Beginning your transition

Now what?

You've come to the realization that you're trans and you might be thinking, "What do I do now?" The road to becoming your true self can have a few pot holes and nice roadside stops where you can enjoy a hot fudge sundae, but it's seldom boring! Some describe it as a rollercoaster ride and I agree!

How well you transition can be based on many factors. Such as where you live, age, trans resources in your area, how your family and friends accept you, being married or in a relationship and the potential for transitioning at a job. There are some basic steps most of us have taken.

Gender identity therapy

Finding a gender identity therapist can be easy to impossible depending on where you live. Most large cities have them. Some alternative and gay & lesbian publications have listings of therapists, or check the yellow pages under gay & lesbian. Networking with other trans people will often get you leads to therapists in your area. If you have several therapists to choose from pick the one you feel most comfortable with.

Like many things in transition, therapy can be expensive. Try to have your therapy, and hormones, covered by insurance. You can sometimes have your therapy covered, even if your insurance has exclusions for gender identity, if your therapist uses an anxiety or adjustment disorder as a diagnosis. Likewise hormones may be covered if your doctor uses hormone imbalance as a diagnosis. If you have to pay out-of-pocket some therapists charge on a sliding scale (cost is proportional to your income).

  • Most surgeons require 6 months of gender identity therapy before SRS. Avoid going to a therapist or doctor who doesn't have gender identity experience. Though you can sometimes educate an unknowledgable therapist, or doctor, it's best to avoid them. They sometimes do more harm than good by misdiagnosing you, not knowing how to prescribe medications, etc.

Find a therapist - online, phone and e-mail counseling
Helpnet - New England area
Dr. Becky Allison's therapist list
Sam Allan Counseling & Consulting
Raleigh-Durham-Chapel Hill area of North Carolina & by telephone


Starting HRT (Hormone Replacement Therapy) is usually done through a gender therapist who refers you to a knowledgeable doctor. The sooner you start hormones the better—as the body ages it becomes less receptive to hormonal changes.

You can start HRT and still work as a guy (or woman for the FTM) for a while, but eventually the changes will be noticed by your co-workers and customers, like a deeper voice in the FTM (that happens fairly rapidly on testosterone and is permanent) and breasts and other physical changes if you're MTF. If you can dress causally at work loose clothes can hide breasts. FTMs use a binder before a bilateral mastectomy to conceal the breasts.

If there are no therapists in your area who will refer you for hormones, or make you live full-time pre-hormones or you just want to do-it-yourself, you can order hormones from overseas pharmacies. This is usually safe unless you take higher than recommended dosages or jeopardize your health by taking them when you have a medical condition such as high blood pressure, cancer or liver damage. Then you should only take them after seeing a doctor. Most surgeons require a year of HRT before SRS.

Hormones by mail and dosages
Choosing the right surgeon for SRS
SRS surgeons links

Support groups

A support group is a safe place to meet for support and camaraderie and make new friends. If you're in, or close to, a major city there are probably one, or more, trans support groups. They may be harder to find in small towns and less liberal areas. Alternative and gay & lesbian publications can have listings of support groups. You can sometimes get info about support groups from a GLBT-friendly doctor or therapist, or your trans friends. Avoid going to an exclusively crossdresser group—their issues are different from ours. If there are no support groups in your area you might consider starting one.

Personal support network

This ties into the preceding support groups. Transition can sometimes be difficult and lonely. Having a network of supportive friends and allies is important, especially if you're currently in a relationship and your partner is unaccepting, or you're having family problems. Women are generally more accepting and easier to approach. Finding a GG (genetic girl) who befriends, and helps, you is a gem!

Of course, if your current friends accept the new you they become your support network. You'll find out who your real friends are by coming out! Trans-friendly bars or night clubs are another source for finding supportive friends (be careful as some people's motives may not be as they appear). There are online TS / TG support groups and communities (IRC, AOL, website chat rooms, etc). They can be a great source for internet friends and networking, especially if you're in an isolated or transphobic area.

Hair removal (MTF)

If you haven't already you'll need to start electrolysis or laser ASAP. Electrolysis is still the only FDA recognized permanent hair removal method. Laser has been approved for permanent hair reduction by the FDA. Whether there's a significant difference between removal and reduction is debatable. Laser is reportedly faster, less painful and can cover larger areas than electrolysis. Some trans women clear their faces with laser then clean up with electro. Electrologists and laser methods and technicians vary in price, type, skill and technique. In the beginning, you'll need to have some beard growth for the electrologist, or laser technician, to work on. This can make living full-time difficult, especially if you have a dark beard. You can have electro/laser done while still working in guy mode or living part-time.

Choosing the right electrologist


The decision to transition at your current job, or start fresh at a new employer, is an important one. Some of the more progressive companies, like Intel, Microsoft, IBM, etc. have policies regarding transitioning. Check your employer's anti-discrimination policy. Also, check your local anti-discrimination laws to find out if gender identity is included.

Where you live and how well trans people are accepted in your community effects how you're treated. You may encounter discrimination and harassment on the job in a conservative area and even some liberal areas. Unfortunately, it's still legal in most states to fire someone just for being transgender.

If you want to transition at your current job, I recommend writing a letter to your employer stating you've been diagnosed with GID and "as required by the Harry Benjamin SOC (Standards of Care) will be transitoning to the female/male gender." Explain it's a medical condition and you're following the standard procedures (i.e. hormones, electrolysis, living full-time, etc) in preparation for your SRS. A letter from your therapist should be included.

The bathroom issue can be touchy. It's probably a good idea to get your fellow employee's thoughts about the restrooms and if there are any company policies in place regarding them. Some employers offer unisex bathrooms or other accommodations, but there's a fine line between reasonable accommodation and discrimination. Once SRS has been performed it's normally accepted that you can use the restroom congruent with your self-identified gender.

Sometimes it's better to start over at a new job (especially if you're very passable) and avoiding potential harassment, wrong pronoun usage or termination.

Changing IDs and other personal identities

Once you're close to living full-time it's time to change your IDs to your new name and gender. Usually the first step is getting a court-ordered legal name change. The procedures differ by state, but typically you file a form with your state civil court, pay a fee and are given a court date. Changing your driver's license also varies by state. Sometimes a letter from a therapist is required (this can be useful for other ID changes as well). Some states will let you change the sex on your driver's license before SRS, others require you to have completed surgery. For Social Security, call your local SS office for details on changing name and gender. Bank accounts, credit cards, etc. are relatively easy as long as you have a court-ordered name change and / or letter from a therapist. For birth certificates contact the Department of Vital Statistics (or Records) in the state (USA) you were born to find out what's required. Usually you will have to have undergone SRS to change the sex on your birth certificate.

Email: It may seem trivial changing your email address if it has a male name, but getting an email from bruce[at] signed Barbara doesn't sound quite right. :)

Deportment: voice and mannerisms

Since we've lived some, or most, of our lives as the wrong gender we usually need to unlearn the traits we developed growing up. This comes naturally to some, others have to learn it. A good way is to study female's (or male's if you're FTM) mannerisms and imitating them until they come naturally. Either vocal surgery, or voice training, is usually necessary (except FTMs, their voices become deeper with testosterone). Unless you started in your teens, before you voice changed, estrogen has little effect on voice.

Developing a female voice
Developing a female walk

Marriage and transition

Most marriages don't last through transition. This is an unfortunate, but common, consequence of transitioning. A few do, it helps if your partner is bi or has lesbian tendencies. I recommend giving your partner accurate information about GID, i.e. it's a biological condition and not a choice. People have misunderstandings about us, may think we're being selfish and 'destroying the family' without any regard for them. In addition, we can be saddled with guilt and your spouse, or partner, may compound that by trying to make it 'your fault.' Couples counseling with a gender therapist may help, but most marriages end in separation and divorce. Sometimes a partner may be supportive, or neutral, at first, but as the physical changes become more pronounced and the reality sets in, he or she may become unaccepting, even hostile!

Transition is necessarily a self-centered process. You have to put yourself first if you're going to do it right.

10 ways to pay for SRS

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