So, you think you may be transgender…..What now?
Well, you have just made the first step, congratulations! Now that you have acknowledged that there is something special about you, you can start to explore what you want to do now.
The next thing to do is to contact a counsellor or psychotherapist, they can help you along your journey by helping you to deal with all these new feelings, and with issues you will be dealing with from day to day. Contact details for a number of counsellors that others have found to be helpful can be found on this page. They are not going to try and “fix you” or make you “get over it”. What they will do is to help you get in touch with yourself, and to give you support and encouragement along the way.
If you decide that you do not want to take the next step in “transitioning” then that is fine. This is your journey, to be taken at any speed and in any direction with which you are happy and comfortable. You can decide which steps you wish to take, and you don’t have to involve any medication unless you want to.
Family & Friends
The second thing to consider is the impact your decisions will have on your family, friends and workplace, especially if no one knows what you are doing and why.
If you are in a relationship, it is very important that your partner is aware of your feelings and plans, and is in full agreement with them. It won't be long before they figure out something is happening, and when it does the reaction will more than likely be very negative if they haven't been told in advance what to expect. Trust is very important in a relationship, and once you start lying to your partner it will be difficult to regain their trust. Not every relationship survives a gender transition, so you will need to bear in mind that there will be repercussions to your decisions. The more involvement your partner has in each stage, the greater the chance of your relationship surviving.
When it comes to your workplace you may want to think about a “softly softly” approach. You are under no obligation to tell your employer anything until you are ready to. In fact, depending on who your employer is, and how accepting they are likely to be, you may need to very cautious in this area. In New Zealand there is no specific legislation that prevents discrimination on the basis of your gender transition. If you do get into trouble find a lawyer who wants to do a “test case” in transgender law, as it will probably be a long and very frustrating battle.
It Takes Time
Time is the most important factor during your transition, a lot of transgender people want an instant fix, with surgery the next week, when in reality a transition takes up to 2 years (sometimes longer). Surgery will not in itself fix your problems. You need to get to a “place” in your life where you are happy with yourself and are comfortable with your presentation to the world. Surgery can then be considered as the “icing on the cake” – but definitely not as “the cake itself”.
If you have not yet had a family, and would still like having your own children to be a possibility in the future, you may want to consider contacting a fertility clinic before you take any hormones. Once you have started taking hormones your fertility will decrease, and eventually disappear altogether (possibly permanently).
Male-to-female trans people can store some sperm deposits “on ice” to be used later with a female partner or surrogate. While female-to-male trans people may be able to store a part of the ovaries, we are not sure how successful this would be for later use, you would need to check this out with the clinic at the time.
If you decide that you want to proceed to investigate the medical options open to you, the first thing you need to understand is that hormones are very powerful drugs, and the effects need to be monitored very closely by a knowledgeable doctor so as to avoid any serious harm to your body.
Some trans people take hormones they have purchased on the street, or from foreign pharmacies. This can be dangerous as there is no guarantee of the purity of these hormones, and the people who take them are usually not being monitored by a doctor for adverse side effects. If you do decide to take this pathway, you should strongly consider telling your doctor that you are doing this.
Some serious side effects include infertility, liver damage or failure, and blood clots leading to deep vein thrombosis, pulmonary embolism or stroke.
So the next thing you need to do is find a doctor (GP) who you are comfortable with. It would be ideal for this GP to have had some prior experience with transsexuals, as there are a lot of different treatment options out there. You can find a list of GPs that other GenderBridge members have found to be useful on this page. It is possible that your GP may refer you to an endocrinologist (a specialist in the endocrine (hormone) system), this is fine, but you will still need to see your GP for regular check ups, as you would usually only see an endocrinologist every 6 to 12 months.
Necessary Medical Tests
Once you have found a GP the fist thing you will have to insist on is a full physical examination, and blood tests including; Liver Enzyme, thyroid, kidney and lipid (cholesterol) profiles, current hormone levels, blood count, clotting factors, serum prolactin and sugar levels. It would also be interesting to look at; calcium; phosphorus (skeletal health) and serum androgen levels.
Getting these test will not only ensure that your body is in a condition to be able to cope with the medication, but will also give you “baseline” levels for you to be able to compare against as you progress with your treatment in the future.
At this point it would be a good idea to give some serious thought to a healthy diet, quitting smoking and limiting your alcohol consumption. You body is going to be busy doing other things, and will not appreciate the extra workload!
Become your own specialist
While things are improving, there are not very many doctors or specialists in New Zealand who have a lot of knowledge in this field. One way to counter this problem is to become your own specialist. Remember that it is your body, you should have control over what is happening to it, and therefore arming yourself with knowledge about what the drugs you are taking will do to you will be advantageous. This information would include finding out what different treatments there are, what the acceptable dosage range is, how they are administered (pills, injections, patches…), what effects you can expect to see as a result of taking them, what are the side effects (these differ not only with which drug, but also on how you take them)
The effects of hormones vary greatly from patient to patient. Younger patients generally obtain better and more rapid results, although genetic factors are also highly significant. With appropriate dosage, most patients experience noticeable changes within 2-3 months, with irreversible effects after as little as 6 months. Change continues at a decreasing rate for a period of two years or more.
Dosages and hormones used vary from doctor to doctor and will also depend on the effects the patient is looking for. The key item to consider is that once the body is saturated with hormones, taking more will not promote faster growth; it will only lead to more complications. No matter what dosage you are on, the effects you achieve will depend on your age and your genetics. Lower dosages may take longer, but in the end, the effects will be the same.
It would be a good idea to talk to some others who are on the hormone treatments, and find out what they have experienced on the various treatments. Often this is discussed at GenderBridge monthly meetings. But make sure that you make up your own mind. Other people are good for research, but everyone reacts differently to each type of hormone treatment. What works well on them may not work well on you, so be prepared to change your treatment if you find that the results you are getting are unsatisfactory.
If you think that having surgery is going to change your life & make all the hurt go away, you are wrong!
Surgery is life threatening. You have to be put under a General Anaesthetic to have it, and that is a very serious thing. There is always a risk associated with just the anaesthetic, let alone the procedure itself.
M2F Sexual Reassignment Surgery (or Gender Realignment Surgery)
There are several different types of procedures that you can have, and there are advantages and drawbacks to them all. Each surgeon will have their own technique, so you may need to approach a few surgeons until you find one who you feel is right for you.
Prices for this operation can range from about $10,000 in Thailand (depending on the exchange rate & not including airfares etc) to $30,000 in the South Island. There is only one clinic in New Zealand, and that is in Christchurch. If you are prepared to travel you can go to clinics in Thailand, Australia, USA etc and you may be able to reduce your costs due to the exchange rate etc.
It is recommended that you research your surgeon, and the technique they use, very carefully.
Where possible get testimonials and references from prior patients, and don’t be afraid to ask for “before and after” pictures from the surgeon. You only get one shot at this, and you are the one who will have to live with the results. A good surgeon will be aware of this, and if the surgeon you approach is unwilling to supply you with this information then there may be good reasons…so try someone else!
(Acknowldegement to Julz for writing this article)