A Brief Guide to What an MtF Transition Can Look Like

Do you know what it means to transition? 

If you answered no, you're not alone. In fact, even those who have transgender loved ones may not understand exactly what the process looks like.

A male-to-female (MtF) transition describes the process undertaken by someone assigned male at birth who then transitions to their correct gender identity.

"One's gender identity—the inside—needs to match their gender presentation—the outside," said Matthew Bryan, M.D., the associate medical director for LGBTQ Health at Intermountain Healthcare in Utah. "When these two don't match, it can create a lot of inner turmoil, which contributes to a lot of other health issues."

Each transition looks different. Some trans women take as many steps as possible to change, while others simply take one or two.

Disclaimer: Here at Giddy, we want to recognize the world of gender-diverse people. There are plenty of people who don't identify as male or female who take steps to transition. However, for the sake of simplicity, we will be referring to all individuals who are moving toward a more feminine identity as trans women or MtF.

Terminology

MtF (male to female): This term describes individuals assigned male at birth who have since chosen to honor their gender identity by transitioning to female.

Cisgender: People who identify with the gender assigned at birth.

Transgender: People who don't identify with the gender assigned at birth.

Gender dysphoria: The state of distress transgender people experience when faced with the disconnect between their body and their gender identity.

Gender expression: How someone chooses to portray their gender identity. Cisgender and transgender people both have gender expressions.

Gender identity: An individual's internal sense of their gender (note: not their sexuality).

Passing: When others, particularly strangers, see a transgender person as their gender identity. When an MtF individual "passes," they are seen as female in their everyday lives.

Coming out

When a trans woman comes out, she's letting others know she doesn't identify as male. It can include telling family, friends, coworkers and others her correct name and pronouns.

Sascha Blank, a board-certified health and wellness coach, offers inclusive care for the LGBTQIA+ community. He helps trans women understand how to take care of themselves and live authentically. This starts at one of the earliest points in their journey—coming out—which can be an incredibly complicated process. When trans women come out, there is a risk of being disowned by family and loss of employment, and a chance of further discrimination.

"There are states that have introduced anti-trans legislation, which leaves folx to either stay in the closet and live a lie (and practice behaviors that are detrimental to their health) or seek out-of-state help," Blank said.

Trans women are not obligated to come out to everyone in their lives, especially if it would put them in danger.

Socially transitioning

Some trans individuals will start socially transitioning before they come out to the people in their lives. "Socially transitioning" means making changes to their appearance and/or mannerisms to better resemble their gender identity.

For MtF individuals, socially transitioning can involve one or more of the following steps.

Dressing differently

One of the most common ways to socially transition is to change how you dress. For trans women, this typically involves wearing women's clothes, such as dresses, skirts and blouses, but not all trans women will feel comfortable with this.

"Not every gender-diverse person is the same," Bryan said. "Like many things in the world that exist in a spectrum, gender does as well."

This means transgender women have different styles of dress and expression, just like cisgender women do.

Grooming differently

Another common aspect of socially transitioning is altering your grooming practices. For trans women, this can include wearing makeup, growing out their hair, using different beauty products or contouring their face with cosmetics to have a more feminine shape.

Attending psychotherapy

Many individuals will see a gender therapist to help them with all aspects of transitioning. This may include processing major social and emotional changes, as well as working through the trauma of the discrimination they may face because of their gender identity.

Working out

Especially when combined with hormone therapy, working out can help facilitate weight loss or weight gain. Most MtF individuals don't target muscle gain, as it tends to make them look more masculine.

Tucking and stuffing

Tucking is a way to reduce a bulging crotch so it reads as more female and involves moving genitalia out of the way. Tucking tape is available to make the process more secure and less likely to come undone. However, this can make using the bathroom difficult, as you'll have to remove and then reapply the tape. Choosing the right underwear makes a huge difference when it comes to tucking.

Stuffing involves making the chest look curvier and more feminine. There are several ways to stuff. Trans women may use bra inserts, padded bras or other materials, depending on what shape they wish to create.

Physically transitioning

For MtF individuals, physically transitioning can involve one or more of the following steps.

Estrogen therapy/HRT

"The goal is to augment feminizing hormones—estrogen and progesterone—using estradiol and progesterone. [People can] also reduce testosterone effects by using medications like spironolactone," Bryan said.

Estradiol is available in injectable, oral, sublingual and transdermal applications; progesterone is available in oral and injectable applications.

Changes resulting from estrogen therapy include:

• Body fat redistribution to the hips and thighs
• Chest tenderness
• Decreased libido
• Decreased genital size

Trans women will also take a testosterone or androgen blocker, which lowers bodily effects from testosterone. However, estrogen is one of the primary hormones used to lower testosterone.

Progesterone therapy is typically used to complement estrogen therapy, and though there aren't many studies out there providing definitive answers as to how progesterone affects transition, many people believe it helps with breast development.

Voice and speech therapy

While estrogen and progesterone can facilitate amazing changes for transgender women, it doesn't do anything to change their voice. This means for many MtF individuals, their voice will be heard as masculine unless they take measures to alter it.

Common tactics in voice therapy include teaching trans women pitch, volume and rate, as well as how to use their mouth and throat. Along with teaching verbal techniques, voice lessons will also include nonverbal elements such as body language and gestures—like facial expressions and eye contact.

Electrolysis

While HRT helps reduce the growth of new facial hair, it doesn't completely eliminate it. Electrolysis uses electric currents to destroy hair follicles and is FDA-approved to remove hair permanently.

Many trans women will get electrolysis to remove facial and neck hair, as well as hair around the genital area if they're seeking vaginoplasty.

Upper surgeries

It's important to note surgeries aren't available to all transgender people. Many don't have insurance, and for those who do, depending on the insurance provider, certain procedures may not be covered.

Tracheal shave

Known as an Adam's apple reduction, a tracheal shave is a process in which the thyroid cartilage is shaved to reduce how much it sticks out.

Voice feminization surgery

Voice feminization surgery removes one-third of the vocal cords to replicate the number of cords in cisgender women. This results in a higher-pitched voice.

Facial feminization

There are several procedures that can be done to make a person's face seem more feminine, such as scalp advancement, nose reshaping, cheek implants and more.

Breast augmentation

"Top surgery, also called breast augmentation, [is available] to create a more female appearance," Blank said.

This allows for a more permanent change than stuffing, but again, is considered cosmetic surgery by most insurance companies.

Bottom surgeries

MtF bottom surgeries include the following options:

• Orchiectomy: A surgical procedure to remove one or both testicles.
• Penectomy: The surgical removal of all parts of the penis.
• Vaginoplasty: The surgical creation of a vagina, which includes removing the penis, testicles and scrotum.
• Clitoroplasty: The surgical creation of a clitoris.
• Labiaplasty: A surgical procedure that includes the creation or reshaping of the labia around the vagina.

Changing your gender marker

David Reischer, CEO of legaladvice.com, mentioned that changing your name and gender marker will differ depending on several factors.

"The process for changing a legal name and/or updating a gender marker depends on where a person lives, where they were born, and other individual circumstances and needs," Reischer said.

Once an individual has updated their legal name and gender marker, they have to update numerous documents to reflect the change. Reischer recommends updating records in the following order:

1. Legal name and gender marker change
2. Social Security records
3. State license or ID
4. Bank statements, financials, insurance records, school and employment records
5. Passport
6. Birth certificate

However a trans woman decides to make the transition, their choices should serve to further the goal of gender expression. What this entails varies from person to person, but all decisions should be made in conjunction with your medical support team.

"One of the most rewarding parts of my career is helping folx navigate gender-affirming care," Bryan said. "I have never seen so much appreciation and true gratitude as when people can be their authentic selves. It is palpable and powerful."