Part 2: Transitioning

Greetings! I’m Cal (he/they/ze/hir pronouns) and I’ll be telling you a bit about gender transition. Transitioning, in the LGBTQ+ world, refers to when a person undergoes social, physical, legal, and other changes in order to feel more comfortable in their gender.  


Gender dysphoria: To start, I’ll define gender dysphoria, which is the feeling of discomfort, distress, or disgust in one’s body, mind, appearance, surroundings, etc., based on how they feel their gender. For example, a non-binary individual who was born with a penis may experience dysphoria about it, or they may be indifferent toward or appreciative of it. 

There are a lot of misconceptions about gender and how gender-expansive people may experience dysphoria. Some misconceptions include the idea that a transgender person has to experience dysphoria in order to be valid as trans (in other words, that anyone who doesn’t have dysphoria is automatically cisgender), and the idea that all transgender individuals must desire or undergo medical transition or surgery in order to be valid. These ideas partially make up the belief set of transmedicalism, where people also might think that “trans” is not a gender identity, but a state of being or neurological condition. Some transmedicalists also believe that there is no such thing as non-binary, and that trans people have to identify strictly with the male and female labels. All of these ideas are untrue. 

The reason that someone does not need dysphoria to be trans, and the reason that transmedicalist arguments are not sound, is the existence of gender euphoria. It’s the opposite of dysphoria, and is the feeling of joy a transgender individual may feel when they get referred to as their correct gender, hear validating words, or have a surgery that modifies their body in a way they are happy with. People can experience euphoria with how their body was originally, how their body is after medical transition, both, or neither. And because an individual can experience euphoria no matter how they perceive their gender, there is no limit to what gender may or may not look like. And with that, I’ll get into what the process of transitioning might consist of.


Physical transition: Transmasculine individuals may choose to take testosterone, which is the primary male hormone. Results of testosterone may include increased libido, more muscle mass, lower voice, increased body hair growth, later-in-life balding, oilier skin, decreased vaginal lubrication, and body fat redistribution. Risks of testosterone can include mood swings, bad acne, and a potential higher risk for diabetes and heart conditions (research is lacking). As with many other medications and treatments, results and side effects vary from individual to individual. Gender affirming surgeries for transmasc people include top surgery, or mastectomy, and bottom surgery, which could include metoidioplasty, phalloplasty, hysterectomy, and oophorectomy. Metoidioplasty takes what an individual already has between their legs, typically after clitoral growth from hormones, and reshapes it to be more phallic in appearance. Phalloplasty takes a graft of skin, typically from the forearm, to construct a larger phallus. Talk to your hormone provider about further options, like the ability to stand to pee or ability to penetrate during sex.

Transfeminine individuals may take estrogen, the primary female hormone, and anti-androgens for testosterone blockers. Results of estrogen can include softer skin, less body hair growth, decreased libido, body fat redistribution, and breast growth. Risks may include blood clots, potential increased likelihood for gallstones, and mood swings. Similarly to testosterone, effects differ between individuals. Surgeries include vaginoplasty, which constructs a vagina; orchiectomy, to remove the testicles; as well as breast implants, facial feminization surgery, and tracheal shave. Everyone, no matter their gender, can get surgeries for hair growth or removal, facial structure, voice, and body fat distribution. (See the end of this post for some helpful links that will provide more information on medical/physical transition!)

Although there are lots of options for medical transition, not everyone can undergo this aspect of transition for various reasons, like physical health or the cost of transition. Individuals also might not want to medically transition, and those desires are valid. Additionally, the FDA does not necessarily regulate hormones, so it’s important to find a source you trust (medical professionals) when acquiring hormones. 


Legal transition: Many gender-expansive people opt to legally change their name and gender because it can make things like doctor appointments and legal matters significantly more comfortable. At places like gender clinics, where gender-expansive people can go for medical transition treatment, you can give them the name and pronouns you go by, even if you haven’t legally changed them yet. Unfortunately, some places will still call out a person’s birth name or deadname, which can be very dysphoria-inducing for some people. Although more and more places are allowing name changes in the system, individuals may still encounter issues with staff in medical settings. (Once a gender-expansive person changes their name, it’s not okay to use any older names. Referring to someone by their birth name is called deadnaming.) It can be a long process to get all documents changed and it takes a lot of patience, but all the people I know who have undergone the process have said it was well worth it for them. For something like an Apple ID on Apple devices, they’re designed so that it’s exceptionally difficult to modify or delete information related to the Apple ID, so some people end up deleting the ID and making a new one rather than having to deal with seeing an old name on the ID.


Social transition: Now for social transition! You’ve probably heard of coming out, which can refer to a person telling others about their sexuality, gender, or pronouns. This can also include changing up how someone expresses themselves, using a different public restroom, and going by another title, such as “ma’am” instead of “sir”.


This was originally designed to be a single post with my previous one, but we decided that it would make more sense as two. If you’re also interested in pronouns and gender vs. sex, I recommend checking out that other post too. Also, if you think someone you know could benefit from any of this information, you should share it with them to spread awareness! Have a lovely day!


By Cal (he/they/ze/hir)


Helpful links: 

Planned Parenthood: What do I need to know about transitioning?

University of California, San Francisco: Transition Roadmap,Testosterone Hormone Therapy Information, Estrogen Hormone Therapy Information

Them: What It’s Like to Medically Transition As a Nonbinary Person

LGBTQ Center of Durham: Transgender and Gender Affirming Programs/Resources

National Center for Transgender Equality: ID Documents Center – North Carolina (resource for how to change legal documents)

American Civil Liberties Union (ACLU): Transgender People and the Law – Frequently Asked Questions


This post was reviewed and approved by a medical professional, Catherine S. Lee, MD.


Tags: dysphoria, gender, transgender, transition, gender-expansive, hormones, HRT