Transition: Difference between revisions

Just as with other kinds of transgender people, some nonbinary individuals want to make certain kinds of changes to their bodies. This can be in order to relieve a distressing sense of [[gender dysphoria]], or for practical reasons, or by personal choice. This article tells about some kinds of changes that some nonbinary people can want, and practical things they can do to achieve those changes. Physical gender transition is never "one size fits all." A nonbinary person does not have to make all or any of these changes in order to be nonbinary. There are nonbinary people who go on hormones and get surgery, and there are nonbinary people who only go on hormones without getting surgery. There are nonbinary people who go on hormones temporarily, in order to try to get some changes they want, and avoid some changes they don't want. There are nonbinary people who do not change their bodies at all, because they do not feel a need to do so.

{{main|puberty blockers}}

Puberty blockers are drugs that postpone or temporarily suspend puberty in children and teenagers. They are used for [[transgender]] children, including those who identify as [[nonbinary]], to stop the development of features that they consider to mark the wrong sex,<ref name=":0">{{Cite journal|last=Stevens|first=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free}}</ref><ref>{{cite web |url=http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |title=Looking at suppressing puberty for transgender kids |publisher=Associated Press |date=March 12, 2016}}</ref><ref>{{cite web |url=https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |title=Transgender Youth Using Puberty Blockers |publisher=[[KQED]] |date=August 19, 2016}}</ref> with the intent to provide transgender youth more time to explore their identity.<ref name=":1">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|issn=2327-6924}}</ref> the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals.<ref name="lancet_pubertyblockers">{{cite journal | last=Mahfouda | first=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 | ref=harv|quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref>{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> In 2019, a study in the journal ''Pediatrics'' found that access to pubertal suppression during adolescence was associated with a lower odds of lifetime suicidality among transgender people.<ref>{{cite journal |last1=Turban |first1=Jack |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |journal=Pediatrics |date=February 2020 |volume=145 |issue=2 |page=e2019172 |doi=10.1542/peds.2019-1725 |pmid=31974216 |url=https://pediatrics.aappublications.org/content/145/2/e20191725 |accessdate=11 February 2020|pmc=7073269 }}</ref>

There are several factors which contribute to how a voice is interpreted with regards to gender, and these factors vary between societies. The most commonly recognised of these factors is pitch, which can undergo a dramatic transformation during ones lifetime due to the physical changes associated with puberty or endocrine therapy, for instance. Several studies have identified a gender-ambiguous average pitch at 155-187Hz, a feminine average pitch at 220Hz, and a masculine average pitch at 120Hz <ref>''Adler et al 2006, Andrews 1999, Gelfer et al 2000, Spencer 1998, Wolfe et al 1990''</ref>.

{{main|hair gain}}

Some nonbinary people want more facial and body hair. Nonbinary people who are on the female-to-male transition spectrum can take [[masculinizing hormone therapy]] to grow more facial and body hair. This gives them the same amount of facial and body hair that they would have had if they had been [[sexes#assigned male at birth|assigned male at birth]]. People who aren't taking hormones can simulate facial and body hair by makeup methods, though these tend to be more effective for stage performance, rather than in everyday activities that are seen up close. Makeup methods for this include using makeup, sticking tiny hair clippings to their skin with gum arabic, and using mascara on existing hairs. These makeup methods are popular with [[drag|drag kings and male impersonation performers]].  

Some nonbinary people want to avoid, halt, or reverse male-pattern hair loss. People who are on the male-to-female transition spectrum can take [[feminizing hormone therapy]] to halt male-pattern hair loss. In the future, people who prefer to take masculinizing hormone therapy may be able to choose a version of it that might have less risk of causing male-pattern hair loss, called [[Selective Androgen Receptor Modulators]] (SARMs). SARMs are not yet officially available. Once male-pattern hair loss has happened, it can't be reversed. Surgical treatments for male-pattern hair loss try to move the hairline, or move hair into the place where it is needed. Non-surgical treatments for it include [[wigs and hairpieces]].  

{{main|hair removal}}

Some nonbinary people want to hide or get rid of some or all of their facial and body hair. Temporary methods for this include bleaching, shaving, plucking, threading, waxing, topical treatments, or using an epilator. Laser hair removal and intense pulsed light are more permanent. Electrolysis is the most permanent.

{{main|top surgery}}

Some nonbinary people want or prefer to have a flat, masculine chest. For transgender children and teens, going on a prescription medicine called [[puberty blockers]] can postpone or pause puberty, which prevents or reduces the amount of breast growth they would have. The effects of puberty blockers are temporary, so breast growth will resume whenever the person stops taking that medicine. For people who have already had breast growth, going on [[masculinizing hormone therapy]] such as [[testosterone]] may reduce breast size just a little bit, if at all, but it does not get rid of breasts. There are also nonbinary people who go on [[feminizing hormone therapy]] in order to get other body changes that they want, but who do not want breasts. Wearing a well-fitted sports [[bra]] or [[binding|binder]] can reduce how large the breasts look, and temporarily make a flat, masculine chest shape. The only way to permanently get rid of breasts is through surgery. Surgery to take away the entire breast is called mastectomy. For transgender men and transmasculine people, mastectomy is also called masculine chest reconstruction, to emphasize that they don't see it as a loss, but as fixing a problem.  

{{main|mastectomy}}

Mastectomy for trans people is not as painful or traumatic as mastectomy to remove breast cancer or lumps, because the latter usually has to remove lymph nodes. For trans people, mastectomy is a short, single-stage procedure done under general anesthesia at a cosmetic surgery clinic or hospital. The patient goes home the same day. The recovery process depends on which method for mastectomy the patient had.  

{{main|top surgery}}

Some transgender and/or nonbinary people have larger breasts than they want. If the temporary methods such as sports bras and binders do not meet their needs, then they may prefer to get surgery to reduce the size of their breasts. The variety of methods for breast reduction are very similar to those for mastectomy described above. Larger breasts or those that need to go down more sizes will be reduced by the T-anchor method. Breasts that only need to be a little smaller can be reduced by the peri-areolar or keyhole method. Breast reduction is also commonly sought by men and women who seek a smaller breast area for a variety of reasons.<ref>{{cite book|title=Gender: Ideas, Interactions, Institutions|last1=Wade|first1=Lisa|last2=Marx Ferree|first2=Myra|year=2014|publisher=W. W. Norton & Company|page=23}}</ref>

Some nonbinary people who have not yet developed any breasts already know that they do not want to have any. If they can prevent their breasts from developing in the first place, then they will not have to get surgery to remove them. If someone knows that developing breasts would be a significant source of distress ([[gender dysphoria]]), then preventing breast development can be better for their longterm mental health.

* [[Breast ironing]] is a non-surgical procedure that attempts to destroy the breast bud, so that breasts cannot develop.  

* For people on the male-to-female spectrum, or people whose bodies do not naturally produce much estrogen, some types of [[feminizing hormone therapy]] make it possible for someone to have a feminine appearance without developing breasts.

Some nonbinary people want to have breasts. For people who are developing breasts without having to take any hormone therapy, breasts can continue to grow during puberty until about the mid-20s. For people who take [[feminizing hormone therapy]], this causes the exact same kind of breast development as happens naturally for women, just not necessarily at the same age. If either of these processes has finished, and the person still wants to have larger breasts than what they have, then they have a variety of options, non-surgical and surgical. They can temporarily make their breasts look larger by wearing a more supportive [[bra]], a push-up bra, or padded bra. They can wear [[breast prostheses]], also called fake breasts. For people who want to permanently make their breasts larger, then they have the option to get [[breast augmentation]] surgery.

{{main|menstruation}}

Periods are often a source of distressing [[gender dysphoria]] for nonbinary people who were [[sexes#assigned female at birth|assigned female at birth]]. There are several ways of preventing periods:<ref>{{Cite journal|last=Carswell|first=Jeremi M.|last2=Roberts|first2=Stephanie A.|date=December 2017|title=Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents|url=http://www.liebertpub.com/doi/10.1089/trgh.2017.0021|journal=Transgender Health|language=en|volume=2|issue=1|pages=195–201|doi=10.1089/trgh.2017.0021|issn=2380-193X|pmc=PMC5684657|pmid=29142910}}</ref>

* [[Transmasculine hormone therapy]], such as [[Testosterone]]: Testosterone will prevent periods (although the changes won't be immediate).

* GnRH agonists: also known as "[[puberty blockers]]" within the transgender community, they are not recommended as a long-term solution, as they cause poor bone health.

Methods for permanently stopping menstrual bleeding which are not a form of hormone therapy include [[uterine ablation]], in which the inside of the uterus is cauterized to prevent it from developing or shedding uterine lining, and [[hysterectomy]], the surgical removal of the uterus. Neither of these necessarily prevent other symptoms of menstrual cycles, such as mood swings during premenstruation.

Some nonbinary people do not want to be able to get pregnant, or to get others pregnant, and the possibility is a cause of distressing [[gender dysphoria]]. There are a variety of ways to temporarily prevent pregnancy, such as [[birth control]]. For those who are certain that they never want to get pregnant, or who have already had as many children as they want, there are permanent methods of [[sterilization]], such as [[vasectomy]] for people who have testicles, and [[tubal ligation]] for people who have a uterus.  

{{main|masculinizing hormone therapy}}

Some nonbinary people who were [[sexes#assigned female at birth|assigned female at birth]] want to look and sound in such a way that most people will see them as men. [[Masculinizing hormone therapy]] such as [[Testosterone]] does this. It is a medicine that a person takes on a regular basis, which makes them go through many of the same changes that men went through at puberty. Some effects of it last only as long as the person takes that medicine, and will go away if they stop, such as looking like a man (due to skin texture, body odor, tending to have more muscle, and where the body stores fat) and having no period. Other effects of this medicine are permanent once they happen, such as growing more facial and body hair, and getting a lower voice. Masculinizing hormone therapy does not stop a person from being able to get pregnant.  

{{main|feminizing hormone therapy}}

Some nonbinary people who were [[sexes#assigned male at birth|assigned male at birth]] want to look and sound in such a way that most people will see them as women. [[Feminizing hormone therapy]] does this. It is a medicine that a person takes on a regular basis, which makes them go through many of the same changes that women went through at puberty. Some effects of it last only as long as the person takes that medicine, and will go away if they stop, such as looking like a woman (due to skin texture, body odor, tending to have less muscle, and where the body stores fat), and some changes to the genitals and sexual responses. Other effects of this medicine are permanent once they happen, such as growing breasts. Feminizing hormone therapy does not make a person's [[voice]] get higher.

{{main|hormone therapy}}

Some nonbinary people want to look and sound in such a way that most people can't categorize them as a man or a woman. There is no one widely recognized hormone therapy for this. Possible options for people who want to suppress both masculinizing and femininizing hormones at the same time are described in the [https://madgenderscience.miraheze.org/wiki/Experimental_non-binary_HRT#Sex-hormone_antagonists_alone Mad Gender Science Wiki].  

{{main|bottom surgery}}

Some nonbinary people want to make various kinds of changes to their genitals and reproductive organs. [[Hormone therapy]] can make some kinds of changes. For example, [[masculinizing hormone therapy]] can make a clitoris more like a penis, and [[feminizing hormone therapy]] can make a penis more like a clitoris. Hormone therapy can't make dramatic changes to the size of these organs, can't change where the urethra (pee hole) is located, can't cause or undo the descent of testicles, and can't change a person's ability to get pregnant. Many kinds of surgery to the genitals and reproductive organs is called [[bottom surgery]]. For nonbinary people who want their genitals to be more like those of [[cisgender women]] or [[cisgender men]], there are surgeries for those. For nonbinary people who have more unique goals for their genitals, there are surgeries for those, such as having both a penis and a vagina, or having a vulva without a vagina, or having [[genital nullification|no genitals]]..

Some nonbinary people want their face to have a more feminine, masculine, or androgynous shape. [[Hormone therapy]] has effects on face shape. Makeup can also create the illusion of different face shapes. People who find that this is not enough, especially those on the female-to-male spectrum, may seek [[facial surgery]].