Exploring Gender Identity

MTF Transition and What To Expect

header Makeup2aBy Sequoia Elisabeth Carpenter



This article is based on information that I have experienced personally and on information I have retrieved from World Professional Association for Transgender Health.  While WPATH protocols for transition include CHT and Surgery, I no longer support this point of view.  While these things offer temporary relief they are permanent and with drastic life changes. Transition is an inner journey and if you feel changing the vehicle will assist in this journey then go ahead, just know that ultimately being transgender is not about how you look.  Consider the Spiritual aspects before making any life altering changes.  I have found Spirituality is the only “reality” we have. What we see around us is a projection from the mind and this includes the body.  Our “self” is far more than what we think it is.  There is no reason to change things externally, rather look within and accept the reality you have created.  If you need to change things; change your mind!

If you do decide to proceed with physical transition then it is always advisable to have a physician monitoring your health when transitioning since we are all individuals and what is best for one person may not work for another. So, yes these guidelines are simply that and should be adjusted to fit your needs. The purpose here is to provide you with expected results so that you can be more comfortable in the progress of your transition.

The usual course of transition for a MtoF transsexual is to first dress as a woman and to socialize with your peers prior to taking the major step of CHT or Contra-Hormone Therapy. This does not need to be on a full time basis, although it can be. Socializing as a woman is very different than as a man so getting used to that aspect is greatly beneficial in both determining if you desire to progress and gaining the skills necessary to be successful. Many things will come naturally for you such as mannerisms, emotional behavior including your needs and desires, and mental processes. What may not be so natural is movement, social expectations and relationships. Transition is basically the process of breaking down the learned “male” persona and allowing the natural female self to emerge. This will be easier for some than others; however it is a big road block for many. Only about 5% fully transition from male to female, while most end up somewhere in between and this is perfectly acceptable.

It is important to be patient with the transition process and allow things to occur naturally, although counseling, feminine coaching, and voice therapy do play an important part. A skilled counselor can guide your path and point out aspects that are not natural if they are not obvious and help you get in touch with your authentic self. The feminine coach is valuable in helping you to get in touch with feminine energy and develop its expression. I must say the first time I felt my feminine energy vs. my masculine energy it was a revelation! Being aware of your body’s energy and what you are projecting is very important, because this is how others will react to you. For women to truly be feminine for instance they do not project energy, they simply center themselves in the feminine within the pelvis and hips which attracts others appropriately.

Voice therapy is very important also and I suggest that you start this process as soon as possible, even before transitioning if you are planning that far ahead, which most of us do not. I also recommend getting electrolysis started as soon as possible and depending on your age, I recommend doing laser first to clear the dark hairs and let the electrologist focus on the light hairs. Don’t let the electrologist tell you that laser is not permanent because I know that it is from experience. I have a page on this website that goes over the whole process of transition planning, so I would like to stay focused here on what to expect. Laser works wonders for most people and with the proper hormone regimen the face is the only area to be concerned with unless you are unusually hairy and I know that some men are, that is OK. I recommend contacting your local gender society, crossdressing group, or regional GLBT center for more information as to where you will find good electrolysis and laser treatment. If you use the phone book and that does work, just be cautious and make sure the person is familiar with male hair removal.

The hormones do a remarkable job of reducing body hair and stopping male pattern hair loss. Find a doctor who specializes in CHT for transgender/transsexual persons, because doing this yourself or using a doctor with little or no experience is setting yourself up for failure. It can be done on your own, but that is contrary to what this whole journey is about in my opinion, which is to fully and completely experience the transition. Many TG/TS’s want to jump straight to the result and if that was the way it was meant to be then don’t you think that you would have been female from birth? I can hear all the opinions flying as I write this which is great, remember this is from my experience and if you desire a different experience then make it so.

Getting back to the transition, CHT is the next step and one that will produce awesome changes that most just love, if you do not love it then stop and talk to your therapist because you are likely not Transsexual. So let’s cover what to expect from CHT so that you are comfortable along the journey. The feminization effects for a MtoF are taken from “Endocrine Treatment of Transgender Persons” published by WPATH, the time frame is included:


               Effect Onset Maximum effect
Redistribution of Body Fat 3-6 mos. 2-3 years max
Decrease Muscle mass and Strength 3-6 mos. 1-2 years max
Softening of Skin/Decreased Oiliness 3-6 mos. Unknown
Decreased Libido (sex drive) 1-3 mos. 3-6 mos. max
Decreased Spontaneous Erections 1-3 mos. 3-6 mos. max
Male Sexual Dysfunction Variable Variable
Breast Growth 3-6 mos. 2-3 years max
Decreased Testicular Volume 3-6 mos. 2-3 years max
Decreased Sperm Production Unknown > 3 years
Decreased Terminal Hair Growth 6-12 mos. > 3 years
Scalp Hair No re-growth ****
Voice Changes None ****


A few things to keep in mind; complete removal of male genital hair requires electrolysis and/or laser treatment, familial scalp hair loss may occur if estrogen therapy is stopped, and treatment by a speech pathologist for voice training is most effective for voice changes. Voice surgery exists and some have had success, while others have experienced disaster and lost their voice altogether. Proceed with great caution when concerned with voice altering surgery. It is recommended that you wait till all other surgeries you plan on having are done, because the intubation process used to put you to sleep can affect the voice surgery.

Please take these maximum effect times into consideration when planning your surgery, especially breast augmentation since if you run out and have D cup implants put in only a year into CHT you will likely end up with DD’s, lol, I know dream on, but it is likely that your breasts will grow for 2-3 years after starting CHT and also some more after SRS or Orchiectomy. I recommend that you wait till after surgery and see how you are doing to get breast augmentation. Personal circumstances will of course need to be considered.

The last step is SRS (Sexual Reassignment Surgery) or GRS (Genital Reassignment Surgery). After getting approval from your Gender Therapist and your physician (most surgeons require two professional letters of recommendation) the process of surgically altering your male gifts to a more appropriate female presentation will alleviate much of the “dysphoria” associated with transsexualism. This is a touchy subject for many TG/TS’s so I will simply share my point of view. My purpose here is to explain what to expect and not go into specifics of need, procedure or surgeons. So why have SRS? The sense of “rightness” for a lack of better word is the answer I hear most often. The possibility of living the sexual life of a woman is also a major reason. It used to be the biggest concern involved with SRS and may still be, whether orgasm is possible after surgery. From what I am told, it most certainly is. The techniques are such today that you can expect to have natural aesthetics and orgasm with your new vagina. The part they are still working on is reproductive capabilities and I believe that some day they will find a way to do that also; stem cell research along with gene altering techniques seem to me to hold the best promise for this. For now though, having a baby by carrying it in your womb is not yet possible. Being a parent though is anyone’s choice, so consider all the possibilities like adoption, foster care, marriage, and surrogates.

The post-op SRS patient often experiences a depression similar to post-partum depression and is a process of adjusting to the new hormone regimen. The psychological effects reported by most are that of elation, emotional comfort and relief. It is important to understand that SRS does not magically make everything OK. If you hate yourself before SRS you will hate yourself after SRS, it is that simple. You still have to do the psychological work to improve your self-image and how you relate to the world. This is why WPATH require a therapist letter before you can get SRS. From what I understand and this makes a lot of sense to me, while therapy is imperative it should not be a pre-requisite of SRS, but assuring that you get the appropriate care after surgery is not guaranteed so hence the requirement.

I strongly recommend doing mirror work, which involves staring into your eyes and saying “I Love You”! I have been doing this for several years and it is helping tremendously. The point I want to emphasis though is that surgery is not a magic pill and while it will help, issues must still be dealt with.

Most realize that there is much more going on than physical transformation and hence my integrated website with the Spiritual aspects of this journey. I urge you to be as aware as possible on this journey, to enjoy the milestones and victories, and be not afraid to feel the pain associated with this transition. I am available to chat with anyone about either Spirituality, Gender transition, or whatever you need to talk about, just drop me a line.

Guideline on the Endocrine Treatment of Transsexuals, retrieved Jan 30th, 2010, Guideline (1st Draft 11.17.08).pdf


article last updated August 29, 2017

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