Transitioning from male to female is an intense and, above all, long process. For many, an MTF transgender transition might take several years to complete, but it's also a beautiful journey. Still, change is the only constant in this reality, and as for all women, the quest into womanhood never really ends. In this article, we'll talk you through the ins and outs of the most typical MTF transition timeline. From hormone therapy to voice training, to MTF top and bottom surgery and everything in between!
And we always remind all of you; as with anything in life, the MTF transition journey is very personal, and each person decides which steps in the journey they want to include and at what moment it feels appropriate. Including or excluding specific MTF transition steps doesn't make one more or less of a woman! With that in mind, let's start the timeline.
For many people who fall outside the cisgender/hetereonormative spectrum, the first step into embodying their authentic identity starts with a social transition to match their gender/sexual identity with their gender expression. For transgender and non-binary people, this often begins with coming out. They can choose to adopt different personal pronouns, change their first name, and/or change their physical appearance. These changes can occur very rapidly or gradually.
For male to female transgender people, this means they will change from he/him pronouns to she/her pronouns. Additionally, a name change might occur, but people often choose to just feminize their first name. For example, Michael to Michelle or James to Jessy. Physical changes often include adopting a feminine clothing style, wearing hair extensions/ letting the hair grow, wearing makeup, non-surgical breast enhancement, and tucking.
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Hair removal is often considered part of the MTF social transition, but it's a bit more intrusive than the other aspects of the social transition mentioned above. The existence of hair on the face and the body is often a major concern for anybody that wants to feel feminine. Therefore, it comes as no surprise that many trans women will try to get rid of it as soon and as more importantly, as effectively as possible.
Before hormone replacement therapy naturally helps you with the hair removal because of the influx of estrogen in the body, it's worth considering alternative/additional methods to get this process on the go ASAP. These include; laser hair removal, electrolysis, body waxing, and epilating creams. Read more about laser hair removal here.
Hormone replacement therapy (HTR)
After a considerable time living life as a woman (and hopefully loving it), it could be a great time to start hormone replacement therapy or HTR for short. Now, this is where the MTF transition gets exhilarating for many trans women. To get accepted for HTR, it's often required to undergo psychotherapy and receive a letter of recommendation from a therapist. This process is necessary to ensure that the person is indeed transgender, and there are no underlying issues such as internalized homophobia or trauma. These could be causes for a misplaced desire to transition and will result in regrets later in life.
There are various combinations of hormone medications possible in MTF hormone replacement therapy, but we see estrogen combined with an antiandrogen in most cases. Estrogen is the primary sex hormone responsible for developing female secondary sex characteristics such as breast growth, wider hips, and a feminine fat distribution pattern.
An anti androgen is a medication that suppresses the primary male sex hormones in the body. The suppression reduces the male sex characteristics such as deep voice, broad shoulders, masculine body and facial hair, and a masculine fat distribution pattern.
With this in mind, we can predict the changes that the majority of trans women will experience after HTR is started:
Breast development; just as with ciswomen, the amount of MTF breast growth varies greatly depending on the woman. The breasts usually take two years of continuous HRT to reach maximum size.
Decrease in body hair; depending on the amount of body hair to start with, it will significantly decrease or even completely vanish on the arms, legs, abdomen, chest, and shoulders. Unfortunately, the existing beard hair will remain the same; check out hair removal options.
Skin; the skin will become much softer.
Fat distribution; the subcutaneous fat will move to the hips, thighs, and buttocks, creating a more feminine appearance figure.
Muscle mass; depending on the individual muscle mass for the upper body disappears, decreasing bulkiness.
Genitals; testes and penile size will significantly lessen, and sexual function will decrease, including fewer erections and ejaculations. However, the ability to orgasm is not related to erections or ejaculations (!)
Prostate gland; the gland will diminish in size and will reduce or completely halt the production of semen.
Infertility; long-term HRT use often leads to permanent infertility. Read more about it here.
In the case of an MTF transition, it's unfortunate that any MTF hormone therapy won't be able to reverse the low voice caused by testosterone. Luckily there are many programs and voice training resources that can assist with the feminization of the voice.
For example, through voice practice, one can raise the pitch of their voice. But voice training goes far beyond raising the pitch, and many trans women often forget to consider voice inflection, choice of words, body language, coughing, throat clearing, and laughter. A voice coach or speech therapist can assist, or an online program can guide this process.
Check out Voice Feminization with Kathe Perez
MTF top surgery
Even though breast development will likely occur due to HTR, it might not help reach the desired size and/or shape. In those cases, breast augmentation surgery, also known as MTF top surgery, is a viable option for many transwomen.
During the MTF top surgery, an incision is made into the breast, and breast implants are inserted into the pockets. These could be saline or silicone breast implants depending on the desired result. Silicone implants are firmer, with a smooth surface, resulting in a more natural look, while saline implants are rounder and more fluidly-feeling.
Besides the implants, there are many options to consider, from implant placement and size to incision type and location. It's advisable to find a qualified surgical team that can help make the best decision based on the specific situation and body type. Ultimately, for many trans women, the desire is to achieve a very natural look.
MTF bottom surgery
The MTF bottom surgery or MTF sexual reassignment surgery is often combined with the MTF top surgery to reduce the times entering an OR and going under anesthesia. In most cases, the MTF bottom surgery is a combination of several surgeries. First, a penectomy and orchidectomy to remove the male genitalia. Second, the vulva, labia, clitoris, and vagina are created using labiaplasty, vulvoplasty, clitoroplasty, vaginoplasty, respectively. Lastly, there is the repositioning of the urethra. The exact approach might differ depending on personal preference and goals, but it's widespread to convert the penile and scrotum tissue into a vagina, clitoris, and labia.
Many wonder about the ability to achieve orgasm after MTF bottom surgery, and the answer is yes! Because the penile tissue is used to create the clitoris, it keeps its high sensitivity, and most transwomen can achieve amazing orgasms through clitoral stimulation.
After the surgery, it's paramount to keep dilating the newly created vagina to prevent it from closing up. You may use specially designed MTF dilators to do this. Usually, doctors advise to start dilating two weeks after the surgery, but it's best to discuss this with your surgeon!
Many transwomen are delighted with their MTF bottom surgery results as their MTF vagina is nearly indistinguishable from a cis vagina. To get an idea of the results of MTF bottom surgery, check out this website. Be advised; this includes graphic content!
Body feminization surgery (BFS)
For some trans women, only HRT is not enough to achieve the desired feminization results. In those cases, body feminization surgery (BFS) can be a great option. Body feminization surgery is in essence, any surgery that aims to feminize body contours to achieve the ideal feminine shape. These surgeries include facial reconstruction surgery to create a less bulky facial profile, liposuction, and butt augmentation. These feminization surgeries can often be performed with the above-described MTF surgeries.
It's important to note that BFS is not a substitute for a healthy lifestyle and exercise. These surgeries are best done by trans women that are very close to their ideal body shape. Ideally, they have built significant muscle tone, only have fat that has not responded to various weight-loss strategies, and have no excess skin.
Keep in mind that each transgender transition story is unique and has its challenges. For many transwomen, it's difficult to start a social MTF transition before any of the other transition stages have been completed. It's unfortunately still ubiquitous that companies fire transgender people, and society still lacks understanding and inclusiveness. Another obstacle for many transwomen is access to resources such as hormones and/or surgeries.
In any case, it's always advisable to have a social support system in place during such an impactful (yet beautiful) experience. If there is no support system near, there are always online groups one can join. In case you know someone who is transitioning or planning to transition, we advise you to continue to read our blog and find other useful information online about transgender transitions to understand how to best support the person in question. And as always, keep in mind; it's on the inside that counts!
Author Unknown. Hair Removal Options. [online] Gender Confirmation Center by Dr. Scott Mosser. Available at: https://www.genderconfirmation.com/hair-removal-options/
Author Unknown., 2020. MTF Breast Augmentation 101 – Everything You Need to Know. [online] MTF Surgery.net. Available at: https://www.mtfsurgery.net/mtf-breast-augmentation.htm
Author Unknown. Transfeminine Bottom Surgery. [online] University of Utah. Available at: https://healthcare.utah.edu/transgender-health/gender-affirmation-surgery/vaginoplasty.php
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