So what happens next?

So now that I’d come out to myself as transgender, what was I going to do about it?

Well, I knew that I wanted to do something about it, and that was this thing called “transitioning.” but didn’t really know how to go about it.

So I sat down, and did some research. Reddit can actually be a very useful tool for this like of thing. In 2014, when I was looking into traveling the world, the travel subreddits were an invaluable source of information.

In my research on Reddit, I learned that there are actually a few different kinds of transitioning:

Emotional Transition

The hardest part of transitioning is accepting yourself. A lot of transgender people suffer from impostor syndrome. It takes a lot of time and introspection to be able to accept yourself, and not feel like you’re a fake, or just pretending.

It can be hard to see yourself as you really are; in my case, it was hard for the longest time to actually call myself a “woman.” The only thing that really helps with it is time.

Medical/Physical Transition

This is the part that everyone always has questions about. What medications do you take? What do you do about body/facial hair or your voice?

What do you do about…down there?

I’ll write more about all of that stuff in future posts, but suffice to say, medical science has come pretty far, but there’s definitely still room for improvement.

Social Transition

This is perhaps the most visible form of transition. This is where you actually put who you truly are out there. It might start with telling a few people, but eventually, you have to go through that awkward phase where you’re trying to present as one gender, but being seen by at least some other people as the wrong gender.

Social Transition is tough. You spend a lot of time explaining to people (who often just don’t understand) why you’re doing it. You deal with a lot of people who are ignorant, or just plain transphobic. I’ve been lucky enough to surround myself with a cocoon of accepting people, but I still run into people who look at me sideways, like I’m some sort of freak.

It’s called transitioning because, at least hopefully, there is an end to it. Eventually, everyone in your life–family, friends, coworkers, even strangers–sees you as who you know you are inside.

I haven’t gotten there yet, but I know I’ll get there eventually.

So how do you actually start?

When I decided I wanted to transition, I found out I had a few of options for starting:

WPATH Standards of Care – WPATH, or the “World Professional Association for Transgender Health” is an international organization of doctors, therapists, and other medical professionals that gets together regularly to make recommendations for how transgender people should be treated, mentally, and medically. Their guidelines are all in their “Standards of Care.”

You can read the full SoC if you want (currently on version 7 when I write this), but essentially, they recommend therapy to determine a diagnosis of “Gender Dysphoria,” which is essentially the mental anguish associated with having a different “gender identity” (or “brain sex”) compared to your gender assigned at birth, which was determined by a doctor based on what genitalia you were born with.

It takes several therapy sessions, but eventually the therapist does or doesn’t diagnose you with Gender Dysphoria, then writes a recommendation letter to a doctor (usually, but not always, an endocrinologist) to start hormone therapy.

Following the SoC is the best path for people who are still questioning whether or not they’re transgender, or whether or not they want to go through with actually transitioning medically (and/or socially). Therapists who are well-versed in gender identity issues can help to determine what the best path forward is.

The down side is that there are a lot of therapists out there who aren’t well-versed in gender issues, have out-dated ideas of what it means to be transgender, or will down-right try to prevent you from transitioning (that’s called Gatekeeping).

Informed Consent – A relatively new phenomenon, Informed Consent skips the step of requiring therapy. Essentially, doctors who agree to prescribe hormone therapy under the “Informed Consent” model will do so as long as they’re fairly certain you’re sane, and that you understand the mental and physical ramifications of what taking hormones does to you.

Informed Consent is a great option, when available, for people who are pretty certain that they want to transition, and don’t need or want therapy to delay starting on hormones.

It can be as simple as talking to your family doctor, and asking them to prescribe hormones (as long as you’re in a country like the US where they’re allowed to do that), but more and more, Informed Consent Clinics are opening up that specialize in providing transgender medical care.

DIY (Do it Yourself) – This is the most risky way to transition, because you’re doing it without a safety net. Technically, it’s not illegal to order hormones from an online pharmacy and import them into most countries (including the US), but you pretty much have to guess, even with doing a lot of research, what medications and doses to take.

You don’t have a doctor checking your blood levels, so you don’t know if you’re on too high or too low of a dose, and you don’t have anyone monitoring things like liver and kidney health.

If you’re generally healthy, do your research, and occasionally consult a doctor for blood tests, the DIY method can be viable, especially if there aren’t any other options for you.

I won’t recommend it or say you shouldn’t do it, but it’s best to only consider it if you don’t have any other options, and if you’re comfortable with doing the medical research to make sure you stay healthy.

So which method did I choose?

When I first decided I wanted to transition, I was about 80% sure; not sure enough, in my opinion, to actually put hormones in my body just yet. So, I decided I wanted to start with therapy.

The problem was, I was traveling around the world at the time. I was in Australia (not the best country for transgender care, though certainly not the worst), and I was moving around from city to city every month.

But I also didn’t want to wait. So, I found a gender therapist who did sessions online, and within a few days had my first session with him over an online chat system.

The first couple of sessions were basically just the therapist asking me questions about my childhood, teenage years, how my parents treated me, how I felt around other kids, etc. He was essentially just trying to get an understanding of who I was.

In later sessions, we talked about what transitioning would mean for me, how I planned to come out socially, and making sure I understood all of the ramifications of of going on hormones, and all of the other parts of transitioning.

It only took a few sessions for me to be 100% sure that I wanted to transition. After eight of those weekly sessions, he wrote me a letter diagnosing me with Gender Dysphoria, and recommending hormone treatment.

Unfortunately, I was still traveling. I wasn’t able to find a doctor in Australia that would start hormone therapy with only a couple of months left in the country, which I was then leaving to head to India, then travel around the US for a couple of months for work.

That meant that at that point, I was looking at at least 6 months before I could get hormones from a doctor. I just couldn’t wait that long.

So, I made the decision to order hormones online. Like I said above, I can’t recommend for or against it for anyone else, but for me, I just couldn’t see waiting that long, now that I knew it was the right decision to go on hormones.

Through Reddit, I found links to resources for standard dosages, and where to order medication from, and in a couple of weeks I had hormones.

By the time I got back to the US, I decided that I wanted to see a doctor, though. Partly because my insurance would cover it then (which cut the cost in more than half), but mostly because I felt I would be safer having medical supervision.

In Minnesota, where most of my family lives, I found an Informed Consent clinic that was able to see me fairly quickly. I think it helped that I told them I had been taking hormones on my own already, so they wanted to see me sooner rather than later.

I had some blood tests, they adjusted my dose slightly, and things have been rolling on ever since.

I’m probably a rarity, in that I’ve got perspective on each of the methods of starting to transition. All three have pros and cons, and everyone needs to decide for themselves how to proceed.

Anyway, that’s how I got started. It’s been working for me so far, which has helped me to be a happier person overall. And that’s the primary goal in all of this.

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