Types of Transition: Medical
The final installment of the transition series
A note before we begin: As with both other articles in this series my knowledge is limited by what I know and feel comfortable speaking on. That being said, this article will mainly focus on hormones, top surgery, and hysterectomy as that is what I have done/am pursuing. I will be touching slightly on other aspects, but those will be more driven towards other resources that I know of. In addition, I want to make note of how lucky I have been to be able to medically transition with relative ease. Not everyone will have the same experiences I have had, and the process to medical transition for you may look different to how it was for me.
What is Medical Transition?
Medical transition is the process of altering one’s physical and/or chemical characteristics to align with one’s true gender. Medical transition includes hormones, therapy, cosmetic procedures, and surgery. Not everyone will proceed with every aspect of medical transition for a variety of reasons. Like most things related to transness, medical transition a broad spectrum. In addition, not all transgender people will medically transition.
Medical transition requires help from doctors and other medical professionals as you will need monitoring and aid to progress through the steps you want to take. The medical system is incredibly convoluted and can be confusing and frustrating to navigate so take this a time to familiarize yourself with your health insurance, what they cover, and what steps you personally want to pursue for medical transition.
Progressing through the steps of medical transition can take months or even years a to happen and a decent chunk of what you’ll be doing is waiting, as unfortunate as it sounds. Be patient with yourself and don’t rush into things just because you feel like it’s what you have to do. Again, medical transition looks different for everyone.
Why is Medical Transition Important?
Just like legal and social transition, medical transition is important as it’s another facet of gender affirmation, and some may consider it the most important facet. It’s especially important to the trans folks who weren’t able to skip over the wrong puberty and are left with traits from an estrogenized puberty that are less desirable like breasts or a period.
Medical transition is also the only way trans folks can correct certain characteristics that cause dysphoria. For trans men/mascs, the big thing for a lot of us is top surgery (which I will get more into later on) and it is widely considered THE trans man/masc surgery to the point that some folks don’t know bottom surgery or facial masculinization surgery even exist.
A note for the cisgender folks: Some aspects of medical transition may seem unnecessary to you. That’s okay, but you should never dictate how a trans person handles their own medical care.
Aspects of Medical Transition
Hormone Replacement Therapy (HRT): Testosterone is the hormone used by many trans men/mascs to help develop the secondary sex characteristics typically associated with men. This includes but isn’t limited to increased body/facial hair, lower voice, slowed or stopped periods, increased hunger, and increased libido.
Testosterone has to be prescribed by a doctor as in the US it’s considered a restricted substance. Your PCP, an endocrinologist, or a doctor at an informed consent clinic like Planned Parenthood will be able to prescribe it to you. Due to its restricted substance status, you typically won’t be able to stockpile testosterone in case your access to it gets restricted. There are ways to DIY testosterone, but for legal reasons I can’t point you in the right direction for that.
Testosterone comes in several forms like injections, gel, pellet, and patch although injections and gel are the most common forms used.
Here is a link to my article going more in-depth on testosterone.
Minoxidil: Minoxidil, the generic form of Rogaine, is another medication commonly used by trans men/mascs during their transition. It helps facilitate facial and head hair growth. It is available as a topical solution over the counter and there is an oral version you can get with a prescription. Minoxidil/Rogaine is toxic to pets. If you are worried about contact with animals, go with the oral version.
Finasteride: This is an oral medication used to help slow the progression of hair loss by blocking the DHT hormone. This medication can slow or prevent bottom growth.
Top Surgery: Top surgery is a surgical procedure to remove breast tissue and masculinize the chest. While it is very similar to a mastectomy, this isn’t for preventing breast cancer.
There are several different kinds of top surgery like double incision, keyhole, and periareolar. Double incision (DI) is self explanatory as you will have two incisions running along the bottom of the pectoral muscles. This is also the type of top surgery where nipples are removed, resized, and grafted back on. Keyhole uses a small incision below the nipple to remove excess breast tissue. Periareolar top surgery works by cutting around the whole nipple and removing breast tissue and can also include a resizing of the nipples. Both keyhole and periareolar top surgery require your to have a very small chest pre-op so not everyone will qualify for it.
You need to keep getting checked for breast cancer after top surgery as they don’t remove all breast tissue to help create a masculinized shape.
This surgery requires visiting a plastic surgeon to discuss surgical goals and desired results during a consultation. You will also most likely need letters from another doctor and mental health professional to move forward in the surgery process. The process from initial phone call to surgery date can take months to years. For me, I began the process in May 2023 and I just had top surgery last December 2024.
Hysterectomy: A hysterectomy is the removal of the uterus. This surgery can also include the removal of the ovaries, fallopian tubes, and cervix as well. The purpose of this surgery for trans men/mascs is to eliminate the chance of getting a period again as well as eliminating the chance of becoming pregnant. For some people, even having these organs is dysphoric.
The process for getting this surgery can be incredibly difficult depending on where you live. Even the process of going to see a gynecologist can be hard for some trans men/mascs due to discrimination and trans broken arm syndrome. Use the resources available to you to try to make the most informed decision you can about who you’re going to for a hysterectomy and overall gynecological care. It may be worth looking into seeing a urogynecologist as opposed to a typical gynecologist.
Vaginectomy: This is the removal of the vagina and sealing of the vaginal canal. This can go hand-in hand with a hysterectomy or it can be a necessary step towards bottom surgery.
Monsplasty: A monsplasty is the removal of fat on the mons pubis to help lift the bottom growth up and make it more visible. This is usually one of the surgical steps in the Metoidioplasty process, but can be its own standalone surgery as well.
Metoidioplasty: One of the two kinds of bottom surgery which utilizes bottom growth in creating a micro penis. The ligaments that hold the bottom growth closer to the body are cut to help it become slightly longer and the labias are used to create testes with silicone implants. Sometimes urethral lengthening is also done for this surgery to give one the ability to stand while peeing. You can also get vagina preserving Metoidioplasty which gives you the opportunity to keep your vagina.
Phalloplasty: The other kind of bottom surgery which utilizes a skin graft to shape the phallus. A new urethra is created which runs through the neo-phallus which allows one to pee while standing. An erectile device is an also available to allow you to become erect. As with Metoidioplasty, you can have vagina preserving Phalloplasty. You can even keep your bottom growth unburied if that is what you want!
Both bottom surgeries are so diverse in their options that I could write whole articles about them. Definitely check out the resources below for more information!
Facial Masculinization Surgery: The masculine version of facial feminization surgery which many of our trans women/fem sisters get, FMS is used to help create a more masculine face shape. This includes sculpting the jaw, making one’s brow bone more pronounced, or even making an adams apple.
Unfortunately, there aren’t too many surgeons out there that perform FMS and I am even hard-pressed to find many folks talking about it.
Voice Training: Voice training can help those that wish to masculinize their voice further than testosterone has or for those who don’t want to/can’t go on testosterone. You‘ll work with a speech pathologist to achieve the voice you want. There are also many tutorials online on how to masculinize one’s voice.
Other Aspects of Medical Transition: This is more so a rapid-fire list of things in addition to/related to what I’ve talked about above.
Leg lengthening surgery, breast reduction, pearling/genital beading, scrotoplasty, oophorectomy, and salpingectomy.
Further Reading and Useful Communities
Communities where you will see surgical photos, blood, pre-op chests, or genitals will be marked with a *
HRT:
Planned Parenthood
Surgery:
* Transbucket - The website looks suuuper sketchy, but I promise it’s not!
* R/phallo
Mayo Clinic
Next week I’ll be coming out with an extra special article, so keep your eyes peeled! In addition, an email will be coming out on Sunday discussing blog reccomendation. While it’s not necessary, it helps my audience grow and I’d appreciate your help passing information along. Thanks for reading!
