FtM Medical Transition 101

So what’s involved in female-to-male transitioning?

 

Generally speaking, transition can be split into two pieces: social transition, and medical transition. In some countries, legal transition could be considered its own unit but in many countries legally becoming your chosen gender is very patchy and complex, and is completely bound up in social transition, so for the purposes of clarity, I’m sticking with these two lumps.

 

Social transition is what it says on the tin: it’s transitioning as far as society and your social life are concerned. That basically encompasses going about your life like you’re already your preferred gender, as much as possible. For me, this was largely about changing my name, coming out to everyone who knew me, wearing men’s clothes, and adopting a male position in life as much as I could without medical transition.

 

Sometimes, social transition is enough. Sometimes it’s not, and people choose to also medically transition. That is, they undergo medical procedures to bring their physical body far more into line with their gender than it originally was.

 

Key point: some transgender people do not medically transition. It doesn’t make them any less transgender, and anyone who says that it does is a dick.

 

Medical transition is very different for MtF and FtM people, and my experience wholly lies with FtM transition, so that’s what this post will focus on.

 

Basically, there’s three main steps: hormone treatment, top surgery, bottom surgery. Typically, they’re in that order too.

 

Hormone treatment is basically being prescribed testosterone by a doctor. It’s known as T generally within the trans community, because it’s a long and clumsy word, and T more or less puts you through puberty. Over time, your voice drops, you grow body hair in places you didn’t before, your sex drive sometimes changes, and in the short and mid term, some people have felt very aggressive.

 

Top surgery is removal of the breasts and re-contouring of the leftover tissue and skin to create a masculine chest. It’s not quite the same as a mastectomy, but it’s very similar to us laypeeps. The procedure is a major surgery, conks you out for a while, and leaves scars. But hopefully over time the scars fade to the point you can’t see them. Google ‘topless transman’ to see some results.

 

Bottom surgery is kind of two things: one version is removal of everything feminine between your ribs and your knees, i.e your uterus, vagina, etc. The other version is lengthening of the urethra (can’t spell…) to create effectively a micropenis. Bottom surgery is actually pretty unusual and the majority of transmen don’t do it. Moreover, removal all the ladybits can have major health complications and surgeons can be pretty reluctant to do it unless your dysphoria is exceptionally bad relating to it.

 

Those are the extreme basics. Each ‘step’ is very complex and individual, can be done out of order, and is wholly dependent on the individual undergoing transition. So here’s a case study: me.

Generally, I can pass okay at the minute. Except in the summer. This is a photo taken in June by the North Sea, so it was cold enough to wear a jacket. Because the problem is that I have a massive rack. Seriously, 30F. And when it came to medical transition, I knew what had to happen.

 

I was not brought up in a trans-friendly area. I don’t currently live in one. So for me, I needed to be able to switch very fast between ‘looks female’ and ‘looks male.’ In the winter, I already look male, but in the summer, there’s not a hope thanks to my chest. So I opted to have top surgery first. See this post for a rant about how difficult that was!

 

In November, I will have my top surgery. Some time after that, I will start hormone treatment. And I won’t have bottom surgery. That’s what medical transition is for me. Other guys have had bottom surgery. Some guys haven’t had top surgery. One guy I know isn’t going on hormones because it’ll wreck his singing voice and that’s more important to him than the funny looks he gets now when he speaks.

 

Medical transition is formed on the basic steps — but the journey through those steps, which ones to take and which ones to skirt around, is entirely individual.

 

 

 

 

 

(Major apologies for skipping a week — I went camping, and had no access to the online world. My bad.)

Bad Days Are Okay

When you’re transgender, you have days when you’re totally cool with it and so is everyone around you, and other days where it feels like you’re an extra in a movie about Hitler and you have less chance of surviving than a Redshirt in the original Star Trek franchise.

 

And that never goes away.

 

Authors, take note of that fact.

 

Non-cisgender folk, take note of this one: it’s okay to feel like that. It really is.

 

Because a lot of the time when you feel like that, it’s not actually true. It’s not true that on Tuesday the whole world was with you, and on Wednesday the whole world hated you.

 

I had one of those days Friday. See, I am out to my friends and family. My friends were all supportive — mostly because the ones who weren’t got frienddumped fast and hard and so long, suckers! My family…ehhh. My family — like many transgender folk — is more complicated.

 

The verbal response from all except my dad (who said ‘no’) and one of my siblings (who has ignored the issue with impressive dedication) was fine. I got a bunch of ‘not surprised’ (cheers, Auntie Liz?!) and ‘whatever makes you happy’ (damn straight) and all — on the surface — seemed fine.

 

Now normally this counts as good days for me. Not only is a huge wing of my family Catholic and very anti-LGBT, but my family don’t talk to each other. We’re terribly British what-ho and refuse all emotional displays (even crying at funerals is to be done quickly and with as little mess as possible, thank you) and generally ignore each other. Acknowledgement and then reverting to that standard is actually what I want.

 

But Friday I had a bad day.

 

Friday felt like the whole world hated me for what I am, and I’m never going to be accepted. It started with a work phone call, wherein the caller laughed and went, “I was so confused! [Manager] said I should get him to come to the meeting and then you turned up!” I went, “Er. Yes. I’m transgender.” Cue the most awkward silence ever.

 

Normally I would find this funny. I’ve certainly laughed at the same before, like the poor man who got into an argument with my colleague when he said, “I need [my name]” and was told “he’s not at his desk right now, I can take a message if you like.” Blew the guy’s mind. “No!” he insisted. “No, no, it was a woman! I need Miss [surname].” This was hilarious, only two weeks ago. And yet the same situation yesterday was like, “Christ, really? This again?”

 

To top it off, I came home to find a birthday card on my doormat. Postmarks are as good as photo ID in my family, so I knew without opening it that it was from my Catholic aunt. My Catholic aunt who is very anti-LGBT people, and sent me pink and cutesy things for my whole life, despite openly acknowledging that ‘you were never really that type of girl.’ (So why did you keep sending them???)

 

The first thing? It was addressed to Miss [previous name].

 

Then? Okay, it was a gender neutral card. A ray of hope! Only to be dashed when I opened it to see that it had been signed by the tribe, but not actually dedicated to someone. Yup. Not even a ‘hey!’ Just the Hallmark greeting, and the tribe signatures. (Key point: my aunt always dedicates the card, even if it’s just writing your name at the top.)

 

And finally, she’d put a birthday cheque inside. On the up side, cool, free money. On the down side, I could hand it to anyone reading this blog and you’d be able to cash it. Yup, no prizes for guessing: no name.

 

So on Friday, I felt like I had no name, and — by extension, weirdly — I was the same out-of-place ‘girl’ that I’d always been.

 

And it’s okay to feel like that, for a while. It’s okay to have off days, and for the same thing that made you laugh last week make you want to cry or punch someone this week. It doesn’t make you any less transgender or non-binary than you’ve ever been. It doesn’t mean you won’t get to the other side of transitioning, or that you’re wrong for transitioning or not-transitioning the way that you want. It doesn’t mean you’re always going to feel shitty, and it doesn’t mean you’re unstable. It means you’re fucking human.

 

It’s totally okay if not every day you feel like you can kick ass and take names.

 

(It’s only when most days aren’t for ass-kicking and taking names that there’s a problem.)

Writing Trans* Characters 101: Pronouns

Let’s get to the good stuff.

 

I am majorly passionate about getting more transgender characters out there — be they FtM, MtF, non-binary, genderqueer, agender, bigender, and any other non-cisgender identity you could possibly think of. And if that’s going to happen, then cisgender authors are going to have to join in. There simply aren’t enough trans* people — never mind trans* authors — to make that change on our own.

 

Good news is that authors have been writing about people who aren’t like them for centuries.

 

That’s actually something really important that everyone needs to remember. Most crime novels are about murder, but most crime novelists are not murderers. Most aren’t even police officers. Most writers of gay romance are straight women. Most writers of children’s books are not children. And so on and so forth. So really, saying ‘I [or they] can’t write a book about a transgender character because I’m [or they’re] not transgender!’ is…really fucking stupid.

 

Seriously, we need to bin that argument. It’s dumb.

 

But like anyone writing about something outside their experience zone, authors need to do their research. So here’s step one, and a hang-up that gets a lot of new-to-the-field people confused: language.

 

More specifically, pronouns.

 

Most transgender people will still use he or she — it just might not be obvious to you which one. Some use ‘they’ as a singular gender-neutral, e.g. ‘This is Jude, they work in Harry’s team.’ [Note for editors: yes, it’s clunky, but it’s also what real people use.] And then finally there are the gender-neutral pronouns, ones specifically created by the non-binary community to describe themselves.

 

I’m going to mostly stick with he, she and they for this post, given that it’s what most people use and the gender-neutral ones that have been created in recent years deserve their own dedicated post.

 

If you are writing a book wherein the transgender character is not going to transition, or has already transitioned:

 

Use the pronoun that character wants you to. Use the one that the other characters who like that character will use. Use the one that comes naturally.

 

It sounds dumb, right? You’re going ‘duh, no shit, Matt.’ Well, yeah, it is obvious — and yet loads of people ask about it on writing groups. “I have this character, Kevin, and he’s trans, he used to be a woman, but do I use he or she???” Well, which one did you just use?

 

If the character either isn’t going to transition, or has already transitioned, then the character likely comes with a pronoun, the same way characters often come with their names, or specific things about the way they look and talk, and so on. And for FtM or MtF characters, their preferred name is usually a pretty big hint. If the first names that come to mind for your character are Joshua and Robert, odds are your character is going to be using ‘he.’

 

If you are writing a book in which the character is in the process of transitioning:

 

This is trickier.

 

It depends partly on what stage the character is at. In Ink and Images, my first adult transgender novel, the transgender character has completely socially transitioned, but not medically. This means that he is he, even though he’s not kitted out with all the blokey bits yet. This is the same in Girls Will Be Boys, an incompleted manuscript of mine in which Anton has just set out being Anton instead of being Natasha. In both books, ‘he’ is the correct pronoun because the characters have socially transitioned.

 

However, in another incomplete one, Letters to a Boy Who wasn’t Me, main character Jamie is a work in progress. In the course of the book, he works out that he’s transgender and that his gender identity is female. For the first part of the book, ‘he’ is perfectly correct because Jamie is himself unaware of what he is.

 

This is both perfectly normal, and perfectly fine. Many transgender people don’t know when they’re very young that they are transgender. I didn’t, for one. So to say ‘he’ until that realisation occurs is perfectly fine.

 

It gets messier, though, once the character realises and begins to socially or medically transition. At some point, especially for MtF or FtM characters, they are highly likely to change their pronoun. [Note that non-binary characters may not.] And at what point do you do it?

 

My advice is this:

• Transgender people commonly switch what they call themselves before telling other people about it. I changed all my online accounts and was practising my new signature before anybody else had the first clue. Having the character switch internally before they tell other people is just fine.
• As is having them ‘test out’ the new pronoun: muttering it to yourselves, gaming with a username typical of your preferred gender and seeing if you like it when other users say your assumed pronoun, etc. etc. are all common test methods. I was mistaken for a man in a pub early in my social transition, and got a warm little glow from it. Similarly, many non-binary people have realised they are non-binary by not liking just swapping he for she or vice-versa.
• Many people ask for others to switch pronouns at the same time as adopting a new name.
• Some will do a ‘three for the price of one’ and come out, offer a new name, and ask for new pronouns, all at the same time.

 

Consistency is your key for when you as the author should use the new pronouns. Once the character decides to change pronoun, both they and the narrative should stick to those guns. Every other character in the novel will — realistically — slip up now and then, but you shouldn’t.

 

Which is another point.

 

It’s okay for other characters to be inconsistent. Take it from me, even your closest, most supportive friends will slip up now and then. A friend at work just today went, “Oi! [My name]! He’s not listening to me. Oi! Holy shit, is she deaf or what?” In the space of three seconds, she switched from one to the other and slipped up. It happens, and it’s totally okay for other people to do that in the story. If transition has been pretty recent, it’s even expected.

 

Those slip-ups will also happen more commonly if the name is gender-neutral, e.g. Alex or Sam, and happen to gender-specific words too. It’s common enough to get a parent used to saying ‘she’ but then still slip up and say ‘my son’s not home yet.’

 

Other characters

 

When and how other characters switch over is largely down to the character, and how they relate to the transgender one.

 

In general, parents change slowest. They also tend to have the biggest hesitations, because they’ve typically known the person longest. By contrast, co-workers tend to switch pretty fast, as they’ve typically not known the person long and there’s often a certain amount of pressure not to be ‘that guy’ in the office.

 

But these are generalisations. Your massively transphobic boss is not going to switch for love nor money. Your PFLAG-chapter-running mom is going to switch like the birth gender never happened. And there’s a whole range of behaviours right down the middle.

 

You have to be clever as a writer, though: people do not change overnight. We say pronouns and gender-specific words more than we realise. (Just try writing a whole blog post about hypothetical people without saying he or she!) And gradually is the key here, as opposed to consistency before. “He — sorry, she–” is going to be common at first. Names tend to do this weird “I can’t remember their new name but goddamnit I will not use the old one!” stutter where your own neighbour will go, “Hi — er — er — how’re you — Julie!” like you’ve never met before. Parents with multiple children will often early on go, “Oh I have one son — no, two sons!” and look totally nuts to strangers, who will be no doubt wondering why this idiot doesn’t know how many sons he has.

 

As a rule of thumb, people friendly to the transgender character will take a little while to switch, but will try. People who aren’t, won’t switch at all.

 

When referring in marketing and so on to the transgender character, use the post-transition pronouns.

 

TL;DR — it’s all about consistency for the transgender character and the narrative, and gradual handover for everyone else.

 

And pronouns are not as complicated as they look. It only gets worse from here…

 

 

 

 

 

 

(Scheduled post, as I am away this weekend.)

It’s Not All About Gender

[This is a post geared towards authors. This will not be news to trans, non-binary, questioning or otherwise non-cisgender persons, nor their active allies.]

Firstly, I’m super-sorry for the lateness of this post, but the reason for the lateness did inspire the subject, so…it’s not all bad.

A very close friend of mine — closer than family, and around whom my entire mad little world revolves — disappeared off my radar over the last couple of weeks. Now, he’s a busy guy. I wasn’t worried for a while. Then the niggling worry starts, then the real worry, then the flying up north to break down his door and find out what the hell has happened.

Turns out, he was in hospital. Seriously ill in hospital too, not did-you-really-break-your-leg-skiing-or-did-you-fall-down-a-manhole-whilst-drunk type of ‘in hospital.’

I have had a terrible week. Worrying about what had happened, then worrying about him when I found out what had happened, then getting him home and playing nurse for a couple of days, constantly on the phone to my day job to provide my duty-bound excuses, and hoping desperately that it would all blow over.

(Good news: it has.)

Which brings me to my actual point: I had a fucking awful week, during which my depression reared its hideous head in a way it hasn’t for a long time, and it was nothing to do with being trans.

Wait, I hear you ask, that’s fucking obvious. Not everything in a trans person’s life is about being trans. Duh.

Keep that thought in mind…now ask yourself why there aren’t more trans characters in books. Any trans characters, never mind main ones.

Many authors I talk to on the subject tell me that they don’t want to get it wrong, or they don’t know enough about being trans. Replace trans with gay, and that’s stupid. You can’t get a gay man wrong, because gay men come in all sorts of varieties. You can’t get lesbians wrong, because there are as many different lesbians as there are different women. Or human beings. Or fish in the sea.

And yet this idea somehow is sticking to trans characters.

If I said, why don’t you write a story about what it’s like to be transgender, then the issue is right. The same way that you’re going to make yourself look mighty stupid if you try writing a lesbian erotica without the first clue what a clitoris is, you can’t write about Ryan’s journey to becoming Rachel if you don’t have the first idea about how that’s done wherever Ryan happens to be. That’s right. And yes, for the love of God, if you’re going to write it, do your research!

But if I say, why don’t you write a story with a trans main character, where’s the argument? You could write a gritty science fiction novel all about alien dinosaurs, and stick a mention that your kick-ass heroine was born a man. Job done. Nobody cares how she’s gotten her hands on that stunning Lara Croft physique, there be space-raptors to shoot.

Because here’s the thing: visibility has two sides. Two stories need to be told here: the stories that are about transgender people, and the stories that show transgender people.

We need stories to tell us how these people are what they are, what they’re going through, what they’re struggling with, and how it can and does get better than that first bleak, terrible realisation that they are different somehow. We need those. We do.

But we also need the stories where they just are. Where being transgender is not remarkable anymore, and where transgender people kick as much arse as their cisgender counterparts. We need stories where, yes, Jamie’s genderqueer, but actually, this story is about Jamie’s adventures trying to awkwardly seduce Suze into a date with zim. Where Lara Croft up there is going to kick arse and take names, and what she was before she became Lara has nothing to do with it.

And you don’t need a degree in gender psychiatry to write that.

 

 

(Also feel free to steal the space raptor idea.)

Who are you anyway?

So I figured I best start from the beginning and introduce myself properly. Who the heck am I, and why would I have any trans* agenda anyways?

So a bit of background…

I was born female. Physically speaking, there is nothing to suggest — and there has never been anything to suggest — that I am anything but 100% female. Sure, I’ve never had my chromosomes checked, but that’s all. Puberty hit pretty early, and all from the girl department, and the monthly hell ever after informs me that the internal lady-plumbing parts are present and accounted for too.

Obviously that’s not where the story ends.

Imagine not knowing transgender people exist. Imagine believing that gender just means your physical sex and nothing else. Imagine being unaware that gender identity, as a concept, even exists.

Couldn’t happen? Sorry, it can and it does. And I was brought up in England in the 1990s and 2000s, so it’s not like I’m talking about the fifties here. I grew up without any idea these things existed.

So how was I supposed to know why I felt so out of place?

I was raised in what you’d call in modern-day terms an agender or gender-neutral household. Gender roles and gender identities just didn’t exist in that tiny micro-society we had in there. My father was the one practised in the taming and feeding of wild children. My mother brought home bacon. Children were to be filthy, noisy, outdoors whenever possible, and crying was outlawed by your fifth birthday as pansy behaviour, whatever gender you were. If the other kid hit you, hit him back, especially if he’s your brother. Behaviour outside societal norms were regarded as amusing — my brother was teased for stealing my Alice headbands, but never really criticised or thought of weirdly for it; similarly, my demand that my father cut off all my ‘impractical’ hair before an adventure camp was met with chuckling and obedience. (It was the first time I had proper boyishly short hair, and I loved it.) By and large, my father didn’t much know what to do with daughters, so raised them like sons and hoped for the best.

So as a little kid, I had no problems whatsoever with my gender identity. I didn’t know what one was, I didn’t care, and aside from the biological ‘this is where babies come from’ talk, I had no real concept of a difference between men and women at all.

While this is all awesome when you’re a little girl, and leaves you relatively unaware and undisturbed by the differences between your body and a boy’s body, and shielded from what society on a wider level expects you to be, eventually, you grow up.

And that’s what happened to me. In short: puberty was horrific, and I was thrust into the girl-world of secondary school, where suddenly muddy puddles and playing football with the boys was just not okay.

But still, with no understanding of gender identity, I simply thought I was a tomboy and didn’t fit in. I thought my level of disgust over periods and my own breasts was normal. (My loathing of the hockey skirt genuinely was normal, everyone hated that damn thing.) I put my growing mental illness down to my crappy home and school life, and didn’t think for a minute that the most disturbing part of that illness was actually feeding off something I didn’t know was there.

(In short, I had intense disassociation problems, where I had the sensation of looking at myself in the mirror and seeing someone else, or recalling memories from a third party POV instead of my own. It scared — and still scares — the shit out of me.)

So I grew up without the ability to even understand, much less express, why everything was wrong. I didn’t know why or how or what, but something was wrong. I hated school, so it had to be school, right? But by this point, I hated home too. I hated me, and yet I was body confident for a girl and would wander round in my underwear without a problem, so it couldn’t be me because that was all there was to teen angst when you’re a girl, right?

I first heard of transgender people somewhere late in high school, maybe age sixteen or seventeen. But I wasn’t one of them either. Transgender people had major body dysphoria, they were crazy fucked up like anorexic people about their bodies, and anyway you knew if you were transgender by the time you were like five, right? And girls weren’t transgender, only boys were. Right?

Then I went to university. And wrong. I finally actually met and saw transgender people. It blew my tiny mind when I saw a non-binary person for the first time. I saw a fanfic with an asexual character and Googled it, and got dropped into a world of people like me. I took up boxing, and realising I liked the way that building muscle on my chest and arms made me feel. I met people who didn’t think me a freak for being a girl who wasn’t really a girl.

I began to like the way I felt.

I toyed with labels like genderqueer for a while, not sure if I was male or something just not-quite-female, but by this point I was building a reputation as a writer under a male name.  I started to prefer being called he. When it happened by mistake once in a pub, I was thrilled.

And it clicked.

Now I’m the kind of guy that when something clicks, I just go for it. My first tattoo was a total click-whim, and I still love the fuck out of it. And it happened again.

I firmly came out as transgender to my best friend in December 2014, after three years toying with the issue. I told my employer in March 2015. I changed my name at the end of that month. I saw my doctor in April, and a private psychiatrist in July. In November this year, I will be getting top surgery to de-girlify my chest (and given the size of it, probably lose about five pounds in the process). Somewhere along the line, I will start hormone treatment.

So that’s me. That’s why I have things to say. And that’s the angle I’m coming from.

What should be taken away from that?

That being transgender or non-binary is nothing to do with knowing they exist. It happens anyway. If you just keep it secret, all that happens is you end up with a lot of very miserable people unable to understand why they’re miserable and, without that understanding, unable to fix it.

That you don’t necessarily know from birth or a very young age — there’s a thousand paths to figuring out you’re transgender or non-binary, and they’re all equally valid.

That I am only one man. Other transmen will have vastly different experiences to me; some non-binary folk will be nodding along going, ‘Oh my God, that’s it exactly!’ Transgender isn’t one experience and one route.

That the transition part is not what makes you transgender. It starts way before then, and many transgender people can’t or choose not to medically transition at all. It’s what’s upstairs, not the physical attributes the world can see.

That being transgender is about you. Fuck other people. If your sexuality is nobody’s business but yours (and arguably your sexual partners’), then neither is your gender identity.

That’s all.

 

 

 

 

(And by the way, this is like a Sunday update thing now.)

 

Becoming Matthew

Yo!

 

So this is the launch of Becoming Matthew. That would be me, by the way.* Becoming Matthew is designed for two things:

• Firstly, as a platform to frankly and openly discuss my experiences as a transgender guy. When I came out, a lot of people on various forums were suddenly messaging me and wanting some input and advice on their own journeys into the weird and wonderful world of not-being-cisgender. So this is it. This is what it is like for one girl to become one guy. It’s not universal. There are some things I will deal with that most transguys won’t, and vice versa, some things I get to go ‘lalala, not listening!’ that’s a huge deal for them. But there are also some things we do all share, and those things are important for others to understand.
• And secondly, to educate the LGBT fiction community. When I get into discussions with other authors about writing more transgender characters, it’s usually a no. Why not? Because they don’t want to get it wrong. Well, you pretty much can’t. Transgender folk are just as diverse as any other gender identity or sexual orientation. Let’s start challenging that shying away from transgender characters, and get their stories out there too.

 

This blog will also run on input from other people. If you want to ask questions, ask them. If you want specific topics discussed, tell me. If you want to guest post, drop me a line. If you have a transgender story, let’s hear about it. If it’s your transgender story, even better!

 

So let’s get this show on the road, guys.

 

Matt x

 

 

*In the interests of stalkerdom: Matthew is a pseudonym. Randomly finding transmen called Matthew in the south-west is not a great idea. Don’t do it.