Transition Roadmap

Many transgender and gender non-binary people have questions about approaches to or components of gender transition.

Gender transition is a very private, personal, and individualized process. In general the first step is to explore your gender identity.  This can include any combination of internal self-reflection, connecting with community and support groups, or working with a therapist who has expertise in gender identity issues. This process could take anywhere from months to years. Questions to explore include:
 
  • Am I transgender/gender non-binary?

  • What exactly is my gender identity?

  • How can I develop the needed coping skills, resilience, and social support to help me through transition and to cope with a world that can be biased against or even dangerous for transgender and gender non-binary people?

Once one feels ready to move forward with transition, steps to consider include any combination of the following social and medical transition components. Per World Professional Association for Transgender Health Guidelines, none of these steps should specifically required to validate your gender identity in the eyes of the medical establishment, society, or the government .  There is no specific order for these steps, other than requirements for a behavioral health evaluation and preparation in advance of chest and genital surgery, and the use of hormone therapy and presenting full time in one's chosen gender identity for 1 year before genital procedures, unless there is a medical or other reason that prevents meeting these requirements.  The behavioral health evaluation before chest and genital surgeries should include a making sure you are prepared to provide the intensive self-care needed during the postop phase, as well as have adequate social support in place to support you with followup office visits, trips to the pharmacy, etc..., and that you are prepared emotionally for the possibility of complications and that you have realistic expectations of what surgery will do for you.
 
For transgender and gender non-binary people under the age of 18, there are some additional considerations both for gender identity exploration as well as for undergoing various medical or surgical interventions.  In general this involves first working with a behavioral health provider or child & adolescent gender program to explore identity and process.
 

Social Transition

  • Presenting in public part- or full-time in your identified gender, may include:
    • Changing your wardrobe or hair style
    • Packing (using a penile prosthesis to give a masculine genital contour)
    • Tucking (placing the testes into the inguinal canal, held in place with tight underwear or a garment called a gaff, to give a feminine genital contour)
    • Binding (using a tight chest garment to flatten breasts and give a masculine chest contour)
    • Breast, hip, or buttock prostheses (inserts into clothing or bra to augment breast, hip, or buttock size)
  • Coming out to spouse, partner(s), children, friends, family, classmates, coworkers, community members
  • Changing your legal documents to reflect your chosen name, gender identity, and pronoun used

 

Medical Transition:

  • Hormone therapy
  • Chest, face, genital, or other gender affirming surgeries
  • Hair removal (face, body, in some cases genital hair removal if preparing for surgery)
  • Speech therapy
  • Fertility preservation (sperm/egg storage)