The Limitations of MtF Transition

Dear Sis,

Medical Science has come a long way w.r.t. addressing Gender Identity Disorder in the last 100 years or so. Transgender demographics are notoriously hard to pin point but it would not be outrageously to claim that thousands of individuals have transitioned medically and are living as members of their opposite sex. It is also not as hard as it once was. And new frontiers are being explored as I write this. There was this research study of uterus implants and carrying a pregnancy to term. But I think one should be aware of the limitations of a medical transition as well. There is only so much we can do.

They have a habit of beginning any new subject with definitions. I have come to think that it is important to agree on definitions so that we can be sure we agree on what we are talking about. We will ignore why the person wants to transition and focus on the physical aspects of transition. We will agree that the goal of a medical transition is to stop/reverse/remove the male secondary sexual characteristics developed in a subject with XY genotype  and induce those seen in a subject with XX chromosomes. There are several secondary sexual characteristics in members of both sex and we will try to discuss as many as possible. The order in which we do so is pretty much random.

Breast

They are almost exclusively sexually dimorphic. They begin developing around puberty and their growth is triggered  by the abrupt rise in the androgen level (not Estrogen), if I remember correctly. Something about aromatization to Estrogen. A certain percentage of the boys will demonstrate some level of nipple development but this gets inhibited pretty soon. During transition we suppress Testosterone and provide estrogen. This will trigger breast development but to what degree depends on genetics and age at transition.

Breast development is measured on the tanner scale viz. 1 to 5, 5 being full fledged development. With genotype XX subjects, stage 5 is reached as late is pregnancy and lactation. Most subjects with XY genotype will not reach this stage. Anecdotal evidence suggest that you will reach a cup size less than your closest female relatives like your mother and/or sister/s. In my experience, I find that body types are a better indicator of future breast development. Of the entire mass of the breast, only a small portion constitute the gland responsible for milk production. The rest is fat. Individuals who tend to put on weight easily will also tend to develop larger breasts.

If you transition later in life, the rib cage has already grown to a large size and there is no way to reduce it. So, a volume x breast would look smaller on an XY skeleton than on an XX skeleton. This problem can be addressed up to an extent surgically using implants. Besides, you can always wear a padded bra. But these solutions have its limitations. It’s not going to help doing these on Arnold Schwarzenegger’s Chest ..hahahahaha. But seriously, I have heard of a “fat-stem-cell” transplant breast augmentation. New and better solutions are being devised all the time.

Bones

Speaking of the Skeleton, XY bones tend to be larger in dimensions and heavier. For example, the Shoulders tend to be wider in XY specimen and the hips wider in XX. Fortunately this difference develops later in life, usually around puberty  and takes several years to complete. Thus the “growth phase” of the individual are a good time for medical intervention. Once this alteration happens, your options are limited to camouflage or trying to de-emphasize the area by doing the appropriate workout. One has to come to peace with living like that.

Facial Hair

Now, now on to the topic of facial hair and body hair. As you all know, XY subjects have more facial hair; the hair is coarser and grow out longer. And you already know that this can be addressed using hair removal methods like laser and electrolysis. Here I just wish to discuss just a few particulars about these methods. First off, the United States Govt’s FDA has approved only Electrolysis to be marketed as “Permanent hair Removal” method. Laser is still classed “Permanent hair Reduction” method. But there are several disadvantages of electrolysis. One that my doctor told me was that it is hard to judge the depth of a hair follicle and hence they may insert the needle too deep or two shallow. This will result in killing some deeper tissue leading to a scar or not kill the hair follicle, respectively. Plus, you can address only one hair follicle at a time. Most girls I know used laser and honestly you will be hard-pressed to find a qualified electrologist in India.

Laser works well enough even though it has short comings. It is painful but so is electrolysis. Here too there is the risk of getting your face seriously burned. But you will find a lot of doctors who can do this procedure safely. There are several types of Lasers to choose from. IPL, which stands of Intense Pulsed Light is technically not a laser. Than there are the diode lasers. I am given to understand that China makes a lot of these at cheap prices and some of them are of questionable quality. If I remember correctly, they use light of around 800 nano-meters wavelength. For “Indian” skin i.e. more and dispersed melanin, NdYaG is a better choice of Laser. It’s wavelength is 1000 plus nano-meters. Apart from the wavelength, there are many parameters like Energy, Fluence, Pulse Length etc. So make sure you have a good doctor.

These days there are also painless lasers available at some clinics. It is used for bigger areas like hands and legs. As of now, painless laser available in india cannot be used on face, since the laser handpiece is big & covers a bigger area of skin. But remember by painless laser, I mean Pain-LESS, not pain-FREE. You will have a little pain with these lasers too, but its far less painful than the other lasers.

Biological Kids

This is still a controversial topic. Getting pregnant yourself is a complicated thing. It involves a womb transplant and  a lot of experimental & ground breaking hormonal intervention. And even at the end of it, with all the current medical technologies, you are not sure, if you have provided the optimum developmental conditions to the fetus as a cis women would. I think the easiest way to make you own biological children is through sperm banking and surrogacy. Given the current medical technologies, I would personally not go to an extent of womb transplant to get pregnant myself, as it involves a life of another human being. A life i feel, I do not have the right to experiment with. But yeah it is personal opinion & i don’t endorse it for others.

Plastic surgery addiction

At the end of day , u can only do so much. The whatever number of years your body was exposed to the testosterone hormone, will have certain effects all over your body. You cannot make that the motto of your life to undo each and every masculine feature in your body. You have to learn to accept yourself and live beyond surgeries and HRT. There is no end  for plastic surgeries that one can do to their body, but we have to put a full stop to it at some point. You cannot achieve everything with surgeries, also try to harness the power of personal styling and right clothing. A right hairstyle can help u bypass atleast a few invasive surgeries.

Most cis women too have some masculine features in their body, but we over look it. The same will happen to you, after you transition and start living in feminine gender role. The new people you meet will over look some masculine features in u. Be confident of yourself and your body. If you believe in yourself and carry yourself with confidence, even the society and people around you will believe in what u believe.

These cover most of the limitations you will run into when you are on the journey to live as your true self. I will write about the Limitations of Sex Reassignment Surgey (SRS)/Gender Confirmation Surgery in my next letter. Obviously it is the one of most interest to you and again obviously it is rather long. I did not think it would be apt to put it here or it would have drawn out too long. So long than my sister :*

Yours forever

N N