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An Introduction to Trans* Issues & Procedures


Image description (shortened to ID): A title card saying “An Introduction to Trans* Issues & Procedures”. The words are cut out of a white border, and behind it: a gradient with blue at the top, purple in the middle, and pink at the bottom. “An Introduction to” is written in a late-19th century font, and the “c” in “introduction” looks like a pac man, or a pie with a slice missing. “Trans* Issues” is written fairly plainly, but “procedures” is written in a bubbly font with pink in the background.

 

This text would not have been published without the help of some invaluable trans* friends. I would like to give a special thank you to Rae Clark, Blythe Varney, and Emily Valentine.

A Note on the Publication of this Text


ID: To the right is a cartoon drawing of my head, with my staple short, curly hair, and chubby cheeks. To the left is a cartoon drawing of a way cooler person, who is wearing cool sunglasses and a bowtie – their smile is contagious. They may have the same curly hair and chubby cheeks as me, but they are way cooler.









Terminologies change over years as new ideas grow and old ideas are proven to be problematic. This text was written in 2021, as of this time, and to the knowledge of the authors of the text, definitions and uses of the words are up-to-date.


But trans terminology changes very often – because we are still learning who we are and how to apply that to binary society.



ID: The same cartoon picture of me, except my eyes are slightly squinted, as I’m doing an awkward job of encouraging people to talk about gender in society!

Whatever your reason for reading this, it is not published with the intention of educating on these matters entirely. We strongly encourage you to do further reading, or discussion of this content with a professional and/or with friends.






 


Index (work in progress)

The Definition of Gender A Note on the Abbreviation of ‘Trans*’ Trans* Terminology and Slang General Terminology and Slang Medical Terminology and Slang Outdated, Offensive, and Questionable Terminology Outdated Terminology Offensive Terminology Reclaiming Offensive Terminology Questionable Terminology Grammatically Correct Use of Trans* Terminology Pronouns Why it is Important to Respect Peoples’ Pronouns How to Practice Using a Person’s Pronouns A List of How to Use Pronouns & Examples Asking About a Person’s Pronouns In a Group or Professional Setting Correcting People After They Use the Wrong Pronouns Gendered Titles and Terms Gender-Neutral Terms for Peers Gendered Terms for Peers Gender-Neutral Terms for Family Trans* Medical Procedures Hormone Replacement Therapy (HRT) Oestrogen Forms of Oestrogen: Forms of Anti-Androgen: Forms of Progesterone: Effects: Testosterone Forms of Testosterone: Effects: Hormone Blockers/Puberty Blockers Top Surgeries Double Excision (Subcutaneous Mastectomy) Nipple-Sparing Double Excision (Subcutaneous Mastectomy) Peri-Areolar Incision (Subcutaneous Mastectomy) Chest Construction Surgery Bottom Surgeries Vaginoplasty Vulvoplasty Orchiectomy Metoidioplasty Phalloplasty Scrotoplasty Questioning Your Own Gender, or Lack Thereof On Detransitioning Some Stuff That Might Help You Talk About Gender If You’re Cisgender Try Not to Say… Trans* is Not a Disability Trans* Does NOT Mean Mentally Ill FARTs Decolonisation//Gender A Bit of Trans* History




 

The Definition of Gender


It is important that we understand what we mean by ‘gender’. For some, gender means male or female - typically noted by whether they have a penis or a vagina. For trans* people and others, this reference to sexual organs is called sex, and not gender.


It is of great importance to note here that the sexual organs of all persons do not fall into the categories of male/female. The sole existence of intersex people absolutely denies this. And, according to Dr. Cary Gabriel Costello, many people are assigned male/female after having involuntary, needless surgeries after birth.

(https://intersexroadshow.blogspot.com/2013/02/hypospadias-intersexuality-and-gender.html, cited 01/07/21)


Gender is often more complicated than referring to one’s sexual organs. While, to some societies, gender is based around the male or female sex, it is not either/or.

By this we mean that gender is often more in reference to societal and cultural differences between what is expected of those whose assigned sex is male or female.


As an example, if the sex you were assigned is male, you might wear suits, and work a full-time job to pay for family - and if the sex you were assigned is female, you might wear make-up and learn how to cook for your family, because that is what is expected of you in your society.


Similarly, the use of symbols can cause a similar confusion around such things as which bathroom to use.

If a 'man' is wearing make-up and a dress, and for all intents and purposes, appears to look like and sound like a 'woman', then 'he' will not be welcome in the 'male' toilets. Often people dismiss this situation as purely hypothetical, as they believe they can always tell if a person is trans* or not – but this is illogical. There are countless people in society that exist outside of gender norms, and I, for one, have used ‘female’ bathrooms even though I am not a ‘female’, because I was assigned ‘female’ at birth, and because I ‘pass’ as female.

At the time of writing this, it is recognised in the scientific community that gender is the way someone expresses themselves (sometimes referred to as ‘gender expression’), and that gender is no longer seen as being male or female but more as a spectrum, or a state of existence.


Despite this, trans* people are still legally categorised as either male or female. It is on passports, birth certificates, and even used on letters as titles; ‘Mr/Mrs/Ms’, and so on. See page _ for more information on pronouns and titles.


When we discuss trans* people, we are often referring to people that do not align with the gender that they were assigned to at birth.

This booklet will act as a brief introduction to some of the identities that people may align with. As always, it is important to know that a person’s gender is not a choice.



What is a choice, or rather – what should be a choice – is how a person presents themselves within society. Some people, who believe in hateful anti-trans views, might see transgender people (for example, trans women) as playing dress-up or acting as a ‘caricature’ of what is means to be a woman. This is not true. To be a woman means very different things to many different people, but there is no woman who is a ‘caricature’ of herself. Every woman is a woman, even if society does not believe them to be this way.

It is important to listen to people when they are discussing their gender identity, whether they identify as being male, female or non-binary, so that we can understand how to address them in a respectful way, e.g. using the pronouns they like to be referred to as. As this topic can be very personal, it may be upsetting to offer opinions you may have about a person’s gender identity if it contradicts what they are saying or to continue to use pronouns they do not feel comfortable with.


Opening up about gender identity, especially if it is a trans* identity, can be very scary and might require a lot of courage out of a person, so it is very important to be supportive of them. It is often of equal importance, therefore, to remember that we do not have to understand every aspect of a person’s existence – or how they are able to express themselves.  


 

A Note on the Abbreviation of ‘Trans*’



We will be using ‘trans*’ as an abbreviation for genders such as the ones listed in the next chapter. This list is in no way meant to be a definitive list, and is merely included as a guide, as there are many genders someone can be.



 

(ID: Title card saying ‘An Incomplete List of Genders’. “An Incomplete” is in 3D capital letters – pink, roughly drawn with a pencil. “List of” is in a green-blue, scribbled loosely with a fancy pen. Lastly, “Genders,” the largest part of the title, is in an old-style serif (tailed) font, a blue with pastel pink shadow behind it – as if it were 3D.)

Transgender;       A person who does not identify with the gender that they were assigned at birth. (ID: 5 horizontal stripes, in order from top to      bottom; a sky blue, a salmon pink, a white line in the middle, and then pink and blue again.)  Non-Binary;       A person who is not definitively masculine or feminine, who exists outside the gender binary. (ID: 4 horizontal stripes, from top to      bottom: sunflower yellow, white, bright purple, and then black.)  Genderqueer;       A person who does not adhere to binary genders, but may be a combination of masculine and feminine, or neither, perhaps varying at points. (ID: 3 horizontal stripes, from top to bottom: a lavender purple, white, and      then an earthy green.)  Androgynous;       A person who is a combination of masculine and feminine, not one over the      other, but both, and in this way, perhaps also neither. (ID:  3 vertical stripes, from left to right: a saturated magenta, purple, and blue.    Pangender;       A person who is not definitively masculine or feminine, to exist outside the gender binary, but is more than one gender. (ID: 7 horizontal stripes, from top to bottom: pastel yellow, orange, pink, white, and then pink, orange and yellow in reverse.)  Autigender;       A gender that is understood exclusively by autistic people. A person whose autism impacts their gender. (ID: 5 horizontal stripes, from top to bottom: a gradient of ‘emerald’ greens, from light but saturated green to a deep, dark green. In front of the striped gradient is a black infinity symbol.)  Transmasc/Trans Masculine;       A person who was assigned female at birth, but aligns more masculinity than femininity. (ID: 7 horizontal stripes, from top to      bottom: a saturated pink, a light pastel blue, a pastel blue, a darker pastel blue in the middle, and then it reverses.)

Transgender; A person who does not identify with the gender that they were assigned at birth.



Non-Binary; A person who is not definitively masculine or feminine, who exists outside the gender binary.




Genderqueer; A person who does not adhere to binary genders, but may be a combination of masculine and feminine, or neither, perhaps varying at points.

Androgynous; A person who is a combination of masculine and feminine, not one over the other, but both, and in this way, perhaps also neither.


Pangender; A person who is not definitively masculine or feminine, to exist outside the gender binary, but is more than one gender.



Autigender; A gender that is understood exclusively by autistic people. A person whose autism impacts their gender.


Transmasc/Trans Masculine; A person who was assigned female at birth, but aligns more masculinity than femininity.




Transfemme/Trans Feminine;

A person who was assigned male at birth, but aligns more with femininity than masculinity.  





Xenogender;

A form of non-binary that aims to deconstruct the gendered existence of humanity, instead relating more to the universe itself.




Bigender;

A person who experiences variation between two genders. This could be any two genders, and can be a simultaneous, or individual, experience.


Genderfluid;

A person whose gender varies, either often or over years. There are not necessarily specified genders that this person will experience over the course of time.



Transsexual;

A person who does not identify with the gender they were assigned at birth. Not to be used interchangeably with ‘transgender’, as it has been used offensively, and has other uses.




Agender;

A person who does not exist within the gender binary. This generally means that the person does not align with any non-binary terminology, and does not wish to label their gender.



Neutrois;

Similar to the above, only that the person exists neutrally between all genders and gendered societies. They do not particularly feel any way, but neutrally.




Two Spirit;

A term exclusive to Indigenous North Americans, that terms one of the gender roles that lies between male and female – to wear the clothes, and do the work of both genders, respectively.



Demigender;

A person who exists as partially one gender over others, but does not identify fully with this gender. It is similar to non-binary, but still utilises aspects of gendered society.


Intergender;

A term exclusive to intersex people, referring sometimes to being between male and female – and other times, neither male or female.



Omnigender;

A person who experiences and reflects all genders as one gender. It is somewhat like non-binary, only it does not exist outside of the gender binary. It encompasses the gender binary, and all outside it.


Greygender;

A person who resides outside of the gender binary, and does not have an affinity for any forms of gender expression in this way.




Genderflux;

A person who fluctuates between genders, which may be any number of genders, but they align with one gender over another.




Demiboy;

A person who aligns with masculinity more so than others – often using the pronouns he/him alongside others, and not she/her.




Demigirl;

A person who aligns with femininity more so than others – often using the pronouns she/her alongside others, and not he/him.




Demiflux;

A person who aligns with one gender mostly, but sometimes fluctuates in other areas of gender.




Femfluid;

A person who experiences femininity, alongside fluidity within this femininity – they align with femininity, but with no specific ‘feminine’ gender.



Domgender;

A person who experiences more than one gender, but one is dominant. Rather than masculine/feminine, the dominant gender does not fit into the gender binary.




Cisgender;

A person who identifies with the gender that they were assigned at birth.





It is also important to note that, whilst intersex people individually may be trans*, intersex people are not – by default – trans*. ‘Intersex’ is a term defined as:


(A) A person with external or internal sex organs that do not fit into the ‘male’ or ‘female’ (gender binary) aesthetic categorisations.

(B) A person with chromosomes that do not fit into the ‘XY’ or ‘XX’ categorisations.



 

(ID: A pink title card saying ‘Trans* Terminology and Slang’. It’s drawn with a pencil, in a 3D style, with rough edges and shading. Below the title is a drawing two trans flags, flipped so that they mirror each other. The poles from which they fly cross at the bottom, and their flags flow diagonally in the wind)



General Terminology and Slang


o Transgender (trans):

A person who does not identify with the gender that they were assigned at birth (AGAB). It is not used by all people who do not identify with their AGAB, however - as they do not wish to use the term.

For example, a person may not wish to partake in the idea of gender - and therefore they may not wish to identify as transgender. It is therefore inappropriate to enforce the label of ‘transgender’ on people.


o Cisgender (cis):

A person who identifies with the gender that they were assigned at birth. This does not negate intersex, two-spirit, third-gender, or other people who were assigned their own gender at birth.


o Assigned Gender at Birth (AGAB):

Used to refer to the concept of a gender that a person was assigned at birth. For example: “My AGAB was ‘male’”, or “They don’t identify with their AGAB”.


o Assigned Female/Male at Birth (AFAB/AMAB):

The gender a person was assigned at birth, which is often within the ‘gender binary’ (male/female), and used to socialise a person as male/female as they grow and exist in binary society. For example: “I’m an AFAB” or “I was assigned female at birth”. It is not correct to use this term in reference to someone without their permission, as it is personal information.


o Coercively Assigned Female/Male at Birth (CAFAB/CAMAB):

Much like the above, this is used to self-refer to one’s assigned gender at birth. However, it is used most prevalently by intersex people, because of operations and other medical action that is forced onto them from birth onwards.


o The Gender Binary:

“A system of gender classification in which all people are categorized as being either male or female.” cit.: Oxford Languages. For example: “The gender binary is harmful to every being on this planet.”

o ‘Outed’:

Refers to when someone’s gender and/or sexuality is made known to another, or others, without the will of the person in question. Somewhat like “to bring their existence out into the open”. For example: “They outed me to my family.”


o ‘Doxed’:

To maliciously search for and publish identifying information about someone, usually on the internet. In relation to trans* identities, this can be a deadname or their home or work address for the purpose to cause harm.


o Non-Binary (enby):

A person who does not align with the gender binary.


o ‘Seahorse Dad’:

A trans* person who carries, or has carried, a child. It is often used in reference to trans masculine people - but it is definitely not a pre-determined factor in the use of this term. Further, this term shouldn’t be used unless the person in question has given permission.


o Transmedicalism:

The idea that, to be trans*, a person must experience dysphoria and pursue HRT and trans*-related surgeries.


o Gender-Neutral:

Gender-neutrality is the pursuit of using and implementing genderless language, objects, and actions. Gender-neutral terminology, toilets, toys, clothes, passports, etc. all fall under the use of this term.


o Gender Non-Conforming (GNC):

This term is typically defined in reference to a person, or persons, who do not fall into the aesthetics (looks) and/or policies (acts and beliefs) of the gender binary.


o Misgendering:

When a person misgenders another person, they (knowingly or not) use the wrong pronouns. See page _ for more information on how to deal with, or avoid misgendering.


o Deadname:

A ‘deadname’ is slang for a person’s old name, whether legally changed or not. Deadnaming refers to the process of using a person’s old name.


o Transitioning:

To transition can be social or medical.

Social transition refers to (but is not definitively) using different pronouns as to what one was assigned at birth, changing name and can possibly refer to changing aesthetics or presenting in a new way. It can also include legal changes, such as changing name, title, or gender on official documents.

Medical transition refers to the process of taking hormones and having surgeries to alter the body.


o Pre-transition:

This term is often used to refer to a person before they have medically transitioned, but can also be used to refer to a person before social transition.


o Detransition:

To detransition is to come off of hormones and/or have gender-reversing surgeries, and/or to take hormones associated with the person’s gender pre-transition. This is often used by FARTs/TERFs to fear-monger against the trans* community.



 

Medical Terminology and Slang


o Hormone Replacement Therapy (HRT):

Wherein the person receives hormones, either to supplement a lack of naturally occurring hormones, or to substitute other hormones for naturally occurring hormones. Common forms of hormones for hormone replacement therapy include:

- Oestrogen,

- Progesterone,

- And testosterone.

These each come in many ways depending on what the person wishes and what is viable for the person.


o Hormone Blockers/Puberty Blockers:

Refers to antiandrogens or gonadotropin-releasing hormone (GnRH) agonists. These stop specific hormones from being produced.


o Top Surgery:

Refers to the surgical procedures on the chest of a person, such as:

- Breast augmentation surgery (also known as; chest construction or breast mammoplasty),

- And subcutaneous mastectomy.

These procedures vary depending on what outcome the person wants, and also what is viable for the person.


o Bottom Surgery/Genital Reconstruction Surgery:

Refers to the surgical procedures on the pubic area of a person, such as:

- Feminising genitoplasty or penectomy,

- Orchiectomy,

- Vaginoplasty,

- Masculinising genitoplasty,

- Metoidioplasty,

- And phalloplasty.

A misconception about bottom surgery is that it is one singular surgery. Often, they are multiple surgeries, with months apart. Again, these procedures vary depending on what the person wishes to have, and what is viable for the person.


o Chest Feeding:

A gender-neutral term that refers to feeding a child human milk, using the chest.


o Pregnancy-Related,

Antepartum (before birth/labour/delivery),

Intrapartum (during labour/birth/delivery),

and Postpartum (after birth/labour/delivery):

These are gender-neutral terms for stages of pregnancy, to be used instead of terms like maternal.


 

(ID: A pink title card saying ‘Outdated, Offensive, and Questionable Terminology. It’s drawn with a pencil, in a 3D style, with rough edges and shading.)

Outdated Terminology



These may be used by trans* people to refer to themselves, but it is not okay to use any of these terms in reference to anyone other than oneself. A great many of these words are incredibly offensive to use for some cultures and/or people, and for this reason I will put a 🗙 symbol before it to highlight.

o Female to Male (FtM), or Male to Female (MtF):


Someone who was assigned female/male at birth who is transitioning to male. These terms are outdated, as they:


(A) Promote the idea that society should assign binary genders at birth, as ‘a person can just choose later’. This negates many harmful effects on trans* people from being assigned the wrong gender, and therefore socialised as the wrong gender, from birth. This includes the negation of the existence of intersex people.


(B) Promote the idea that a person is inherently their assigned gender at birth (AGAB). To say that a person was their AGAB before ‘identifying as trans’ (see page _ for why this phrase is harmful) assumes that this person chooses their gender, their feelings, and that their feelings have changed towards a gendered, binary society. Many trans* people feel the same way about themselves through life, wishing to achieve their internal feelings externally.


Often, struggle comes from trying to fit into a society that assumes one is always one rigid gender, rather than living as a human being. The exploration of the self, and of one’s gender, often comes with attempting to fit into societal labels, in order to help society, and sometimes oneself, in understanding trans* existence.


Labels may aid a person in understanding what they wish to pursue in terms of treatment and expression. However, the pre-determination of a person to have historically existed as a gender they did not ask for is unjust - and, as previously noted, provides society with the idea that trans* people ‘chose their own gender identity’, rather than searched for it against a cisgender system.




o Sex Reassignment Surgery/Gender Confirmation Surgery (SRS/GCS):


The surgical procedure(s) by which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble what is socially associated with their gender.

This terminology is incorrect, as it assumes that a person’s gender is ‘confirmed’, or ‘assigned’ alongside their genitalia. The correct terminology to use is ‘Genital Reconstruction Surgery’, else it is often referred to as 'bottom surgery'.


o Facial Feminisation Surgery (FFS):


Reconstructive surgical procedure(s) that alter(s) societally 'masculine' facial features to make them closer in appearance to societally 'feminine' facial features. This terminology is outdated, as it needlessly enforces stereotypes from the gender binary on people’s appearance. However, it is still used often by trans* feminine people, as it is a way to communicate the goals of a person’s transition to the gender binary societies.


o Gender Identity/Self-Identify (GID/SID):


The term used when ‘identifying’ or ‘self-identifying’ as a gender, or several genders. For many, it is a problematic notion to presume that gender is something that a person can ‘identify’ as, rather than just ‘be’. It assumes that there is autonomy in one’s gender, as ‘to identify’ means:


1.) To have searched and established a person’s gender, rather than that gender being a label for communication purposes only.


2.) To have searched and established a person’s gender, as if their gender dysphoria is something that can be established, instead of it existing, whether to one’s own knowledge or not.


3.) ‘Identify’ is often used to indicate similarity, rather than equivalence. By this it is meant that, in saying ‘she identifies as a woman,’ one is also saying ‘she is not the same as a woman’.


This may not be the case for everyone, but a useful exercise would be to ask yourself if you would use the same terminology for any cisgender people that you might know. If not, then this supports not using ‘identify’ for others. And if you would use it, then it likely means that you do not attach the meanings that others do to the word.


It is important to remember that these terms have varying meanings in different cultures, and that it’s always better to ask for permission to, or not use, a word that could potentially be harmful.



o 🗙Transvestite:


This is often (wrongfully) used interchangeably with ‘transgender’ and ‘transsexual’. They are not the same thing.

A transvestite is a term used to refer to a person who gains pleasure from using aesthetic materials (clothes, makeup, jewelery, etc.) of what the gender binary sees as the opposite gender.

It has historically been used often to insult trans* AMABs, or what the gender binary classifies as masculine people.



o 🗙Cross-dresser:


This term is often used against whomever the gender binary deems masculine, or AMABs.

It is used in the same light as transvestite, and transsexual. While anyone may wear clothes associated with a different sex, the term cross-dresser is typically used to refer to men who occasionally wear clothes, makeup, and other things that are often culturally associated with femininity.

This activity is a form of gender expression and not done for entertainment purposes. Cross-dressers do not wish to permanently change their sex or live full-time as women. It is often used in the same light as the term ‘transvestite’.


o 🗙Transsexual:


Oxford Languages defines this term as “denoting or relating to a transgender person, especially one whose bodily characteristics have been altered through surgery or hormone treatment to bring them into alignment with their gender identity.”


This is incorrect, as it equates ‘transgender’ to ‘transsexual’. These two are not the same thing, especially on a cultural level - though it is often misused interchangeably with ‘transgender’.

As with ‘tranny’, in many cultures this term is used as an insult to mock and alienate trans*, intersex people, and people who ‘are not a stereotype of their assigned gender’.

The term should never be used in the same light as ‘transgender’, but individuals may use it towards themselves, and give permission for others to use it for them, as they are transsexual.



 

Offensive Terminology


Again, these may be used by trans* people to refer to themselves, but it is not okay to use any of these terms in reference to anyone other than oneself.



o ‘Tranny’:

Unlike transsexual, this term has never been used as a scientific term, and is almost always used to insult trans*, intersex, or trans* adjacent people (those who do not fit into the gender binary).


o ‘He-She’:

Like ‘tranny’, this term is used to insult. Often, it is used against AFABs, or what the gender binary labels ‘feminine’ people, who do not fit into euro-centric ‘feminine’ beauty standards.


o ‘Transgendered/transgenders’:

These are offensive terms used both by accident and with intention.

o ‘Transtrender’:

A derogatory term that is primarily used to ‘gatekeep’ trans* existence. It is used to call a person a ‘transtrender’ is to say that they are trans* because of social ‘trends’. It implies that the person is ‘not actually trans*'.

This term is often used against non-binary or GNC trans* folks, as their genders, or lack thereof, are frequently misrepresented (in media, and on social platforms) as something ‘trendy’ - as they do not fall into the dominant narrative of binary transition.

The irony here being that the concept of ‘gender’, especially in the binary form we have today, is younger than the concept of existing without gender.


o ‘Truscum’:

The belief that a trans* person must experience gender-dysphoria, and medically transition. Also known as transmedicalist. Short for ‘true transexual scum’, often used in reference to oneself.


o ‘TIM/TIF’:

An abbreviation used by TERFs to refer to transgender people that stands for ‘trans-identified male’ and ‘trans-identified female’, often in order to invalidate transwomen and transmens’ identities.

For example, a TERF may refer to a trans woman as a ‘trans-identified male (TIM)’ because they do not accept them as being female in any way.


 


Reclaiming Offensive Terminology



Reclamation is to take something that is previously used against you, and re-appropriate it for your own use. For trans* people, this can include the list of offensive or outdated terminology.


‘Queer’ has also been reclaimed by many trans* people, as a part of the LGBTQIA2S+ community. Though it has historically been used as an insult, from its meaning: ‘strange’, many people have found it as an easier label to use to denote the fact that they are not straight and/or cisgender. Applied to gender specifically, many people also use the word ‘genderqueer’ to describe a non-specified, but not cisgender existence.


It is worth noting that some people are not comfortable with this word, as its historical connotations and contemporary usage as an insult has not yet dwindled into the history of stupidity.



 

Questionable Terminology


These terms are only appropriate for a trans* person to refer to themselves.

o ‘Passing’:

‘Passing’ refers to when a trans* person can ‘pass’ as a specific binary gender within a binary gendered society.


o ‘Stealth’:

‘Stealth’ refers to when a trans* person ‘passes’ as their gender, and then proceeds to re-enter society as within the cisgender binary.


o ‘Transwoman’/’transman’:

It has been suggested that we should use the terms ‘trans woman’ and ‘trans man’, instead of ‘transwoman’ and ‘transman’, as the latter is effectively a linguistic way to distance transgender binary people from cisgender people. Instead of ‘transwoman/man’ being a gender, it is better to say ‘trans woman/man’, as they are women/men regardless of their transgender existence.



 

Grammatically Correct Use of Trans* Terminology


❌Incorrect: "There is a high population of transgenders here"

✅Correct: "There is a high population of transgender people here"

❌Incorrect: "She is transgendered"

✅Correct: "She is transgender"

❌Incorrect: "He is a transgender"

✅Correct: "He is transgender"

❌Incorrect: "What is it like being a transgender?"

✅Correct: "What is it like being transgender?"

❌Incorrect: A transgender

✅Correct: A transgender person/man/woman

❌Incorrect: "These transgenders are protesting"

✅Correct: "The transgender community is protesting"



 


(ID: A pink title card saying ‘Pronouns’. It’s drawn with a pencil, in a 3D style, with rough edges and shading. Around the title are pronoun badges drawn roughly with a pencil. A round badge says ‘she/her’, a rectangular badge says ‘they/them’, and a square badge says ‘Hello, my pronouns are: he/him’)

Why it is Important to Respect Peoples’ Pronouns


It is important to respect and use a person’s pronouns, as it makes them feel respected and seen. It is not necessary to understand why a person uses specific pronouns, but to help a person feel safe around you, using their pronouns is the first step to treating them with respect. If you make mistakes, this is perfectly normal - but to actively ignore a person’s pronouns is, in effect, to ignore their potential for safety and happiness.


A person’s pronouns are not entirely self-chosen. They are often a way for the person to communicate and present themselves to others, as society often overlooks the ways in which we do not accommodate for others.

For example, in many English-speaking cultures it is not socially acceptable to refer to a woman as ‘she’, in her presence. This is a reason for the idiom, ‘SHE is the cat’s mother’, often said to a child who refers to a person who uses she/her pronouns in her presence. This is largely applied to the historical ignorance of feminine figures, and of how others often speak over women or people who use she/her pronouns. It is, in some ways, a feminist necessity in these cultures.

To apply this to other pronouns, for example they/them, these people often wish to not have the historically/socially applied, gendered stereotypes or ideas (ideologies) that come with she/her or he/him. The binary genders are, after all, not universal or integral to existence in society.


By ‘universal’, it is meant that the gender binary of only female and male is not apparent in all cultures - many cultures have a third gender, at least - and even their categorisations of female, male, and third gender are not entirely the same as the gender binary. By ‘integral to existence’, it is meant that there is no preconception of gender that can be applied to our being.


There are certainly sexual organs, hormones, chromosomes, and so on - but these vary wildly from person to person - a person with a beard does not necessarily have a penis, a person who doesn’t have periods does not necessarily have a vagina.


Some people argue that the pronouns ‘they/them’ can be confusing, because ‘they’ is often used to refer to more than one person. However, these pronouns have historically been used when referring to someone whose gender is unknown (rather than the archaic academic form of defaulting to ‘he/him’). As a result, it has been used to refer to singular persons on many occasions.


Another example could be: if you’re an Arsenal fan and told to wear a Spurs shirt because everyone else is wearing a Spurs shirt, as it would be awkward and uncomfortable for everyone else if you wore an Arsenal shirt. Football analogies aside, however, you can see how that situation might make an Arsenal fan uncomfortable - as they must pretend to be someone they are not - for the sake of other people.


Much like referring to someone as their name, it is important to do the same when referring to someone by their pronouns. If a person is trans*, they may introduce themselves by saying:

or have an indication as to what their pronouns are somewhere on their social media, or on a badge, and it is respectful of you to use those pronouns when referring to that person, even if you do not understand why they use them.


A lot of trans* people have gone through a lot to find themselves, and part of that journey was finding the pronouns they feel most comfortable with.


If you are unsure of a person’s pronouns, don’t be afraid to ask them. Maybe introduce yourself by saying:


to help the conversation feel more inclusive. There is nothing wrong with asking someone what their pronouns are, as long as you use the correct ones given to you by that person.



 

How to Practice Using a Person’s Pronouns


Try to think of scenarios in your head that include this person and the use of their pronouns.








 

A List of How to Use Pronouns & Examples



o She/her/hers

o He/him/his

o They/them/their(s)

o Xe/xim/xir(s)

o [Person’s name](‘s)



Xe/xim/xir(s) can be used in the same ways as they/them/their(s) is used.


They are going to town in their car. It is theirs.
Xe is going to town in xir car. It is xirs.


You also do not have to use any pronouns, on most occasions.


Person is going into town in Person’s car. It is Person’s.

The reason that an apostrophe is not used with his/hers/theirs/xirs seems to be pretty much down to ‘we just don’t’.


To use an apostrophe was common in middle English, and has since fallen out of fashion.


It is still used with names, however, to point out that the thing belongs to the person, and the ‘s’ is not a part of their name.



 


Asking About a Person’s Pronouns


To begin with, we should never assume a person's gender, and we should always use 'they/them' pronouns in reference to a person - unless they have stated otherwise.


To accidentally use the wrong pronouns is a normal experience, especially for those who are not used to using a new set of pronouns. If you do mistakenly use the wrong pronouns, correct yourself as soon as you can.


A 'sorry' in recognition of the accident is not always needed, but this may depend on your relationship to the person - and the situation in which you are both interacting. It is easy to make mistakes as you learn to use the right pronouns, and unless the trans* person has expressed that they are upset, it is not always required to apologise formally.


Some trans* people will be uncomfortable if you apologise too much. Though reasons may vary as for why, an example would be that you are then asking the trans* person to comfort you.



In a Group or Professional Setting


It is not uncommon to ask a person for their pronouns. In some cases, a person will wear a pronoun badge. In others, a person will introduce themselves with their pronouns. However, it can be dangerous to ask for a person's pronouns. Society, at large, is still transphobic. By this, it is meant that a person can be 'outed' as trans+ when asked their pronouns.


For example, a person who uses 'they/them/xe/xir' will be recognised as trans+ upon stating their pronouns. If there is any transphobic presence around them, they will be in danger of transphobic attack. Further, a trans* person may be questioning their pronouns, or perhaps not ‘out’ yet, and therefore asking them of their pronouns may be a point of anxiety for them.


Another example would be that, if a person does not wish to state their pronouns for fear of transphobia, they will then be at risk of experiencing transphobia.


The best way to tackle this issue in group settings is to use the pronouns 'they/them' by default, and encourage everyone to do so, unless individuals of the group have stated otherwise.



 

Correcting People After They Use the Wrong Pronouns


As a trans* person, or even as a cisgender person, it is often uncomfortable to be called the wrong pronouns. The discomfort often grows with each time one is misgendered. Of course, it is on nobody but yourself to judge and determine how you react to being misgendered.


As a peer (friend, family, colleague) of the person whose pronouns are being overlooked - it can be helpful to remind others to use their correct pronouns. It is always advisable to check with this person beforehand, however. It is not your responsibility to speak for a person, especially if they have not given permission for you to do so.


Knowing what an appropriate reaction is to a situation entirely depends on how the individual feels, and this is for nobody else to judge. It may be that this person has trauma associated with being misgendered, or that they do not care at all, and we can never assume what a person has gone through in order for them to react a certain way.


If someone is disrespecting your pronouns, it is important to listen to how you feel about it. Often, it is also important to be aware of your safety in the situation, and sometimes waiting until you are safe is one of the best ways to deal with transphobia.



 


Gendered Titles and Terms


These terms are often very heavily influenced by cultures and their historical uses.


It is generally advised to use gender-neutral terms when referring to a group, for example, or when referring to a peer whose gender you do not know, you would use ‘they/them’ pronouns.


It’s a good idea to ask, if you are close to a person, if they are okay with talking, preferably in private, what terms they are comfortable with - but they do not owe an answer. Otherwise, using broadly gender-neutral language would be the safest form of inclusivity.



Gender-Neutral Terms for Peers


For friends, family, colleagues, and groups of people.


o Folk(s)/folx,

o Friend(s),

o Fellow(s),

o Colleague(s),

o Comrade(s),

o Sib(ling(s)),

o Bestie,

o Chum(s),

o Partner(s) in crime.


Some of these are certainly more informal than others, but don’t hesitate to get creative. Maybe there is something that you have in common with a person, and this can be used in reference to your relationship.



Gendered Terms for Peers


Friends, family, colleagues, and groups of people.


o Guy(s),

o Bro(s),

o Mate(s),

o Boy(s),

o Girl(s),

o Lad(s),

o Lass(es),

o Dude(s),

o Buddy/ies,

o Bud(s).


In bold are the terms that are heavily gendered. There are ongoing debates around what terms are actually gendered, as many of these terms are used by people without any thought to gender - in many cultures, historically masculine terms have been appropriated by those who are not cisgender men.


As with many issues surrounding terminology in this group, it is best to either use gender-neutral terms, or make sure that those around you are happy with using gendered terms for them. [A/N: the fact that the ‘feminine’ terms are much more widely gendered indicates that we should not take lightly the historical usage of these terms and our reasons for appropriating them.]



Titles


Mx is generally used when the gender of a person is unknown, and it is used by trans* individuals. It is pronounced ‘mix’ or ‘mux’.


Many trans* people prefer to use no title at all, but if there is a necessity, a gender neutral title should always be used unless the trans* person has given permission for another to be used. If you are uncomfortable with using binary gendered titles, in cases such as an unimportant questionnaire where they give you no choice but to choose from binary gendered titles, but have professional titles, it is not uncommon to choose ‘Dr.’, ‘Prof.’, and so on.


Gendered titles include: Ms (this can mean Miss or Mrs, it is used when the marital ‘status’ of a state-recognised ‘woman’ is unknown, or that they do not wish to be referred to by their marital status), Miss, Mrs, Mr/Mister, M/MSTR/Master.


Gender-Neutral Terms for Family



​​​Gender Neutral

Gender Binary

Partner, or significant other

Boyfriend, girlfriend, husband, or wife.

Spouse

Specifically for husband or wife.

Betrothed

Fiancee or fiance.

Pibling

Aunt or uncle

Nibling, chibling, or sib-kid (sibling’s kid)

Niece or nephew.

Grandchild

Grandson or granddaughter.

Grandparent, Nonny, or Baba

Grandfather or grandmother.

Parent, Pubba, or Baba

Mother or father.

Sibling, or sib

Brother or sister.

Child or kid

Son or daughter.


 


ID: A pink title card saying ‘Trans* Medical Procedures’. It’s drawn with a pencil, in a 3D style, with rough edges and shading.


Disclaimer: We are not medical professionals. The information given here is from informative texts and experiences. Please always go through a doctor rather than self-medicate with hormones, as this could potentially have serious effects on your health. The information below is purely to explain aspects of medical transition to those who wish to learn more.



 

Hormone Replacement Therapy (HRT)



HRT is where the person receives hormones, either to supplement a lack of naturally occurring hormones, or to substitute other hormones for naturally occurring hormones.



Common forms of hormone replacement therapy include:

o Oestrogen,

o Progesterone,

o And testosterone.



These each come in many ways depending on what the person wishes and what is viable for the person.


Medications, age, and pre-existing illnesses can influence how a person is treated with hormones.


Before starting HRT, it is best that a person book for blood work to check things such as:

o FBC (full blood count),

o U&Es (urea and electrolytes),

o LFTs (liver function tests),

o Lipids (cholesterol),

o HBA1C (haemoglobin, blood sugar),

o and Testosterone or Oestrogen levels.



It is also recommended to have these tests done after around 3 months, especially if a person is on other medications, or for people over 60.


(https://www.gendergp.com/blood-test-orders/, cited 31/07/21) 



 


Oestrogen




It is advised to start on a low dose of oestrogen to ensure that you are comfortable with the effects, and that your body does not react in any unexpected way.



Forms of Oestrogen:

o Oral (tablets),

o Transdermal (patches, gels),

o And implants.



Anti-androgens will also be recommended, as they inhibit the production of testosterone. Progesterone is also an option in the case that anti-androgens have not worked, but this blocks less testosterone, and may come with other side effects.


Forms of Anti-Androgen:

o Spironolactone,

o Cyproterone acetate,

o And Flutemide.


Forms of Progesterone:

o Dydrogesterone,

o Medroxyprogesterone,

o Norethisterone,

o And Levonorgestrel.



According to UCSF Transgender Care, progesterone is thought to:
“have a number of benefits, including: improved mood and libido, enhanced energy, and better breast development and body fat redistribution, there is very little scientific evidence to support these claims.” UCSF also states that “progesterone should be used with caution as it can cause mood symptoms such as anxiety, depression, or irritability, and can cause weight gain. Progesterone can have a negative impact on blood cholesterol, though this is usually of minimal significance unless there is a pre-existing and poorly controlled cholesterol or cardiac condition.”

(https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy, cited 31/07/21)


Effects of Oestrogen


The following effects will vary from person to person. Much can depend on genetics and kinds of treatment. The amounts of each of these prescribed (usually noted in mg, short for milligrams), will vary based upon both what results a person wishes for, and what is safe for the person.



The Mayo Clinic lists these potential effects of oestrogen;


o “ Decreased libido.

This will begin one to three months after starting treatment. The maximum effect will occur within one to two years.


o Decreased spontaneous erections.

This will begin one to three months after treatment. The maximum effect will occur within three to six months.


o Slowing of scalp hair loss.

This will begin one to three months after treatment. The maximum effect will occur within one to two years.


o Softer, less oily skin.

This will begin three to six months after treatment.

o Testicular atrophy (shrinkage, likely to less than half of their original size).

This will begin three to six months after treatment. The maximum effect will occur within two to three years.


o Breast development.

This will begin three to six months after treatment. The maximum effect will occur within two to three years.


o Redistribution of body fat.

This will begin three to six months after treatment. The maximum effect will occur within two to five years.


o Decreased muscle mass.

This will begin three to six months after treatment. The maximum effect will occur within one to two years.


o Decreased facial and body hair growth.

This will begin six to 12 months after treatment. The maximum effect will occur within three years.”


The Mayo Clinic lists these potential side effects of oestrogen;


o “ A blood clot in a deep vein (deep vein thrombosis) or in a lung (pulmonary embolism).


o High triglycerides, a type of fat (lipid) in your blood.


o Weight gain.


o Infertility.


o High potassium (hyperkalemia).


o High blood pressure (hypertension).


o Type 2 diabetes.


o Cardiovascular disease.


o Excessive prolactin in your blood (hyperprolactinemia).


o Nipple discharge.


o Stroke.


o Increased risk of breast cancer compared to [those] whose gender identity and expression matches the stereotypical societal characteristics related to their sex assigned at birth (cisgender men).”



Other possible effects include:


o A change in emotional state:

Some people experience a wider range of emotion, a change in their interests, sexuality, and behaviour.


o A change in sexuality:

Some people experience a change in their sexuality, their preferences, interests, and so on. Erections may last less time, and penetration may be more difficult (this can be helped with erectile medications). Ejaculation may produce clear fluid. Further, orgasms may spread further in the body, but with a less intense climax.


(https://www.mayoclinic.org/tests-procedures/feminizing-hormone-therapy/about/pac-20385096, cited 31/07/21)



 


Testosterone


It is advised to start on a low dose of testosterone to ensure that you are comfortable with the effects, and that your body does not react in any unexpected way.



Forms of Testosterone:

o Injections,

o Transdermal (patches, gels),

o Oral (tablets).


Effects


The following effects will vary from person to person. Much can depend on genetics and kinds of treatment. The amounts of each of these prescribed (usually noted in mg, short for milligrams), will vary based upon both what results a person wishes for, and what is safe for the person.


Possible effects of testosterone are:


o Increased libido.

o Redistribution of body fat.

The change of musculature and body fat distribution will occur over months into years, which is why doctors recommend waiting 6-12 months before top surgery - as by then, the shape of your body will allow them to operate with more accuracy.

o Cessation or interruption of menstruation.

Within around 5 months of starting testosterone.

o Gain in muscle.

o Oily, sweatier, coarser skin.

o More visible veins.

o Acne.

Should arise in the first year and go away after this year.

o Deeper voice.

Varies a lot, but should occur within the first six months and continue to change over the year.

o Facial and body hair growth.

Depending on genetics, like baldness, it should occur over the first few years of testosterone therapy.

o Baldness.

Depending on genetics, like baldness, it can occur after a year or even several - the rate at which baldness effects you can be heavily impacted by genetics.

o Clitoral growth.

Usually peaks at around 2 to 3 years into HRT, growth averages anywhere from 4-5cm, but can be up to 8cm.


Other possible effects include:


o A change in emotional state:

Some people experience a smaller range of emotion, a change in their interests, sexuality, and behaviour. People also report a heightening in confidence or energy, though this may be from the transition itself.


o A change in sexuality:

Some people experience a change in their sexuality, their preferences, interests, and so on. Libido may increase, and orgasms may be more localised with a higher climax, but with less of a full-body effect.


The Mayo Clinic lists these potential side effects of testosterone;


o “Producing too many red blood cells (polycythemia),

o Weight gain,

o Acne,

o Developing male-pattern baldness,

o Sleep apnea,

o Developing an abnormal level of cholesterol and other lipids,

which may increase cardiovascular risk (dyslipidemia),

o High blood pressure (hypertension),

o Type 2 diabetes,

o Deep vein thrombosis and/or pulmonary embolism (venous thromboembolism),

o Infertility,

o A condition where the lining of the vagina becomes drier and thinner (atrophic vaginitis),

o Pelvic pain,

o [and] Clitoral discomfort.”

(https://www.mayoclinic.org/tests-procedures/masculinizing-hormone-therapy/about/pac-20385099, cited 31/07/21)



 

Hormone Blockers/Puberty Blockers


Refers to antiandrogens or gonadotropin-releasing hormone (GnRH) agonists.


These stop specific hormones from being produced. Antiandrogens and GnRH agonists are used for people who wish to treat production of testosterone, whereas GnRH agonists are used for people who wish to treat production of oestrogen. In the UK, these treatments are not allowed for any children under the age of 16, and these children must then have been on puberty blockers for at least 12 months.


TransHub states that:

“GnRH analogues have been used to suppress puberty for the last 20 years and short-mid term studies have found them to be well tolerated by the body when used temporarily. Long term studies are currently underway.
GnHR analogues can affect your final height and could make you slightly taller if administered without gender affirming hormones and before the first growth spurt of puberty. This is because bones do not stop growing until exposed to estrogen or testosterone.”

(https://www.transhub.org.au/puberty-blockers, cited 31/07/21)




Examples of antiandrogens are:

o Spironolactone,

o Cyproterone acetate,

o And Flutemide.




Examples of gonadotropin-releasing hormone (GnRH) agonists are:

o Leuprorelin,

o Histrelin,

o Triptorelin,

o And Goselerin.

 

(ID: A pink title card saying ‘Top Surgeries’. It’s drawn with a pencil, in a 3D style, with rough edges and shading.)

Content Warning: diagrams of these surgeries follow.



The information that we provide is only supposed to be used as basic provisions in order to understand surgeries to a better extent.


Always listen to medical professionals, but never hesitate to contact more than one surgeon if there is any worry about misinformation.


You should never have to put up with any transphobic behaviour from your surgeon or doctor, and it is always worth having more than one professional opinion.



 

Double Excision

(Subcutaneous Mastectomy)



Wherein two incisions are made to remove the unneeded skin, along with the fatty tissue of the chest, and the nipples are grafted on and possibly resized to fit the new shape. The feeling in the area may change or disappear entirely. There is a small risk of these nipples not receiving enough blood flow due to this movement, and the nipples may not survive the grafting - please discuss this risk with your surgeon.




Nipple-Sparing Double Excision

(Subcutaneous Mastectomy)


Wherein two incisions are made to remove the unneeded skin, along with the fatty tissue of the chest - but due to there being less tissue removed - the nipples are not removed and grafted back on. Therefore, the nipples maintaining feeling and have no chance of tissue death.




Peri-Areolar Incision

(Subcutaneous Mastectomy)


For those with a very small chest. Smaller incisions are made around the areola (nipple), and then larger incisions surrounding the nipple are made – the surgeon then removes the skin between these incisions and sutures the two incisions together. Those with smaller chests can have this surgery, avoiding the long scars that a double excision surgery provides, and maintaining feeling in the nipple.





 

Chest Construction Surgery


For chest construction surgeries, there are implants.



According to the NHS website, chest construction surgery includes:


o An incision made next to or below the chest.

o The implant put behind the chest muscle or between the breast tissue and chest muscle.

o Takes around 60 to 90 minutes.

The most common type of implant is made of silicone, as it is “less likely to wrinkle and [will] feel more natural. However, they can spread into your chest and cause lumps”. There are silicone implants with a rough side, designed to prevent any slipping from happening.


As the NHS website further states, “saline implants are more likely to fold, rupture or go down over time. If they go down or rupture, the saline will safely be absorbed into your body.”


(https://www.nhs.uk/conditions/cosmetic-procedures/breast-enlargement/, cited 04/08/21)


 

(ID: A pink title card saying ‘Bottom Surgeries’. It’s drawn with a pencil, in a 3D style, with rough edges and shading.)

Again, the information that we provide is only supposed to be used as basic provisions in order to understand surgeries to a better extent. Always listen to medical professionals, but never hesitate to contact more than one surgeon if there is any worry about misinformation. You should never have to put up with any transphobic behaviour from your surgeon or doctor, and it is always worth having more than one professional opinion.


As with any surgery, the patient is required to stop any intake of nicotine at least one month before the procedure, and to continue this whilst recovering - as it can effect recovery results.


The risks of these procedures include struggle to urinate, haemotomas (blood mass within the area of surgery), tissue death, and other issues that are best to discuss with one, or multiple surgeons or doctors before having a surgery. Further, many of these surgeries may require a long span of time in between surgeries. For example, when having scrotoplasty, a surgeon may recommend implants to stretch out the labia for a duration of time before surgery. Further, the more intense procedures will require numerous check-ups and possible re-touchings. Many of these surgeries will take at least a year to heal appropriately.


As this text has been made in the UK, I feel that it is important to note - no bottom surgeries are being performed under the NHS as of publishing (01/09/2021).



 

Vaginoplasty


Before this surgery, the patient will need to undergo electrolysis hair removal on the pubic area being used for the construction of a vagina. They will also need to quit smoking for at least a month before the procedure, as any nicotine will decrease blood flow and hinder surgical recovery. They may also need to lose weight for best results. A risk of this surgery, which is much higher than a vulvoplasty, is what is called a ‘rectal injury’ - a tear between the rectum and vagina.1


A vaginoplasty consists of:

- A surgeon will use penile tissue to create the inner and outer parts of a vagina.

- They will then use penile and scrotal tissue to construct the inner and outer labia of the vagina. Scrotal tissue will also be used to create the vaginal canal, but if there is not enough tissue, they will use “skin from the sides of your abdomen where there won’t be a very noticeable scar.”1

- They will relocate the urethra into a new opening for urination.

- The tissue from any foreskin will be used to create the entrance of the vagina.

- For the vaginal canal, the surgeon “will create a space between your rectum and bladder. Once your skin graft is inserted, your surgeon will place gauze or spongy material inside the new vaginal canal for 5 days. The gauze puts pressure on the skin graft so it grows like it should into the surrounding vaginal tissue.”1

- The penile tissue used to create the clitoris, for most people, can achieve orgasm.

- A patient should stay in the hospital for 5 days for bed rest, with bandages for compression both inside and outside the area, to promote proper healing.


The University of Utah recommends at least 2 weeks before dilating the vagina, to allow time to heal - after this period, using the dilators that the surgeon has given, “you should dilate your vagina 2-3 times each day for the first 6 months after your surgery.”1


 


Vulvoplasty


Before this surgery, the patient will need to undergo electrolysis hair removal on the pubic area being used for the construction of a vagina. They will also need to quit smoking for at least a month before the procedure, as any nicotine will decrease blood flow and hinder surgical recovery. They may also need to lose weight for best results.


This surgery focuses on the vulva, which is the outer part of the vagina. It does not include the construction of the vaginal canal, which means the patient will not be able to have vaginal intercourse - however clitoral stimulation will still function.

A vulvoplasty is often chosen for the faster recovery (3 days in the hospital), lower chance of injury, and other problems. It is a good choice for those who do not wish to have vaginal intercourse.


A vulvoplasty consists of constructing:


- A clitoris out of the head of the penis,

- “An inner and outer labia from skin on the penis and scrotum,”1

- “The opening of the urethra so you can urinate, and”1

- The “opening of the vagina.”1


 

Orchiectomy


An orchiectomy is specifically for the removal of testes. This may aid in HRT, as the person will be able to take less oestrogen - aiding the avoidance of health complications from oestrogen, such as blood clots. However, it is important to maintain a healthy level of hormonal intake, blood tests and oestrogen will still be needed.


The surgery can take around 20 minutes, and only needs to be operated under general anaesthesia.


As the University of Utah describes the procedure:

“Your surgeon will make an incision (or cut) about an inch long in the middle of the scrotum. Then your surgeon will clamp your spermatic cord and tie some strong stitches around it to prevent bleeding. After that, your surgeon will cut your spermatic cord and remove your testicles. Your surgeon will then close your incision with absorbable stitches that will dissolve on their own.”1

The largest risk of this surgery is a haemotoma, a pooling of blood somewhere within the surgical area, but this risk is at less than 5%.1



 

Metoidioplasty


This surgical procedure is for the construction of a small penis using tissue within the pubic area. It is often preferred over a Phalloplasty, as it does not require a skin graft from the forearm. Boston Children’s Hospital points out that a metoidioplasty can be used for a phalloplasty, but not the reverse.3


A metoidioplasty consists of:


- “Clitoral release - the tissues that hold the hormonally enlarged clitoris are divided. This allows the clitoris and its shaft to rotate outward.” Using the clitoris to create the head of the penis. It is for this reason that taking a course of testosterone to increase the size of the clitoris is required.

- A vaginectomy, the removal of the vagina - “the uterus, ovaries, and fallopian tubes.”

- “Vaginal mucosectomy & vaginal closure — The vaginal canal lining is removed and the canal is closed with absorbable sutures (stitches). This allows the tissues to heal together.”

- ‘Urethral elongation’ - the lengthening of the urethra and repositioning through the constructed penis, “to move the opening to the tip of the newly created penis.” The lengthening is done by using other areas of the vagina, such as the labia minora, but can use the inside of your cheek and similar tissues - to allow the patient to stand whilst urinating.

- If the patient has a ‘Centurion procedure’, the surgery will “involve repositioning round ligaments under the clitoris to increase the girth of the penis.”

- The whole procedure can take anywhere from 2 to 5 hours, and may include further surgeries.

- A metoidioplasty “may become erect, due to the erectile abilities of clitoral tissue,” but the penis constructed will be “too small for penetrative sex.”

- “Scrotoplasty — A scrotum will be created from the vaginal tissues of the labia majora. Testicular implants may also be placed at a later date. Both of these are optional.”

- A catheter inserted into the urethra will stay for 5 to 7 days,2 until the urethra is structurally sound for removal, according to Medical News Today, but Boston Children’s Hospital specifies 3 to 4 weeks.3

- “According to estimates reported in 2019 in the journal Translational Andrology and Urology, urethral fistulas occur following 7-15% of metoidioplasty procedures, and urethral stricture develops after 2-3%.” 2


In a partial hysterectomy, a surgeon will remove only the uterus.


In a total hysterectomy, they will also remove the cervix.


A bilateral salpingo-oophorectomy, or BSO, involves the removal of the right and left fallopian tubes and ovaries.3



 

Phalloplasty


A phalloplasty differs from a metoidioplasty primarily by the fact that a large chunk of skin will be grafted on to the penis. It is often taken from the forearm, but in difficult cases it may be taken from other areas.


The penis will also be larger than in a metoidioplasty, but it will not become erect without the penile implant that is surgically inserted after initial surgery to construct the penis. A phalloplasty requires a much larger amount of surgical revisions, and will cost a great deal more than metoidioplasty.



 

Scrotoplasty


A patient can have a scrotoplasty alongside a phalloplasty or metoidioplasty.


A scrotoplasty consists of using the labia majora to construct testes with testicular implants.3


For Phalloplasty, Scrotoplasty, and Metoidoplasty procedures - the patient is usually required to stay in hospital for a couple of days after surgery. Further, it is advised that the patient does not engage in a great deal of activities for at least 6 weeks - to promote the healthy healing of the pubic area.



 

1 (https://healthcare.utah.edu/transgender-health/gender-affirmation-surgery/vaginoplasty.php, cited 04/08/21)

2 (https://www.medicalnewstoday.com/articles/326590, cited 04/08/21)

3 (https://www.medicalnewstoday.com/articles/metoidioplasty#risks, cited 04/08/21)

4 (https://www.childrenshospital.org/conditions-and-treatments/treatments/metoidioplasty, cited 04/08/21)  



 

On Detransitioning


There are many reasons for why a person may decide to detransition, for example:


- Botched surgeries,

- Lack of support from peers (family, friends, and colleagues),

- Being unable to find a job due to discrimination,

- Difficulties or unwanted results from HRT,

- Discrimination and anti-trans* society,


- Threats to:

- Lose custody of children,

- Losing a job,

- Divorce or lose relationships,

- Lose housing or shelter


It is extremely rare for someone to detransition due to someone no longer feeling like the gender by which they exist.


Detransitioning is constantly used to gaslight trans* people.

In the case of children, transitional care means puberty blockers up until an age that the family and the doctor(s) responsible for that care determine that it is appropriate for them to begin HRT.


“The 2015 U.S. Transgender Survey found that 8% of respondents who had transitioned reported having ever detransitioned, and 62% of that group had later returned to living in a trans identity. About 36% reported having detransitioned due to pressure from parent, 33% because it was too difficult, 31% due to discrimination, 29% due to difficulty getting a job, 26% pressure from family members, 18% pressure from a spouse, and 17% due to pressure from an employer.” (Sarah Boslaugh, Transgender Health Issues, 2018, pp. 43–44).

 

(ID: A pink title card saying ‘Help To Talk About Gender’. It’s drawn with a pencil, in a 3D style, with rough edges and shading.) 

 

If You’re Cisgender


Don’t speak over trans* people, but speak when nobody else is. Further, try not to speak symbolically for trans* people - saying “I’ve been told that…”, “I think that…” and so on before stating an argument. Trans* people should also do this to avoid making generalised statements about all trans* people, or any category that exists within. As mentioned, all trans* experiences are unique, and a person can only talk about themselves with absolute certainty.


Try Not to Say…

Biologically/genetically male/female

Born a man/woman

Passing

Trans* is Not a Disability


“You’re disabled under the Equality Act 2010 if you have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities.” - https://www.gov.uk/definition-of-disability-under-equality-act-2010

Often, gender dysphoria is categorised as a disability. Gender dysphoria is not a disability, though some people and academic sources refer to it as such. It is often classified as a disability because:


1.) It can impact a person’s ability to perform day-to-day activities, as caused by things like depression and anxiety, which are often caused by no treatment of gender dysphoria.

2.) Mental illness is categorised as a disability if it impacts a person’s ability to do day-to-day activities.

3.) Some people believe that gender dysphoria requires medical attention (hormones, surgeries, and so on).


The argument against this is:


1.) Not all trans* people, even with dysphoria, wish for medical attention.

2.) Mental illnesses caused by gender dysphoria can be eradicated with treatment and social change.

3.) Trans* issues such as hate crime are already protected under the Equality Act.


Trans* Does NOT Mean Mentally Ill


Being trans* does not require having gender dysphoria. Often, having gender dysphoria is an aspect of being trans*, but this does not mean all trans* people must experience gender dysphoria – contrary to what transmedicalists assume. Other than gender dysphoria, trans* people often have to deal with discrimination and misunderstanding in many areas of life. This can very easily lead to a struggle with mental wellbeing.


A large issue with mental health in the trans* community is finding appropriate resources to help with the struggles of gender dysphoria and societal discrimination. For example, it can be hard to find and/or fund hormone replacement therapy, surgeries, counselling, therapy, and even clothing.


It is through these problems, and the lack of treatment for gender dysphoria, by which trans* people can develop mental illnesses. It is not a trans* person’s existence in and of itself that determines this. It is how society (friends, family, the workplace, and so on) mistreats and misunderstands people who do not identify with the pre-defined gender binary.

Sources for Reading:


"DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS." 5 (2013): 452-53. American Psychiatric Association.

Parekh, Ranna, and American Psychiatric Association. “What Is Gender Dysphoria.” What Is Gender Dysphoria?, Feb. 2016, http://www.psychiatry.org/.../what-is-gender-dysphoria.

Glicksman, Eve. “Transgender Today.” Monitor on Psychology, American Psychological Association, Apr. 2013, www.apa.org/monitor/2013/04/transgender.aspx.

American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders: DSM-5.” Diagnostic and Statistical Manual of Mental Disorders: DSM-5, vol. 5, American Psychiatric Publishing, 2014, pp. 451–459.



 


(ID: A pink title card saying ‘A Bit of Trans* History’. It’s drawn with a pencil, in a 3D style, with rough edges and shading.)


 

Marsha P Johnson



Born August 24, 1945

Died July 6, 1992


Marsha P. Johnson was the fifth child of seven children – born in Elizabeth, New Jersey. She was wrongfully assigned male at birth.


As a kid, Marsha wore women’s clothing and found happiness in dressing as her gender. Unfortunately, due to the characteristic harassment of the gender binary, she had to stop dressing as her own gender.


When Marsha had graduated high school, she moved to Greenwich Village, New York City – with only a bag of clothes and fifteen dollars. She started her drag career here, at first under the moniker ‘Black Marsha’, which later developed into ‘Marsha P. Johnson’ – the ‘P.’ standing for ‘Pay it no mind’, which was her response to people that asked her gender.


In the 1960s, it was illegal to dress in drag – though she was one of the many women to defy against this rule. She proudly wore feminine clothes even during day hours (very daring for the time!).


It was on June the twenty-eighth, nineteen-sixty-nine, the day when police raided the Stonewall Inn, that Marsha’s bravery made a lasting impact on the LGBTQIA* community. As routine, the police would check the patrons’ identifications, and, in a horrific sense, ‘determine’ the gender of any patrons dressed as women. Any AMAB wearing ‘feminine’ clothing would be arrested and taken to jail.


The patrons of the Stonewall Inn, this time, had enough. Lesbians had been inappropriately ‘touched’, and others were gearing to engage in their right to protest. Word had began to spread about the altercation in the Inn. As a response to these tensions, the police had aimed to arrest the majority of the patrons at the Inn – but during this time, Marsha P. Johnson, Sylvia Rivera, and one-hundred to one-hundred-and-fifty others had made it onto the scene. As the police had no intention of letting innocent people go, or at all to leave any person alone in the future, bottles and bricks 103 were thrown at police. From there on, the Stonewall Riots were commemorated in history as one of the most important dates in LGBTQIA* history.


Marsha and Sylvia had gone on to create STAR (Street Transvestite/Transgender Action Revolutionaries) – in order to aid homeless LGBTQIA* people, specifically trans* people of colour.


On the fourth of July, nineteen-ninety-two, Marsha disappeared after getting into a fight with a neighbour. This neighbour had, later, ‘bragged’ in a local bar about killing a ‘drag queen named Marsha’. Many people came forward, recounting Marsha being seen with ‘a group of thugs’. What is particularly concerning is, Marsha herself believed that the mafia was tailing her after the events of Stonewall.


On the sixth of July, her body was pulled out of the river, and police named the death a ‘suicide’.


Read more:

https://www.biography.com/activist/marsha-p-johnson


 

Magnus Hirschfeld





Born May 14, 1868

Died May 14, 1935.


Magnus Hirschfeld, a gay German-Jewish physician and sexologist, studied homosexuality and transgender treatments.


In 1910, he coined the term ‘transvestite’ – as with any term, it had not yet gained its notoriety as an insult. ‘Vestite’ meaning ‘body’, and ‘trans’ meaning ‘different’, or ‘change’. His institute was based in Berlin-Charlottenburg, and was called the ‘Institute of Sexual Research’, or ‘Institut fur Sexualwissenschaft’.


Magnus was one of the first people to attempt early forms of gender ‘affirmation’ surgery, the first of which was Lili Elbe – the first person to undergo surgery to ‘affirm’ their gender. It should be noted that Hirschfeld was not Elbe's surgeon.


In 1933, whilst Hirschfield was away in the US, Nazis terrorised the institute – screaming hysterically; ‘Burn Hirschfeld!’ and assaulting staff. As fascists are want to do, they proceeded to burn the books, journals, and documents alongside the institute itself. They took the list of his patients and sent all those on the list to the concentration camps.


Magnus never returned to Germany.


It is of great note to state that – there are famous pictures and videos of the fascists storming this Institute. These pictures and videos are hardly ever noted to be of the Institute for Sexual Research.


Read more:

Magnus Hirschfeld: The Origins of the Gay Liberation Movement, by Ralf Dose; Translated by Edward H. Willis MR Admin.

https://magnus-hirschfeld.de/ausstellungen/institute/


 

Lili Elbe




Born 1882

Died 1931


Lili Elbe is famed as the second trans woman to under-go genital reconstruction surgery.


She was a Danish artist, having studied at the Royal Danish Academy of Fine Arts. Here, she met Gerda Gottlieb, her wife. They had moved to France, where Lili painted landscapes, and Gerda illustrated and photographed for fashion magazines. At one point, Lili modelled for Gerda in women’s clothing – and, after this, discovered that they would like to pursue transition. Gerda continued to support Lili, who left her art behind (it being a figure to her of her masculine life), and became a model for Gerda’s fashion career.


Lili travelled to Germany for genital reconstruction surgery – which, in those days, was four surgeries. Adding insult to modern practice, Lili was accepted as socially and legally female in 1930 (after the third surgery). Even the King of Denmark recognised her femininity, and hence annulled her marriage to Gerda, as lesbian marriages were not recognised at the time.


After the marriage was annulled, Lili re-married with an old friend, planning on having a uterine implant in order to have her own children with her fiancee. Unfortunately, in 1931, the fourth surgery (constructing the vaginal canal and transplanting a uterus) proved to be fatal, after her body rejected the transplant and became infected.


Read More:

Man Into Woman, by Lili Elbe

https://www.biography.com/people/lili-elbe-09081


 

Sylvia Rivera






Born July 2, 1951

Died February 19, 2002


Sylvia Rivera, a Puerto Rican or Venezuelan trans woman, fought alongside Marsha P. Johnson in the Stonewall Riots. She had worked the streets since she was just ten years old. Like many trans people, she was subject to sexual exploitation and violence from countless people.


Sylvia Rivera was a person who would throw herself out of a moving police car to escape arrest. She did that. She never hid her femininity, whether it be wearing make up to school at eleven years old, or fighting cops in a dress and heels. Having founded Street Transvestite/Transgender Action Revolutionaries (STAR) with Marsha P. Johnson, she helped open a homeless shelter for trans* youth.


She is also well-known for her ‘Y’all Better Quiet Down’ speech after being angered by the marginalising mindset of white, bourgeois gay people of NYC during a parade in 1973:


““You all tell me, go and hide my tail between my legs.
I will no longer put up with this shit. I have been beaten.
I have had my nose broken.
I have been thrown in jail.
I have lost my job.
I have lost my apartment.
For gay liberation, and you all treat me this way?
What the f**k’s wrong with you all?
Think about that!”

Sylvia passed away in 2002 from liver cancer.


Read More:

https://www.biography.com/activist/sylvia-rivera


 

Dr. James Barry




Born November 9, 1795

Died July 25, 1865


As a child, he would state "Were I not a girl, I would be a solider!" and a solider they became.


A military surgeon in the British Army. He earned his medical degree at University of Edinburgh Medical School. He was a strict vegetarian and teetotal. He performed the first cesarean section in Africa in which both the mother and child survived the operation.


He unwillingly retired from the military in 1859 where he spent the rest of his retirement in London until he passed away from dysentery.


When a nurse removed his clothes to prepare and clean his body (against Dr Barry's wishes), she noticed he had a vagina and stretch marks that indicated he had given birth.

Sources:

https://en.wikipedia.org/wiki/James_Barry_(surgeon)

https://www.history.com/.../the-extraordinary-secret-life...

https://www.spectator.co.uk/.../doctor-in-disguise-the.../#



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