Medical Transition

Medical Transition

A medical transition is any combination of surgical and nonsurgical options that we, as trans and intersex people, may pursue to ensure that our sex characteristics better match our gender identity as part of our gender-affirming journey. It can be described as feminizing (for transfeminine people), masculinizing (for transmasculine people), or gender neutralizing, which may be desired by non-binary people, particularly trans people.

Mental Health

Psychotherapy (individual, couple, family, or group) is often recommended for trans and intersex people.Benefits of psychotherapy include : 

  • exploring gender identity, role, and expression; 

  • addressing the negative impact of gender dysphoria and stigma on mental health; 

  • alleviating internalized transphobia; 

  • enhancing social and peer support; 

  • improving body image; 

  • promoting resilience

If mental health professionals are uncomfortable with or inexperienced in working with trans, intersex and gender diverse individuals and their families, they should refer clients to a competent provider or, at a minimum, consult with an expert peer. If no local practitioners are available, consultation may be done via telehealth methods, assuming local requirements for distance consultation are met.

General guidelines for mental health professionals working with adults who present with gender dysphoria according to WPATH

  1. Assess gender dysphoria – The evaluation includes, the assessment of gender identity and gender dysphoria, history and development of gender dysphoric feelings, the impact of stigma attached to gender nonconformity on mental health, and the availability of support from family, friends, and peers (for example, in-person or online contact with other trans, intersex and gender diverse individuals or groups). 

  2. Provide information regarding options for gender identity and expression and possible medical interventions  – An important task of mental health professionals is to educate clients regarding the diversity of gender identities and expressions and the various options available to alleviate gender dysphoria. Mental health professionals then may facilitate a process (or refer elsewhere) in which clients explore these various options, with the goals of finding a comfortable gender role and expression and becoming prepared to make a fully informed decision about available medical interventions, if needed. 

  3. Assess, diagnose, and discuss treatment options for coexisting mental health concerns – Possible concerns include anxiety, depression, self-harm, a history of abuse and neglect, compulsivity,substance abuse, sexual concerns, personality disorders, eating disorders, psychotic disorders, and Autistic spectrum disorders (Bockting et al, 2006) ; Nuttbrock et al., 2010;  Robinow, 2009). Mental health professionals should screen for these and other mental health concerns and incorporate the identified concerns into the overall treatment plan.

  4. If applicable, assess eligibility, prepare, and refer for hormone therapy – Mental health professionals can help clients who are considering hormone therapy to be both psychologically prepared (e.g., client has made a fully informed decision with clear and realistic expectations; is ready to receive the service in line with the overall treatment plan; has included family and community as appropriate) and practically prepared (e.g., has been evaluated by a physician to rule out or address medical contraindications to hormone use; has considered the psychosocial implications). If clients are of childbearing age, reproductive options should be explored before initiating hormone therapy.

Physical Health

Transfeminine Folks

Medical transition for transfeminine people may include any of the following:

  • Gender-affirming hormone therapy entails using hormones such as estrogen to develop secondary sex characteristics such as breasts, fat redistribution toward the hips and breasts, and less body hair.

  • Breast augmentation, also known as “augmentation mammoplasty,” is a surgical procedure used to increase the size of the breasts. It entails inserting breast implants beneath the breast tissue or chest muscles.

  • Voice training, which entails working with a professional to learn new ways to use your voice

  • Feminization laryngoplasty is a surgical procedure that raises a patient’s pitch, making the voice sound higher and more feminine. It is a type of voice feminization surgery (VFS) that can be used instead of vocal therapy.

  • Laser hair removal: the removal of hair from the face, neck, or other areas of the body.

  • Feminizing chondrolaryngoplasty, also known as “tracheal shave,” improves the appearance of trans women’s necks by effectively reducing the prominence of the Adam’s apple and is performed through a frontal incision.

  • Facial feminization surgery: surgeries that change the shape and/or size of parts of your face, like your nose, lips, cheeks, or jaw.

  • Orchiectomy, also known as a bilateral orchiectomy, is a surgical procedure that removes the testes. Transfeminine people typically seek it to either stop the production of testosterone and sperm or affirm their gender identity.

  • Vaginoplasty: the surgeon uses skin and tissue from the penis to create both an outer and inner vagina.

  • Fertility preservation is the practice of storing sperm in order to have children in the future.

Transmasculine Folks

Medical transition for transmasculine people may include any of the following:

  • Gender-affirming hormone therapy entails using hormones such as testosterone to develop secondary sex characteristics such as a deeper voice, facial hair growth, muscle growth and fat redistribution.

  • Mastectomy, also known as “top surgery,” is a procedure that removes breast tissue in order to create a more masculine chest.

  • Voice training, which entails working with a professional to learn new ways to use your voice,

  • Masculinization laryngoplasty is a surgical procedure that lowers a patient’s pitch, resulting in a deeper, more masculine voice. It is a type of voice masculinization surgery (VFS) that can be used as an alternative to vocal therapy.

  • Hysterectomy involves the removal of the uterus as well as the cervix, ovaries, and fallopian tubes.

  • Phalloplasty is the reconstruction or construction of a penis using tissue grafting techniques.

  • Metoidioplasty, also known as “bottom surgery” or a “meta,” is a procedure that creates a neophallus, or “new penis,” using tissue from the clitoris.

  • Scrotoplasty is a procedure that involves creating a scrotum.

  • Vaginectomy or vulvectomy: surgery that removes the vagina and/or vulva—commonly combined with other genital surgeries; and

  • Fertility preservation: is the practice of storing eggs that can be used to have children in the future. 

Source

  • Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 by The World Professional Association for Transgender Health (WPATH)

  • What do I need to know about transitioning by Planned Parenthood

Resources

PLANNED PARENTHOOD

Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People

The World Professional Association for Transgender Health (WPATH)

Please Remember:

It’s important to note that not all trans, intersex and gender diverse people will medically transition, and that being trans, intersex and gender diverse isn’t contingent on medical procedures. Therapy is typically recommended to assist one in taking care of their psychosocial well-being while affirming their gender. Individuals differ in their desire and ability to transition. While some people pursue hormone therapy and gender affirming surgeries, others are denied access or are discriminated against. Others are opposed to full genital surgery.  Medical transition aims to help people live as their true gender, but it does not prescribe a specific course of action.