Deciding to have gender confirmation surgery can be life-altering for a transgender person, because it allows them to more fully encompass the body that matches their gender identity, rather than that of the sex they were assigned at birth. But the physical transition and surgical procedures are only one part of the transitioning experience, and the majority of it happens on the inside.
Once a person transitions — whether that means coming out to friends and family, using hormone treatments, or having gender confirmation surgery — then they have to "adjust to physically wearing their gender in a way that's congruent to what it's already been for a long time — but now people see it," says Aydin Olson-Kennedy, MSW, executive director of the Los Angeles Gender Center. Transitioning can be "the most interesting time in people's lives," and afterward, a person's interactions may feel different; there can be a loss or gain of status and privilege; relationships ebb and flow, and so much more, he says. "If you only focus on the physical transition, those stories and experiences aren't seen and they're not witnessed or validated for people."
Transitioning from your assigned gender at birth is as monumental as other life changes — like getting married, going to college, or having a kid — and the process can rock your entire world, says Dara Hoffman-Fox, LPC, a gender therapist in Colorado Springs. "Gender is everywhere; it's a part of your life almost every second of the day, whether you realise it or not," Hoffman-Fox says. "Many clients know it's a big deal but they don’t know until they actually begin going through the process of transitioning."
Ahead, Olson-Kennedy, Hoffman-Fox, and Ryan Sallans, a transgender public speaker and author in Omaha, shared some of the myriad ways that transitioning is so much more than just a physical process. "Gender dysphoria and medical transition are so nuanced that to talk about it as if it is an equally experienced and applied concept is inaccurate," Olson-Kennedy says. With that in mind, they've given just some examples of how individuals can experience transition.
Medical transition isn't the end-all, be-all.
People choose to transition at different times, but whether they transition at age 16, 36, or 66, it really just marks the beginning of the rest of their lives, Olson-Kennedy says. "If you can’t transition when you need to, it's an arrested development; you get stuck in that place," he says. There are lots of factors that contribute to a person's ability to access medical care that they need, but unfortunately, because the medical services needed to transition can be so difficult to come by, he says "the trans community is very easy to exploit." Being able to access (and afford) medical care for gender confirmation, for those who choose it, is a huge deal in and of itself. But "transitioning" means different things for different people. Some transgender people may never have surgery, take hormones, or adjust their physicality in any way. Medically transitioning is never a requirement, but for some transgender people, it's a crucial part of their process.
Relationships can change.
After a person transitions, every relationship — from ones with coworkers to romantic partners, siblings, or spouses — can change. In some ways, transitioning involves taking a risk because there's a chance you might lose people, Hoffman-Fox says. "There's not necessarily a guarantee that you're going to be treated the way you were before, or treated with fairness and equality, so your very livelihood could be on the lines as well," Hoffman-Fox says.
Sallans says he had a hard time with his parents and sister when he first began his transition. "You feel very isolated, and you feel like you've lost the people that are supposed to unconditionally love you," he says. This requires some patience, and doesn’t mean that people are going to stay that way or in that place of rejection forever, he says. "Anything they say to you is a projection of what they're experiencing themselves."
The medical part takes a relatively short amount of time.
Medically transitioning can take years, but in the overall scope of someone's life, it's a relatively short amount of time, Olson-Kennedy says. "The medical transition follows the arc of puberty — and puberty, thank god, doesn't last a long time," he says. During these years is when the majority of those changes happen, which is part of the reason why typical portrayals of trans people include the medical transition, he says. "It is very compelling to watch somebody physically change or physically go through medical transition, whether that's surgery or not; we are in a society that's about immediacy," he says. But then, a person has the chance to live the rest of their life.
Gender dysphoria doesn't always go away with surgery.
The clinical term used to describe the "conflict between a person's physical or assigned gender and the gender with which he/she/they identify," is gender dysphoria, according to the American Psychological Association. In the past, care for transgender people was organised around gender dysphoria, and the belief was that if a person medically transitioned or had surgery, then they would be alleviated of gender dysphoria, Olson-Kennedy says.
But there are other aspects of gender dysphoria that are ongoing, which he describes as "gender dysphoria noise." While some things are addressed in medical intervention, even if a trans person has every medical and surgical intervention they want, and are relatively happy with how they express their gender, "what will remain true is she is going to have a past history of being trans," he says. In other words, gender dysphoria is also about being a trans person, negotiating life with a history or experience that's not congruent with assigned sex. "And that, you can never get rid of."
It helps people feel safe.
There's a misconception that people just get gender reassignment surgery because they want to "look the part." For many transgender people, surgery is a chance for them to feel safe walking around in their daily life, Sallans says. "[Transitioning] becomes such a source of focus for trans people, because if you're not able to walk in the world as your true self, then you cannot continue to appropriately develop your authentic self," Olson-Kennedy says.
Now that he's 12 years post-transition, Sallans says the most drastic change is being able to walk around in malls or airports and not think about himself. "I’ve reached this point where I’ve become comfortable in my skin, and am navigating different environments where I don’t have anxieties that I used to have," he says. "I feel very fortunate for that."
A person's sociocultural standing can shift.
When Olson-Kennedy transitioned 10 years ago, he moved from perceived femininity into white masculinity. "As somebody who came out of the lesbian community, I had a very clear sense of the role and value of feminism," he says. "To move into a category of people who have that privilege and status and permission to not pay attention was just very jarring for me." For trans masculine people, or trans people of color, this can be an entirely different experience.
Transitioning can be a stepping-stone for grappling with mental illnesses.
While there's a lot of joy that comes from transitioning, many people find that there are new levels of distress and discomfort that they have to navigate, Hoffman-Fox says. "A lot of times 'the transgender question' can be one of the big ones that needs to be addressed first before some other questions can be answered about their mental health and happiness in general," Hoffman-Fox says. Once they're able to address the stress of gender, they can figure out what else in addition to being transgender still remains, Hoffman-Fox says.
In Sallans's case, he says transitioning did help his mental health, but he still struggled with anorexia. "How I take things out on myself wasn’t changed because of my transition, I just have a better quality of life because of my transition," he says. Some people build up how they're going to feel in their head after transitioning, but then end up frustrated when their feelings are still the same, he says. "There's always going to be more there left to discover about ourselves," Hoffman-Fox says.
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