Coming out as trans is hard.
It is scary to realize you don’t fit into the cis-hetero patriarchy that dominates our culture. Deciding to make a change can be terrifying, but also liberating. I spoke to two individuals on the beginning of transition, Stella, an non-binary person currently in medical transition, and Zil Goldstein, a nurse practitioner and Program Director for the Center of Transgender Medicine and Surgery at Mount Sinai in New York.
As both Goldstein and Stella see it, there are many many ways to begin a transition. Transition doesn’t begin with the medical, surgical, or legal parts, it starts with you as a person.
Goldstein focuses on medical intervention (both hormone therapy and surgical procedures), but stressed that there are many steps (different for everybody) that come before this and she works to make sure that every case she works on is tailored to the individual’s needs. She recommends that people begin a social transition before a medical transition as a way to begin experimenting with who they truly are.
For Stella, their first step was a haircut.
“My first step was to get a semi pixie cut that I could style either as a traditional male side part or style as a cute pixie.” They explain, “I was still working on figuring myself out, so it was great to be able to experiment but also easily switch back if it wasn’t something I was comfortable with.”
Years after cutting their hair, Stella decided they were ready to begin taking hormones, but first they made sure they had a great therapist they trusted and knew they could trust throughout the process. Goldstein recommends that patients know exactly why they want to go on hormones before they begin the therapy.
“I spend time talking with people about why they want to go on hormones specifically, not ‘why hormones like why would you do that’, but ‘why hormones like specifically what is it that you want to get out of being on hormones.’” Goldstein says, “Having a clear idea of that is really helpful when going to see a medical provider. A lot of people know and a lot of people don’t know and we talk about it.”
Once Stella decided to go on hormones the process was surprisingly easy for them, with only a small hiccup. “I got up the nerve to call Callen Lorde (a community health center for LGBTQ individuals in New York) to schedule an appointment with a transition-experienced doctor. I knew it was almost impossible to get an appointment there, and they told me they were not accepting any new patients at their Chelsea location. I was crestfallen. But then they said they had an appointment the very next day at their Bronx location. I didn’t even hesitate. I booked it right then.” From there they made sure Stella was healthy and that their liver function was strong enough to support hormones and a month later they had a prescription in hand.
Once on hormones, Goldstein says that folks taking estrogen may notice their skin clear up and may see some loss in libido where as folks taking testosterone may see oilier skin, a higher sex drive, and an increase in clitoris size (it is important to not that some folks choose not to call this body part a clitoris and under no circumstances should you ever tell a person what to call their body parts). Goldstein also points out that for many people on the transmasculine spectrum, the first priority is chest reconstruction and not hormones.
“There are no [prior] requirements in the guiding documents of transgender health or on the part of insurance companies [for chest reconstruction] because there is no requirement for hormone therapy prior to reconstruction. I see a lot more people who see their chest as causing the most distress and so there are a lot of people who want to masculinize their chest and are very happy to just do that [without any kind of hormone therapy].”
On the flip side of medical intervention is legal intervention. This is the process of changing legal documents to represent one’s actual gender, instead of reflecting the sex they were assigned at birth. Goldstein’s program at Mount Sinai has volunteer lawyers who help people with this process. Goldstein explains that not everybody wants to do this, some are happy to keep their legal documents as they are where as others find this to be a higher priority than body reconstruction.
For Stella, this was very important and as they call it “extraordinarily nerve wracking and extremely boring.” They had to bring a lot of identification to the courthouse, fill out forms, and get them notarized. They paid $65 and then sat in a waiting room for a while. The next step was to choose a newspaper publication where they would announce their legal gender change. They also had to get a signed and notarized letter from their doctor affirming their gender. From there it was just about showing up. They went to the DMV and the passport office and the bank and everywhere they went they had to show documents affirming their gender. Stella explains they were lucky, “This process usually takes a really, really long time. Months. But Callen Lorde did workshops every Saturday throughout December where my doctor was in a room with a lawyer and notary public, prepared to get the letter to you that same day.” Stella also sought help from their head of HR at work to make sure the coming out process was smooth and that they could seamlessly transition their gender and pronouns in the office. Luckily for Stella, their company is quite liberal and was 100% on their side.
The coming out process can be extremely difficult for trans people and even more difficult because of all the medical and legal processes that can go along with it. Stella says that their queer support network was incredibly supportive and that was helpful in getting them through the legal changes. Goldstein ends our conversation with a beautiful piece of wisdom, “The thing that I would say that is most important is that nobody ever feels like they are trans enough. I talk to people who began their transition twenty years ago and they still don’t feel trans enough. And especially for younger folks, this is a super common feeling. I just want to tell everybody that that’s normal. There’s no such thing as trans enough.”