Many transgender and nonbinary individuals decide to transition from the gender they were assigned at birth to the gender that matches how they feel inside. Each person has different goals that they wish to achieve with their transition – to feel true to themselves, to relieve dysphoria, to pass, to achieve certain physical characteristics. Transition is complex, and every person’s transition will be different.
Social transition is the first step most people take. You may choose to come out publicly, or to tell only a few close friends. Many people adopt a new name and pronouns, and begin to dress in a manner consistent with their gender identity. A support group can be a safe space to test out your new identity - check out the Houston Trans Meetup site to find a group.
Legal transition involves legally changing your name and gender marker (birth certificate). Detailed instructions may be found here. The process can be complicated, and unfortunately depends on the personal opinions of the judges and county clerks involved in your case. This Facebook group has specific and up-to-date information about individual judges, documentation requirements, and roadblocks you may face when applying in certain counties. With proper planning, however, it is possible to change your name and gender marker, then get a new birth certificate, driver's license, and social security card, all on the same day!
Medical transition involves hormone therapy, surgery, or both. Hormone therapy (also called hormone replacement therapy, or HRT) comes in two flavors - masculinizing and feminizing. Masculinizing hormone therapy is given to increase the body’s masculine characteristics - an increase in facial and body hair, a deeper voice, a male body fat distribution, an increase in muscle mass, and cessation of periods. Feminizing hormone therapy is given to increase the body’s feminine characteristics - breast growth, softer skin, a female body fat distribution, decreased muscle mass, and decreased facial and body hair.
There are a variety of surgical options available as well: breast augmentation, facial feminization surgery, body contouring, and vaginoplasty for MTFs, and male chest reconstruction, facial masculinization, body contouring, and phalloplasty/metoidioplasty for FTMs.
Some people choose only to transition socially. Many choose to undergo hormone therapy, but to skip surgery. Some people choose to physically transition as completely as possible to their desired gender. Others are unable to transition to the extent they would like due to extenuating circumstances – family pressures, relationship issues, financial limitations, or other reasons. Many people seek therapy to help them navigate the complex issues that arise during the transition process.
Dr. Zwiener at Braeswood Endocrinology supports the various ways that trans and nonbinary individuals choose to transition. She is able to initiate and manage the hormone regimens involved in the medical transition, and can provide assistance with other aspects of transition, including
- referrals for support groups, therapists, surgeons, and supportive primary care physicians;
- letters to support your legal transition and/or surgery;
- pre- and post-op care if you choose to undergo surgery outside of Houston.
Dr. Zwiener respects the autonomy of each individual in deciding how to proceed with their transition. For this reason, she practices under an informed consent model - while therapy is always beneficial to help navigate the transition process, Dr. Zwiener does not require a therapist’s letter to start HRT.
No matter what path you choose, I recommend that you always seek advice from experts who have experience with the unique issues faced by transgender, intersex, and gender-nonconforming people.
In our next post, we will talk about what to expect from your first visit at Braeswood Endocrinology.