Words by Charlie Andelman
Let’s talk about sex (and gender and how medically transitioning can really mess you up if you’re not prepared for things to go wrong), baby. Don’t mind me, just casually using Salt-N-Pepa as an icebreaker to talk about something really important.
Let’s make sure we all understand the basics. When you’re born, you’re assigned a sex (male, female, or intersex). Because of this sex, you are put into a gender category (boys and girls, men and women), and the expectations and roles of each category are henceforth thrust upon you. Trans people may be uncomfortable with the gender and/or sex they are assigned at birth due to gender dysphoria, which is normally defined as a severe discomfort with one’s primary and/or secondary sex characteristics.
Gender dysphoria can be alleviated through hormone replacement therapy (HRT), which involves taking hormones (through intramuscular injections, pills, patches, gels, and so on) to achieve a more male or more female appearance. In female-to-male individuals, HRT also ends one’s menstrual cycle, which can be a very intense catalyst of dysphoria for some. Furthermore, many trans people hope to undergo surgery (breast augmentation surgery, top surgery to remove the breasts, bottom surgeries to alter the genitals, etc.) to alter their bodies depending on what provides the most comfort and relief from dysphoria. The most important part to understand is that all of this is optional and varies from person to person. Not every trans person feels the need or is even able to transition. I, however, am a female-to-male trans person who felt that transition was absolutely essential for me to continue living.
Now, I didn’t always know that I was transgender. For me, it took a lot of self-exploration and discovery, not to mention countless hours of research and reading before even learning the word transgender. I went through stages: In ninth grade, I identified as a bisexual girl, but I was unfortunately outed to everyone in my small private school. I didn’t get a great reaction—some girl told everyone while I was at home sick, and when I returned the next day I was literally mobbed by questions and insults. A horde of people surrounded me and shouted obscenities at me. In tenth grade, I tried conforming to the compulsory heterosexuality that my school seemed to love at the time in a half-hearted attempt to avoid more bullying. I grew my hair out and talked about having crushes on boys because that’s what girls were expected to do; it quickly became a self-defense tactic. In eleventh grade, I publicly owned my sexuality, believing myself to now be a lesbian. I fought to start a Gay Straight Alliance at my school (and was its inaugural president the next year), and even dated a girl briefly. But none of these labels felt right to me. By the end of that year, I thought back to everything I had seen and read and realized: Oh god. That’s me. I’m transgender.
I didn’t come out until October, 2014, at the start of my freshman year of college at Florida State University. Ironically, I was placed in the all-girls dorm. My roommate was trying to figure out her own sexuality at the time, and we ended up coming out to each other the same night. We were watching the show Once Upon a Time, and I turned to her and asked, “You know how I don’t go by my birth name? Would you mind trying out different pronouns for me?” She hugged me and told me of course she would, and within a minute of returning our attention to the show, she blurted out, “I’m a lesbian.”
She and her family were incredibly supportive of me while my parents were struggling to get used to the idea; I don’t really know what I would have done without her. I ended up telling every friend I made from that moment on that I was trans, and all of them fully respected my name and pronouns. As far as my social transition goes, I have been fortunate to have met such kind, open-minded people. Even my parents got on board after six months of hearing how desperate I was to feel at home in my body, and they agreed to let me see a gender therapist to determine whether or not transitioning was the right choice for me. After just a single session, it very clearly was.
Before I started my transition, I was naive and hopeful that as long as I found doctors willing to help me, I would be able to transition with the results I wanted and needed. Unfortunately, this was not entirely the case. Transitioning is the hardest thing I have ever gone through, and I’m not even done yet. I don’t know that I ever will be.
Getting on testosterone was a challenge in itself. I had been seeing a general therapist and psychiatrist for roughly a year and a half before finally finding a therapist who specializes in gender identity. I saw her for a few months before she gave me a referral letter to an endocrinologist so I could start HRT. The first endocrinologist I saw was located in Tallahassee, near my university, but she kept losing my paperwork and making me do things that weren’t actually part of the protocol for medical transition. This went on for two months before her office stopped answering and returning my calls entirely. I finally found a good endocrinologist back in my hometown of Saint Petersburg, FL, who told me that because testosterone is a controlled drug, I would have to fill my prescription and pick it up in my legal area of residence. This means I either have to drive five hours home to get my vial of man juice, or my dad has to fill the prescription and mail it to me—which poses the very real risk of it getting lost in the mail.
But now that I have the testosterone, let’s talk about some of the changes it causes. According to Hudson’s FTM Resource Guide, the following changes can be expected:
- Thickening of the vocal chords and deepening of the voice
- Facial hair growth (mustache and/or beard growth)
- Increased body hair growth (notably on arms, legs, chest, belly, and back)
- Increased body musculature
- Enlargement of the clitoris
- Cessation of menses (monthly periods)
- Potential hair loss at the temples and crown of the head, resulting in a more masculine hairline; possibly male-pattern baldness
- Migration of body fat to a more masculine pattern (i.e., fat deposits shifting from hips, thighs and buttocks to the abdomen area)
- Increased activity of the skin’s oil glands (i.e., skin becomes more oily, which may result in acne)
- Scent of body odors and urine may change
- Skin may become rougher in feeling and/or appearance.
- Increase in sex drive
- The face may become more angular in appearance, with a squarer jaw.
- Increase in energy level.
- Increase in appetite.
- Slight decrease in density of the fatty breast tissue.
- Emotional changes. Some trans men report shortness of temper or feeling lethargic/down at different stages of their T cycle (i.e., just after a shot, or a few days before their shot). Others report that T has made them feel more even-tempered and calm.
The changes are absolutely what I want and need, but there’s nothing that could have accurately prepared me for how to deal with them. I’m now nine months into HRT, and I still experience extreme anxiety when I try to do my weekly testosterone injections. My voice is still cracking as it gets lower, which people around me find hilarious due to my age. My hair is receding into a more male hairline, but I have no idea when it will stop. I’m dying for a beard, but when I first started seeing signs of stubble I had a panic attack because I didn’t know how to shave and didn’t know if it would be weird or uncomfortable to ask my dad. Don’t even get me started on the clitoral growth. It happened much quicker than my endocrinologist said it would, and it really took some getting used to. I think it resembles a micropenis, with the clitoris being the head and the clitoral hood acting as a sort of foreskin. My feelings about it tend to go back and forth because, yeah, it’s cool that my genitals are no longer flat, but it still doesn’t register to me as a “real penis.”
I was actually off testosterone for a few weeks in December, which caused a freak period cycle. During this, I hit one of the lowest low points I’ve ever reached. My body was betraying me in the most intimate way possible. The irony of it is that I was off testosterone because I was getting top surgery, another supposedly life-affirming miracle event along my transition timeline. After uncomfortably binding (the common term for compressing one’s breasts using a tight garment for the purpose of achieving a flatter chest) for a little over a year, I got a letter from both my gender therapist and psychiatrist recommending me for top surgery. I set up my phone consultation with the surgeon I had researched for two years, got my surgery scheduled, and held out for another five months with the binder. After getting all the blood tests and physicals, I was cleared for the surgery and went into it feeling great. What came after was terrible.
My nipples had been removed and grafted back on so that my chest would look more naturally male, but a stitch came loose on the left nipple—my surgeon somehow missed this at my post-op appointment. The nipple then got infected because everyone (including the surgeon) told me it was probably fine and would heal itself soon enough. Eventually it got so bad that almost the entire areola and the nipple in the center had jumped ship. I finally got an antibiotic and it healed, but it hardly looks like a nipple anymore. The other nipple was doing fine until the six-week mark, when I was supposed to be done healing, but then it gave up. My guess is that a subcutaneous suture (a tiny dissolvable stitch under the skin) just refused to dissolve properly, causing the areola above it to become irritated and puffy whenever it comes into contact with anything.
To top all of it off, most of my chest remained puffy and swollen all the way through March and the beginning of April, around which time little pimple-like bumps started appearing along my right incision scar. These pimples burst and made way for three abscesses, two of which became infected (surprise, surprise) and meant I had to be back on an antibiotic until they healed. For months, I was overridden with a kind of depression, anxiety, and dysphoria that I had never felt before. I couldn’t understand why I was still experiencing complications so long after I was supposed to be done recovering.
Now, the surgery clearly had the effect I needed as far as a flat chest, physical comfort, and breathing are concerned; however, my chest doesn’t yet feel as though it’s my own. It feels foreign, just as it did before but for different reasons. It may be flat, but it’s mangled by asymmetrical incision scars and swollen nipples that resemble the original Nickelodeon splat logo. I can’t even feel certain spots on my chest, and others feel prickly when I touch them. I can raise my arms above my head now, but only if I’m extremely careful. I can hug people, but not too hard. I can sort of sleep on my side, but never on my stomach. I thought that after surgery, my life would magically improve with no complications, but the hard-to-face truth is that it didn’t.
Don’t get me wrong—I’m still trans, I’m still a guy, and this is all for the best. Both my mental and physical states have definitely been improving. But my point in saying all this is that when I started researching methods of transitioning, I rarely came across any other trans guys talking about the negative effects medical transition can have on one’s emotional/mental health. Neither YouTube videos nor real-world conversations gave me much warning at all since everyone was always so focused on the positives. I was physically and mentally under-prepared for everything to go wrong, and I want to help make trans people more aware of this possible reality of transitioning.
At the same time, though, I hope sharing my transition experiences doesn’t deter anyone from pursuing HRT or surgery. The reward far outweighed the risks for me, and now that I’m healed I can start living again. I can do things I always wanted to do but couldn’t. I’ve never felt better or freer than how I felt the first time I was able to go swimming after recovery. I was at a family reunion at Anna Maria Island in Florida, and I was talking to my mom about going in the pool. I hadn’t been shirtless in front of my family before, and she was worried. She suggested I keep my shirt on so my cousins wouldn’t have to see the scars on my chest. It wasn’t unreasonable, but I declined. I took off my shirt and cannon-balled into the pool, finally taking my place alongside all my male cousins. My scars are a part of me now. I may struggle with them, but I’ll be damned if I don’t wear them proudly.