My Book/ Part 2 - Now it Gets Serious.

The following below is still in progress.

I used Photoshop to create a female look from my face, without applying sculpture, and asked my general practitioner, dermatologist and laser hair removal spa tech, what the possibilities are to get a more feminine look as in the picture without doing any kind of facial surgery. (FFS)

Chapter One: Social Transitioning.

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At Home.

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At Society.

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At Work.

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Chapter two: Medical Transitioning

Medical transitioning usually starts with mental health therapy, since most endocrinologists require a referral letter, and surgeons require two letters, each from a different therapist.

Hormone Replacement Therapy.

Hormone Replacement Therapy, HRT, is the name commonly used to describe the procedure of cross-hormone medicine to start, and maintain, the medical transition process. This is the same medicine used for cis-gender woman and is a prescription for two medicines, namely estrogen and progesterone. Instead of HRT, Estrogen Replacement Therapy, ERT, can be prescribed, and it is a prescription for only one medicine estrogen, so there is no progesterone added. For male-to-female transgender people, HRT, often includes antiandrogens in addition to the estrogens and/or progestogens, to lower the testosterone level.

There are many physical changes of being on HRT, or ERT, and with variation in outcome for each individual. The psychological changes are harder to define, because HRT is usually the first physical action that takes place when transitioning and the act itself of beginning HRT has a significant psychological effect, which is difficult to distinguish from hormonally induced changes. HRT does not usually cause facial hair growth to stop or the voice to change. For transwomen, taking estrogens might affect some of the following in different degrees of outcome:

• The growth of breasts and enlargement of the nipples.

• Redistribution of body fat.

• Softening/drying of skin.

• Change in body odor/sweat.

• Slowing down growth, and softer, body hair.

• Getting hot flashes.

• Becoming easily emotional.

• Mood changes.

• Reduction in libido.

• Decrease of spontaneous erections.

• Male sexual dysfunction.

• Shrinkage of the prostate and bladder.

• Reduced physical strength.

Partially reversible changes:

• Breast development (may need reconstructive surgery to reverse the effect)

• Infertility, eventually leading to chemically induced a spermatogenesis.

The reversibility of this effect depends on the length of time and effects of androgen suppressing substances. Androgen suppressing drugs are not a substitute for other birth control methods.

Reversible changes:

• Softening/drying of skin.

• Redistribution of body fat.

• Reduced muscle development.

• Various skin changes.

• Significantly reduced and lightened body hair.

• Change in body odor and sweat production.

• Less prominence of veins.

• Ocular changes.

• Reduced gonadal "gonads" size.

Primary sexual characteristics.

Primary sexual characteristics definition:

Primary sexual characteristics represent all genital organs that enable the differentiation of the male and the female. They determine the sex at birth according to the external genitalia: a penis and testicles located in the scrotum for boys; the labia and vagina for girls. Some also consider the inner organs, in differentiating between men and women, among the primary sexual characteristics such as the prostate and seminal vesicles in men, and the ovaries, fallopian tubes, and uterus in women.

Secondary sexual characteristics.

Secondary sexual characteristics definition:

Any physical characteristic, developing at puberty, which distinguishes between the sexes but is not directly involved in reproduction, which are acquired later during puberty and hormonal development: hair, deepening of the voice, and increased muscle for men; and hair, breast development, milk secretion capacity, and the onset of menstrual cycles with periods for women.

Chapter three: Legal Transitioning.

Mensen die (ex) transseksueel zijn kunnen sinds 1 juli 1985 voor het eerst hun geslacht en voornamen officieel wijzigen op hun geboorteakte en sinds oktober 1994 in de Gemeentelijke Basisadministratie (tegenwoordig Basisregistratie Personen). Men moest toen een advocaat zoeken om voor diegene een verzoek tot geslachtswijziging en voornaamswijziging in te dienen bij de rechtbank. De voorwaarden was dat er operatie(s) hadden plaatsgevonden en dat men definitief ontvluchtbaar is. Sinds het in Nederland mogelijk is om met iemand van gelijk geslacht te trouwen of een partnerschap aan te gaan, is een echtscheiding niet verplicht, voorheen wel. De kosten hiervoor verschillen per zaak. Omdat men de advocaat en griffiekosten moest betalen. Kortom, er is geen vaste prijs. Ongeveer tussen de 250 en 600 gulden/euro. Nu presies 29 jaar later is dit geschrapt en kunnen transseksuele naar de burgerlijke stand van hun geboorteplaats. Er hoeven geen operatie te hebben plaatsgevonden. Men is dan wel minimaal 16 jaar en mensen onder de 18 hebben geen toestemming nodig van hun wettelijke vertegenwoordiger(s). Men moet een verklaring hebben van een genderteam die niet ouder is dan een half jaar. Uiteraard ook een identiteitsbewijs. Hierna wordt wijziging van de voornamen en geslacht als latere vermelding op de geboorteakte geplaatst. En in de Basisregistratie Personen verwerkt. Hierna kan men een nieuw identiteitsbewijs aanvragen en instanties de nieuwe gegevens doorgeven. Men kan eventueel de gegevens over de oude voornamen en geslacht uit de Basisregistratie Personen laten verwijderen. Dit in onomkeerbaar.

Official Documents: The Netherlands First.

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Official Documents: The USA Second.

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Now That I Am Legal the Fun Begins.

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Chapter Four: The Surgery Most People Think About.

Sometimes you meet up and talk with people and one of the questions that eventually comes up is like; so did you have “it” cut off? Well first of all a trans woman do not need to have any form of surgery to be a woman, but I understand the way some people think. There are actually many form of feminization surgeries a trans woman can choose to undergo. Bottom surgery is only one of them, and even those surgeries come in different ways and with different options. And no, “it” is not just cut off. “It” is more like being recycled. So when I did my research, and decided to come out the closet and medically transition, I did not think of ever having “the” surgery. I thought that as long as I can become more feminine in every other way, it will make up for living without a vulva. Oh dear was I wrong. As my body changes progressed, both physically and mentally, it kind of backfired when looking in the mirror, or when taking a shower. These daily, often just 10 to 15 minutes simple things of life, became the most irritating moment’s trough out the day. I just couldn’t stand “it” no more.

So while most cis gender people don’t think much about transgender surgeries other than “the” bottom surgery (SRS), the other surgeries available to trans woman are “top” surgery (BA), which stands for Breast Augmentation, and comes with a variety of different type of implants, and facial surgery (FFS), which stands for Facial Feminization Surgery, and this involves a variety of procedures.

Next to these surgeries there are also cosmetic options for body and/or facial hair removal and scalp hair transplants.

SRS: Sexual Reassignment Surgery.

One in four to five thousand cis gender woman is born without a vagina (Dr. Sidhbh Gallagher, www.gallagherplasticsurgery.com)

BA: Breast Augmentation.

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FFS: Facial Feminization Surgery.

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Chapter five: Fine-tuning and some other things.

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Hair removal and growth.

Body hair removal

Facial hair removal

Scalp hair growth

Facial Cosmetics.

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Voice Therapy.

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