I am a transgender man and I started my transition in 2017. It was one of the happiest moments of my life. I have started my transition once before in 2015, however I had to end it then because of lack of support and proper knowledge of the process. When I began the process of transition, I experienced a lot of pain, especially due to the injections that my body was not used to. It was only with time, that my body got conditioned to the regular injections and only then did the pain lessen.
For a trans person, transition is a process by which they change their gender expressions or sex characteristics to that of their preferred gender. This process may or may not include various steps like changing one’s name to their preferred name, taking hormones or going for surgeries, and many more. Broadly, there are three types of transition – social, medical, and legal.
Social transition is process through which a trans person makes the people around them aware of their gender and start consciously changing their gender expressions, especially in ways obvious to the others.
For me, social transition included:
- Coming out to self and others around them.
- Sharing with people the name of their choice and asking them to use that name for them.
- Sharing with people their preferred pronouns and use gendered language which aligns with their gender.
- Changing gender expressions and making their gender expressions aligns with their gender.
Social transition, colloquially known as ‘coming out’, is definitely the first and the most fundamental step towards transition. Depending on social conditions such as the level of acceptance, conservative beliefs of the people around, the trans person’s assumption of what constitutes a safe space and what does not, people choose to transition at different points in time. For instance, someone may have socially transitioned with their friendship group, but not done the same yet at the workplace.
For me, medical transition was the most expensive part of transition. Not everyone always chooses to go for it and this could be due to various reasons, such as their dysphoria level, lack of money, lack of support systems, inadequate exposure to counselling sessions, etc. For me, once I was sure I wanted to do it, I plunged into it. Here are a few general steps that I followed which others who are contemplating a medical transition could find useful:
- Visiting a psychiatrist for the gender dysphoria letter
- Visiting an endocrinologist for HRT
- Visiting a psychiatrist for surgery letter.
Visiting A Psychiatrist For GID (Gender Identity Disorder)/GD(Gender Dysphoria) Letter
For initiating medical transition, the first thing any trans person needs is a GID (Gender Identity Disorder) letter or gender dysphoria letter. Despite common knowledge that dysphoria is not as a disorder, in India, the term GID continues to be used commonly. When it comes to the financials involved in this step, I realised that the fees varied from one psychiatrist to the other. The procedure of getting the letter varies i.e. some psychiatrists insists on getting a psychological test, some insist on meeting an endocrinologist before getting the letter to check if the blood composition is normal or not. Further, the time taken to procure the letter also varies. While some psychiatrists give the letter in one sitting, others take months. Also, it is important that one stays alert of the many psychiatrists who would attempt to advise them against undergoing the medical transition, thus subverting the process and conducting conversion therapies illegally.
That there is still no standard protocol that a psychiatrist is supposed to follow in India as prescribed by the government or the Indian Medical Association makes it even more difficult.
Visiting An Endocrinologist For HRT (Hormones Replacement Therapy)
After getting a letter, the next step is to visit an endocrinologist to start taking the hormones or start HRT (Hormones Replacement Therapy). The endocrinologist will do a general check-up and prescribe blood tests just to ensure if your body is ready or not. The cost of the blood test may range anywhere between INR 5,000 and INR 1,500.
As a trans man, I found that most of the time, HRT for trans men starts from 100 milligrams of testosterone shots for three months. Following this, the liver is tested to gauge how the body is responding to the hormones as well as to keep a check on the liver. If everything is functioning smoothly, then the dose is increased to 250 milligrams. The cost of the 100 milligrams bottle is around INR 150 and that of 250 milligrams is around INR 250. You can prefer to get injected by a professional nurse in the beginning however gradually, many prefer and learn to self inject.
Visiting A Psychiatrist For Surgery Letter
In most cases, the doctors make a letter sanctioning both HRT and surgery. This letter deems one mentally and physically fit to undergo the surgery.
The order of the steps I am mentioning here might not be the same for every trans person because of a lack of a standard protocol, however it is to give people a general idea about them. One of the most important factors for a person undergoing transition is to have the constant and undeterred support of their loved ones in every step of the way. Especially during the hormone therapy, they might be undergoing varied emotions such as aggression, sadness, anger etc. and everyone would respond differently. When a trans man takes testosterone shots, he may experience a surge in the energy levels of his body, which may manifest in different forms like increased libido, anger, or anxiety. That is why, one common suggestion is to hit the gym. However, everyone should take the liberty to deal with things in their way and time.
One of the most important things, especially when tangible changes begin after HRT, is to find a safe space. Finding a safe space is important so that you can express you gender, experiment with it and if needed, question it, or just take your time to get comfortable with changes that are happening. There will be many physical, emotional, and social changes that will happen during this period so it is important to have supportive people around.
Overall, having gone through one myself, I believe transition is a beautiful journey of second puberty which a trans person goes through. But due to the prevalence of entrenched transphobia in the world, most of us are often denied the chance to enjoy this journey. Here is hoping that we steadily move towards a space where a person’s liberty to express their gender with joy is not questioned and stigmatised.