Transition: Difference between revisions

Public reactions to individuals whose presentation, for whatever reason(s), appears to challenge binary-gender stereotypes varies widely. Some models, musicians, and other celebrities are known internationally and celebrated specifically for having an androgynous appearance (see [[notable nonbinary people]]). Meanwhile, many people receive negative reactions for challenging binary-gender stereotypes. Safety is a concern for many nonbinary individuals attempting to transition to a socially visible nonbinary status.

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.

 

 

 

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>

 

 

 

Many societies recognise certain ranges of vocal communication as being typically "masculine" or "feminine." As a result, a given person's own vocal range can trigger an uncomfortable or distressing feeling of [[gender dysphoria]] in that person. That person may try to alter their vocal range or voice in order to resolve those feelings.

 

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>.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

* For people who are on the female-to-male spectrum, or whose bodies do not naturally produce much testosterone: taking [[Testosterone]] or otherwise being on a [[masculinizing hormone therapy]] can prevent or temporarily stop the development of breasts, for as long as they are on that therapy.

* 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.

 

* '''Incision location:''' there are three ways to insert an implant: through a periareolar incision around your areola, an inframammary incision just below your chest muscle or a transaxillary incision through your armpit. With silicone implants, an inframammary incision is normally the best choice, as they are inserted fully inflated. With a saltwater implant there are more possible choices.

 

 

 

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).

* [[Progestogens]]: these will also prevent (or, at least, decrease) periods, although they are not as effective as testosterone. However, they won't cause masculinisation.

* [[Aromatase inhibitors]]: aromatase inhibitors increase the testosterone that is already found in any person's body. However, it has menopausal-like side effects (such as fatigue, headache, etc.).

* [[Selective Estrogen Receptor Modulators]]: SERMs are not commonly used on transmaculine people for this purpose, as they also cause menopausal-like side effects.

* 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 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.

 

 

 

Some nonbinary people who were [[sexes#assigned male at birth|assigned female 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.

 

 

 

 

===Changing the genitals and reproductive organs===

 

 

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 no genitals ([[genital nullification]]).

 

 

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]].