An Overview on FTM Transition

Let’s take a break from our regularly scheduled programming and chat about gender. For those who don’t know, I am a transgender man. This means that I was assigned female at birth (AFAB), but identifies as a man. I started my physical and social transition when I was 19 years old, about 7 years ago. This was about 2 years before being diagnosed with schizophrenia. 

As this is my first post about being transgender, I want to give an overview of physical and social transition. To be clear, one can be transgender without physical and/or social transition! Neither is required, though many people will do one or both. 

Social transition typically entails changing your name and/or pronouns. A successful social transition involves changing your peers’ and society’s perception of you, from one gender, to another. Or neither! Non-binary people are neither one nor another gender, OR possibly both genders at once, OR without gender altogether. It’s kind of hard to explain, so I offer my apologies for the awkward explanation. I, for example, actually came out as non-binary before realizing I was a man. So there was a phase in my life where I was using they/them pronouns, and considered myself to be neither male nor female. It was actually in my job as a caregiver where I realized that I was actually a man. For the ease of the people I was caring for, and for my own physical safety, I used he/him pronouns and told everyone I was a man. Eventually, the use of he/him pronouns felt more natural to me than they/them. So I officially changed my pronouns once again to he/him. 

I want to explain female-to-male (FTM) physical transition. Typically, a FTM or female-to-nonbinary person will take testosterone, the male sex hormone. This will cause the person to develop male secondary sex characteristics such as a deeper voice, increased facial and body hair, increased muscle mass and upper body strength, body fat redistribution to a male pattern (storing body fat around the belly rather than the thighs and buttocks), “bottom growth” (enlargement of the clitoris), increased sex drive, and cessation of menstrual cycles- to name a few. How is testosterone taken? Usually, a gender specialist will prescribe intramuscular testosterone, to be administered through injection- typically into the thigh or buttock. For those who don’t want to inject testosterone, there is a secondary option via testosterone gel, typically applied to the back of the arm. 

The effects of testosterone come faster than many people think! My voice started changing about a month into my physical transition. By the sixth month, I had a cute little moustache, thicker eyebrows, unbelievable upper body strength, and side burns. A note about increased upper body strength. I was going to the gym regularly- rock climbing and weight lifting. I was able to do about 20 unassisted pull-ups, and about 50 push-ups without stopping. It was wild! I was pretty physically active before physically transitioning, yet I was unable to even do just 5 pull-ups. Three months into my transition, I had a rippling six-pack of abs. Then, COVID happened, and now I have a six-pack of pudding cups. 

Another aspect of FTM transition is surgery. There are a variety of surgeries one can get while transitioning. I, for example, got “top surgery” (removal of the breasts), and a hysterectomy (removal of the uterus, ovaries, and fallopian tubes). 

When I got top surgery, I had to be out of work for about three weeks. The worst parts of the surgery were having drains and not being able to shower for four days while having the drains in. What are drains? Well, they are tubes that are placed under the skin to allow for blood and lymphatic fluid to drain out of the body. I had two, one on each side of my chest. I had to have them in for a bit longer than usual, as I had increased drainage. While you have drains in your body, you are not allowed to shower. As a person who is obsessed with personal hygiene and showering, this was rough. When I went back to OHSU for my post-op appointment, expecting to get my drains removed, I was informed that I was still draining too much, and had to keep them in for a few more days. The nurse at the hospital tried to get me to schedule another appointment to remove my drains. I told her that I was not driving two hours north for a five minute appointment. She provided me with the supplies to remove the drains on my own, at home. It was actually quite easy! I clipped the stitches holding them in place, and simply pulled the tubes out of my skin. When you get top surgery, at least for me, I was completely numb from my collar bones to the bottom of my ribs. Removal of the drains, while feeling weird and uncomfortable for a few seconds, did not hurt at all. 

The decision to get a hysterectomy, other than the ones to get top surgery and starting testosterone, was single handedly the best decision I ever made for my reproductive health and mental health. I have never once wanted to be a parent. And I certainly had no desire to get pregnant or give birth. My periods were awful, luckily ceasing after starting testosterone. But I had to walk around worrying that I would get a random period out of nowhere. The process to get a hysterectomy was fairly intense, though. The gynecologist required two letters of recommendation from different mental health professionals stating that I was aware of the consequences of this surgery. During the consultation for the surgery, and the morning of, I was grilled about not being able to have children, despite me stating MANY TIMES that I did not want children, and that simply having a uterus was giving me crippling dysphoria. I was asked if I wanted to freeze my eggs, to which I responded, yet again, that I DID NOT want children. 

The recovery from the surgery was a breeze, actually. I’ve had periods that were worse than the recovery. I actually went to class the same day as my surgery. This was during COVID, so class was on zoom. My surgery was scheduled for 9 am, I was home by 1, and class was at 2:30. I waddled over to my desktop computer, and logged into zoom. I was still loopy from the anesthesia, and was struggling to stay awake. The professor went into a breakout room with me, and asked if I was okay, as they saw that I was barely awake. I told them that I had a hysterectomy earlier that day, and they told me that I should log out and go take a nap. I did. My best friend came over later that evening with a pizza and we sat around and chatted until I was ready for bed. The pain wasn’t too bad. I think I only took two or three of the opiate-based pain pills provided to me by the surgeon. Again, I’ve had periods worse than that surgery. 

Okay, I think that’s enough gender stuff for today. I will write more posts about my journey with gender in the future, so stay tuned!

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