Because bodies (especially secondary sexual characteristics) are gendered, a lot of trans people need to modify their bodies as they transition. Cis people know that: every time they talk to us, they will ask a question about our bodies, centred basically about how we can magically embody “the other sex” or about whether or not we had “the surgery”. Obviously, they don’t know is that trans bodies are much more complex than this and of the wide variety of strategies trans people use to be amazing unicorns.
A few comments before we start
1) This list is not complete. People may use other body modifications or body management tactics, or use those I list here in other ways and with other meanings (especially if they want to project a non-binary gender expression).
2) Not all trans people will want body modifications. Some will want several items on this list, and some won’t want even one. Despite the normatively enforced paths that cis people expect, building on medical gatekeeping, there is no mandatory path going from hormones to (genital) surgery except as a trajectory imposed on some trans people by doctors & gender identity clinics. This is in part because the effects of these procedures are numerous and complex, especially because many of them cause temporary or permanent sterility (trans activists are often very strong believers in and activists for reproductive justice, because it hits very close to home).
By the way, readers from Quebec who care about reproductive justice: it’s really time you start talking about how the governement cut sperm/ovary preservation for trans people by sheer incompetence. I talked about it a year ago as a thing that was going to happen if nothing was done to prevent it. The Minister promised not to cut that and to keep the coverage, but we’re starting to get reports of trans women being refused access, so visibly he’s incapable of doing his job of not screwing over trans people by accident. It’s really an issue where we would have needed support and allyship, yet despite the (completely legitimate) feminist uproar about a potential reduction in access to abortion under Bill 20, nobody said a word about how the very same law unnecessarily sterilized trans people.
3) The reason I talk about trans body modification & body management (instead of, say, “trans surgeries” or “trans medical procedures”) is to dedramatize these procedures a bit. Most of them are also possible for and requested by cis people, sometimes for reasons that resemble those of trans people (because they too need to be at ease with their gendered bodies), sometimes for reasons that have nothing to do with gender. However, access to them is often more difficult for trans people (even when they are standard for cis people) because trans experiences are not recognized and because doctors & medical professionals make many of the decisions related to access to these procedures (i.e. they are the gatekeepers and decide who is or isn’t properly trans). I also think it is closer to the relationship trans people have with their bodies, and better shows the range of ways they will manage them.
4) This is not intended at trans people exploring their transition options. My point here is to tell cis people an idea of the range of possibilities that exist, with relation to the needs that trans people often experience and what is currently possible. I wrote it originally because I didn’t have the time to cover this topic in depth at a training I gave on gender to the peer support volunteers of the Centre for Gender Advocacy, an organisation I have a strong crush with.
To trans & questionning people reading this, I hope this effort will prevent some of you to be confronted to the awkward, inquisitive, even voyeuristic questions you might otherwise have gotten. I recommend you go to trans people around you or online (Youtube is an amazing resource) and to your local trans organisation if you want to know more about your options.
Now that all this is clear, let’s go 🙂
Hormones & hormone replacement therapy (HRT)
Hormones (mainly estrogen & testosterone) are a very important part of trans experiences. They can strongly masculinize or feminize one’s body in many complex ways. As most physical markers that allow people to gender adults are secondary sex characteristics (breast, beard, etc.) that normally develop under the effect of sex hormones, they can have a strong influence on whether someone is recognized or not as a woman or a man (and perceived or not as trans, with all the violence this can entail), just as they can be used to mark a non-binary body.
Before or during puberty, children can use hormone blockers to stop the effects of their naturally occurring hormones. It can be followed by HRT, but not necessarily. These only delay the effects of puberty to allow children to make their own decisions about their bodies. As we will see, many parts of the body are not affected by HRT after puberty, and can only be altered with surgeries or not at all. This is why it is so important for trans children to be given time to think about what they want for their body.
People who want to masculinize their bodies will use testosterone (often through injections). Amongst other things, it changes fat distribution to create a more masculine appearance, grows muscle mass, enlarges the clitoris, makes facial hair and other hair grow (but can cause baldness), and deepens the voice. It does not remove the breasts.
People who want to feminize their bodies often use estrogens and anti-androgens (to block testosterone). Amongst other things, it changes fat distribution to create a more feminine appearance, decreases muscle mass, decreases erections, and make breasts grow. It does not reverse baldness (although it stops the process), and it does not alter the voice.
Unless growth is not finished, HRT doesn’t affect the bone structure. For instance, trans men using HRT will often be much shorter than cis men, while trans women will be much taller and broader than cis women, with smaller hips. Although fat tissue on the face will move, it won’t change the underlying bone structure, so trans women will often have a very square-looking figure.
In addition to these visible changes, many trans people report complex changes in their emotions and sexuality. Many trans men report increased sex drive, for instance, while some trans women feel more in tune with their emotions and cry more often.
(Yes, the fact that trans people change this way when they start to take hormones is an uncomfortable truth for some radical gender constructivists who expects that gender stereotypes is all about socialization and that biology has nothing to do with anything. But let’s carry on.)
Even trans people who take hormones (not all do) can have contradictory opinions about their effects, and feel good about some and not about others.
Even though cis people talk about these as “the” surgery, there a quite a few procedures available that relate to the genitals & reproductive system. Until recently, in Quebec, these were necessary for legal recognition, and wanting them has been a criteria for access to other procedures. They still are in many other places. Obtaining them can be fairly difficult and costly. Here are some of them.
- Hysterectomy: Removal of the uterus (and the ovaries).
- Phalloplasty: Construction of a penis. This can be a very costly and demanding procedure, requiring several surgeries and tissue grafts that leave visible scars on other parts of the body.
- Metoidioplasty: Releases the clitoris (which is often also enlarged by testosterone). This can be enough to provide some penetration during sex.
- Vaginoplasty: Creation of a vulva and vagina, using the tissues that exist in the penis. Contrary to popular belief, this is not a “castration”: the procedure used in Quebec actually involves reversing the tissue from external to internal. For people who prefer that, there is also an option to not have a vaginal cavity (basically, creating a vulva without a vagina), which is less intense in terms of aftercare, but doesn’t allow penetrative sex.
- Orchiectomy: Removal of the testes, which eases “tucking” (see below) and allows to stop using anti-androgens.
Even without surgeries, trans people have options here. For instance, trans men can use a packer to simulate the presence of a penis when clothed, or use a stand-to-pee to use urinals without a penis, while trans women can use “tucking” to hide their genitals. Or they might not. Tucking, for instance, can be very tricky and uncomfortable, and can reduce fertility (often, the testes are pushed inside the body, where the temperature is unsuited for sperm production), so some trans women will not bother.
Just a few examples to show the diversity of needs that exists:
- Mastectomy: Because HRT doesn’t remove breasts, trans men will often get them removed surgically. If they don’t want surgery, or if they can’t access it, they can use a binder to hide their breasts.
- Breast augmentation: Even with HRT, some trans women will develop smaller breast (especially considering that they might be very tall and broad) and will desire breast augmentation.
- Electrolysis & laser hair removal: Because facial hair doesn’t disappear with hormones, trans women will often need to remove it with laser or electrolysis. Trans women may also feel uncomfortable with the hair they have in other parts of their bodies.
- Facial feminization: As we saw, bones are not affected by HRT, so many trans women will try further feminize their appearance with surgeries to their nose, jawline, etc.
- Voice: Trans people will often work to feminize or masculinize their voices, whether they take hormones or not, by changing the pitch of their voice, their airflow, their breathing, their speech patterns, etc. This is especially a problem for trans women, because the changes to the vocal cords occurring in puberty are not reversible. Trans women can also get surgeries to alter their vocal cords, but it’s a fairly hazardous process (the surgeon with the best reputation is apparently in South Korea).
- Haircuts: Hair can have a lot of symbol meaning. For many trans people, cutting their hair short or starting to let it grow will be a part of their own path to transition (and being forced to cut their hair or to let it grow, part of their childhood traumas). Some trans women will also use wigs, either because of baldness, because they have shorter hair, or because they just like to. Those who have bald patches might also have hair grafts or pursue other ways to correct that.
- Trachea shave (there is a fancy name but no one uses it): Removal of the Adam’s apple.
- Makeup: Many trans women will need to wear makeup to hide their beard stubble if they don’t have (or have not finished) permanent hair removal. They may also want to feminize their features with contouring. Also, they may just like looking wonderful, which is a thing makeup does.
Saw anything wrong in this list? Please tell me in the comments 🙂