Andrew Camacho
Andrew Camacho
Copyright © 2021 by Andrew Camacho All rights reserved. No part of this book may be reproduced or used in any manner without written permission of the copyright owner except for the use of quotations embodied in critical articles and reviews. Book design and illustrations by Andrew Camacho acayde.com
In nature, a flock will attack any bird that is more colorful than the others because being different is seen as a threat… Wrabel
Contents
Acknowledgments Preface
9 11
Section 1 Section 2 Section 3 Section 4
13 37 41 47
Personal Experiences What is Transgender? Social Transition Medical Transition
Bibliography
61
“I have started a journey to be happy with myself. I never knew why I wanted short hair, I never knew why I liked certain things, or why I preferred to look a certain way. If you’ve known me for a while, it’s obvious that I am not of the feminine type—
Acknowledgments | 9
Acknowledgments
Thank you to my mom for being my biggest supporter since the start. With her support, I was able to find my passion for design and live my true authentic self. I’m grateful for my friends, online and in-person, my classmates, professors, and everyone who lent a hand when I needed them most. Whether someone knew I transitioned or not, chances are they made my day. A special thanks to Emma for allowing me to grow as a person, for validating my experiences, and most importantly for reminding me every day that I am loved.
—I like to think I’m not feminine at all and have come to the conclusion that I am masculine inside. It may not be shocking to most, but as a confirmation to you and myself, I am going forward in my transition. My new name is Andrew, with he/him pronouns. I'm still the same goofy person you met. Any questions? Ask away, I'm chill.” Facebook //August 11, 2017
Preface | 11
Preface
I am a Hispanic transgender man. Often I find myself to be the only trans man in both LGBT and trans specific communities. The only connection to other trans men I had was YouTube. Over the years it became apparent that trans men weren’t that visible unless you were specifically looking for them; why is that? Could be because it’s generally more accepted to transition to male, than to female such as transwomen, or that most trans men are read as cisgender. Whenever the term transgender is used in the media they are most likely talking about trans women, although most of the comments are negative. On December 1st, 2020 Elliot Page came out as transgender on Twitter. As a fan of his, my mind was beyond blown when I read his coming-out letter. For the first time, I saw a transgender man on the front lines who would bring trans men’s awareness to a new level. To say that I was inspired is an understatement, but it did plant the seeds of what would become this book. My goal was to raise awareness that trans men exist and to provide information that anyone could use as a foundation for further knowledge. With so much misinformation on the internet, I wanted to streamline the important details about transitioning and tried to be as unbiased as possible. The transgender community is massive, complex, and is highly divided in ideologies. For that reason, I limited the text to personal experiences and general information. All we want is to be acknowledged and accepted.
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Section 1
Personal Experiences
Just how no two people live the same exact lives in the general world, it comes to no surprise that every transman’s experiences and opinions differ between individuals. In this section, I will be introducing you to myself and four other trans men. There was an effort to find a diverse group of men who could offer a unique experience for both social and medical transitions. Along with their stories, I asked everyone to provide a song that best reflected their personal experiences as another way to help understand what words cannot describe. These interviews are personal experiences and remain respectful to the interviewee.
Authentic
Personal Experiences | 15
Andrew Pronouns: He/Him Age: 22 From: Virginia, United States
“My appearance and voice may change, but I’m still the same person you first met.” When I was younger, about eight years old or so, I always envisioned myself growing up to be a man in my twenties. These aberrant thoughts were always prominent in my everyday life, but were never expressed because I thought every girl imagined the same thing, so why mention it? Everyone just assumed that I was the typical tomboy and I waited for the day I’d transform into a regular girl. But to no one’s surprise, I never grew out of it. Generally, when one hears about transgender experiences, everyone talks about having this defined dysphoric reaction to puberty and knew that they were meant to be the other sex. Oddly enough, I never felt like something was completely wrong with me, but just had a more neutral feeling. Even though my childhood was very much geared towards socially being a girl, I always played with toys and did activities typically associated with boys. Without having many gender pressures up until high school, I was okay with my body and just lived my everyday life without a thought. I never truly saw myself as either a girl or a boy. The differentiation between girls and boys wasn’t apparent either; it’s as if I lived in a bubble my entire life so I never realized that my outlook on life wasn’t normal. Video games have always been part of my life and one thing that always stood out to everyone was that when given the choice, I’d always create a male character. My usernames were neutral or were perceived to be male and it was never questioned by any of my online friends. In
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June of 2017, I went on a trip to an out-of-state convention where I met up with my gaming group for the first time. At that point, I had already won the war at home to cut my hair short and dressed how I wanted, t-shirts and shorts. One of my friends walked up to me and politely asked what my pronouns were—a question I didn’t even know could be asked. At this very moment, I believe that my gender-neutral bubble popped. My reply was to use female pronouns, but a strong mental note was made. When I got back home, the research began. After two months of extensive research through forums, articles, YouTube videos, and everything possible; I came across the term transgender. With immense research and soul searching, there was no doubt when saying, “I am transgender”. The first person to know was my online friend, Shadow, who immediately called me his brother. Eventually, I came out to my mom using a YouTube video by Sam Collins and his mom that explained what transgender meant and gave advice for parents on processing the news. She fully accepted and respected my decision to transition socially and medically. Overall, my experience coming out was no surprise to anyone, and was met with complete support. Transitioning means living my authentic self. My process for transitioning was rather fast. In order to start testosterone, a letter was needed from a therapist. Through private insurance from my mom, an appointment was easily set up with a gender therapist who gave me the letter after only one or two in-depth visits. Usually, people are asked to continue therapy for at least six months, so starting testosterone within a month of coming out is dramatic. Rest assured, with years of introspection and intense research over the summer, I knew I was ready to physically transition. My first self-admitted injection of testosterone was on September 8th, 2017 at the age of nineteen. It was the start of my sophomore year in college, professors were emailed about my preferred name and pronouns, no one knew each other, and I was ready to start my journey towards living as a man. Honestly though, I had chosen the worst time to take communications 101, where frequent speeches in front of the class were required. I was given odd looks by classmates because they saw the name Andrew and heard a high-pitched female voice. But for the most part, no one questioned it, though it was pretty awkward. I had to record myself presenting speeches and looking back at them now is
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hilarious because my voice started to break and drop every video. At the time, I had made a friend who claimed they didn’t know I was trans until I personally told them. Apparently, I was just seen as a young boy going through something and honestly, that was very reassuring. I had also discovered a transgender community on the streaming service Twitch where I could share my experiences with other transgender people. Being able to connect with other people who understood what I was going through for the first time helped my confidence in how I presented myself. I started the semester worried that I wouldn’t pass well because I had only recently started testosterone, but in the end, my final speech in class was about being transgender. Officially coming out to a class of thirty people was scary, but it was an important milestone towards being myself and being confident. During the first year of transition, I really focused on my appearance and how I carried myself. I wasn’t confident enough to use the men’s restroom just yet, so I had mapped out where all the gender-neutral bathrooms were on campus. There was a constant worry about passing and fitting in, which is interesting because I never really had to do that before. Imagine having to conform to a societal role, with minimal
“My life changed drastically for the better because of this vile and needle.”
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social skills to begin with, since I was pretty isolated growing up. For the first time, I was aware of the differences between boys and girls. It was definitely a learning experience on how to perform and where I stood in society. I used to think everyone was watching me as if they knew I wasn’t a cis guy. My hardship while transitioning was relearning how to live life normally. Three and a half years later now in 2021, I forget that I’m transgender the majority of the time. The only time I am reminded about it is when I’m applying my testosterone gel every morning, although it just feels like any other routine. My voice has dropped, I legally changed my name, had top surgery, started growing facial hair, and live stealthily while passing every day. There are still a few steps I want to take, referring to getting a hysterectomy in the summer of this year and legally changing my gender marker on my ID and birth certificate. Transitioning never ends, but after being three and a half years on testosterone, I’m comfortable with who I am and now know where I stand. My advice to anyone who may be in a similar situation is to really take your time. I consider myself to have lived a neutral experience while never having to force anything. I started transitioning fairly quickly, but that’s what I was presented with, I never asked to start immediately. Taking time to fully understand yourself can lead to a happier life in the long run, if it’s the right choice. The trans community is highly diverse in ideologies and is complicated to fully understand. As a transgender person myself, I do not associate with the LGBT community for a couple of reasons that have to do with my personal outlook on life. First, labels have never been important growing up to me, although they’re helpful in understanding or defining yourself, I’m just another person who lives just like anybody else. I am Andrew, a man who had a different start in life—being transgender does not define who I am at all. Second, I found the LGBT discourse to be a bit chaotic. As much as we show love and respect for one another in the general public, there are still major issues between sexuality and trans groups, or even between trans groups themselves. When it comes to politics, our human rights and safety are continuously thrown around because it’s hard to understand what being transgender is like over the hodgepodge of ideologies on the internet. Instead of trying to identify with a community that’s beyond my scope, I choose to tell people my personal story as is, because that’s truly all I can speak
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for. Although I don’t go announcing that I am trans every day, I still have long conversations with people who have questions. The hope is to educate one person at a time. Granted, writing a summary of my experience can only go so far. My situation at home still was not the best growing up, with divorced parents, a conservative and religious father, very few friends, and no siblings to talk to, I had music to help me cope. A song that most trans men know is “The Village” by Wrabel; a song that talks about the struggles of coming out in a world that isn’t ready for you. With religious undertones, I relate closely to the message and the overall emotion that’s expressed throughout the song. It reassures me that there’s nothing wrong with being who I am, but instead, there’s something wrong with society. Overall, I want to live my life by my terms, putting myself first is important. Another song that I used to listen to repeatedly during the two years I didn’t talk to my father was “My Life” by NF. It doesn’t matter if there are people that do not accept or agree with my choices, but it’s my life. A rather empowering song, it’s how I managed to push forward to be confident in my own skin. My advice to anyone is to be true to yourself and take nothing less than support.
My Life - NF The Village - Wrabel
Reassure
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Jack Pronouns: He/Him Age: 24 From: Ticino, Switzerland
“What is wrong with me? Why don’t I feel normal?” Interviewing Jack was a unique experience on its own for several reasons. First, I never had the opportunity to learn about someone’s transition experience from a different country. Realizing that there are people going through similar experiences around the world is an important note to take because it helps solidify that being transgender is not an isolated occurrence. Second, there’s a misconception that being transgender will inherently lead to a difficult and lower quality of life. That is just not true and Jack proves it. We both joked around that he probably was the best-case scenario for a trans person because overall he had a supportive family and didn’t have many struggles with transitioning either socially or medically. Like most people, puberty was an uncomfortable time for Jack. As his female chest started developing, he’d wear shirts that were about four times his normal size just to hide his body. Wearing larger shirts was a coping mechanism that helped distract him from his chest, but also led to him being mocked by peers. Along with chest development, the start of menstruation was a major dysphoric trigger. It was disclosed that he was prone to epilepsy attacks when high levels of stress were reached. Although at the time, Jack was unaware that he was experiencing dysphoria, there was no defined reason why he was feeling uncomfortable. Access to information was limited to internet forums and Facebook groups. It’s hard to research something
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when you don’t know what to search for. Eventually, Jack came across the term transgender on these forums and stated, “the forums explained to a T on what I was feeling.” Once making the realization that he was transgender, it did not take long to come out to his family. Around the age of sixteen, out of the blue while on a car trip, he decided to tell his father that he was not meant to be a girl. At the moment no one knew what to say or think, but his father did his own research afterward to better understand Jack’s situation. He took the initiative to further discuss the matter with his immediate family, Jack’s stepmom, and siblings. It took some time to fully grasp the concept and adjust to the changes that would come with socially transitioning, but in the end, everyone was supportive of Jack. Transitioning was mostly about becoming comfortable with his body and being perceived as his true gender, as opposed to pretransition where Jack would avoid going out in public so that people wouldn’t look at him. Changing his name and pronouns was not that difficult for Jack as he naturally appeared androgynous and had a fairly neutral voice. More often than not, people would confuse his gender before starting testosterone. In order to start hormones, Jack had to first talk to a psychologist, which proved to be difficult. General psychologists often refused to talk about gender as it was taboo, or out of their practice. Gender-specific therapists are still not very common in Ticino, Switzerland today. Eventually, he found someone that could help him start testosterone. Starting at the age of eighteen, Jack’s process involves going to the doctor’s office to administer a long-lasting shot of testosterone about every three months. The next steps for his transition were to get top surgery, which needed a wait time of two years on testosterone, and a hysterectomy. Currently, in early 2021, Jack’s in the process of getting phalloplasty done. When asked for advice for anyone who may be questioning their identity today, he responded with, “It’s best to take it slow and not rush things, especially medical transition.” He advised to test the waters by having people close to you use a preferred name and pronoun, and over time see if it’s ‘right’. Being transgender is fairly mainstream with no context nowadays. It’s okay to explore questions one might have; it’s easier to bail out any time socially than it is after starting hormones or getting surgery. He hopes that in time there will be more clarity for the general public on what being transgender means, especially the fact that
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trans people are just trying to be comfortable with their bodies and can’t just snap out of it. In his opinion, he believes there’s a lot of confusion on the definition of the term, which has and will continue to damage trans people and the way they are perceived. There is no one person with the same definition of what being transgender is, and often enough people confuse their identity with gender expression. Jack states overall, being transgender is not a choice and wants to raise awareness about the fact that we are regular people, not just a trend on Twitter. Jack’s song of choice was Body Terror Song by AJJ. He noted the song related to the extreme discomfort he felt with seeing and being seen with a body that wasn’t his. The great lengths to hiding between layers of baggy clothes and the distress of having the wrong body parts are something that a person with dysphoria feels every day. These are real experiences that Jack and every trans person who has or wishes to transition feels. He feels reassured to know that there’s a reason why he felt the way he did and that it wasn’t him as a person. His final comments were, “coming out is always a stressful experience, so if someone comes out to you as a trans person, chances are they had to build the courage to talk to you about it. They wish to keep you in their life, so even if it might take a while to get used to it, be supportive and remember [they] will always be the person you cherished.”
Body Terror Song - AJJ
Mysterious
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Drake Pronouns: He/Him Age: 30 From: Missouri, United States
“Having information could’ve changed my outlook on life, I’d given up before, but I won’t again.” Drake is a small-town trans man who knew he wanted to be a boy as young as two years old. With no external influences, he made comments about wanting to have male anatomy at a young age; how he knew about anatomical differences is unknown. Upon remembering a conversation, Drake added, “On graduation from high school, one of my friends from preschool goes, ‘I remember this one day we were like five or six and you literally said one day you were going to have money to get surgery to be a boy.’ I don’t remember saying that—like what six-yearold knows surgery is an option?” Drake didn’t know how those thoughts came to be, just that they were innate. Even though it was apparent that Drake viewed himself to be a boy, the term transgender was highly uncommon and he didn’t officially start transitioning until much later in his life. The first time Drake had encountered trans people was during an episode of Oprah while staying home sick from school around the age of seven. The episode specifically highlighted trans men who were describing their experiences, similar to what Drake was feeling. This exposure was only in passing and did not come up again until a few years later when he and his grandmother were watching Boys Don’t Cry, a film about a trans man in Nebraska. His grandmother made a comment about her not wanting Drake to be like the character in the film, which he stated, “being young and already depressed and not having anybody to really talk to about why I felt weird;
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I thought she meant like she didn’t want me to be trans.” Only later did he find out that she meant she did not want him to hide who he was; to be careful and smart about his relationships and interactions. At the age of thirteen, Drake had officially come out as transgender and started socially transitioning by using a new preferred name and pronouns. His main source of support came from his grandmother, while his father wasn’t fully supportive. Although he did experience verbal bullying for a while, Drake was accepted in school for the most part. Access to information was close to none, as the internet wasn’t fully developed by the early 2000s. It wasn’t until the age of twenty-four where Drake encountered another trans man who shared information about starting hormones. Although having a place to start for his transition journey, mental health and depression factored into postponing medical transition until three years later at twenty-seven. He stated firmly, “it’s something that I hadn’t done for twenty-seven years, it’s time for me to love myself. I will finally have everything on the outside that I’ve always known I should have had at birth.” With a goal to better himself, Drake started to cut people out of his life who were harmful to his progress. His main hardship while transitioning was just trying to get people who said they supported him to actively show it. Drake had officially started weekly testosterone injections in early 2017. “I would say transitioning was blissfully mysterious because I never truly knew if I was going to get the outcome I wanted with T,” he said while thinking about his transition thus far. Drake overall is happy with what he’s got, although he’s not still one hundred percent happy with his voice, or the fact that he’s short, transitioning helped him like his outward appearance. Currently, his goal is to have top surgery when his financial situation balances out. As someone who values appearance and wanting to fully live the male experience, Drake uses items such as binders to flatten his chest and packers to give the appearance of having a bulge like cis men. Ultimately, his medical goal is to have phalloplasty done so he could be able to stand while using the restroom. A unique, event-based subject came up during the interview, and that was having to ration his testosterone during the pandemic. Rationing hormones is not uncommon for a multitude of reasons, but for Drake, it was financial and health risk-based. While in between jobs when the pandemic hit, Drake did not have insurance and had a tight budget. In order to renew his testosterone prescriptions, he had to visit the doctors
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for an annual check-up which had a high price. In addition to the risk of exposure to covid-19, Drake did not have the means to expose himself. He’d been able to stockpile doses of testosterone which he could ration over time. The problem with doing so is having an overall lower level of testosterone in your system; it is important to be consistent with hormone levels and not doing so can have side effects such as starting menstruation again. Even as a trigger for dysphoria, Drake continues to hold strong. With his experiences, his advice to anyone who may be questioning is to surround yourself with truly positive people. He added, “just because someone is questioning, doesn’t necessarily mean that they are trans, but it’s worth exploring. With all the resources available today, you have to dissect the information since not everything is accurate.” Never be ashamed to question. There is so much misinformation on the internet, so it’s important to talk and listen to someone who is transitioning and living this life. If someone wants to understand the trans perspective, whether it’s because they’re questioning or just want to be a better ally, just be kind. “What parts I have don’t make me who I am, don’t ask what’s in my pants. I present myself as male, I look male, and I am male.” Lastly, Drake provided two songs that align with his transition experience. The first one is This is Gospel by Panic! At The Disco. What he takes from the song is about letting those you love go and asking people who wanted to be in his life to use the correct pronouns and refer to him as Drake. The second song is Getting Away With Murder by Papa Roach. A rather strong-sounding title, Drake explained that instead of reintroducing himself to the world like other trans people do when they come out, he envisioned having a funeral, or celebration of life ordeal of the person that people once knew.
This is Gospel - Pan!c Getting Away With Murder - Papa Roach
Survival
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Moe Pronouns: He/Him Age: 22 From: Virginia, United States
“I also discovered there were reasons why I was interested in gay-ships,but I also didn’t bother to explore them.” “Apparently if you wear capri-cut pants with flower patterns on them, people just kind of assume you’re a girl until you turn around and surprise them with a deep voice. I can laugh at it now—before it would only make me cry.” Up until the age of fourteen, Moe felt like something was weird in his life, but did not understand what was weird. His description was, “it’s like a person with autism who may have trouble recognizing and expressing emotions, it was a mixture of that with the desperate want to not be weird.” Instead of trying to explore and understand these feelings, his reaction was to ignore them and forget about it. But avoiding something is never a permanent solution. At some point in time everyone might have been asked if they’d rather be born a boy or a girl, this is a question that Moe firmly answered that he’d rather be born a boy. Yet, it was never questioned as to why that was always his response. For him, he thought that every girl wanted to be a boy and that it was normal. While having a conversation with peers about that same question, Moe was directly asked if there was a chance that he might actually be a guy inside. That very moment he described as if the world started falling down on him. He was trying really hard to live as a normal girl, but once that was questioned, it clicked within him. “It was a weird and terrifying experience because I knew I would never be able to go back to the state of
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ignorance that I was in.” For context, Moe comes from a rather conservative and religious household, so coming out as transgender was not an ideal situation. Once Moe came to the realization that he was trans, coming out was immediate with his friends who were supportive. With his parents, on the other hand, the subject came up during an argument that was related to a previous partner of Moe’s who was expressing interest in getting top surgery. When coming out himself, he was met with immediate rejection and told that he was both spitting in God’s face and that no one was ever going to love him. For Moe, coming out was important because he’d already spent fourteen years of his life in misery while trying to be something he was not. He stated, “honestly, even though it really hit the fan when I came out, I don’t regret it. I wish I’d gone about it in a way that wasn’t an argument with my parents, but I don’t regret it still.” Throughout high school, teachers who supported him had more or less taken on parental roles when his parents were not there for him. He, later on, found support through talking to likeminded trans people and visited a therapist regularly to help manage his experiences. Access to information was restricted by his parents who had blamed the internet for breaking their child with LGBT ideology. Because of that, Moe did not have internet access for a number of years which led to a cripplingly lonely and isolated life for most of high school. As a way to manage living in a censored home, dissociation was a default response. This was a culmination of not wanting to bend who he was or what he wore in order to fit his parent’s perceptions. In doing so, Moe opened himself up to be able to gather resources that he wasn’t allowed to have for so long. Transitioning meant survival and perseverance fueled by spite, or in the face of spite. Moe went on a long continuous journey to come into himself. His hopes were to be able to look in the mirror and not feel overwhelming dysphoria. He compared seeing female primary and secondary sex characteristics as being parasites. His body felt as if a weird alien had invaded him against his will. “As a way to cope, I would take these parts and depersonalize them from myself; make them into separate entities to not completely lose my mind,” Moe added when describing his dysphoric experience. While his parents restricted access to getting help to transition medically, Moe eventually took matters into his own hands and started testosterone injections in 2019 during
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his sophomore year in college. For the most part, Moe had found ways to pay out of pocket for hormones, doctor’s appointments, and therapy. His next goal is to have top surgery after graduating from college. It has been about eight years since Moe had first come out to his parents, they still don’t respect his transition, but his mom started showing support by contacting their insurance about getting top surgery. “I never would have expected her to do that even two years ago. Let alone when I first came out, but that’s a thing and it makes me a little bit hopeful about our relationship,” I could hear the surprise and excitement in his voice. Moe’s personal advice to anyone who may be questioning their identity or sexuality is to not force a label on yourself and share your experiences with a therapist. He was able to learn how to communicate with himself and understand the root causes for his thoughts and emotions. Discovering where your feelings stem from and the underlying, or overlying influences that affect them can greatly help to decide something for yourself. Before jumping the gun, introspection is important to pursuing something like transition that has permanent life-changing effects. To best understand his experience, Moe provided a few songs that hit different aspects of his transition and the relationships around him: Lost Boy by Ruth B., The Village by Wrabel, I’m Still Here (Jim’s Theme) from the film Treasure Planet, and Body by Mother Mother. These songs provide a greater snapshot of Moe’s relationship with his body, the undertones of religion at home, and his family wanting Moe to be something different and refusing to submit. Although they may sound depressing, Moe was able to find hope.
Lost Boy - Ruth B. Body - Mother Mother I'm Still Here - Jim's Theme
Weird
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Mikhail Pronouns: He/Him Age: 22 From: London, Ontario, Canada
“There’s something about music that conveys emotions in a way that words can’t.” Mikhail, or Mik for short, always knew that something was off about himself, but did not want to explore why. With having a punk mom from the nineties and being surrounded by diverse groups of people, Mik was in contact with transgender people who’d share their experiences growing up. The problem was that he did not believe that he himself could be transgender. It was only until he was eighteen and hospitalized due to a mental health crisis that he admitted to himself that he was a man. Once the realization clicked, Mik immediately came out to a close circle of friends online while still on the hospital bed. Coming out to his family was a different story. A few months had passed after the moment of realization for Mik to come out to his mom and stepdad; both of which were accepting and supportive. In contrast, Mik’s biological father and his Russian conservative and religious family were not as supportive. “I felt like there was a strain in the relationship between that side of the family as I wasn’t what they defined to be the perfect daughter. Coming out as trans was only then like a nail in the coffin” Mik added. It was possible for his grandfather to come around as Mik described him as being a nice guy, but with external pressures from the family, his grandfather ultimately stepped back. Losing family and relationships is sadly common with coming out and it can be a major toll on anyone’s mental health. As for Mik, he had already come to terms with the idea and by expecting
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the worst it removed the shock factor. When asked about any hardships while transitioning, Mik said the disownment from his family would be the only one if he hadn’t already accepted the fact. He considers his mom to be his biggest advocate, someone who will not tolerate anyone that brings negative experiences. With a balance of support, Mik commented, “I had no choice but to have a better experience, I guess because my mother is a wrathful being.” Mik began socially transitioning in August 2017, at the age of eighteen. For Mik, transitioning meant being able to pass as male one hundred percent of the time, but there were physical attributes like height and curves that made it difficult for him. He had started testosterone injections in early 2018 and a major worry that came up was having to maintain an aesthetic to pass. In hindsight, it was noted that it was an experience to stop caring about what people thought of him, whether it was good, bad, or anything in between. His philosophy was, “do no harm but take no shit.” During a tangent conversation, Mik brought up a somewhat ironic story where he tried to present himself as a male at work and it didn’t go his way. He’d been working at a company with his family before starting testosterone and had been recognized from old family photos as being the granddaughter of a family member. “Everyone at work sees me as a woman with a strangely deep voice. I don’t know if they haven’t figured it out yet or if they have and they’re just being polite about it,” he said jokingly. With his family being involved at work, he just settled with the idea because, in the grand scheme of things, he was still a man to the rest of society. Obtaining information about starting the transition process still required some work, but as a reflection of Mik’s own experiences, he advised to try and talk to as many trans people as possible if you’re questioning identity. There may be some overarching themes that trans people experience, but his experience is different than someone’s in Texas and of someone across the world in Dubai. Mik had often confused his dysphoric experiences with the generalized notion that women were supposed to hate their bodies. It’s difficult to have different perspectives on a problem when you’re only exposed to one narrative. Continuing with the topic of society, Mik wishes that trans men were taken more seriously. It’s apparent that trans men specifically are far less represented in the media than trans women. By all means, this is not a complete negative, but the reality is that it’s not uncommon for
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someone to not know trans men also exist. “I feel like we’re very much an unknown part of the trans community, which is ridiculous,” Mik stated. Most societies have certain rubrics for males and females that trans people try to follow when transitioning in an attempt to pass. It always baffled Mik when trans men try conforming to the extreme stereotypical misogynistic man in order to be taken seriously. Toxic masculinity is the premise of the song Real Men by Mitski, provided by Mik as a reflection of his experience transitioning. His father’s side of the family exercised the hyper-masculine mentality of being a tall macho man weighing in at three hundred pounds. Because of this, Mik thought he couldn’t possibly be trans because he wasn’t masculine enough and that his favorite color was pink. Disassembling his societal view of men was an important process that would lead to his personal development.
Real Men - Mitski
What is Transgender? | 37
Section 2
What is Transgender?
Before delving into the transition processes, I want to define common terminology and briefly discuss the transgender community. The scope of this book focuses on binary transgender men. Although non-binary experiences may overlap, I do not have the primary experience, or research to properly discuss them.
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According to the American Psychiatric Association, gender dysphoria is the psychological distress that stems from a disconnect between one’s gender identity and their sex assigned at birth. Dysphoria is diagnosable and is categorized in the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5. Not all transgender people experience gender dysphoria, but why? More information is needed. Similar to the definition of gender dysphoria, transgender is an umbrella term that refers to anyone whose gender identity is not the same as their sex; the difference being that psychological distress may not always be present. A cisgender person, for clarification, is someone whose gender identity and sex match; this term is often used to differentiate people in context and is not a derogatory term. Another term often thrown around is intersex which is a condition where a person’s physical reproductive anatomy or chromosomes are not clearly male or female at birth. This is more of a genetic disorder that may confuse people on someone’s gender based on their sex. There are cases where an intersex person is raised as a female but later learn that they are internally male; there would be no way to discern if they were male or female based on physical attributes. Okay, so why is this confusing to the general public? Honestly, it took me four years and research for this book to somewhat understand the confusion myself. Within the transgender community, there are major divisions of ideology on whether someone needs dysphoria to be transgender and what classifies as transgender. To simplify it, there are two main groups under the term transgender. First is the binary group, including both trans men and trans women. For example, someone who was born a female and identifies as the opposite sex, male, would be a binary transgender man; vise versa for trans women. Second is the non-binary group which would include anyone who does not identify as either male or female entirely, or partially. Both groups have something to do with self-identity. Gender non-conforming is a term often confused with transgender. According to the National Center for Transgender Equality, “Being gender non-conforming means not conforming to gender stereotypes. For example, someone’s clothes, hairstyle, speech patterns, or hobbies might be considered more “feminine” or “masculine” than what’s stereotypically associated with their gender.” When it comes to phrases such as “gender is a social construct,” typically they mean gender roles.
What is Transgender? | 39
We as a society choose what is defined as feminine and masculine, such as the colors pink and blue respectively for example. These definitions are open to change and have changed in the past, just look up why the color for girls was changed from blue to pink. Lastly, gender expression is how a person chooses how to present their gender through appearance like clothes, body language, etc; regardless of their gender identity. The main takeaway from all of this is that there is a clear separation between one’s own gender identity and how they dress or present themselves. People often label themselves as transgender solely because of how they choose to express themselves but are comfortable with their bodies and how they are perceived; this doesn’t correlate to their gender identity. Generally, binary trans people who have the means to transition do indeed transition and this requires the diagnosis of gender dysphoria through a psychologist. Medical transition, like going on hormones and having surgeries, essentially is a path of treatment to relieve gender dysphoria. There’s a division in the community on whether being trans is a mental illness, which is what the DSM-5 implies. To give my point of view, although the chances of being trans is natural and personal, having a DSM-5 classification is important from the medical and legal perspective. This has to do with insurance coverage of hormones and surgeries, basically saying that gender dysphoria is something real and may need treatment, it’s not a choice. There are many ways to view something, but being objective is a good way to start.
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Section 3
Social Transition
Social transition may be the first or the only step someone may take and there’s more to it than just telling people your preferred name and pronoun. The following information is generalized because different states and regions have their own requirements for things such as legal name changes. This by no means is legal advice, just something I’ve already dealt with in the past and have talked to others through their process. Along with name changes, I briefly discuss other topics relating to picking a new name, passing, and most importantly... relationships.
42 | Transmen
Picking a New Name This can be the easiest or the hardest decision to make for your entire transition, in my opinion, that includes surgeries too. Choosing a new name is a major deal, it’s the first step you can take towards fully being yourself. Some people may have gender-neutral names such as Jaime, or their names could have male variants making the decision easy. Just because you have a name that could work doesn’t mean it has to be that, you could change your first name or your full name entirely. I’ve always had nicknames growing up and during my freshman year in college, my roommate had given me the nickname “Androo”, before I came out. When I came out to my mom, she had told me that if I was born a boy, she would have used the name Andy. Of course, I had a long list of names to try out beforehand, but the name Andrew sounded right and Andy could be my nickname. I know some people that searched up random baby boy names until they found something they liked. You’re always welcome to have people use certain names to test which fits best before finalizing your choice. There’s no need to rush the process.
Legal Name and Gender Marker This section is mainly useful for those in the United States, but the best and the only advice I can give about this topic is to visit your local government’s website for their processes and requirements. Some places have filing fees to submit name change requests, others require specific written statements, therapist letters, proof of gender change, etc. I found it to be better if I wrote out my legal experiences to give a general idea of the process. In order to get my name legally changed, I needed a letter from my therapist diagnosing gender dysphoria and attesting that I have been on testosterone for one year as proof. Along with the letter, I had to personally write a petition with a template to get signed by my district court. There was a seventy-dollar filing fee and I got a letter back from the district court within a couple of weeks with the signature of a judge. With this signed document, I could then go to the DMV (Department of Motor Vehicles), social security office, bank, and other official places to have my name changed. The court letter is basically written proof that my name was going from ‘X’ to Andrew. The only part I needed help with was changing my name in the insurance
Social Transition | 43
because I was still a dependent; all of these steps were easy and free besides the court filing. At the time of writing this book, I still have the female gender marker on my ID for two reasons. One, if I were to change my gender marker to male before getting a hysterectomy done, there would be problems with scheduling gynecology appointments because they are for women only. I’ve run into this problem several times with nurses questioning why I needed certain appointments. Just imagine having someone with a male name asking for a female visit for themselves because they need it, but can’t get it. Second, in my state, a gender-confirming surgery and letter are needed in order to change gender markers. Top surgery was already checked off, but because of the first problem I still have not changed my marker. For these two reasons, it’s important to triple-check your personal transition plans and how legal changes may affect you. Once my gender marker is changed, I will only then file to have my birth certificate amended with my current legal name and gender.
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Socially Passing as Male Passing means that society perceives someone as their gender identity, I am a trans man and pass as male. Unless I were to tell people directly that I was transgender, most of the time they would have never guessed, which is encouraging. The response of “oh I would have never guessed you were trans, you look so good,” is generally taken negatively because it’s implied that trans people are supposed to look a certain way. Personally, I am not bothered by those comments and just reply with “obviously, I know I look good.” Giving tips on how to pass is difficult because how we express ourselves is unique, but society may not understand that. The best example is like Moe from the interviews, he is a proud trans man who also wears clothes with flower patterns; that doesn’t make him less manly, but some people may still read that as female. Passing in my opinion is all about finding inner confidence and staying true to yourself. Going on hormones makes it easier to pass with a deeper voice, but again like Mik, there’s the slightest chance of being read differently. There are a few general tips that I have gathered over the years: •
Hair: getting a masculine haircut from a barbershop to help structure your face is an easy step.
•
Binding: flattening the chest pre-surgery using binders is very common among trans men. It is important to not wear the binder for more than eight hours as it can restrict breathing.
•
Packing: prosthetics or even socks are often worn in underwear to give the appearance of a bulge.
•
Mannerisms: this has to do with how you talk, walk, sit and carry yourself. Minor changes in these can help with being perceived as male, but if it’s unnatural to you, just be you.
•
Bathrooms: no one makes eye contact or talks in there, so they probably wouldn’t notice you, to begin with. Everyone has to sit down at some point, so if you can’t stand to pee, don’t be discouraged. Search up STPs (Stand-to-Pee) devices as an option.
GC2B Binders are the best in my opinion. PointOfPride.org is a great resource for free binders if you can't get your own.
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Relationships Relationships can mean friends, family, or romantic partners. Yes, romantic relationships are possible and whoever you end up with is with you for who you are, not your body. One of the biggest decisions we as trans people have to make is when to tell someone we are trans, if at all. It’s not an obligation to tell everyone, but I think telling people in my inner circle is better in the long run; though I am very conservative about who and when I tell people. I would say I lucked out when it comes to romantic partners as a mutual friend told my crush that I was trans and she wasn’t bothered by it. Communication is important when in a romantic relationship, your partner doesn’t know when you’re feeling dysphoric, or what your physical boundaries are. During my interview with Drake, he briefly talked about using the trans man tag on dating apps to deter people and as a way to get out over with. Before things get serious with people, it’s best to disclose you are trans so they’re not in complete shock. Transgender people are still a small minority in our society and if you pass very well people just assume you’re cisgender; best to avoid that awkward encounter. In the end, it’s your decision on who knows this personal side. We’re still normal people who went on a small detour on our journeys. Three words that got me through my journey are self-care, confidence, and respect.
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Section 4
Medical Transition
In this section, I will be outlining different topics such as hormones, surgeries, and their variations. This information is a culmination of the past four years of online anecdotes, and my personal research and experiences. This is not medical advice, always speak to a medical professional to see what is best for you. The goal of providing this information is to create a stepping stone of knowledge so that anyone wanting more information knows where to start. I’ve also added some commentary on subjects that most people do not talk about, although uncomfortable to write, it’s important to acknowledge them. Remember, everyone’s transition is different and not everyone decides to medically transition for their own reasons. Trigger warning: anatomical names of body parts are used for clarity purposes.
48 | Transmen
Hormone Replacement Therapy (HRT) There are two main sex hormones, testosterone, and estrogen, that dictate how our bodies develop for males and females respectively. Both males and females produce testosterone and estrogen but at different levels. HRT for transgender people is the process where synthetic hormones of the opposite sex are prescribed. Typically this is the first step towards medically transitioning, but everyone’s transition is different. The effects of HRT are commonly described as going through a second puberty (if one has already experienced puberty).
Hormone Blockers As noted by the Mayo Clinic, Gonadotropin-releasing hormone analogues (GnRH), also known as hormone blockers, is a medication that can block naturally produced sex hormones in order to pause puberty. These are commonly used for youth who may be suffering dysphoria, or are questioning their identity and do not want to experience puberty. There are no overall negative side effects to taking hormone blockers short term, but it’s highly recommended to talk to a pediatric endocrinologist for more specific information on the individual level.
Testosterone The primary hormone for cismen is testosterone. Trans men naturally produce estrogen, so by going through HRT, the hormonal balance would change so that testosterone becomes the primary hormone while estrogen levels decrease to reflect a cisman. The following are common natural changes/side effects of testosterone HRT: •
deepening of voice
•
increase/thickening of body hair
•
changes in scent
•
rougher skin texture
•
facial hair growth
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•
changes to sexual organs
•
stopping of menstruation
•
distribution of body fat
•
changes in muscle density
•
increased sex drive and appetite
•
emotional changes
The intensity of these changes varies per person. Much like cis males going through puberty, the voice will begin to crack as it begins to lower over the next year while on testosterone. There are a couple of factors to how deep a voice can drop: starting T dosage and genetics. In order to get a general idea of one’s own changes, one can look at the men in their family. When it comes to facial hair and hair loss, it’s a general rule of thumb to look at the men on the mother’s side of the family. One of the most significant changes that can start within the first week of starting testosterone that is not mentioned often is the change to sexual organs. To put it simply, the clitoris is capable of growing up to an inch or more, sometimes referred to as the T-phallus, and may resemble the anatomy of a cismale with similar functions. This may often be referred to as bottom growth and can be a source of euphoria for men.
Notes During the first year of HrT, your body retains a lot of water to ease fat distribution. You'll probably go through a chubby phase, which is okay—just blame the extra food you're eating. Most trans guys that start T around their 20s look younger than their age. I used to feel bad about that, but now I just go with it.
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Types of Testosterone The most common types of testosterone are: •
Injections, intramuscular and subcutaneous
•
Topical gel
•
Patches
•
Pellets
•
Pills
Almost everyone starts off with injections as it’s the most effective and quickest way to introducing your body to testosterone. I started off with self-administered bi-weekly intramuscular injections in my thigh as recommended by my endocrinologist. For the most part, the injections were good in that I only had to worry about doing them twice a month, but the downside is that when I did my injection, my testosterone levels would start high and dwindle over the next two weeks. This would cause mood swings often and left me tired until the next dose. Because of this, I switched to topical gel that is applied to my shoulders daily. The gel allows for a constant dose of testosterone every day, but have to be conscious of other people touching the applied areas. Some people cannot absorb the gel through their skin well, which would lead to lower levels of testosterone and requires a different method. All types of testosterone deliver the same effects, some are more reliable than others and it’s best to do due diligence and speak with an endocrinologist for dose amounts.
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Negative Effects and Fertility The first thing to note about any downsides of taking testosterone is that cismen also suffer the same effects; these are not trans men specific. As explained by my endocrinologist, testosterone can lead to higher chances of cardiac issues such as heart attacks and strokes. These are based on genetics and environmental influences, so if the men in your family have high cholesterol or other medical problems, then you would also be at a higher risk. Mood changes, weight gain, and male pattern baldness are also natural side effects of testosterone to be mindful of. Just like before, if the men in your mom’s side of the family are balding, then you probably will too when you’re of age; it doesn’t mean that you’ll start going bald at sixteen. Testosterone HRT is like a ciswoman going through menopause at the beginning which has its own effects such as atrophy. There is a misconception to take note of and that is that testosterone causes cancer to the reproductive organs; it does not. It is important though that if one still has their reproductive organs, they need to get pelvic exams for their overall health. Many trans men do not visit the gynecologist because lets be real, it’s traumatic, but it’s vital to catching and preventing cancerous cells from developing if present. Fertility is another important topic. First and foremost, testosterone is not a form of birth control, even if menstruation has paused. It is still possible to carry a child if a hysterectomy wasn’t performed. If you were on testosterone for years and then decide to have biological children, it is possible to do so with some things to keep in mind. The whole process to extract and preserve eggs is very expensive, but if you choose to do it, the most important factor is doing it early. Testosterone has no effect on eggs while time and age do.
Final Comments No matter what, it’s always advised to speak to a therapist who has gender experience with starting testosterone. They may have to write a letter before you start hormones and make you wait longer but remember, once your voice drops, it can’t go back up. Some things are permanent so please do more research.
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Top Surgery Top surgery is the procedure to masculinize the chest by removing breast tissue and the surrounding fat. Requirements may vary per region, but in general, to have this surgery a person must be diagnosed with gender dysphoria and in some cases must be on testosterone for a number of years. It is important to note that the chances of breast cancer developing are not impossible because some tissue is left behind in order to have a masculine peck shape rather than caving inward. This procedure can cost between USD 3,000 to USD 10,000 but is covered by most insurances. In places that have national health care, top surgery is generally covered, although there may be long wait times and requirements to continue. A couple of factors that can dictate which surgery is best are chest size and skin elasticity. Only the surgeon will have the final recommendation as to which surgery is best though.
Double Incision Double incision, or bilateral mastectomy, with nipple grafts, is the most common top surgery done. This surgery results in the often familiar two horizontal scars across the chest; depending on the procedure, the return of nipple sensation is not guaranteed. Double incision works best for those with larger chest sizes because of the extra skin around the breast. This is often the most popular procedure as well because nipple placements are closer to those of cis men. The following are the general steps for the procedure: •
Incisions are made along the pectoral muscles or ribs.
•
Skin and breast tissue are removed. Nipples are placed aside.
•
Incisions are closed, forming horizontal lines.
•
Detached nipples are trimmed to the average male size.
•
Nipples are reattached where male nipples would be placed.
•
Drains are inserted into the chest for the removal of excess fluid.
•
Post-op binders may be used for a couple of weeks for healing.
Double Incision Scars normally follow the pecs, but vary per surgeon. Some can be straight across or a lot more curved.
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Periareolar and Keyhole These two procedures unlike double incision have minimal scars around the nipples. Both of these surgeries are for chest sizes smaller than a B cup; the smaller the better because no excess skin is removed during the procedure. Far fewer people can get aesthetically pleasing results from this surgery due to their chest size, but there is one downside. Both peri-areolar and keyhole do not have nipple repositioning, meaning they will be a little closer together than average males. The plus side to that though is having more nipple sensation since the nerves are untouched. Basic steps for Peri-Areolar Top Surgery: •
One incision is made around the base of the areola.
•
Another concentric circle incision is made to create a removable ring of skin around the nipple.
•
Breast tissue is removed using liposuction around the nipple, leaving the stalk of nerves alone.
•
The nipple may be trimmed, depending on the surgeon.
•
A drawstring technique is used to close the two circular incisions.
•
Drains may be inserted to drain excess fluid.
Basic steps for Keyhole Top Surgery: •
A half-circle incision is made at the bottom base of the areola.
•
Breast tissue is removed using liposuction through the incision, leaving the stalk of nerves alone.
•
The areola is not resized and incisions are closed.
•
Drains may be inserted to drain excess fluid.
Nipple sizes generally stay the same for both of these surgeries.
Periareolar
Keyhole
I had this surgery after one year on T.
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Bottom Surgery Bottom surgery is the creation of a phallus and scrotum through two types of procedures. There are two types of surgeries, metoidioplasty, and phalloplasty, which can be chosen based on result preferences. Before getting either surgery, a hysterectomy is often required but may be optional based on the surgeon, to remove all female reproductive organs because both procedures will close the entrance, making it impossible to do pelvic exams. Every surgery comes with risks and complications, the information provided is just an introduction to the topics.
Metoidioplasty Metoidioplasty is a surgery that uses current bottom growth T-phallus as the basis for the neophallus. The length of the T-phallus (one to three inches) will determine the final size of the neophallus. This procedure is for people who want the look of male anatomy rather than female anatomy regardless of the phallus’s length. The benefits of metoidioplasty are sensation, erections are less invasive, and have fewer surgical stages. The downsides include shorter lengths and may not allow for penetration. Basic prodecure steps: •
Stage 1: a graft is taken from the inside of the mouth’s cheek to use as tissue for lengthening of the urethra.
•
The T-phallus is opened on the underside and the skin graft is attached to the urethra.
•
Stage 2: The surgeon will perform a vaginectomy, which removes the inner lining and closes the vaginal opening. Then the original urethra is redirected to the neophallus.
•
The V-Y method is performed to create the scrotum
•
Stage 3: testicular implants are inserted. The size of these are discussed with the surgeon to best fit your anatomy.
Post Stage 3 General results depend on existing growth. There are ways to improve them that you may search up.
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Phalloplasty Phalloplasty is the creation of a neophallus that resembles closely that of cismen. Unlike metoidioplasty, the size and length of the neophallus are determined by the amount of skin available to use on either the forearm or the thigh and by your physical proportions. This complex procedure requires multiple stages and significant recovery time. Upsides of this surgery after recovery are the ability to stand while urinating and have a normal but singular phallus length. Downsides include loss of erogenous sensation (although some people claim to steadily get feeling after several years post-op) and the inability to become erect without the support of implanted devices such as a pump or rod. This is only a quick summary of the procedure and may be improved in the future as techniques are innovated. Basic procedure steps: •
Stage 1: donor skin and fat are taken from the non-dominant forearm to create the neophallus and urethra. A neutral nerve and artery are taken as well to preserve sensation and blood flow for the neophallus.
•
The donor site is covered by a thinner graft of skin and fat from either the thigh or the buttocks.
•
The urethra is created using donor skin and is rolled into the larger skin and fat grafts along with the nerve and artery to create the neophallus.
•
The nerves, arteries, and phallus are connected through a hole that is cut in the groin region. The previous anatomy is untouched.
•
Stage 2: The bladder is connected to the new urethra that goes through the neophallus. The old urethra is then closed.
•
A vaginectomy is then performed. Then the region is prepared for the next step.
•
The V-Y method is performed to create the scrotum.
•
The head of the neophallus is created by cutting the skin and folding it inward to create a hem.
•
Stage 3: Testicular implants and/or erectile devices such as a pump or rod may be inserted; this is an optional step.
Skin Graft
Stage 1
This was only an introduction to what a trans man may experience and consider. Here are some extra resources I found helpful for myself and others: - Binders// pointofpride.org - Surgery Results// transbucket.com - Lifelines // The Trevor Project: 866-488-7386
Self Care - Confidence - Respect
Bibliography | 61
Bibliography
Deutsch, Madeline B. “Overview of Masculinizing Hormone Therapy.” Overview of Masculinizing Hormone Therapy | Transgender Care, 17 June 2016, transcare.ucsf.edu/guidelines/masculinizing-therapy. Accessed 15 March 2021. “Frequently Asked Questions about Transgender People.” National Center for Transgender Equality, 4 Sept. 2020, transequality.org/ issues/resources/frequently-asked-questions-about-transgenderpeople. Accessed 15 March 2021. Staff, Mayo Clinic. “Pubertal Blockers for Transgender and Gender Diverse Youth.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Aug. 2019, www.mayoclinic.org/diseases-conditions/ gender-dysphoria/in-depth/pubertal-blockers. Accessed 15 March 2021. “What is Gender Dysphoria?” American Psychiatric Association, www. psychiatry.org/patients-families/gender-dysphoria/what-is-gender- dysphoria. Accessed 14 March 2021.
Trans men You may find that the term transgender appears often on the news and social media. Majority of the time it has to do with bathroom rules, or banning trans athletes from playing sports. About that, they’re probably talking about trans women. There’s nothing wrong with that, but let us not forget that trans men exist and have similar, yet differing experiences. Whether you’re questioning your gender identity, or are an ally looking to understand trans men—this book is for you.
Trans men Playlist // From Interviews Body - Mother Mother Body Terror Song - AJJ Getting Away With Murder - Papa Roach I’m Still Here - John Rzeznik Lost Boy - Ruth B. My Life - NF Real Men - Mitski The Village - Wrabel (must listen)
