Category: Transition Support

Categories
Friends & Family Mental Health Transition Support

How to Support a New Trans Person

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Photo by Anna Shvets on Pexels.com

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Transitioning genders is complex, emotional process, especially at the beginning. Most trans people have a circle of friends and family that want to support them, but struggle to understand what and how to do it best. Certainly, transitioning is growing more common, but most people still don’t have direct experience supporting a trans person. And that’s ok – we’re all in this process together.

So I wanted to write a post for everyone who is looking for advice, particularly someone at the start of their journey. I’ll talk about both the “Dos” and the “Don’ts”, as often times meaningful support is as much about what you do not do as it is about affirmative actions or words.

Things you can say and do

Tell them you love them. This is the first and most important thing you can do. Specifically, tell them you love the person they have been, and you’ll love the person they are becoming.

Someone sharing their true gender identity with you is an amazing act of trust and vulnerability. This person, who has gone through a lifetime of shame, trauma and general unhappiness, is opening up to those they love, and your first job is to love them back. They are likely terrified of the response and rejection they’ll get from you and everyone they know, so affirming this first is the most important thing you can do.

Ask how you can help to support them. Transitioning genders is a really complicated, expensive and challenging process. There are a thousand things that need to be done, learned, processed and shared. Asking how you can help is a powerful act in of itself; even if there is nothing specific you can do, the simple act of asking means you embrace and support their decision. This is incredibly affirming, and there may be some specific things that you can help with.

Ask questions about their experience. Trans people have spent a lifetime hiding a large part of who they are. Taking the time to ask questions about how they’ve felt, what their hopes and goals are, and what they’re feeling right now is a powerful form of love and connection. This is your chance to learn about a whole new part of someone you care about, so take the time to explore with them.

Offer to guide them. Being newly trans means having to learn and do almost everything in a new way. From buying clothes, to getting a haircut, to going to the doctor; almost every single day-to-day experience is new and can be really stressful to have to figure out on your own. Just like a native guide in a foreign country, you can help navigate the unknowns and provide a sense of comfort.

Educate yourself. Last, and not least, you can take the time to read about trans experience and learn about things like pronouns, dysphoria and the process (HRT, FFS, GRS, so many terms to learn!) This will help you to understand and connect with, at least a little bit, the trans journey, and will probably help to allay some of the fears and concerns you have.

Things not to say or do

Don’t assume and apply a trans stereotype. Being trans means different things to different people. Unfortunately, we don’t have a lot of great examples in society right now of what a happy, successful trans person looks like. Most cis people assume that transition means turning into a drag-queen, or at best an awkward mess of a person. Don’t assume you know what the end goal of transition will look like, or mean, because you are probably wrong. Most trans people don’t even know themselves – transitioning is as much about exploring as it is about reaching a particular destination.

Don’t ask whether they’ve thought about the impacts (to life, family, career, etc). This is such a demeaning question. Especially for someone coming out in adulthood, the obvious answer is: “yes, of course I have”. We’ve spent a lifetime thinking about the impacts, and being afraid to be our true selves precisely because of those imagined fears. The fact that this person has decided to be open with you about their gender identify means that they have already decided the pain of hiding themselves far outweighs any transient negative impact on the rest of their life.

Don’t talk about your own fears. Right now, this is not about you. You may be feeling a lot of things, maybe its fear for their safety, or fear that they’ll be unhappy, or fear that it will reflect badly on you as a parent, spouse, etc. These are all real feelings, but you need to recognize that sharing them, at this moment with this person, is not appropriate. Trans people have spent a lifetime being defined by other people’s fear, and there is nothing more frustrating than having a conversation about their experience and goals be turned into one about you. I highly recommend you seek out a therapist or counselor if you’re feeling like your fear is overwhelming.

Don’t compare them to a gender ideal. Look, transitioning genders is awkward. We know that better than you ever can. It takes years and can require hormones, surgeries and lots of practice with new skills. Sometimes, the most well-meaning compliment can actually be really demoralizing, like the dreaded “Wow! You look like a real woman!” Or “You’ve made so much progress, you hardly look like a man anymore!” Instead, try a simple “You look great!”

This is by no means an exhaustive list, but I hope it helps to provide some general tips you find helpful. And finally, please remember that the most important thing a trans person wants to be seen and loved for who they are, and who they will become.

I’d love to hear if you have your own suggestions in the comments.

Categories
Mental Health Transition Support

How to Have ‘the Conversation’ with Your Spouse

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Photo by RODNAE Productions on Pexels.com

This is a post I’ve been meaning to write for a long time, but I’ve put it off because it is about one of the most difficult topics: telling your spouse you are transgendered.

I waited until about 6 months into my transition to tell my wife. Partly this was because I wanted to be really, really sure this is the path I wanted to take before making the ask of her. Partly it was because of timing, and trying to find the right time and place to share something this big.

I’ve written this from the perspective that I know; as someone who was closeted, and for whom this was the first real conversation about their gender outside of therapy. Each person’s story is different, but hopefully this will present some helpful ideas no matter what your background.

Being realistic

The hard truth is that a lot (most?) of these conversations lead to a divorce. Though we’ve all read about the best case scenario where a wife is unconditionally supportive, or even excited about the possibility of being in a lesbian relationship, this is not a likely outcome. For many women, being married to another woman is a deal-breaker, and something they just can’t or aren’t willing to do. Even if divorce isn’t the immediate outcome, you may be starting a process that inevitability results in the end of your marriage.

No matter the ultimate outcome, ‘the conversation’ will inevitably lead to changes in your relationship and a lot of big feelings. Even the most progressive woman will probably have a hard time being her best self when learning that her spouse is trans, nonbinary or otherwise different.

As we all know, there is a lot of bad information and stereotypes about what it means to be trans. And unfortunately, you’ll be battling against these stereotypes (especially with older women or in less progressive places of the country). It can be a really frustrating; the person you are trying to become isn’t necessarily what your spouse imagines, or is afraid of.

Though you can’t predict how your spouse will react, you definitely can do some specific things to make the conversation go as well as possible.

Lay the relationship groundwork

Sharing something difficult with your spouse is always easier if you have a solid foundation of communication, trust, love, and compassion. This is especially true when you’re talking about existential issues like gender and sexuality. If you have underlying issues in your marriage that are unresolved, this conversation can act as the trigger to bring those up as well; rather than honestly sharing, you’ll find yourself trapped digging up old hurts.

If you have the option, I highly recommend you go to couples therapy before you come out to your spouse. A year of couples therapy can give you both the tools and trust you both need to have a really difficult conversation.

Another factor is timing. Unfortunately, you can’t always chose the best time and place, especially if its something your spouse brings up. But, if you have the option, chose a time and place where you both are rested and relaxed. After work at the dinner table with screaming kids is probably not the best time 😉

Be clear about your ask

Often, the first question your spouse will ask is ‘what can I do to help?’ or ‘what do you want from me?’ It is worth putting a fair amount of time into considering this question before you have the conversation, and a therapist can be a really valuable resource for helping you think through.

One of the key decisions to make is whether you want to try and stay together, or are you looking for a separation. If you want to stay together, its also worth thinking about what you need from your spouse to accommodate your new identity. Are you comfortable with a slow transition, or are you looking for sudden change and acknowledgement of your new identity?

Unfortunately, there are a lot of stereotypes and misinformation about trans people, and you’ll be battling against those. The more clear you can be about your specific needs and ask, the more likely it will be that your spouse can focus on what you actually said rather than their own fears of what transness means.

Your ask should be as specific as possible, and focused on actions rather than feelings. Rather than say ‘I need your support’ or ‘I need you to love me’, think about specific things your spouse can do to support you and your transition. ‘Help me find clothes’ or ‘give me feedback about how I look’ or ‘go to therapy with me’, are all things that can give your spouse a sense of agency in the transition.

The thing to avoid is making big, unfair requests, like ‘stay with me’ or ‘love me for who I am.’ Though you may desire those more than anything, it is putting your spouse in an unfair position – you’ve had a lifetime to wrestle with your identify, while your spouse has likely just been introduced to the idea. It will take them a long time to fully process everything, and big emotional requests will like just make them feel defensive.

Make it about them

This might sound weird, but hear me out. One of the key messages that people often forget to communicate clearly, and repeatedly, is that this decision is about being a happy, healthier person for those that they love.

The reality is that transitions are scary, awkward and filled with uncertainty. Your spouse will naturally think about those downsides, so its your job to reinforce the positive aspects and desires for transition.

If you can, try to think specifically about the benefits – why will your transition make life better? How will it help your mental health? What are the specific issues in your relationship that your transition will improve? This may not be sufficient to save your marriage, but it will certainly help your spouse to understand some of the motivation for your transition.

Have compassion

You have had a lifetime to process your gender identity, and have obviously reached a point of acceptance if you are considering talking to your spouse about it.

But its really important to have compassion for the difficult position your spouse is in, too. In sharing your gender identity, you have just upended not only their plans for the future, but also their understanding of your marriage up to that point. This is an incredible amount of change and uncertainty, and any spouse would be understandably overwhelmed and need time to fully process.

More than anything, your spouse is likely feeling a lot of fear. Fear that their life as they know it will end. Fear that the person they thought they knew is fundamentally different. Fear for you and what you are likely to encounter as you transition. Fear for your children (if you have them). Depending on your spouse, that fear can come all at once, feel overwhelming, and trigger defensive mechanisms like anger.

The fact that your spouse feels uncertainty, fear, doubt, anger, or anything else doesn’t invalidate you or your experience, and you shouldn’t feel shame about triggering those emotions. But it is a reality you’ll have to deal with, and showing compassion and understanding for whatever your spouse is feeling will go a long way towards rebuilding your relationship.

Be patient

In an ideal world, the conversation will end with a clear and unambiguous ‘I love you and I’ll always be here as your partner.’ Unfortunately, that is rarely the case. Your partner is going to need time to process, and this will likely be the start of a number of intense conversations before you come to some sort of closure and resolution.

Be patient with your partner, and try to give them the space they need to process without withdrawing. If they are feeling a lot of fear, withdrawing will only feed into the narrative that your marriage is disappearing.

These are incredibly difficult conversations, and require you to confront the very real possibility that your marriage will end. Give yourself, and your spouse, time to carefully consider what this means, and what is best for both of your individually and together.

Do you have any tips on having the conversation? Is there anything you wish you had done differently?

Categories
Body Care Transition Support

Does the Tria work for beards?

Why yes, yes it does! I was able to basically eliminate the dark beard hairs on my face in about 6 months. But, you have to use it a bit differently than for other types of body hair. I’ll walk you through the process I used.

Lots of people, both cis and trans, would rather do without their beard. There are many options for dealing with facial hair, but laser removal or electrolysis can be expensive (a few thousand dollars) and time consuming (months).

One appealing solution is to use an at home hair removal product, of which there are two types: IPL (or intensely pulsed light) or Laser. Both are similar, in that they use light to kill the cells that build the hair follicle, but Laser removal is much more effective for beards. These products usually run in the low hundreds of dollars, rather than thousands for professional laser treatments.

Besides being cheaper, at home treatment is also a lot more convenient and potentially faster to see results, since you can do more treatment in smaller chunks.

The best at home laser product is the Tria 4x. Unlike other products, this is actually a class 1 laser, similar to what a professional laser hair removal machine will use. But, because it is for home use, it is lower powered in order to improve safety; commercial machines usually run 30-40 joules/cm2, while the Tria maxes out at 20 joules/cm2. Because of this, you need to do a few special things for it to work effectively.

How Laser Hair Removal Works

Laser hair removal works by turning light into heat, which then kills the cells that grow your hair. The laser is specially designed to emit light that is only absorbed by the darker pigment in your hair follicles (the light is around 810 nm, or in the infrared range that is invisible to the eyes). Once it is absorbed, the hair follicle heats up and this heat then spreads to the cells around it, killing them. If you reach a high enough temperature then the hair is prevented from growing back, but too high and you burn the skin around the hair follicle.

This is why laser hair removal generally works best for people with brown or black hair and fair skin; if the skin is too dark, then the laser will heat up skin cells, causing burns. If the hair is too light, the laser light passes right through without being absorbed.

You actually have two types of hair on your body.

  • Vellus hairs: the soft, ‘peach fuzz’ hairs on your arms, legs and rest of your body.
  • Terminal hairs: the thicker, darker hairs on your head, pubic area, armpits and face (in men).

Because Vellus hairs are smaller, and usually grow closer to the surface of the skin, it takes less energy to permanently remove them. Terminal hairs are thicker and grow farther down in the skin, meaning it takes more laser energy to generate the heat necessary to kill the growing cells.

Regardless of the type, you body hairs generally grow for 2-3 weeks then go dormant for 6-8 weeks. They’ll repeat this cycle until they die and fall out, to be replaced by a new follicle. This is why laser treatments usually are staggered over months: you need to do it multiple times to catch the hairs in the process of growth in order to kill them. Each time you do a laser treatment, you’re only catching 10-20% of the hairs in their growth phase.

Using the Tria on Your Face

As mentioned above, the Tria is primarily recommended for Vellus hair removal. But you certainly can use it on your face (or any other part of your body to remove terminal hairs) if you use it slightly differently than recommended for body hair.

To start, you’re going to pick a few square inches of your face to start with. When I started, I focused on the upper lip and chin of the left side of my face so I could see if it was working.

Each day, you will slowly increase the intensity of the laser until you get to the max ‘5’ setting. At that point, you’ll do up to five pulses in the same place in order to get enough energy deep to the hair follicle to kill the cells. Remember, terminal hairs grow deeper than vellus hairs, so require more laser energy.

I generally do 5-10 minutes up to 100 pulses every day until the area is hair free, then move on to another area. You can also rotate each week, but you want to make sure you hit the same area with the highest power pulses for a few days in order to permanently remove the hair.

One thing to note: this hurts. If you’re doing it right, it will feel like a hot needle poking your skin (but only for a fraction of a second). The pain goes away immediately, but I recommend focusing on shorter sessions more frequently in order to reduce discomfort. When the pain at a particular setting decreases, you’ll want to increase the power. If the pain is too intense, you can use a lidocaine spray to help numb the skin. It doesn’t eliminate the pain, but certainly makes it more bearable.

  • Week 1: Setting 2-3, 50-100 pulses per day. Move the laser slightly between each pulse.
  • Week 2: Setting 3-4, 50-100 pulses per day. Move the laser slightly between each pulse.
  • Week 3: Setting 4-5, 50-100 pulses per day. Move the laser slightly between each pulse.
  • Week 4: Setting 5, 50-100 pulses per day. Keep the laser on the same spot for 3-5 consecutive pulses. Each pulse should feel ‘hotter’ than the last and deeper under the skin; it hurts, but means the intensity is high enough to remove the hair.

You’ll want to make sure to come back to areas you’ve already treated every few months, until all the desired hairs are gone.

Results

Here is a picture after the first month or so of my upper lip. I focused more on the right side of the picture, and there is a noticeable reduction in the number of whiskers.

After about 6 months, I was mostly hair free of any dark hairs on my face. I had a naturally splotchy beard though, so if you have more full facial hair, it will take longer.

I can go out in the morning without makeup and have no visible 5 o’clock shadow!

Though the dark hairs are gone, I still have a fair number of lighter colored hairs on my face. Someday, I may get electrolysis to remove those, but since they aren’t really visible I use an electric razor to remove them every few days.

Let me know what you think in the comments!

Categories
Transition Support

How to Start Your MtF Transition

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Photo by Tatiana Twinslol on Pexels.com

Welcome, and congratulations! If you’ve landed here, you’re at least curious about what it might take to transition to female, and that in itself is a big step. Or you may already be on your way, and looking for tips and guides for how to improve things.

Every person’s journey is different, and there is no right or wrong way to transition; but there are things you can do to make the process easier on yourself and those you choose to bring along with you on this adventure. The goal of this post, and this site in general, is to provide the basics and more advanced topics for those who are looking to transition from male to female, and to take some of the mystery out of the process. Think of this as a roadmap – I’ll help you understand the landmarks, and what to look for, but ultimately it’s up to you to take the steps and explore all there is to see and enjoy.

Before we get too far, its worth acknowledging that this journey isn’t without its risks, and will be a very stressful, embarrassing, emotional and anxious process. You are creating a new you, and asking everyone in your life (or at least those you choose), to undergo the process of creation along with you, whether they want to or not. This is a complicated process that is hard for everyone, and even the most supportive, loving family and friends will struggle at some points, just as you will.

But that said, if you’re seriously exploring transitioning genders, it means that you are driven by a deeper need to explore the unknown and to find your true self. The wonderful thing is that the destination is whatever you choose it to be, wherever you find your sense of happiness and acceptance.

Preparing for your MtF journey

Which leads us to the starting point. Like any good journey, the first, and most important step of any MtF transition is the planning. In the same way you wouldn’t set off into the jungle without some basic equipment and skills, you’ll want to spend some time preparing the things you’ll need, and need to know, in order to make your transition as comfortable and gratifying as possible.

There are 5 things you’ll need to assemble, learn and decide on before you begin.

  1. An end goal. Transition means different things to everyone, so clearly, and specifically outlining your goal is the most important step.
  2. The basic skills. Depending on your goal, you’ll need to learn how to change your hair, makeup, clothes, voice and anything else necessary for reflecting your vision.
  3. A strategy. You have a few of different options for how you want to approach your transition – do you need to go fast, or can you take it slow? Do you want to transition gradually as your body changes, or all at once and let the physical changes catch up?
  4. Your transition support team. You need a team of people who can support you during and after your transition. You don’t have to go it alone. I’ve written more about this in another blog post.
  5. A timeline. Once you’ve figured out your route and prepared, its time to pick a starting point and the major milestones you’d like to reach along the way.

The Goal: Where do you want to go?

Transitioning is really hard. That said, we are living in a world where there is more support, knowledge and understanding of fluid gender identity than ever before. This means that there are a range of transition options that are available and supported. For many people, the goal is full transition to female, up to and including gender confirmation surgery (GRS/SRS).

For many though, the journey is one of exploration, where the goal is more uncertain. Perhaps you are simply interested in exploring your feminine side during specific times, but largely continuing to live as a male. Or you might be considering how to integrate your feminine attributes into a non-binary or gender fluid presentation. Or maybe you just want to have feminine breasts and keep everything else the same. These are all completely valid and viable end goals, unique to each individual.

Whatever you choose, you will want to have a visual or emotional picture of what the end of the journey is. This might be a picture of a woman you feel a specific connection to. Or it might be a painting, or a poem, or a word. Whatever it is, you’ll want to choose something that is both inspiring and also specific enough to help you find your way along your journey.

It’s important to remember you can change your goal at any point; most people do. Transition is a process of learning, and you’ll be happier if you allow yourself to update what your end goal is based on what you’ve learned you like or don’t like. I know plenty of trans women who start out with a very femme vision of themselves in their new gender identity, but after a few years trend towards something a bit less over-the-top girly.

The Basic Skills: What do you need to learn and buy?

Regardless of what your goal is, you have a lot to learn! On my own journey, I’ve made a running list of all the things I’ve had to learn, many of which I only discovered when I was well on my way.

This will usually include hair, makeup and clothes. For most trans women, voice training is also a key requirement for passing as a woman. For more information on where to go to learn these skills (there are people much better than me!) check out the resources page.

In addition to the skills, you’ll also want to plan a budget for all the things you need to buy. A basic budget might look like:

  • Bras/Underwear: $400
  • Work Clothes: $1,500
  • Casual Clothes: $1,000
  • Hair Products: $100
  • Wig: $300
  • Makeup: $300
  • Miscellaneous: $500

In addition to the one-time costs, you’ll also want to plan on ongoing expenses like hair appointments, nails/waxing, and hair removal treatments.

This obviously doesn’t include any surgery costs, which can be tens of thousands of dollars. Some of that may be covered by your insurance, but for most trans women, things like Facial Feminization Surgery (FFS) still aren’t.

The Strategy

There is no wrong way to transition, but there are strategies that can ensure you have the time and space to take care of yourself and those you love as you transition.

A lot of people assume that once they have made the decision to transition, they immediately have to tell everyone and change their appearance, pronouns and name. Though this may seem appealing at first, it also puts you under a lot of stress. Not only does that mean you have to do and manage a lot of complicated, emotional things at once, it also means you have less time to learn along the way. Transitions are a journey, not a race, and though it might feel desperately urgent to transition, planning to give yourself some time and space is important so you don’t get overwhelmed.

Generally, I encourage people to first practice the skills necessary to successfully transition, then once they are comfortable, slowly engage the people in their lives in the process of transition.

Some questions you’ll want to think about are:

  • Who do you need to tell? Who do you want to tell first? Who do you trust to open up to about your journey and goals?
  • How do you want to handle rejection? Do you want to engage with people who don’t support you, or move on immediately?
  • How will you answer the inevitable questions like ‘why?’ and ‘are you sure?’
  • When do you want to change your name? Are you comfortable living under your old name while you transition, or do you want to assume a new name immediately?
  • How will you handle your professional relationships? Do you want to continue in your current job or find a new one?
  • What are the barriers unique to your life? If you are going to change your name, what needs to be changed as well (like loans, legal documents, etc).
  • If you have a significant other, what do you hope and expect from them during the transition? Do you have contingency plans if they can’t or won’t provide those things?

Having at least considered these questions before you transition can provide a helpful set of inputs to your process. Sometimes the downside risks are very real, and should be considered carefully even though they may not change your ultimate decision.

Your Transition Support Team

As I wrote about separately, you will benefit immensely by having a team of professionals who can support you in your journey. At minimum, I suggest seeking out the following types of people:

  • A therapist: you’ll need someone who you trust and can help you understand and heal from a lifetime of trauma.
  • A primary care physician: a good doctor who can help you to navigate the long-term health implications of a gender transition.
  • A professional coach: someone who can help you to navigate the professional challenges unique to trans people.

Be sure to give yourself plenty of time to find these people; building a solid relationship that you trust takes time.

A Timeline: When do you want to reach certain goals?

A transition is actually a lot of small milestones. As you set out, its helpful to set some goals for when you want to reach those points, and how long you want to take to get there. Some people want to move as quickly as possible, while others may have larger life events they’d like to plan around. There is no right answer, just the process that works for you.

Some key milestones in my own transition (and timelines)

  • Learning the basics: 3-4 months
    • Hair and makeup took about 2 months
    • Clothes took 2 months
  • Voice training: 6 months of daily 30-60 minutes of practice before I felt like my voice was passable.
  • Transitioning to my closest personal relationships: 4 months
  • Transitioning my professional relationships: 12 months

All total, my transition took about 2 years. In the first year, I focused on the core skills and the people closest to me. In year 2, I focused on my extended personal and professional network. By that point, I was a passable woman, which helped me to move beyond some of the doubt and uncertainty that comes with the early transition phases.

I hope this helps you have a big picture view of what a transition can require. As the old saying goes, the devil is in the details, but you’ll never make progress unless you take the first step and start your own journey.

Best of luck and let me know how its going in the comments.

Categories
Health Mental Health Transition Support

Building A Team to Support Your Gender Transition

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Transitions are hard, but you don’t have to do it alone. Though it is largely a personal journey, it can be extremely helpful to find the right people who can help you navigate the physical, emotional and social challenges required by a transition.

One theme I keep coming back to is how much there is to learn when transitioning genders. Even after a couple of years, I was still finding out how little I knew about certain subjects, and how much I was still learning about myself. Having a group of people I can rely on as new challenges arise helps to keep me emotionally and physically healthy.

These professional roles are in no particular order, but I’ve found each to be a really important and ongoing part of my life. The upside of COVID is that it is now easier than ever to build a support network of people who may not live in the same city as you; especially if you are in a part of the US that is increasingly transphobic, you can find and work with people who are accepting of you.

A Therapist

I know of many people who have transitioned without the help of a therapist, but this is one of those supporting relationships that I can’t imagine doing without. More than anything, gender transition is about integrating a lifetime of traumas and fundamentally changing the way you look at yourself and your place in the world. Doing this alone is incredibly difficult.

A good therapist is someone who can help us reach a new perspective on our lived experience which has so often been warped by the negative influences of the people in our lives. On my own journey, the hardest part of transition has been dealing with the constant sense of shame and failure that I’d lived with for a lifetime. For example, having someone who could tell me, from the outside, “that makes sense why you would want to grow breasts” was a shockingly validating experience; I had lived for so long thinking I was crazy.

Finding a therapist is more than making an appointment; you need to build a relationship with someone you can trust and work with long-term. It took me almost three years of seeing my therapist once a week before I felt like I could talk about my gender identity.

I would recommend searching for someone who is a Licensed Marriage and Family Therapist (LMFT), even if you’re not married or in a relationship. They typically have more experience dealing with the types of family trauma common to trans people, as well as training that you will find helpful when navigating your own interpersonal relationships during transition.

A Primary Care Physician

Transitions take a toll on your body, and in some cases can lead to unexpected health consequences. Finding a good primary care physician who can help you make informed decisions about your health is a long-term win. You’ll want to find someone who has direct experience working with trans patients, and can to tailor your hormone regimen along with other lifestyle changes to help you meet your goals.

I know many trans people who have worked exclusively with an endocrinologist during their transition, but I think there is great value in finding a primary care doc with a wider range of knowledge and experience beyond the effects of estrogen and progesterone.

Transitions involve more than your hormones; for example, do you know when to start and how often you should get a mammogram? There is actually a lot of conflicting advice on this, with some doctors saying trans women don’t need mammograms as the breast tissue is different, more typically gynocomastic, than cis women. Other doctors will advise you to get a mammogram as often as cis women (yearly depending on age) as the breast tissue actually is similar and includes the ducts and lobules where breast cancer tends to start.

Obviously, the consequences of getting bad advice here are obvious. Questions like these can and should be answered with the advice of a good primary care doc well versed in the standards of care for trans patients.

A Professional Coach

Managing a career is a tough prospect for anyone, and those transitioning genders face some unique challenges. Having a dedicated career or professional coach can be an important source of support and advice as you attempt to navigate your professional and personal relationships.

I frequently encounter people frustrated that they have to spend a lot of time managing others’ feelings when they decide to transition. This is absolutely true, but honestly, is not really different than what any successful person has to be doing constantly in their career. Managing other people and their emotional reactions (either formally as a boss, or informally as a peer or subordinate) is just part of the game.

What can help is having someone you can vent to and brainstorm with on how to handle those particularly tough relationships that require the most care. At the end of the day, there will always be people who control your success to some degree, and avoiding the conflicts and finding the opportunities within those relationships is what long-term success is built on. A practiced career coach is the person to help you do this, and help you hold yourself accountable to your own goals.

Your Informal Support Network

Last, but certainly not least, is your informal support network. Each person has their own version of this: it is your spouse, children, family, co-workers and friends. These are the people you can rely on for support in challenging times, or just to make you feel good on a Saturday afternoon.

Having and strengthening these relationships during your transition can be immensely gratifying, and is an opportunity to invite the people you love to grow with you on your journey.

Some Practical Challenges

I’m sure reading this, a lot of people will be thinking “sure, sounds great, but how do I find and pay for all these supportive people?” Transgender men and women are often struggling to just make ends meat, and these additional supports probably don’t feel like they’re in the budget.

As I mentioned above, COVID has dramatically changed how we connect with the people in our lives. Finding your support network is a lot easier today, where most therapists, doctors and coaches have been seeing clients remotely for the last year. This opens up a lot of opportunities to seek out those who you may not have considered prior to COVID.

The key thing about finding the right person who can support you is knowing what you are looking for. By far, the most important thing is finding people who you can be open and honest with, and who you feel respect you and your experiences. At the same time, you want people who have different areas of expertise and will challenge you, and not always in ways that are comfortable. The point of building a support team is to expand your source of knowledge and experience, and you can only do that with people who know more than you do about certain things and who you trust to tell you uncomfortable truths.

So how to pay for it? In my experience, most professionals in these positions are willing to be flexible with rates depending on your ability to pay. There is nothing wrong with seeking them out, building a connection, and being honest about your ability to pay. Some may decline, but most will be able to provide fees that work for your unique situation.

I’d love to hear what relationships you’ve found most helpful in supporting your transition.