STEP ONE
The Decision Is Made:

You have decided that you are transsexual, or at least transgendered in some way, and that in order to live your life you must dramatically change your body. However you came to this decision, the impulse to act is strong, and now you want to know how to actually accomplish the task, either partially, or in full, to completion. You need to understand a few things first.

Transition is irreversible. It can never be undone. The changes you make will be forever, and if you have made your decision in error, you will never be able to truly reverse your actions. Understand this. Transition is for life.

There are risks. You could die from the process. It is serious stuff, and should not be taken lightly. Transition is a last act of a desperate person, a person in pain. It is not something to be done for adventure, or because it seems interesting or exciting or even 'better'. Transition is a path that is best taken only by a person who has determined that there really is no other option. If you are looking at death or transition as your only two realistic outcomes in life, then you are possibly ready to go for it.

You need to comprehend that if you change your physical sex, and you were wrong about who you really are inside, you will end up stuck forever in the exact plight that the true transsexual begins life trapped within. Being transsexual hurts. So be as sure as you can be before you begin transition. Only you can decide if transition is for you; no authority can do this for you, or tell you what you are. Be very honest with yourself.

 

STEP TWO
Time To Get Ready To Wait:

Transition takes a long time. It is not done quickly. On average, the minimum time required to change your physical sex is about two years, and that is a best case situation. Often, the process can take three, four, five, or many more years. In some ways, the process never really ends; each year that passes one still changes a little, even after surgery. In general, however, one can expect to be more or less living as the appropriate gender after about two to three years.

You will need to find a doctor. Any doctor can potentially help you, if they want to: you do not need an expensive specialist for transition. You just need someone to prescribe hormones for you, and occasionally to check on your health. Any doctor can do that much. Understand that not all doctors are equal, and that doctors are human: they can have prejudices and bigotries of all kinds. You may need to shop around, to find a sympathetic doctor. Be prepared to face this. Hormones are not very expensive, and almost anyone can afford them.

The first thing in transition is hormones. Sex hormones do most of the work of physical transition. Indeed, many people may simply use hormones, and never deal with surgery at all. They may do this for a variety of reasons, such as a fear of surgery, a desire not to risk losing sexual function, or that they find that they are comfortable where they are after the hormones do their work. It is never correct to have surgery first, and then to take hormones. Hormones first, then surgery. Understand this. Accept nothing less.

Hormones change all the soft tissues of the body. They change the look and feel of the skin, they change the shape and curves of the body. Hormones grow breasts where there were none, or in the Female-To-Male, grow beards and bulky muscles where before there were none. Know that these changes are permanent. Breasts do not go away with hormones, and beards do not disappear with hormones. Hormones can give to the body, but they cannot take away. Only surgery can take away from the body. If you have no breasts but want them, hormones can do that. But if you have breasts but do not want them, you will need surgery. The same is true of sex organs, too.

Sex hormones cannot change the skeleton. You cannot become taller or shorter with sex hormones. You will stay the same height, but not the same build. You may lose or gain weight, and your body will change shape amazingly.

Cosmetic Surgery And Hormones:

Most cosmetic surgery, such as to reshape the face, or to enlarge the breasts in the transsexual is not needed. Give the hormones time. It takes years to grow new body parts. It takes this long in nontranssexual people, so this is natural. You cannot tell how well you will turn out after only a single year, or even sometimes two. There is no need to rush into cosmetic enhancements: let the hormones have time to work. In general, if hormones work well on you, you will develop in a similar manner to your parents and siblings. How they look is how you are likely to turn out. However, if after several years, hormones have not worked well, then that is another issue. Some rare people are not affected strongly by sex hormones. It is for them that cosmetic surgery is appropriate.

Risks of Hormones:

Hormones do most of the work of transition, but they are not without risks. Hormones can kill or damage you. This is more likely the higher the dosage you take. The rule is to always take the smallest effective dosage of hormones. More hormones do NOT speed up the process; in fact, extra hormones can slow transition down! Always take the lowest dose that creates the change you seek.

The risks of sex hormones include heart attack and stroke and cancer of all kinds. The risk is proportional to the dosage. Remember that before final surgery, your body is already making sex hormones, so transition is a battle between the hormones you take, versus the hormones you already make. That means that your body is going to be flooded with hormones, more than it is evolved to handle. This by itself is a risk situation. When taking hormones, watch your health, and watch your body carefully.

Do not smoke, drink, or do drugs during transition! You are growing new flesh, and changing existing flesh. Be as gentle and healthy to your body as you would be to a newborn baby; because, literally, you are growing and developing once again. Watch your nutrition, get enough sleep, in general be really, really healthy in all ways. Transition is a second puberty. Destructive behaviors can destroy the process of transition: chemicals affect the way cells divide and grow. Treat yourself like a baby during transition. Be clean, be healthy, be very gentle with your changing body.

 

STEP THREE
Surviving And Changing:

Once on hormones, there is much to be done. As the months pass, you will witness your body changing around you, very dramatically in fact. But there is another part to being your appropriate sex, and that is the matter of gender expression.

Gender is the non-obvious part of sex. The sex we can see is the shape and construction of the body, but there is a neurological component too. Although you may recognize that your mind is a given gender, and you may have many expressions of that internal, mental sex, that are obvious to yourself and others, you must understand that you have missed out on years and years of social conditioning.

The natural behaviors of gender are exaggerated by society. Little masculine or feminine behavior traits that we are born with and express naturally have been developed into a complicated performance over centuries of social development. Sometimes these behaviors can be so exaggerated that they are unrecognizable as natural traits. In order to be accepted as your chosen sex and gender, you will need to learn some of these affectations, in order to fit into society. However, you do not need to learn all of them, or use most of them, if you do not want to. It is important to use only as much of social gender performance as you need to gain the level of acceptance you desire. Ultimately, you are going through transition to become yourself, and not simply to become some artificial role, or some doll, or some puppet. Use the behaviors of gender, but do not allow them to limit or trap you.

To learn these lost lessons, gain the assistance of friends, or even of professional therapists. There are speech therapists to help you with your voice and manner of speaking. There are those that can instruct you in manners and in grooming as well. You may need to seek such help. This too, is part of transition. Transition is not only physical, it is also learning the rules and codified behaviors that society demands of people too. The value of this is passing, the act of being accepted without question, and in general, passing is survival.

You cannot successfully transition without food and shelter and supportive friends, or at least some kind of supportive emotional connection to something or someone. So that means you need a way to support yourself, above all else. It is wise to have a good, and a liberal, means of employment before even beginning transition. It is almost always better to transition on the job. If you become unemployed during the hellish middle of transition, it will be vastly more difficult, if not impossible, to find work, and you will end up desperate and in poverty. The higher the level of technology of the job, in general, the more liberal the policies the company will hold.

If you are faced with no other options, stop transition long enough to get employed again, then continue the process: in short, if everything goes wrong, regroup and start over again if you have to. Transition is not easy, it is a fight. Sometimes, to win a war, you must sacrifice a given battle, to fight again another day. Understand this. Prepare for the next battle with more diligence and determination.

During transition, your biggest danger is always other people. Other people are a constant risk, because of the bigoted and narrow things people can believe. Be careful, and trust no person completely. You would be wise to also always expect that sooner or later, you will have to face a person -or persons- who will make it their personal quest to attack and destroy you, usually for religious reasons. Such people exist in almost every situation, and many religions have strong directives to harm and hurt those considered Queer -and in being transsexual, you are most definitely Queer. Indeed, transsexuals are considered Beyond Queer, even within the Queer community. 

Generally, the best method to deal with narrow and insane people is to never play into their game. The goal of the bigot, in the process of destroying you, is to prove to others, and to themselves, that you are the monster they see you as. If they can provoke you to anger, to violence, to insane behavior of your own, if they can push you too far, so that you are disturbing to others around you who are indifferent to your situation, then they have won. Therefore, to be victorious, you must endure their insults, their baiting, their evil, and always act lovably. Your goal is to ensure that the bigot embarrasses themselves in persecuting you. Take your example from the baseball player Jackie Robinson. Jackie Robinson was the first black player to play in mainstream professional baseball, which at the time was racially segregated. He was instructed to, and forced himself to never, ever be impolite, or angry, or rude in public, regardless of what was said or done to him. The horror and difficulty of this is horrendous. He was treated terribly. But in the end, he won, because he could not be broken, could not be shown to be less than civilized, and because he gained the sympathy and the respect of those who followed his career. His efforts made a great impact for the benefit of not only himself, but all other black people too.

Being transsexual is like being black in 1960's America, only more so. Be aware of this fact, and your part in the whole of things.

Lastly, be extra, extra careful where you go and what you do. Transsexuals are constantly being killed or hurt by bigoted people. You want to succeed with your transition, so you must recognize that you do not have the full freedom of a nontranssexual person. This is real. Face it.

STEP FOUR
Surgery And Beyond:

Several, perhaps many, years have passed. The main part of your transition is almost done with. For some, including the transgenderist, it is complete. For the true transsexual, however, nothing less that the finishing surgery will suffice. The final step is called SRS, or Surgical Reassignment Surgery'. The cost of SRS generally runs around the level of purchasing an automobile. If you can buy a car, in cash, you can buy your SRS. Unless you were born wealthy, you will have had to save up for surgery.

By this time, you should have made contacts among the Queer community, met other transsexuals, or at least written to them, found at least some helpful group or institution to advise you, or consulted with your hormone doctor; the end result is picking a surgeon. You will then have to have the money for surgery available to you, usually in full, since it is rare for such things to be covered by insurance in many countries.

Surgery is easy. You simply have to lie down and breath deeply for a few seconds, then endure days of horrific pain, gore, and the healing process. If you live through all of that, then you have made it, you are the supreme success among transsexuals, the post-operative transsexual. It is an amazing and rare thing to achieve, and you are a hero! Congratulate yourself, you deserve it.

Now shut up an listen: in a matter of weeks you will discover that surgery, the goal you have suffered and worked and fought for, really doesn't change much. The things that surgery changes are almost entirely private. The only public matter that surgery affects is whether or not you can hope to have a more-or-less uncontested claim to a right to use the proper toilet, or some hope that should you end up in an emergency ward, people may save your life before they realize that you are transsexual, and maybe...look the other way and let you die. That...is it.

Everything else about surgery will not in any way whatsoever affect your life, or the way you exist. However life was before surgery, it will be after surgery. UNDERSTAND THIS. If your life sucked as a hormonally transformed transsexual before surgery, it will go right back to sucking after you return from surgery. The only real benefit, and the only real reason to even have surgery at all, is for yourself. Your own peace of mind, your own confidence, your own sexual, hormonal, and urinary functioning, your own sense of your body. That's it. There is no other reason. 

After your surgery, your life will go on, just as it did the very day before you stepped through the doors of the hospital to have it. No different. You will have ups and downs, and hopes and failures and good things and bad things. By the time you are ready for surgery, pretty much you are already done with transition. You already have won about as much of your identity and flesh as you are going to ever get. You are already finished by the time you get to surgery. SRS is the icing on the cake. The last little touch. Nothing more.

However much you want it and need it, it only changes things for you alone. You have to fully appreciate that. That said, it is still an incredible accomplishment. It truly is!

 

SPECIAL SITUATIONS
For The Transsexual That Doesn't Fit The Above:

The Underage Transsexual:

You are under 18, and you know exactly what you are, and how much your body does not fit you. You have probably known since your earliest memory, usually around age five. This is very typical for transsexuals, what is not typical is that you can actually face all of this so young in life. You are very brave, or else suffering a very, very great deal. What should you do?

You will not like my answer, but if you follow it, you will survive, and you will succeed.

In general, wait. I know that this is a terrible thing to hear. I know that you are suffering and it is the last thing you want to hear. But understand something clearly: you have three-fourths, or MORE of your life ahead of you. Things feel extra desperate to you because you have only been alive for less than two decades. Your pain is real, but the intensity of it is being magnified by time and by the power of your raging hormones.

The one thing you need to do is to endure, and to prepare. Endure the pain, and prepare for when you are not powerless, for when you can truly take action to fix your life. If you are good at doing this, your transition will be almost the best imaginable. You will be able to sail through what others suffer through.

To transition, you will need three things, when you get old enough to act. You will need  the best job you can get, to support yourself completely, and afford the hormones, and the surgery, if you choose to go for surgery. That job needs to be as high tech, as intellectual, as you can make it. Such jobs not only pay more, they also attract more educated and liberal people to them, meaning you can stay employed while you transition. You also need education...about your condition, and about your options, and about the world. You need smarts to survive. Lastly, you need to be alive. Yes, I know the misery is great, and suicide is always on your mind. I was there myself. Face it, you are going to have to hurt for awhile: but you must endure, because you cannot transition if you are dead. Stay alive, and win.

As for parents: you should be able to tell what your parents attitudes are about these matters. If they are narrow, face that and keep your secret until you are old enough to survive on your own. It won't be that long. Seriously, it really won't; it just feels like it.

Lastly, and this is absolutely vital: DO NOT have children before transition under false pretenses. By false pretenses, I mean getting involved with someone who you are in love with, and figuring that this will cure your being transsexual, and that if you just get married and have a kid, it will change you, and straighten you out.

This delusion, that by jumping into a 'normal' life you can cure yourself, or make the pain go away, or fix your problem is the main way that transsexuals mess up their lives, and also the lives of others. It simply does not work. All that will happen is that you will end up losing your children, and your partner, and still be driven to transition, only at a much older age, with more problems, and less perfect results. The younger you transition, the better you will pass, and look, and succeed. Don't screw up your potential, and avoid the delusion that you can be 'cured' by pretending to be normal.

 

The Elderly Transsexual

I, personally, have known transsexuals who successfully completed transition, surgery and all, in their eighties. Eighty years old. 80. If they can do it, you can do it. Being old is not a limitation here, beyond basic health issues.

Yes, transitioning young has better results. An interesting thing, however, is that being very young, and being very old, have a similar benefit in terms of passing. A very old person can pass well with transition, because as we greatly age, we all, male and female, tend to look more alike. Great age tends to even us all out. The truly difficult period for transition is the part in the middle, between youth and old age, when sexual differences are the most obvious.

 

The Handicapped Transsexual

Perhaps you are in a wheelchair, or perhaps you have a chronic disease. Perhaps you have emotional problems, or a mental condition. I won't lie to you, your situation is a lot harder in being transsexual on top of all of that. If you want transition, you will have to fight harder than anyone, and there is no easy way to put that fact. However, you should know that people have succeeded, even people who are quads, people with serious mental and emotional damage, even people who cannot hold a job. It is not unheard of. That, at least, is something.

 

The Hopelessly Unpassable Transsexual

Almost certainly, in thinking you will never, ever, ever hope to pass, to be accepted, you are wrong. In most cases, people who are convinced they cannot succeed because of the way they look, because of their shoulders, or neck, or chest, or size, or weight, or height, or face, are all completely, utterly wrong. Hormones are amazing, they change the body so dramatically, that there is no way to adequately state the fact. If a person is so unfortunate as to not be strongly affected by hormones, cosmetic surgery can cure a host of ills. But mostly, your problem is almost certainly that you do not clearly see your own situation, and potential.

However, there are some, who truly can never hope to pass. Some who truly cannot realistically hope to ever be fully accepted as their target gender and sex. Perhaps it is an issue with hormones, perhaps it is the shape of their skeleton, or some other real and strong issue. For those, there is only one way to evaluate the problem, and that way is actually the basic rule any transsexual must use, which is to ask oneself exactly what one can live with, and what one cannot bear to live without. In that question is the answer to the issue of surgery, of beginning transition at all, of bothering with anything, really.  It all comes down to 'what can I put up with, and what can I not stand to bear?'

It is possible to transition, and be unpassable, and still have a decent life. There are many ways to do this. One might, for example, have surgery, the whole thing, and still work in the original gender role, only being ones real self at home. People have done this, are doing this now. One can simply face the world, however one turns out, and deal with it. Those with a thick hide, who can ignore any nasty words, do this, and there are more than a few. Life is harder, sure. But at least life is closer to what is needed, than before. And ultimately, transition is about only one thing: having a life one can bear to live.