This article is a general guide for people who are born female but identify as male. You don't have to make the physical transition completely - it's okay to stop at the stage where you feel most comfortable. You can always continue it further forward if you decide to do so, but in most cases you cannot go back.
Steps
Step 1. Accept yourself for who you are
The first important step in your transition is to accept who you are. It is something you have known all your life, or maybe you have recently realized / accepted it. Take all the time you need to think about everything, do some research, cry, in short, whatever you need. Know that you are not alone - there are a lot of trans people (this phenomenon is also called "gender dysphoria").
- Find a safe support group in your area where you can meet people like you, hear their stories, gather more information, ask questions, and be able to accept yourself.
- Understand what you need to do to be at peace. Some transgender people are perfectly comfortable wearing clothes of the kind they identify with, and some need to use masculine pronouns, "he / she" when referring to them. Others feel the need to modify their body in order to be perceived correctly by others and to be able to accept themselves when looking at themselves, so they face hormone therapies (intravenous testosterone, gel or cream). Some transsexuals have such a strong form of dysphoria that they need the complete transition, which includes everything we've already talked about and surgery (surgical sex reassignment). Remember that you don't have to make all the choices right away, in fact it is a very long road. Many people find it frustrating because of its slowness (hormones can take months or years to do their job, beards may not grow at all, surgeries are not covered by the health care system and can be very expensive, and so on).
Step 2. "Come out"
There is no "right" time to declare yourself transsexual and it doesn't have to be a secondary step on your path. But it is very important and it is a delicate move. It will be a long process for you and it will not be an easy road - you need a support network and people who are always there for you. Especially your family. Be careful not to rush your family and friends to treat you like a boy - they've seen you as a girl for years and it won't be easy for them.
- It's probably best to tell this first to either a really close friend or your parents (especially if you live with them). Letters are perfect if you're not good at speech or aren't sure how to say it. Be kind and don't overwhelm them. Give them time to think about it and try not to be offended if they need to get away, cry, or something unexpected. In case they are angry with you, remember that you have been facing this reality for a long time, while they are the first time they have heard of it.
- You can test your family on the subject by talking about some FTM-related news. Look for some interesting stories, like "the man who got pregnant", and talk about them. Find out how they react by discussing strangers before confessing who you really are, especially if you are a minor. In some families there is a risk of psychological violence. Don't come out until you feel physically safe and make a "backup plan" in case things go wrong.
- Many people will have several questions (especially the family). Read up on it. You need to know what the next step is and know all the options of the path you are taking. Be patient with their questions and don't make fun of them about the obvious things they will say. Don't be too vague, or don't seem unsure of your plans. They may take this as a sign that you haven't really thought about the matter or they may be convincing you not to complete the transition. They may take some examples of your being transsexual (e.g. not feeling comfortable in an all-girl group, wanting to be muscular, or maybe your dream of becoming a footballer) and saying that these phases are normal for many girls., because they want to find a way to convince you that you are wrong. It is very difficult for them to understand how you feel because they are cis-gender and have no idea of the millions of reasons behind your condition. You won't be able to fully explain it to him, just as a man cannot explain to a woman what he really thinks and feels. So try to stay calm and not get angry or frustrated, because, if they're talking to you and they're not yelling at you, they're just trying to support you, they love you, and that's something you need.
- If this is of interest to your family and friends, remember that there are support groups for family members and companions of transgender people. The AGEDO website can be consulted online and the association has several offices throughout the country. You can also bring them to your meetings if you go and if they are allowed (ask first as these are usually quite confidential contexts).
- The words "transgender" and "gay" are often confused or mistaken, and this can be confusing when you come out. Remember that the word transgender refers to a person's gender identity, while sexual orientation can be any of the cisgenders: gay, straight, bisexual, asexual, etc. The confusion probably arises from how to "label" a person during their transition. So, as an FTM, you are a male, which means you may have to explain to others that if you like boys, you are gay, if you like girls, you are straight, and if you like both men and women you are bisexual.. No matter who you date, you always remain a man. Another reason people might confuse transsexuals with gays could come from cross-dressers (who are portrayed in the media as homosexuals, but are usually straight), butch lesbians, who are definitely not men but dress like such, and by drag queens.
Step 3. Go for a boy
If you don't yet, you'll soon want to start dressing like a guy to show the world how you feel on the inside. There are some websites where you can find advice on how to "look" like a man, but you will probably find that they are counterproductive, since you want to stop acting and start being yourself. Some bona fide advice that transsexuals might give you might include the following: be coarse, spit, be vulgar and swear, take up space by keeping your legs apart (even on the bus), and be braggart. Most of the cisgender men around you would probably not do any of this, so it's best to observe what actions you have been taught as a woman and stop doing them, such as covering your mouth with your hand when you giggle. You no longer have to act like a girl 24/7, so you can lose those habits you have taken to integrate with others (you already feel better, right?).
- Be careful and discreet during this phase. Showing a radical change in your home before you even talk to your parents about it could throw them off and lead to tension or unpleasant conversations. Doing this at school, especially in elementary or middle school, or at work, could cause you a lot of problems with your peers. To start, it is better to restrict the passage to the intimacy of your home, or to public places where you do not risk meeting someone you know. However, if you are ready to dress differently to go to school or work, go in stages: start with an androgynous haircut and men's cut clothes, then add t-shirts, jeans or shoes bought in the men's department. Slowly, switch to an even shorter cut if that's what you prefer. A slow transition will make it easier for you, right up to the end. You are a man behind your destiny now.
- Feel free to explain what it means to be transsexual to your classmates or colleagues, also to feel more comfortable in your new look at school or work. Again, be aware that not everyone in this world will accept you as they should, and may say bad and false things, such as calling you a repressed lesbian. Live one day at a time and talk about it in your support group, even if it's online.
Step 4. Find a therapist
This is important for two reasons. One, living a life where you feel trapped in the wrong body can have devastating effects on your mind. Transgender people (about 50%) often suffer from depression and suicidal thoughts. Better to have someone to talk to who can help you deal with these problems and feelings. Two, before you can move on, you need a psychologist who can confirm that you are indeed transsexual, and from there refer you to a good endocrinologist for hormone treatment and a surgeon for various operations. However, this step is falling into disuse in many places since changes were made to the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) and transsexuality was removed from the mental illness list (note: homosexuality has been removed decades ago). In Italy there is a very specific procedure for the surgical reassignment of sex. Never buy testosterone online or start such treatments yourself! The reason your doctor or psychologist will refer you to an endocrinologist is to do blood tests and analyze your current hormone levels. It is vital that they do not give you too much testosterone, or it will be turned into estrogen by the body, and that would go against your plans, right? The passage to the doctor and psychologist in Italy are mandatory, so you must be patient and respect all the steps, especially for your safety.
- It is best to find an experienced surgeon and a psychologist who specializes in transitioning from woman to man. If you're having a hard time finding it, try asking your support group or check online who they recommend (and who they don't recommend).
- Transition is a very important step in your life and no phase should be rushed. It may take multiple sessions with the psychologist to confirm the diagnosis, and from there you have to work together throughout the transition process.
Step 5. Make a plan
There are many steps to consider, including hormones, surgery, confessing to the people you work / live / interact with who you really are. So, having some guidelines could come in really handy. It can help you put everything in perspective, keep you in line, help you keep track of resources, make a list of doctors, plan for name changes on legal documents (driver's license, passport, birth certificate, ID card etc.) and motivate you to organize your budget (and it will be large, since the state will not pay everything you need, so save a few thousand euros).
- Be realistic. Even if you want to do it all in one year, it will take several to get it all done. If your plans include a full transition, a realistic goal could be something like ten years. This gives you time to calibrate each step, and also gives your family, friends, and colleagues time to get used to. Your therapist can help you build strength during the process and know when you are ready for the next step. If you don't have a therapist, ask members of the transgender support group you attend, as they can tell you when they took each step.
- Your therapist will be the best person to ask for help when you lay out your work plan. These professionals know how much time passes approximately between one phase and another and probably have a more realistic view based on experiences with other patients.
Step 6. Start hormone therapy (optional)
Not all trans men choose to start HRT. This is for several reasons, including cost or the fact that their body doesn't accept testosterone, but that doesn't make them any less male or transgender. FTMs are quite lucky when it comes to testosterone, because this hormone is very strong and changes the body considerably over time, unlike estrogen, which is used for the opposite transition (MTF). Testosterone makes your body much more masculine. That's how:
- Recalibrate fat distribution by moving it from your hips, butt, thighs and (partly) chest and relocating it to your stomach (you won't lose fat, it will shift, so it's important to keep exercising to lose weight).
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Increase muscle definition (but this only if you work out; it won't make you more muscular if you lie on the couch), widen your shoulders, and in some cases enlarge your hands and feet (probably due to increased cartilage, but not guaranteed).
- The definition of the muscles and the displacement of fat usually make the face more square (if you are under 21, you may even have an Adam's apple).
- Guys lose weight faster because they build lean mass more easily (and this burns fat a lot), so you will be able to flatten your tummy a bit (however, you will gain a lot of weight because you will be much hungrier; also, you cannot lose weight. sitting on the couch if you are on testosterone, you need to get your metabolism working, no matter your gender).
- Many FTMs admit that they felt much stronger once they started the testosterone treatment, and even calmer.
- It increases hair and hair growth (and hair loss occurs at the temples; sometimes it triggers irreversible baldness, even if you stop taking testosterone).
- Increase the depth of the voice (it may be shrill at first, and you will lose vocal range if you sing).
- Makes your skin thicker and more resistant to cold.
- It changes your body odor and makes you sweat more when it's hot.
- Testosterone could make you grow again if you are not out of puberty.
- Testosterone stops menstruation within three months (it depends on the dose).
- Your sexual appetite, such as your appetite for food, will increase.
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Your clitoris will also start growing. The clitoris and penis are made of the same cells and testosterone triggers their development. Usually it becomes two to five cm.
This is important for metoidioplasty (one of the options for surgical sex reassignment), which uses the enlarged clitoris to form the penis
- This is your second puberty, so if you suffered from acne the first time, you will still suffer from it and your skin will be oilier (be prepared to take Topexan out again).
- There is no precise time window for these things, but menstruation should disappear completely in six months. Your voice will be at its deepest between six months and a year, and the same goes for the growth of your clitoris.
- Most start taking intravenous testosterone, but can switch to pills, patches or gels. Cost varies by dosage and method.
- Some FTMs choose to have their breasts removed before starting testosterone treatment. This is because having breasts when you start to look more and more like a man could be weird or embarrassing. It could also be because the breasts are the part of your body that makes you feel the most uncomfortable and testosterone can wait. In some cases, surgery works better before the testosterone cure, but your surgeon will be able to tell you more. Others choose to wait to save money or lose weight, so that the bust is smaller and they can choose another type of surgery (there are three, and based on your size you choose the best one).
Step 7. Change the name
Many transsexuals will start calling themselves by their chosen name early in the transition from family and friends. You can choose to be called whatever you like at the time you want, even if you don't "pass" as a man yet. Check the Italian laws to understand what you need to do and what the costs are.
- Do not forget to communicate the new name jointly and to the ASL. You will also need to notify this at school or your employer.
- There may be religious problems or inconveniences at this point. As long as you are not legally a man you will have limits, be well informed.
Step 8. Undergo surgery
As with hormone replacement therapy, not all trans men decide to undergo surgery. If your appearance looks good and you don't feel the need for surgery, that's fine, otherwise you can have surgery. The bodies of trans men can come in many shapes and sizes, just like those of cisgender men. There are three types of surgeries you can do to physically become more male:
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Bust surgery: removes the breasts and makes the chest more masculine. There are different procedures, based on the size of the chest, the elasticity of the skin and your preferences (scars, convalescence and risks / benefits). The three main surgical operations are:
- Bilateral mastectomy or bilateral incision (if you have a C, D or larger cup, this is your only option).
- Subcutaneous mastectomy (ideal for those who have practically no breasts).
- Subcutaneous mastectomy with periareolar technique (it is not as scary as the previous one, but if you are over the B cup you cannot do it).
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Hysterectomy: is the removal of the uterus. It is often combined with bilateral salpingo-oophorectomy, which removes the ovaries and fallopian tubes.
- Since testosterone blocks the menstrual cycle, some say it may increase the chances of reproductive organ cancer, but it's not proven. Your doctor may recommend this procedure within the first five years of testosterone treatment. However, if you undergo a hysterectomy and by chance you decide to stop testosterone, you may need to take estrogen and progesterone pills to avoid the loss of firmness of the bones.
- Many men want to remove everything in order to avoid the embarrassment of visits to the gynecologist.
- In Italy this procedure is mandatory if you want to start legal sex change procedures.
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Sex Reassignment Surgery: It is the construction of the male genital organs. There are two types: metoidioplasty and phalloplasty.
At the same time, you can extend the urethra so that you can use the penis to urinate standing up. The vagina can be sealed or removed during the procedure if it hasn't already happened, and you can also choose to have silicone testicles inserted
- The ASL does not cover these surgical operations, as they fall into the same category as plastic surgery, therefore aesthetics. They are very expensive and not all hospitals do them.
Step 9. Legally change the gender
Again, be well informed about Italian laws and what you need to do to officially change the sex. Of course, you will need a letter from the psychologist or doctor to confirm your sexual identity, but it is best to inform yourself well throughout the procedure.
Advice
- Be yourself. Do what makes you comfortable. But always be aware of your safety. Also be understanding of friends and family, try to respect their discomfort or attempts to change your mind.
- Take your time. Tell the people you love when you are ready. Remind everyone that this is strictly personal and you don't want the flag flying at seven winds.
- Be ready to talk about it. You have to be able to explain how you feel, give examples about your life so that others can understand your feelings and that is not a one day whim. Read as much as you can about the issues transgender people face, so that you can explain what the next step will be and what your plans are. Find out about the money you will need; this is not the time to ask for financial help for this project, so you must have some ideas on how to earn the necessary money.
- Take your time. If you are young, you may have the feeling that everything has to happen quickly, or you will not be able to go all the way. Be strong, patient, and make sure you make the right decisions. Talk to as many people as possible (and you trust). These decisions are life changing and should not be taken on impulse. Some of the older generation have lived their whole lives preparing themselves, and in the meantime the world was preparing to accept them as well. Some have paid a very high price (addictions, suicide or worse), but many live happy lives, whether they have completed the physical transition or not. Consider your options and don't isolate yourself.
- Choose the right context to announce it to important people (like your parents). Find a neutral place, where you feel comfortable, and where the people involved are free to walk away or leave. They shouldn't feel cornered, and you too need a way out in case things get bad.
Warnings
- Beware of bigotry and people who don't accept transgender people.
- The transition is permanent. Surgery is practically irreversible, and you cannot return to your original physical condition. Most of the effects of testosterone are permanent, such as voice changes, hair and hair growth, and clitoral enlargement. If you still have the ovaries, the fat and muscles will revert to feminine characteristics. Sexual appetite, oily skin and body odor may return to their original state. Make sure you know what you are doing, and that you really want it. It's something your therapist can help you with, but the final decision is up to you. Do what you think is right.
- Don't let anyone pressure you to take hormones or have surgery because otherwise you're not really trans or a real man. Many transmen live happily without doing either or both. For example, some transmen don't like the weight they take on hormone therapy and some sing, so they don't want to lose vocal range. Surgery is very expensive and a very personal choice. Nobody needs to know what your naked body looks like, just you, your doctor and your partner (or partner).
- Do your best to proceed calmly. Help others, especially your family, get used to you.
