Transgender people experience their transitions in a variety of ways, with many opting to transition only socially, only hormonally, or opting for a combination of hormonal transition and surgery. In this week's Sex Talk Realness, Cosmopolitan.com spoke with three men about their experiences with having surgery and taking hormones in an effort to become the person they always were.
First, a brief glossary of terms you'll need to know.
Hormonal transition: When someone changes the balance of sex hormones in their body via some form of supplement. For trans men, this means taking extra testosterone.
Surgery: References gender reassignment surgery, which involves altering the physical aspects of a person to match their gender identity. "Top surgery" involves a double mastectomy and optional reconstruction of the chest and/or nipples, and "bottom surgery" is when the genitals are surgically altered to match the person's gender identity. RFF phalloplasty stands for radial forearm flap phalloplasty, and is a procedure that uses the skin and veins from a person's forearm to create a penis. Another type is the ALT phalloplasty, anterolateral thigh flap phalloplasty, which uses skin and veins from the thigh to create a penis. A hysterectomy is a surgery that removes an uterus. An oophorectomy is the removal of the ovaries.
FTM: an abbreviation for "female to male."
How old are you now?Man A: Thirty-two.
Man B: Twenty-three.
Man C: Fifty.
How old were you when you came out as transgender to your friends and family?Man A: I was 25 when I came out as a transgender man to close friends and coworkers, and then came out as a transgender man to my close family when I was 26.
Man B: I was 23 when I came out to my family, and I was 22 when I came out to my friends.
Man C: I suppose you could call me a late bloomer! I have always believed I was "different" and for years I have referred to myself as lesbian, although I never felt quite as though it fit how I felt. In late April 2015, I watched the Jenner interview on television. As I listened to Caitlyn share her story, I began to realize there were a number of parallels to my life that I could no longer deny. I was moved to tears and realized that it was time for me to allow myself to be the me I have always believed myself to be.
How old were you when you began to transition and when you completed the transition? Man A: There is a difference between social transition and medical transition that is important. I socially transitioned when I was 25. This included changing my name and having people use male pronouns. I don't think that transition is ever "complete." I had a stop-and-start hormonal transition due to allergies to several of the commercially available testosterone creams/gels/solutions. I started when I was 25 but was unable to find a good type of testosterone until I was 29. At one point I had given up on hormonal transition due to difficulty with having rashes develop. This was not due to the testosterone itself but what it is dissolved in. I had top surgery — which is a two-stage procedure — in 2014 when I was 29, and RFF phalloplasty in 2015 when I was 30. I finally found a method of testosterone that works in 2014, so I have not been on hormones consistently since after first stage of top surgery. I am choosing not to have stage 2 of my phalloplasty (testicular implants and semi-rigid rod implant) because I have good sensation and enjoy a good sex life. I don't feel like I need it. I will need to have a hysterectomy and oophorectomy in order to facilitate effects of testosterone and reduce risk of cancer. I don't have it scheduled yet.
Man B: I believe that transition is such a broad term to categorize the diverse experiences transgender people have had. It is a series of states of being. I could say that I consciously began to transition on Oct. 29 of 2014 after my first therapy session, attending a talk and book signing by Marjane Satrapi, and becoming inspired to pursue my authentic self. I could also say that I began to transition as soon as my memory formed by rejecting pink, switching my Barbie for a truck, and using the men's restroom. I'm not sure if we ever complete transitioning, because we cannot stop being. It is not a simple journey from point A to point B; it is our unique ways of relating our bodies to the outside world.
Man C: My transition began in late April of 2015. I began seeing a therapist immediately upon sharing with my significant other that I believed I am transgender. Three months after that, I began doing hormone treatments and started giving myself a weekly shot of testosterone. I had gender-affirming top surgery in December of 2015 after years of struggling with gender dysphoria over having breasts. At this time, I am comfortable with the changes I have made. I am not sure if I will proceed any further and get bottom surgery, but, to be honest, the only reason I am not really considering it is because it is extremely expensive and will have to be done outside of the U.S. I know some trans men who have had bottom surgery and they are extremely pleased with their results, but they had to spend more than $30,000, which is a lot of money in my humble opinion. My top surgery alone was $7,000 and I had to pay for it out of pocket because my insurance still sees this surgery as cosmetic and I was not interested in waiting any longer.
How did you decide to transition and whether you wanted to pursue hormones or surgery or both? Man A: The first time I started hormones, it was partially due to this belief that if I identified as male, I must want hormones. I had an allergic reaction to that batch, but I also found that I wasn't ready.
I had a lot of ambivalence about top surgery but had been considering for so long that I finally decided to take the plunge. Otherwise, I would be torturing myself going, "What if?" Once I had top surgery, everything else (pursuing hormones again and bottom surgery) seemed like it was a simple decision. I decided to have phalloplasty after going to a conference where surgeons spoke about nerve hookups. The talk debunked a lot of myths about bottom surgery for FTMs. After that talk, it was just a matter of finding the insurance for the doctor I wanted, getting a date that worked well with time off from work, saving up enough money for the costs that aren't covered, etc. That process took two years.
Man B: I decided to consciously transition when I realized that I could earn straight As, break athletic records, and care for the elderly in assisted living, but I couldn't even go home and look at myself in the mirror. I wanted to stop feeling suicidal and start feeling worthy of love. I realized I could no longer make other people comfortable at the expense of my own life; I could no longer set myself on fire to keep others warm. Once I started recognizing myself by changing my name, pronouns, and clothing, I wanted to go further with hormones and surgery.
Man C: My decision to medically transition came after doing a great deal of research. I wanted to be sure I was fully aware of the risks to my health prior to beginning any hormones. I was also curious about what to expect in my appearance. I knew I would grow facial hair and possibly even deal with a receding hairline or male pattern baldness, but since there isn't a history of baldness in my background, I am pretty confident that will not be an issue for me. I have always been secretly infatuated with facial hair, so growing a mustache or beard is something I am actually looking forward to. There are other side effects and I was extremely grateful my doctor took time with me to explain. I am happy to report that I have had only moderate side effects like sweating, increased body odor, increased sex drive, increased body hair, and acne. The other physical effects I am extremely pleased with: deepening of the voice, increased libido and enlargement of the clitoris, change in body structure from rearrangement of fat cells (this has been minimal at this point because I have only been on T for four months), cessation of menstruation, and increased energy.
What were your biggest fears about transitioning? Man A: That I'd regret it or have severe complications that would make me regret it (like an infection that kills me or disables me severely).
Man B: I was afraid that once people figured out who the real me was, they would see me as mentally ill, and either laugh or scream at me. I was afraid that they would throw me on the streets and beat me. I feared that all the things I worked hard to achieve would mean nothing in the face of shame.
Man C: One of the biggest was what impact being on hormones would have on my body. I also worried about coming out at work and whether or not I would be accepted or even be able to keep my job.
How long after you began your hormonal transition did you start noticing a change?Man A: I don't pass as male, but my partner, close friends, and I have noticed a slight drop in my voice, more facial hair, and a higher sex drive. I also have more acne.
Man B: I started hormones in July and I noticed some non-visible changes right away. My energy levels and sex drive both skyrocketed. When my voice first dropped two months later, I posted a video on my Facebook right away so I could share my amazement. I didn't sound like a little boy anymore. Everyone else noticed the change, and that's around the time I started being perceived by the general public as male.
Man C: I immediately began feeling emotionally more balanced and free. It wasn't until after the first three months that people began to see the changes because of the increased facial hair. My partner began to notice the changes almost immediately in my mood and overall sense of well-being. Unfortunately, right now, I do appear to people as somewhat in between genders and still get referred to as "lady" or "ma'am." I am hoping that one day it will be a given and I will have enough facial hair and my voice will be deep enough that people don't think twice and refer to me as "sir."
Were there any aspects of the hormonal transition that surprised you? Man A: I became attracted to men sexually. I also was no longer attracted to butch women and started being attracted to more feminine ones.
Man B: I think the increase in sex drive surprised me the most. I knew it would happen, but I still didn't expect it to be that strong. Masturbation turned from a fun activity to an everyday necessity. It also made me realize how fluid sexuality is. Before hormones, I was mostly attracted to femininity and female-identified people. After hormones, I'm mostly attracted to masculinity, male-identified people, and non-binary people.
Man C: The mental clarity I have felt and the increased energy levels were unexpected. I also started getting painful acne on my head, but at least it's not on my face.
Was there a gap between starting your hormonal transition and having surgery?Man A: All of the steps took a lot of planning and I had to save up almost $12,000 to have the procedures done, so it wasn't immediate. I also decided to go out of town for my bottom surgery and their first available appointment date was 18 months out, so that gave me a while to save up money, arrange a sabbatical, and prepare mentally.
Man B: There was a six-month gap between taking hormones and having surgery. I did that because I wanted to take the time to adjust to initial changes on testosterone. I also wanted to ensure that I had independent housing and finances during recovery. Far too many trans people have their birth families abandon them in the last second, leaving them completely vulnerable with nowhere to go and I worried about that.
Man C: My insurance told me the top surgery would not be covered unless I could prove a history of breast cancer in my family. Also, the doctor who performed the surgery was not willing fill out the form saying it was a mastectomy, since it was actually double incision top surgery that removed the nipples, resized them, and grafted them on the chest. Ironically, my medical records do show it as a mastectomy.
Since some transgender people don't feel it necessary to get surgery, why did you feel it was necessary for you? Man A: Everyone's journey is different. I don't feel like I "needed" surgery to survive, but I did need it to thrive. I had phalloplasty and scrotoplasty for bottom surgery. Phalloplasty involves getting tissue moved from another part of the body and creating a penis, which can be done with urethral lengthening or without. I had urethral lengthening, so I can pee standing up. The option to remove the vagina (vaginectomy, which also requires a hysterectomy) is optional. I enjoy having a vagina and can still have vaginal orgasms. I don't have psychological distress over having a vagina at all (unlike the distress I had from not having a penis). Hence, I opted not to have a vaginectomy. Surgery in general also opened me up mentally to holding better boundaries at work (I don't stay late at work because I won't be paid for it) and being more able to be open to a relationship. I am much happier.
Man C: I have always been incredibly uncomfortable with having breasts. Now that I am on the other side of it, I can't even express in writing the happiness it brings me to be free of breasts. When I look at my chest now, I feel as though this is the way it always should have been. I had a friend ask me if I was sad afterward and I said, "Absolutely not!" Don't get me wrong, I am a breast guy, I just prefer them on my girlfriend's chest.
How did you pay for the surgery? Did you have insurance when you began transitioning? Man A: My insurance didn't cover top surgery and my out-of-pocket expense was $12,000 because I chose an out-of-network doctor who could preserve nipple sensation. I could have gone in-network and paid much less. My insurance covered bottom surgery and paid approximately $145,000, but I had to pay a $6,500 deductible, travel costs, bandages, ointments, and other non-prescription requirements (about $3,000). I also was on disability for three months. So my total out-of-pocket cost was about $35,000 with lost income and extra expenses. I mostly worked long hours, borrowed money, and started fundraising to pay for it.
Man B: I was under my parents' insurance when I began transitioning, but my parents did not know I was transgender, and they hold certain religious and political beliefs that prevent them from understanding or accepting trans people. Even though I knew it was risky, I started taking hormones and went through surgery without their prior knowledge, since I knew I wouldn't have their approval. I was very lucky their insurance covered both the hormones and the surgery. A lot of people don't have that.
Man C: Insurance covered my therapy and hormone treatments, but it didn't cover my top surgery. My partner and I used our savings to cover the top surgery.
Describe the day of your surgery. Man A: On the day of the first half of my top surgery (I had to go back a second time for the nipple deduction), my best friend, another close friend, and I went to the surgery center. My mom stayed home to get the house ready and disinfected for when I came home. I remember going into the operating room and then waking up extremely nauseated and loopy. After about two hours in the recovery room, I was sent home. I was exhausted for a few days and slept through most of it. When I went back for the nipple deduction, it was pretty similar. For the bottom surgery, my best friend took two weeks off from work and then arranged to work remotely for the remainder of the time. I took a sabbatical for the entire term. I woke up from surgery and was "blind" (this can happen sometimes with a long surgery time and mine was eight hours and 23 minutes), which made me have a panic attack. With the panic attack, my heart started to race and I became worried that I would "kill" my penis with all the new capillaries connected. They gave me a drug that knocked me out.
Man B: I had wisdom tooth surgery during the summer, and my top surgery didn't feel any different. I looked forward to it, but I looked forward to getting over recovery since it impedes my daily functioning. I did laugh to myself at the hospital when the staff played what I like to call "pronoun volleyball," since my birth name was on my insurance, but I appeared male, and they weren't sure how to address me.
Man C: I was excited and nervous the day of my surgery, but more excited than nervous because this was something I had been waiting to do for years. My surgery was scheduled for 4:30 p.m. and I was told I couldn't eat anything the night before, so it was a very long day. My surgery was also delayed due to the surgery prior to mine taking longer than expected. During the day, I posted a few photos of my partner and I preparing for the surgery on social media, and so many people sent out lots of love and healing energy, and they all wanted to be updated along the way. Almost all of the staff at the hospital referred to me with the proper name and pronouns, although there were some slip-ups along the way. I remember being wheeled into the surgery room and being introduced to some of the surgery team, but after that I only remember waking up in the recovery room. When I woke up, the first question I asked the nurse was, "Are they gone?" She said, "Yes, they are gone." I felt an overwhelming sense of relief come over me. I did feel a little nauseated after surgery, but the nurse gave me some anti-nausea medication that took care of it immediately. I felt a great sense of relief and ready to take on my recovery.
Did you have any complications post-surgery?Man A: I had no complications with the surgery and actually healed better than any other patient, according to my doctor. The only issue I had was that my resting heart rate remained high for a long time post-op, but it finally returned to normal after six months and I'm fine now.
Man B: I am only a few days post-op right now, but so far my right side has had a significant amount of bruising. I've also developed an allergy to one of the medications. I'm glad there haven't been any other complications yet, but my fingers are crossed.
Man C: My surgery and post-op went extremely well. I was released from the hospital later that night and everyone said they were surprised at how well I was recovering. I did have some problems with my skin healing after we removed the bolsters that were stapled to my chest to hold my new nipples in place.
What surprised you most about the changes in your body post-surgery?Man A: The changes that surprised me were mostly mental. I started acting like someone who loved themselves right away. I was inspired to eat healthier, to focus on the things that were important to me, to build relationships that were intimate, and to stop using work as a way to avoid feeling.
Man B: I think it's too early for me to tell, but I think it will be cool to be able to take my shirt off without it being a scandal.
Man C: I look so much like my dad. When I returned to my friend's house two weeks after surgery to have him take my post-op photos, I realized my pre-op photos didn't even look like me. I feel like a whole new man.
How did you learn how to use your new body? Man A: I did have to learn how to pee for the first time through my new penis. This is a painful process, because there is a catheter that goes through the walls of the abdomen. When you urinate out of your penis, it creates a vacuum, which sucks the tube in and it really hurts. Peeing on my own took about a month, so I had a urine bag for that amount of time. I learned through practice. I didn't have any unexpected challenges, but it has been frustrating trying to train my bladder to recognize that my urethra is now 6 inches longer. It didn't know to push out urine for a longer time, so I end up dripping for a little bit after I finish peeing.
Man B: I'm still in the recovery process, so I'm not able to lift my arms up, which makes it hard to wash my hair or reach for something.
Man C: I didn't feel like I had to learn anything new, I just felt more free. I am excited to be able to get back to the gym and see how my body will continue to change.
How has your sex life changed, if at all? Man A: I did not have sex after my top surgery/pre-bottom surgery. I always felt like even though I was having sex with women prior to surgery, it wasn't "real sex" only because I'd always felt dissociated from my body. Now I have full sensation in my shaft and also have an external device called an Elator that allows my penis to be stiff enough for penetration. The combination of both the emotional and physical changes is amazing.
Man B: I have a lot more sex now and I'm more into hooking up. I've also had a lot of cisgender men say they want to "try me out" then become too afraid of sleeping with me, but I just laugh at them now.
Man C: Once I came out as trans and began my hormone treatments, my libido increased, but my partner, who has suffered from horrible pain from her monthly periods, was diagnosed with having high levels of natural testosterone in her body. She's now on a blocker that has decreased her sex drive, so that's made things difficult. Fortunately, our sexual relationship is only one part of our relationship and I am so very fortunate to have her by my side either way.
Can you describe the way your transition has helped you feel closer to your gender identity? Man A: It feels like I have a life force flowing within me that wasn't there before. It isn't about being connected with my gender, it's about being connected with me.
Man B: Before hormones, I felt like a prepubescent boy because I felt like I was stuck in time, yet aging simultaneously. Being on testosterone now has made me feel at home in my own body. And after surgery, being able to look myself in the mirror and feel comfortable has been amazing.
Man C: Hormones have helped me feel more free to make choices based on how I feel on the inside. I always dressed in a more androgynous way, preferred shopping in the men's department, and felt like I should act a certain way or I'd be judged. Also, having a flat chest and being able to walk around the house without a shirt on has given me so much peace. When I look in the mirror today, I see the me that used to be hidden behind a 44DD chest.
If you could change anything about your transitioning experience, what would it be?Man A: I wish that I wasn't allergic to injections of testosterone (I'm allergic to the oil they use to suspend it) or the creams and gels. I have to use a pellet that implants testosterone into the skin, which is a much slower process. I also wish that I had been able to connect more with transgender folks sooner.
Man B: I wish I could have consciously transitioned earlier, or at least explained myself to myself as a child. I grew up with a lot of bullying and confusion, and I used those experiences as reasons to hate myself. I thought I was a demon or a monster and that this planet didn't deserve to have me on it. Mostly I regret spending all those years not loving myself.
Man C: I would have loved to have had the courage to transition sooner.
What advice would you give other people considering a hormonal or surgical transition?
Man A: I think that seeing a therapist to process the trauma that can be associated with surgery — a knife being used to cut open your body can be traumatic — is important. There is also the emotional pain of grieving in terms of the changes in your body, as well as the emotional and financial cost associated with surgery and hormones. I think that a good transgender-knowledgeable therapist can help make the process better. Unfortunately, there are a lot of therapists that can be really shaming, but my psychoanalyst was the most important person during my surgical transition, because she helped care for my mind.
Man B: I would tell other people to give themselves all the space they need and if possible, watch all the YouTube videos pertaining to each step they plan to take. Also, read stories written by trans people in their own words. It's most important to remember that no matter what step you take, you are worthy of love and respect, not just from everyone else, but also from within yourself.
Man C: Find a therapist and doctor who will support you along your journey and provide you with all the information you need to make a decision that is in your best interest. Do your research, ask a lot of questions, and follow the doctor's orders.