In Transition: Physical transitions can include hormone treatment, surgery

Photo credit: Karyn Simpson

By Molly Atchison | Opinion Editor

Editor’s Note: This is the third installment in a four-part series about gender transition and the issues surrounding it. For the personal safety of some of the individuals mentioned below, last names have been omitted.

Physical health is a multi-faceted issue that transgender people focus on once they’ve determined that they want to begin their transition. Many health professionals point to the World Professional Association for Transgender Health’s Standards of Care manual to give transitioning individuals a jumping off-point for research into sexual and physical health.

The first step in the transition process is to go through hormone therapy process, and the second step of the process is to commit to the sex-reassignment surgery.

For McLennan County junior Jessica, a transgender student attending Baylor University, beginning these transitions was not an easy decision to make.

“I was praying and thinking about this decision for about a year before I began the process at all,” Jessica said.

Hormone Treatment:

Jessica began her hormone therapy process almost a year ago. The Standards of Care manual states that hormone therapy is the administration of exogenous endocrine agents to induce feminizing or masculinizing changes.

“In Fall of 2015, I began taking steps towards hormone therapy. I worried about the haters and the higher rate of suicide, but I kept pushing on until I got what I set out to achieve,” Jessica said.

Testosterone and estrogen are two main hormones in the body. Every human has varying levels of testosterone and estrogen in their bodies, and the hormones will rise and fall naturally to maintain a healthy physical equilibrium. Both of these are the hormones that are supplemented in the transition process.

According to the Center of Excellence in Transgender Health, in a female-to-male transition, an individual will take testosterone supplements to help introduce general changes such as facial hair growth, deepening of the voice and redistribution of muscle and weight gain. This transformation happens over the course of 12 months, which is the general requirement to be eligible to receive the sex-reassignment surgery.

In contrast, the male-to-female transition can be administered with several different categories of estrogen supplements. According to the Center of Excellence in Transgender Health, these estrogen supplements aid in breast development, vocal shifting and the redistribution of fat and muscle on the body.

The Standards of Care manual says that the physical side effects of these therapies most commonly include decreased auto-immunity, lack of genital functioning and many other symptoms of raised or lowered increased levels of testosterone and estrogen. Other side effects include a higher risk of breast cancer in both types of patients, as well as other forms of cancer and genetic diseases, including heart disease and diabetes.


Sex-Reassignment surgery:

Now that Jessica is nearing the end of her initial hormone treatment, she awaits approval to continue to the sex-reassignment surgery.

The final step in the transition process is the sex-reassignment surgery. According to, sex-reassignment surgeries are “Surgical procedures that change one’s body to better reflect a person’s gender identity.”

For male-to-female patients, the Standards of Care manual cites two basic surgeries, the first being breast enhancement, and the second being a series of up to five smaller procedures to replace the existing male genitalia with female genitalia. Different doctors choose to use different techniques of genital conversion in the male-to-female transition.

In the same way, female-to-male patients go through a series of different surgeries, as is stated in the Standards of Care manual. They will undergo a surgery to remove the breasts, called a mastectomy, and then several surgeries that remove the female genitalia, and then phalloplasty that adheres a phallic implant in its place. One of the biggest differences between these surgeries is that with male-to-female transitions it is more common to use existing tissue to create the new genitalia, whereas in the female-to-male, fresh tissue is more commonly implanted.

There are many risks to undergoing such significant surgeries, which can be found online in the Standards of Care manual. “I do fear the pain of recovery and the possibility of complications that any surgery could have, even as severe as death,” Jessica said.

Health after surgery:

Along with risks during surgery, there are risks in the years following the surgery. However, the Center of Excellence for Transgender Health is one of the leading researchers in transgender health. Their guidelines have detailed lists of general and sexual health problems transgender people may face post-surgery including but not limited to Sexually Transmitted Diseases, blood pressure problems and reproductive health issues.

The Baylor Health Clinic also offers primary care services. Medical Director of Baylor Health Services Sharon Stern, M.D., said “As primary care physicians and nurse practitioners, we care for the patients who come into the clinic. That means that we can do any testing and treatment of many infections, including sexually transmitted ones.”

Stern acknowledges that the clinic, being a primary care clinic, does not directly identify or prescribe transgender treatments. However, the electronic medical records system the center allows healthcare professionals to make sure that the general medications they may be prescribing to a transgender individual will not counteract the hormone supplements they are taking.

“If we had a patient present to us who was thinking of transitioning, we would most likely refer them to a counselor and an endocrine doctor who specializes in the type of specialized hormonal treatment necessary. We want to help all patients and we strive to never be judgmental. We want to help all Baylor students be healthy,” she said.