a different gender often allows the patient to "pass" or be seen as the gender they identify with, which causes significant social and psychological changes. Introducing synthetic hormones into the body impacts it at every level and many patient report changes in energy levels, mood, appetite, etc. The goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their true psychological gender identity.

A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times. Sometime in the late teen years epiphyseal closure (in other words, the ends of bones are fused closed) takes place and the length of bones is fixed for life. Consequently total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone.
• Pelvis: The pelvis in females tends to be wider than in males and tilted forward; the pelvis in males tends to be more circular and tilted upwards.
• Hands: Male hands and feet tend to be larger than female hands and feet.
• Upper Arm: The upper arm in females tends to be significantly longer.
• Head: Females tend to have smaller heads than males.
• Chest: Female ribcages tend to be narrower than those of males.
Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age. Within a population of similar body size and ethnicity:
• Brow: Males tend to develop heavier bony brows than females.
• Cheeks: Female cheeks tend to be fuller and more rounded. Under the influence of estrogen, fat is deposited beneath the skin and overall facial and body contours become softer.
• Nose: The tips of the nasal bones tend to grow more in males than females, creating a larger (longer or wider) nose.
• Jaw: The jaw in males tends to grow wider and more deeply sculptured than in females.
• Larynx: At puberty, the bones and cartilage of the voicebox tend to enlarge less in females than males. In some males, the larynx becomes visible as a bony "adam's apple."
• Lips: Females tend to have thicker, fleshier lips than males.

Changes
For transmen, taking Androgens ie; testosterone cause among other changes:
• Deep voice.
• Facial hair.

Irreversible changes:
• deepening of the voice,
• growth of facial and body hair,
• male pattern baldness (in some individuals),
• an enlargement of the clitoris,
• growth spurt and closure of growth plates if given before the end of puberty, and
• possible shrinking and/or softening of breasts, although this is due to changes in fat tissue.

Reversible changes:
• increased libido,
• redistribution of body fat,
• cessation of ovulation and menstruation,
• further muscle development (especially upper body),
• increased sweat and changes in body odor,
• prominence of veins and coarser skin,
• acne (especially in the first few years of therapy),
• alterations in blood lipids (cholesterol and triglycerides), and
• increased red blood cell count.

The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most trans men report an increase of energy and an increased sex drive. Many also report feeling more confident.

While a high level of testosterone is often associated with an increase in aggression, this is not a noticeable effect in most trans men. HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most natal men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen. It is assumed that the effect of the start of physical treatment is such a relief, and decreases pre-existing aggression so much, that the overall level of aggression actually decreases.
Some trans men are unable to pass as men without hormones. The most commonly cited reason for this is that their voice may reveal them.

Types of androgen therapy
The half-life of testosterone in blood is about 70 minutes, so it is necessary to have a continuous supply of the hormone for masculinisation.

Androgens to bring about and maintain masculinisation. The available formulations are as follows:
• Testosterone esters: intramuscular injection; 250mg every two to three weeks (licensed in the UK for the treatment of trans men (eMC.org, electronic medicines compendium) (post gonadectomy: 250mg every four weeks or 100mg every two weeks).
• Testosterone enantate: (if peanut allergic) 250mg intramuscular injection every two to three weeks (post gonadectomy: 250mg every four weeks).
• Testosterone undecanoate: injection, 1,000mg every 10–14 weeks
• (post gonadectomy: 500mg every 10–14 weeks).
• Testosterone undecanoate tablets can be given for those who wish to masculinise slowly or who do not want injections: 120–160mg daily; this is less recommended because of the extensive ‘first pass’ metabolism that reduces bio-availability and increases likelihood of abnormal liver function tests (post gonadectomy: 40–80mg once daily).
• Testosterone gels: 50mg/5g applied twice daily (post gonadectomy: once daily).
• Testosterone patches: 5mg twice daily (post gonadectomy: once daily).
• Buccal testosterone: 30mg twice daily (post gonadectomy: once daily).

Medication to lower oestrogen levels
This medication is not always regarded as necessary because testosterone alone can be very effective for transmen.
• Goserelin – 3.6mg subcutaneous implant, four-weekly, or 10.8mg 12-weekly.
• Leuprorelin – 3.75mg, subcutaneous implant, four-weekly. Regarded as posing a higher risk of gastro-intestinal side effects and altered lipids, pulmonary embolism, low blood pressure and mood alteration.

Sex reassignment surgery from female to male includes a variety of surgical procedures for transsexual men that alter female anatomical traits to provide physical traits more appropriate to the trans man's male identity and functioning.

F-M surgery is generally divided into three main groups:
1. Chest reconstruction surgeries (also referred to as "top" surgery or male chest contouring);
2. Hysterectomy and oophorectomy (removal of the uterus and ovaries, respectively); and
3. Genital reconstruction surgeries (also referred to as "lower" or "bottom" surgery or GRS).

Many transmen considering the surgical option do not opt for genital reassignment surgery; more frequent surgical options include bilateral mastectomy (removal of the breasts) and chest contouring (providing a more typically male chest shape), and hysterectomy (the removal of internal sex organs).

Genital reconstructive procedures (GRT) use either the clitoris, which is enlarged by androgenic hormones Metoidioplasty, or rely on free tissue grafts from the arm, the thigh or belly and an erectile prosthetic Phalloplasty. In either case, the urethra can be rerouted through the phallus to allow urination through the reconstructed penis. As part of the surgical options for trans men, Scrotoplasty is one of several operations performed to transform/reform the external genitalia into a penis and a scrotum.
In this procedure, the labia majoria are dissected to form hollow cavities, and united into an approximation of a scrotum. The surgeon may or may not deploy some sort of tissue expansion prior to the operation if there is insufficient skin tissue. Afterwards, silicone prosthetic testicles can be inserted to fill the new scrotum to enhance the look and feel. Sex reassignment surgery is usually preceded by beginning hormone treatment with testosterone.

Before you embark and commit yourself, particularly anything that is irreversible, be absolutely sure that it is what you really need and want. You will have had these feelings from as very young age, probably some of your earliest memories. These feelings will be with you in your waking and sleeping hours; they are always there. The journey across the gender divide is rarely an easy one. The combination of physical and emotional issues that can emerge can make the transitioning process a time of increased stress and risk for symptoms of depression, substance abuse, and anxiety. But understanding the requirements and forward planning can make your journey just that little bit easier. The hormones, apart from the desired physical changes also cause emotional changes. Despite this reality, most transsexual individuals report that the joy they experience in becoming themselves makes the journey so worthwhile.

I started my journey in March 2004.  Before this I had become severely depressed and clinically obese due to that depression. My health was deteriorating and I was a candidate for a heart attack. I am now extremely happy, I love being a woman and am in a long term relationship with a wonderful man whom I love dearly. It has not been easy but I had the support of a good Gender Specialist, excellent specialist surgeons and a really good and supportive GP and his clinic. I had been with the same practice for nearly 30 years. Because of that I was very concerned about telling my GP. He really surprised me, listened to me, discussed the hormones that I was self medicating on; carried out a medical examination and arranged a full blood test. The value of his support has been immeasurable.

At the end of this paper I have printed a list on the likely effects of taking Testosterone. I have downloaded this from the internet and cannot guarantee the accuracy but basing it on my studies and my experience of taking female hormones and those effects I would be fairly confident in its usefulness. Most would be the opposite of what I have experienced.

Embrace your life, your gender and sexuality and enjoy it.

If you want to talk about anything that you have read have a query in general, just want to talk or have some support, please feel free to contact me; details can be found on the cover of this paper.

Michelle J Dibble MASC FASC CCCreg.
 

TESTOSTERONE
For Female to Male Transitioning.
Testosterone will cause these permanent changes:
• Lower, or change your voice.
• Cause body hair to grow on your thighs, abdomen, chest, back, and arms.
• Cause facial hair to grow. The facial hair you grow will depend on your body and what you’ve inherited from your family.
• Cause hair loss and, possibly, complete baldness.
• Cause your Adam’s apple and bones in your face to thicken and look more "masculine".
• Cause your clitoris to become larger.
• Cause your skin to become coarser Testosterone can also cause these changes that should go away when your stop taking it:
• Decrease of fat in breasts, buttocks and thighs and increase of fat in abdomen.
• More red blood cells in your blood .
• Make it easier to build muscle if you work out.
• Increase your sex drive.
• Cause weight gain.
• Stop your periods. Some F-Ms start having some bleeding later in their life. If this happens, talk to your health care provider.
What Testosterone Won’t Do:
• Your breasts will not go away.
• You won’t grow a penis.
• It won’t work overnight How long do I have to take hormones before they start working?
The effects of testosterone may take several months to become noticeable and up to five years to be complete.
Why do some TG youth prefer not to take hormones?
There are many reasons to decide not to take hormones, if you are not sure you want to change your body, if you’re happy with what your body is like now, if you have health concerns or if you want to have children. There are many transgendered people who decide to on the "NoHO, NoOp" option (no hormones no operation).

Hormones will not make you any more or less of a "real" transsexual or man or woman. They will change what you look like, but not who you are inside.
 

Testosterone should not be used to prevent pregnancy. Even if you have stopped having periods you should still use birth control (practice safe sex!) if you are having sex where your partner’s semen could contact your vagina. Whether or not you want to take hormones is your choice. This table may give you some help in deciding.

I cannot comment on the accuracy of the information but basing it on my experience with female hormones it could be correct.

What about the side effects and dangers of taking testosterone?
• If you experience hives swelling, vomiting, call your health care provider immediately.
• Taking hormones can cause problems with your liver. You should get regular blood tests to check your liver function.
• Taking testosterone can increase your risk for breast cancer. Even people who have had top surgery (chest reconstruction) can still have some breast cells that can be affected. You should examine your breasts or chest regularly. Your health care provider can show you how to do this.
• It may increase your risk of uterine cancer. • Many people get acne (pimples) when starting testosterone. Make sure to wash your face regularly with a mild soap. Some people will have very bad cases of acne that could cause scarring if not treated. If this happens, talk with your health care provider about treatment options.
• Taking more testosterone than your health care provider recommends will not make your body change any faster. If you take too much testosterone, your body can change it into estrogen, which can stop the effects of the testosterone. It is very important to talk with your health care provider about the right dosage for your body.
• It may put you at risk for diabetes. • Testosterone may increase your risk of getting heart disease or stroke later. This risk will be the same as it is for non-transgendered men.
Some TG youth should not receive hormonal treatment.
You should not use hormones if:
• You are still exploring*
• You smoke
• You have liver problems
• Are pregnant
*Some of the effects are irreversible.

How are hormones
Given?

Testosterone is given by injection every other or every four weeks. After awhile, you may be able to learn how to give yourself these injections.
Whom can I talk to if I have problems or questions?
TS groups can provide very useful information, List of contact at the bottom of this page. You must judge what is useful.
I may also be able to help. You can contact me, contact details on the cover of this document. How will the effects and side effects of hormones affect my emotional state?
The way hormones effect people can be very different. Some people feel that they become more aggressive when taking testosterone, while other people feel that it calms them down.
Changing your injection schedule may cause mood swings and irritability (crankiness).

For a list of contact groups and sites for F-M and M-F Transsexuals, go to: www.Tranzwiki.net There are many others but this is a list compiled by GIRES. There is also useful information and papers on GIRES own website: www.gires.org.uk

Paper last updated, 29-07-’12.