Keep in mind that most transgender people know they are transgender at a very young age that they are transgender, that their REAL selves are not the gender they were ASSIGNED at birth.
Unfortunately, most of us had to keep the real person hidden. Transgender girls often experience a great deal of harassment and ridicule from parents, from adults, and from kids their own age.
By the time they are in first grade, forced segregation of boys and girls begins, and transgender kids hate being put in the wrong group. The tomboy wants to roughhouse and tumble and mix it up with the boys, and the sissy lives in fear of being severely physically assaulted, sometimes so badly they end up in the hospital. These are a DAILY experience, with the most dangerous places being bathrooms, playgrounds, and outside school.
By the time they reach high school, most transgender kids who haven’t come out are terrified to do so. They are acutely and painfully aware of the “girl inside” or the “boy inside”, but often they are terrified to let anyone know. They begin to develop the mask that lets them pass as the gender they were assigned at birth, but it’s very unnatural for them.
Puberty has done a lot of damage, and they often struggle to SURVIVE those changes, hoping somehow that they will be able to find some way to live with those changes caused by puberty. Puberty through early twenties is often a time where they are at VERY high risk of suicide or self destruction.
Drugs, alcoholism, and suicide attempts are common. Transgender men often get into fights, street racing, and other ways to prove their man-hood by doing dangerous things. Transgender women often struggle to find themselves, trying to date women or men and having difficulty with both as the mask. Love is very elusive because their partners are aware that something is being hidden. Many end up being loners romantically, finding ways to fit in socially, within a niche crowd, but few real friends.
Coming out is incredibly difficult for both Transgender women and transgender men.
For transgender men, the most difficult is going from “toe in the water”, wearing men’s clothes and hair style, but still being perceived as a woman, learning that they have to conform to the same strict norms that men aren’t even aware of, or settle for a more gender fluid identity with confusion of others.
For Transgender women, the biggest challenge is overcoming their own fear. The fear is based on some intense reality, lots of PTSD, living with nightmares fueled by real memories of real violence, verbal abuse, bullying, and ridicule. They have grown up knowing that their parents would reject them, throwing them out on the street if they were to come out, they have been unable to communicate with doctors or therapists who refuse to accept that they are transgender, and coaches and church leaders act like a boy who is a girl is the lowest form of life on earth, an abomination.
For the transgender woman, there is often a point where they try to “settle” for being a cross-dresser, dressing up in private, often keeping their secret from friends, family, even spouses and children for years or decades. The cross-dressing gives them minimal relief, enough so they don’t just give up on life entirely.
At some point, many transgender women finally get the courage to get fully dressed, learn to put together a good presentation that will allow them to go “public”, often dressing up to go to gay bars or other “safe” places, usually on Friday or Saturday night, but only 1 or 2 nights a week, sometimes on the road. If they haven’t done so earlier, this is when they give “the girl inside” a name. This is necessary for social reasons, but also so that they can talk about their true selves with people who have met the girl, without drawing attention to themselves.
Initially, during the early public cross-dressing stage, there is often the perception that this new person, with the new name, is the costume, the mask, the identity. Often this is because during this early “transgender puberty”, they tend to dress very sexy for clubs, with little or no wardrobe for normal activities like shopping on the week-end or going to the grocery store. In this “Cinderella” stage, they even enjoy being the center of attention, being admired by others, and a personality that had been so hidden and repressed for so long comes bursting out.
Soon, especially if they start seeing a therapist who knows ANYTHING about treating transgender people, the transgender person begins to realize that this other person they thought was an act, a mask, is who they REALLY ARE! They start to realize that the person they were assigned at birth is actually the mask. The boy is a mask they have learned to wear, no matter how painful or uncomfortable, because they have to wear the mask to survive.
This is when the therapist follows WPATH standards of care and recommends that they start spending more time as their true selves. The lucky ones have wives who love them enough to want their happiness, and will support them. Too many find that they have to confront the fact that their spouse fell in love with the mask, and will leave them rather than get to know the real person underneath. Others find that their wife becomes a friend, but the intimacy and romance they once shared has been gone for a long time, and won’t be coming back.
The “Real Life Experience” phase is probably the hardest part of the entire transition. They have to learn how to BLEND in with other women, dressing appropriate to age, size, and situation. The club wear was great for the clubs, but now they have to learn to dress less sexy, more like most of the other women in the rooms they are in. Jeans or leggings instead of dresses or short skirts, a C-cup bra instead of a Double-D breast form, and bare legs with shorts or skirts rather than sheer energy panty hose. Fortunately this is a relatively short period, a few weeks to a couple months.
Then comes the transition process in earnest. Having a 5 o’clock shadow removed with laser or electrolysis, having arms, legs, and other body hair waxed off, having eyebrows shaped, and growing out hair. Many therapists want to see these processes started before recommending hormone therapy.
Hormone Therapy (HRT) is often a three phase process. First, the doctor needs to get natural blood levels of testosterone and estrogen before starting anything. Many transgender women already have low testosterone levels, either part of the same biology that made their brains feminine, or attempts at self-castration during early puberty.
Then the doctor will start the “Blockers”, these are medications like Spirinolactone or Finistride, also used as diuretics and for prostate reduction. These blocker lower the amount of testosterone in the system. Doctors use blockers on younger trans-girls if they are near age of puberty, but often wait until 14 or 15 to start the estrogen.
One of the important things about blockers is that they also function as chemical castration. In fact, these same medications are given to sex offenders to prevent them from being able to be sexually active.
For adults, the doctor will start the estrogen within a month or two, as soon as he can determine how much the estrogen levels increase. Estrogen levels have to be very carefully monitored. Too much can cause blood clots, heart attacks, and strokes. Too little can result in stunted feminization. In most cases, the doctor will try to monitor testosterone, estrogen, and prolactin to make sure that they are the same levels as a muenstrating woman, often a girl going through puberty.
By this point, the trans-girl is living at least half-time as a woman, pretty much only living as a man during work hours. She has already planned her transition at work, often making sure she understands the companies diversity policy, especially their policies toward LGBT issues. Often, they have already contacted the LGBT community contact, as well as LGBT centers in their area.
Female coworkers are often the first to notice the subtle changes. The thinning eye-brows, improving complexion, and the budding breasts. This is a period when trying to continue as a man gets awkward, wearing compression shirts or binders to protect the breasts and keep them from showing at work.
Often, the transition at work and the name change process are closely coordinated. It’s best to tell your employer LGBT contact that you are planning to transition so they can plan the transition with you. The legal name change requires that you publish your name change in the local paper, but it has to be a major paper. Many of us by this time have already established e-mail accounts and other accounts in our planned name, and when the name change is approved by a judge, we begin the process of getting our name and gender legally changed on all our documentation, including driver’s license, passport, credit cards, bank accounts, and credit agencies.
The day we transition to full-time, is often a very happy day for us. We finally get to live authentically. We can finally stop pretending to be something we never wanted to be, and start being who we really are. We may have to learn new rules and codes of conduct, for example, when to start speaking in business meetings, how to guide a man to the right decision or action without direct confrontation, and so on. Ironically, for many of us, it actually comes quite naturally. In fact, it was a struggle to do it the “man’s way” and we only did it because we would be perceived as “wimps” if we did it as men.
The final stage, which is often optional, is getting the Gender Confirmation Surgery (GCS). Keep in mind that GCS very expensive, as much as $30,000 including everything, and often it’s a challenge to get it covered by insurance. Many insurance companies only cover half because it’s “out of network”.
GCS is not “chopping it off”, it’s actually turning the tip into a clitoris and turning the shaft inside out. Bringing up a second problem. Many transgender girls are not well endowed to begin with, so the simple surgery may involve grafts of skin, colon, or paratineal tissue that is used to provide functional depth. After the surgery, it is necessary to dilate regularly, at least once a day for the rest of our lives.
Other trans-girls opt for an orchiectomy. This is necessary because at some point, the blockers become less effective, and there is the risk of going through male puberty again. This is a MUCH less expensive procedure, costing about 10% of the cost of GCS. The orchiectomy essentially makes us eunuchs. The chemical castration has eliminated the ability to have erections or ejaculations, but not orgasms, in fact, the orgasms are more like female orgasms and possible in a number of different ways. The orchiectomy just makes this permanent.
Some transgender girls, a small minority, like to become she-males. They often get breast enlargement surgically and discontinue or reduce blockers and maintain lower doses of estrogen. They are often gay and enjoy being “tops”. Even so, these women are very careful not to put their junk on display for anyone other than their lover. As a transgender woman, she wants to be accepted as a woman in her regular life.
This was probably more than you ever wanted to know, and it’s long. I have written several books on the topic and my web site debbieballard.org has a bibliography of transgender fiction and non-fiction to give you a sense of what is involved and the thinking and feelings we experience as we are going through the various stages. I strongly suggest you look at a few of them.