By Stephen Whittle
All of these timings are approximate and I can make no guarantees as regards the efficacy of the NHS services.
For convenience, there is a separate page for each year.
First Year of transition - Ground Zero!
Ask for a referral to one of the specialist Gender Identity Clinics (GICs) such as Charing Cross Hospital (see Resources List in this manual). Your GP will expect you to explain why you want this appointment.
If your GP refuses to refer you, contact you local Family Practitioner Committee to get details of other GPs in you area, and change your GP.
While you wait for appointments consider seeking some private counselling to address some of the issues that you wish to discuss. GICs rarely have the funding to provide counselling, or psychotherapy.
Also consider meeting some other Ftms - and learn everything you can from them.
Check your GP has actually written the referral letter - if not - cry! It always gets them moving - alternatively threaten to take your mother in to see them.
… for the GIC. If you haven’t got one by now, see your GP again.
Think about the name that you are going to choose for yourself. Pick something sensible: Scully is not sensible, you are too old to have been named by your parents after a recent television character.
Remember your age and try and fit in with what would have been appropriate at the time of your birth.
(If you are considering changing your surname, please read our guidance on surnames in the FAQ page on choosing a name).
This will normally be a 1 hour appointment, wherein you will be assessed as to whether you have any psychiatric illness which is making you wish to seek gender reassignment. This is rarely the case, but there are a few psychiatric disorders that make people think they want to change sex.
As a very general rule of thumb, if you get up at a reasonable time in the morning, you keep your clothes reasonably clean, you go to work or college regularly and you don’t think that Princess Diana (or Ulrika Jonsson or Gazza or any other similar person) is giving you special messages through your television you will not have one of these rare psychiatric disorders.
If you really do intend to go through gender reassignment, attend the clinic looking like you are serious in wanting it - if Ftm do not go wearing a dress - try and reassure the doctor that you know your own mind, and all that that entails. Wear appropriate gender clothing - for example, as if you were going for a job interview, as a man, for the local DIY Superstore, i.e. smart trousers, a shirt, maybe a tie, polished shoes, a sports or leather jacket. Don’t be over the top, a 3-piece suit, unless it is your normal wear and you are already working as a man, is a little too up front.
Try not to be too nervous - they are meant to be there to help you, but help them by reassuring them, in your dress and manner, that you are aware of what you are doing, that you realise what is possible and what is not, and that you realise the difficulties ahead of you. The clinic will normally then give you a second appointment 3 months later.
Make sure that you have a job, or are at college by the time you attend the next appointment.
Attend 2nd Appointment at GIC. If you can show that you are working, or attending a full time college course, or a full time volunteer worker, or even an unemployed local councillor, the clinic will give you the go-ahead (if you wish) to start the real life test. If you are in agreement, at this time, the clinic will write to your GP and authorise them to prescribe you male hormones.
Next injection: - the cycle starts again, family and loved ones resort to day trips out to escape from you and your newfound moody-ness. Partners find that they need a constant headache to get some of the jobs around the house done, and you think that you might need glasses soon at this rate.
Menstruation: next period is likely to be very slight. Hopefully that should be the end of menstruation for the remainder of your life. But give it another month and see what happens before you burn all the tampax and panty liners. Breast Binding: Sort out now how you are going to bind your breasts comfortably and so that you can still breathe. Start to sort out your wardrobe - you really are not going to ever again wear that dreadful dress that you wore to sister’s wedding
Periods completely ended now - Hooray, voice begins to deepen and break, Those who don’t know what is happening start to ask you about the cold you have, and sometimes on the phone strangers call you Mr.
3rd Appointment at the GIC - report back how fantastic you feel and ask them to put you on the waiting list for a mastectomy. Now is the time to think about formalising matters and making the transition from female to male. This is going to be the biggest day of the rest of your life.
Change your name by statutory declaration and start to change all your paperwork, such as driving licence, tax records etc. (For a step-by-step guide, see the FAQ section on changing your name).
our boss, or personnel director, and take 2 weeks off work to enable staff to be told. It also gives them time to practice your new name, to get over most of the gossip, and it means you have a little time to live full time as a man in your social life, first, which is a little easier.
The first day in work as yourself
At this point also consider whether to tell your parents.
Why leave it this late? Well for a start it is too late for them to hassle you and to try and persuade you not to start hormones, secondly you have built up an external support network in case they refuse to see you ever again, and thirdly you will feel a lot more confident about yourself.
Your parents will not like what you are going to do. A few are very understanding and they cry in the privacy of their own bedroom. Some divorced or separated parents start to use you as a weapon in their own personal war - “it’s all your fault and they way you treated her when she was six” etc. Some shout and scream and say they never want to see you again. Some are quiet but say they never want to see you again. Some cry a lot in front of you, however they rarely say they don’t ever want to see you again.
Either way it is rarely a pleasant scene. Think about telling them over the phone or by letter if you are not feeling up to the crap. In reality as you tell your parents, you have to remember that in 99.9% of cases, things will be a lot different in 3 years time, they may well not be perfect, but it is rare for Ftm’s to be excluded forever from families. In some cases, this may well be the start of the open and honest relationship that you were all looking for in your family and it may well be a route through to something much better than you have ever had before.
4th Appointment at GIC - insist they put you on the waiting list for a mastectomy. Tell them who you would like them to refer you to. They will probably say they can’t because the surgeon is ‘out of area’ - but insist on a surgeon who is experienced in performing mastectomies on Ftm’s.
Voice well and truly breaking now and a few hairs break through. You may want to grow a beard - but shave them. Men either have beards or they shave their faces, they do not grow ‘bum fluff’ over their chins.
Grow a moustache (of sorts).
Consider dieting to remove a few of the pounds you have put on.
You will be off work for around 2 weeks, depending upon heaviness of job.
Cut down or stop smoking for the operation and for several months afterwards to maximise bloodflow to nipples.
Grow your first real beard.
A series of major events:
Make sure that after everything you have been through that from now on you live life to the full. It is not a dress rehearsal and if you don’t bungee jump in this life you are never going to have the opportunity again.
Go to see your counsellor again and discuss the issues over whether you want to have phalloplasty or not.