MTF Pre-HRT CheckList

*[mtf] pre-hrt checklist

Once you start hormones it takes a very long time for your face and body to transition, but from the moment you start really questioning things until you start hormones can also be a long journey with many steps along the way. I started seriously looking into things more than half a year before I started HRT and below is a list of things I did in that time or that I have heard others have done. This was just my journey; someone that knew something was off since childhood and transitioning well past male puberty had done its thing, your journey will be different, and there is no right or wrong way.

Therapist

Having a therapist was instrumental in helping me work through this journey. Before I started talking with my therapist I had already checked and double checked a ton to see how true my feelings really were and talking back and forth we discussed the topics and more depth. I was not 100% sure when I started and so for me talking with someone was very helpful. After starting hrt being able to occasionally vent about a frustration or just how darn slow it is helped take the edge off too.

Being gendered correctly

Being gendered correctly is so very important and there is what I call the girl in the baseball hat problem. If you have every seen a girl wearing a baseball cap and jersey at a baseball game you don’t think, oh that sure looks like a feminine man, no you instantly know that it is a girl. Girls can be tall with short hair, they can have some facial hair, and have low voices, but your brain will still gender them as female. This instant recognition is done by a number of things, from the way the skin looks, the muscle and fat on the face and the underlying bone structure. You can have someone that has the long hair, perfect voice, feminine clothes, but the face is gendered as male and you can have the girl at the baseball game.

The changes that occur with HRT are truly magical, but it has its limitations and you don’t really know how you will turn out 6,12,24+ months after hormone levels are in the right range (which can also take a few months to a year+). Some have it easy and male puberty didn’t change their bones much, some do not and FFS is required. FFS is about resolving your dysphoria, not about becoming traditionally pretty and unfortunately surgery can often take a while to get done with their own set of delays. I intimately and completely understand how other transwomen are female, but when I see their early transition photos I hate how I have no control over the fact that my brain instantly genders them as male. And I assume that almost everyone would do that to me. On top of everything else I would love to be wrong, but my impression is that I will be treated in a not very positive manor as someone that is transitioning and this behavior shift will occur the moment I tell them. It was with this backdrop of a transition of unknown length, with unknown results that I decided that I would not come out ahead of time. I would hope for the best, but plan for the worst. I wouldn’t come out when I was really really sure I was transgender, I wouldn’t come out when I started HRT, I wouldn’t come out until at least I started getting male fails. But that doesn’t mean I wouldn’t do everything I could to help that happen as soon as possible. And even given the girl in the baseball hat problem I knew that I might only be speeding it up by a few months because so much depends on how well hrt works. So that was my plan.

Given the huge uncertainties as long as I didn’t come out publicly it could sort of be looked at as a win-win situation. If after taking HRT I start getting gendered female without my prompting then hooray it worked and I get fully socially transition. If after taking HRT and am still gendered male I still: have made myself privately more comfortable with my body, got the joy of running on the right fuel, and the only major public change would be that I might have to wear a bralette/sports bra all the time. And if I want to I can always come out socially but with the full understanding that I will get harassed for looks like a transwomen, but it will be my choice to make now that I see the outcome.

Many months after writing this section I came across a comment by another reddit user that distilled this perfectly down to just a few sentences:

I put in a fuckload of effort into passing and got misgendered constantly. Then one day enough fat had moved around in my face or something and it suddenly looked female. After that, I started passing all the time. I could put in a lot less effort and still expect to be gendered correctly.

Checklist / Timeline

The most important thing for me was creating as full of a timeline / checklist / todo list of everything to do before starting HRT. My plan was to get as much lined up as I could so I would spend as little of an amount of time in the in between stage looking like a mtf transgender as possible. What drove the timeline more than anything else was removing my facial hair. This is not a fast process and requires waiting many weeks between sessions for new hair to wake up to be zapped away and for me would probably require 6+ sessions which translates into more than a year. At the time from what I gathered the earliest I might possibly pass was at the 6-9 months mark (naive to the point of harmful I know) so that is what I tried to line things up for. Beyond facial hair other things that would take time include improving my voice, losing weight (while 100% of weight lose would be come from male fat), and just letting my hair continue to grow out at its glacial pace. And finally I assumed I needed to see a therapist for three months before I could start so I made sure to budget that time in correctly. Trying to do as much as possible at once was my plan to give me the best possibility of transitioning as soon as possible.

My timeline wasn’t set in stone and I was constantly moving things around and adding new things as I learned more. When I would feel hopeless and thinking how I would never get there I could reflect on how I had a plan and that each and every day I was taking one small step forward can help even if it is as simple as today was another day I let my hair grow or lost some weight.

There are many topics and you don’t need to learn about everything at once, but delve into each item one by one. For the time sensitive ones make sure to work on them regularly. Schedule your appointments in advance, set aside regular time for things that need practice such as your voice and working out. Each month try to acquire one piece of clothing and practice makeup. For each topic you will find dozens of blog entries, reddit posts, etc covering the topic in much more details. Learning is the most valuable thing you can do. The tsroadmap site http://www.tsroadmap.com/ as well as the e-book “Hacking Transition” (http://www.mediafire.com/file/ir9u1q5f8k6q9zz) was very helpful and as I approached each new topic I frequently would go back to that ebook to see what it had to say.

The way things lined up I started HRT in early summer. As a result I could spend all fall, winter, early spring all bundled up, which would make hiding breast growth and other early changes much easier all while my face would still be gendered male by probably everyone. After going through this starting early spring might have been even better as I could stay bundled up and kept my chest hidden until month 13+ if I wanted. Don’t know how much it actually mattered, but an interesting thing to note.

Books

There are a number of other books you can read, two that I would highly recommend you get are “Whipping Girl” and “She’s not there”. Both of these books I wish I had been given when I was starting out as it would have helped me. “She’s not there” is a well written biography and I couldn’t put it down as it was way too close to home and I really needed to see how the story would turn out to give me hope for my own life. “Whipping Girl” is a book that deconstructs gender, sexual attraction, biological sex, and how to place these within the larger world and why different people react so differently to one thing, but not another. I wish I had read this book early on as it would have helped me figure out some of my own struggles such as why it took me so long to put the pieces together and really helped me clarify who I am. If you do read Whipping girl try to grab the second edition with has a preface which talks about various things which were true when the first edition was written, but no longer is. “Trans/Portraits: Voices from Transgender Communities” by Jackson Wright Shultz is also a good book with a wide variety of stories and can help you know that others are going through what you are. And not a book, but you might enjoy the show Black mirror season 3 episode 4 “San Junipero”.

Start laser / electrolysis

Get an appointment asap. A common thing is to have laser every 6-12 weeks for 6+ sessions with some electrolysis follow up. I had some red/blond whiskers that only electrolysis can remove and that was something to work on during this time too. Wear sunscreen on your face every single day starting today. When getting laser AND electrolysis do it first on your chest or neck or somewhere out of the way before going all in to make sure they are doing it right for your skin. You don’t want small scars or pockmarks on your face that end up looking like you still have facial hair under the skin! With electrolysis Don’t let them overtreat one area at once. I know you want it now, but what you really want is it done correctly. If you are getting laser understand that there are different types of laser and some work better on different skin types and different hair types. If you are doing electrolysis understand that there are different types there too and your skin might respond really badly to one or the other. In both cases there are things to do before and after a session to further minimize damage. Do them! If you don’t exfoliate regularly besides helping your skin doing that will help the dead hairs fall out. After HRT some (not much) facial hair can turn blond which laser can’t get anything with so getting as much of those zapped with laser before HRT is helpful. I started laser before I was 100% sure I was transgender or that I needed to transition, but I knew 100% that I would absolutely love to not have hair on my face and chest so this was a no brainer and easy to start. Bonus since you already have the appointments you can get your underarms or whatever else you want done 🙂 Lastly don’t pluck out hairs that are attached during this process because they will just grow back when you want to be done with laser / electrolysis. In summary it is incredibly important to do your homework as this is the skin on your face which can be easily damaged and the whole process takes a long time so start learning now.

Voice

HRT will not change your voice so you have to learn how voice works even if you get some sort of vocal surgery. Getting a female voice will be its own journey that takes some education and practice on your part.

Your voice has a number of components from pitch to your larynx height, tongue position, lip position, aes engagement and more. Talked about a lot is pitch (more than it deserves because a dude voice with a high pitch still sounds like a dude) which will take a while to master (thing month(s)+, not week) so take your time, and work at it slowly. If your voice gets sore stop or you will be sad. After your pitch you need to reduce your vocal tract length. This is where raising your larynx and tongue, and lip position comes in. As your larynx is attached with muscle it will not happen overnight no matter how much you wish, but like pitch will take some time. Surgery can change your pitch, but it might not be able to change your VTL especially the larger mouth cavity, there is no easy way out. For a fantastic and quick video of how and why this is all required checkout sex in voice explained simply.

Because I read that voice can take a very long time I actually started working at my pitch before anything else after I had worked at it for about a month I had three pitches for voices. My old male voice, a high female pitched voice and something in the middle. As soon as I could I began moving the pitch of my every day voice up to the mid voice. It let me practice my pitch full time, build up my vocal muscle stretch, my confidence and not one person cared. Many months later I got more serious and learned more about things such as VTL and putting them all together it sounded so much better, from gay male voice to female voice. I have my first recording where it clicked and it sounded completely female and I listened to that so many times. I never had a day where I suddenly went full time with my female voice, I was always “full time” getting better every day and there was never a jarring transition. And in the morning or when I got to work I don’t switch voices or anything my voice is my voice and I am always working to make it better.

A grab bag of tips: Develop a consistent time to review all the aspects of your voice and do whatever you can to switch your voice in the direction you want to go full time. Work on listening to your own voice and spotting when you made errors and correcting yourself, even writing down words you screw up. The hardest word for me was “blue”. Listen to girls around you and how they speak. Record yourself, listen to it over. Subscribe to the various trans voice subreddits such as r/transvoice. Checkout classics like https://www.youtube.com/user/deepstealth and http://lena.kiev.ua/voice/ Play around with Pink Trombone to understand more about how your tongue works with VTL Checkout http://www.fon.hum.uva.nl/praat/ to see your voice. Practice. Maybe find a vocal coach. I am working with one of our own at https://www.transvoicelessons.com/ And of course there are many good posts like this one https://www.reddit.com/r/transvoice/comments/7krqov/9_steps_for_a_more_typically_female_voice_mtf

Lastly If you want to show off your old lower voice have the other person close their eyes before talking so they will not associate your voice with you or hear male and try to see the male in you too.

Therapist

If you need to have a letter plan the date you want to start talking with a therapist to give yourself the time required. Therapist is also a handy place to practice your voice and practice hearing someone use the name you picked out. Transition takes a long time so having a therapist is nice to have someone you can share things with even if you can’t share it with those around you. You don’t always need to get a recommendation letter from a therapist, many places such as PlanedParenthood or FenwayHealth in Boston will let you do an informed consent.

Healthcare

Understand what healthcare plan is. Learn your healthcare transgender policies completely in and out, even call them and ask if you are confused. If your companies health care plan is horrible switch jobs or even switch states to one where all health care plans must have transgender policies, For example in MA some insurance even covers FFS.

Finances

I have never heard anyone say transitioning in cheap. Laser / electrolysis will be your first bill. Understand your finances. Make a budget. Start saving today. Save, cut some expenses, etc. Be that person among your friends that understands money because you have a higher chance of being without a job or support from friends and family. If your married, the possibility of divorce is very high which brings about its own set of financial issues. To go with healthcare maybe even make a career change or move to a place that is more trans friendly. Some companies / states are not. In summary get your finances in order, understand where every dollar is going and have a plan for the worst case scenario and hope you do not have to use it. There is the very real joke about how before hrt you had 20 job offers a day, but after transitioning you now have 0 job offers and 20 OKCupid ‘likes’. Checkout subreddit (and their sidebar!) such as financial independence and personal finance.

Record your progress

On your computer create a folder and keep the best digital examples of your transition. Audio recordings of your voice, photos of your face in makeup, your best hair style you found, headshot and body shot done up best you can, etc. The first batch of things you save in this folder will suck, but its okay, because you want to review, learn, and try again. When you have a hard day you can look back and see how far you have come. By the time you start HRT you will not have all of these down, but you will be well on your way and can work on them slowly, deliberately and with practice without feeling like you are rushed.

Smoking

If you smoke do whatever you need to to quit now. Ignoring the whole dying of lung cancer some doctors won’t prescribe hrt if you are smoking. Smoking increase clotting risk. And you have to stop if you want FFS.

Weight Loss

At what weight do you want to start hrt? Beyond being a healthy weight is overall healthy and will make you happier, the less fat in male deposits locations the easier it will be. Join dietbet or whatever your preferred weight loss method. Target healthy, slow and steady, not crash diet. Accept that you will not eat any halloween candy, easter candy, holiday pies etc. That is all for next year, not this year. It is easier to lose weight with more muscle mass than with fat and with higher levels of T it will just be easier now. When you lose weight after hrt some fat will come from male deposits, some from female deposits, try to get rid of as much male fat as possible before starting hrt.

Exercise

You have more T in your system than you will in the future, take advantage of it. Tone your entire body. And build your butt 🙂 Develop a regular exercise routine you can continue after you start HRT. The goal is to find a routine that is not insane and you will actually legitly do for the next several years. Every day probably wont last. You don’t have to go to the gym. If that only means 8 minutes in the morning three times a week before breakfast that is still a ton better than nothing. Walk more, take the stairs and not the elevator. Build a better lifestyle.

Grow out Hair

Don’t let it get too horrible, trim, not cut every once in a while as needed (2-4 months?). You will need to trim the back more to let the top catch up. Trim the bottom so it looks clean and doesn’t get split ends. Just because you are growing it out doesn’t mean you can’t have fun with it and style it. Lots of girls get a short pixie cut and then grow it out and they can look good at almost every stage and so can you. As it gets longer play around with it, take lots of photos with styles you will later hate, but in the end you will find one or two you like. Keep a close eye out of hair styles on other woman that you like or that have very similar face/hair to you that you might be able to pull off.

Makeup

Read and watch tutorials on reddit/youtube. Pickup some cheap stuff to start. You will look like a clown the first time. That is okay. Write down what worked, what did not and a week later try again, practice, iterate, get better. Watch videos on the stuff you are bad at. Its okay to say take several hours figuring out one thing say eye shadow and not working on anything else. Practice, learn, write down what works. Making a checklist on my phone of what to do and the order to do it helped me and every time I tweaked it. Get better stuff once you have a clue what you are doing. Develop a daily facial routine. I was thinking of having a makeover at Sephora and getting properly colored makeup once I was further along and could understand what they were talking about. My goal was to create an every day no-makeup look. Laser and Electrolysis really “helped” here. For a little while after each session putting on makeup would let me conceal the bruising that my skin happens to do. This continuous practice helped me get a lot better at it over time.

Nails

You can probably start painting your nails now if you do not already. 🙂 Note your mistakes you make and work on getting better. When the opportunity arrises you can even pickup a shade or two that you like.

Glasses

If you have glasses, at your yearly prescription make sure to get the PD value. When you happen to be at the mall try some styles on at the glasses store. Order a cheap pair or two of whatever style you think is women’s glasses from some cheap online store like Zenni Optical or eyebuydirect and try them out for a while, see if you really do like that style or not. Or even have you thought about contacts?

Piercing your ears

I decided to hold of on this until after I came out, but many males have their ears pierced so it is something you can do whenever works best for you. You want to go to a piercing or tattoo shop where they will use a sharp hollow needle which is much safer and better than the gun.

Walk

Men and Women walk slightly differently due to skeletal and weight differences. Feet closer together, elbows in, head steady, hips swing rather than shoulders etc. You don’t need to exaggerate this, but be aware and practice how you walk if you want to change it. An interactive tool you can play with is the biomotionlab bml-walker

Wardrobe

Create a list of items to acquire (2 skirts, 3 tank tops, 2 t-shirts, 1 jeans, 1 blouse, etc) . Not single pieces, but items you can mix and match to create outfits. Little by little acquire these. Figure out your style. Visit a thrift store more than once and pickup cheap stuff or an online store like thredup.com. Cheap is important, you will buy stuff you regret later because it doesn’t work for you or is the wrong size. Yes you want a dress, but also figure out a good pair of jeans, a t-shirt that fits well, and shoes that are not heals. Note that your feet can shrink a size or two so do not invest to much in shoes. Pay closer attention to what other women are wearing around you. Pay attention to not accidentally build up a full wardrobe that is androgynous (unless that is your goal). Do not try to be trendy, but get the basics down first for what works with your body. Learn. When buying at retail pay attention for sales; which are often. Because you have the time wait for these sales and pickup an item from your list you are missing. Learn the difference between stores like Old Navy, Gap and Banana Republic which cater to different markets.

Name

Spend time thinking about your new name. With someone, by yourself, whatever works, roll it around, write it 100 times on paper. New middle name? New last name? Learn what other people have done and why. Maybe find out what name your parents would have named you if were a girl. Learn how to change your name where you live. You probably won’t change your name for many months, but you can pick a name and use it in private for a month or two before deciding on it or trying a different one. You will probably tell others sooner than you would expect, but if someone asks and you are not sure tell them that! Maybe they will even help you pick a name. What about your online name? If you have always been radDude97 now is a time you can make a clean break and choose a new name. Same goes for email if you want. Whenever possible create new accounts with the new name and don’t rename old accounts, inevitably the old name will resurface and creating new accounts is the cleanest way.

Identity

I stopped posting photos of myself up online and start slowly taking down existing ones. Found where photos had been copied and got those taken down, etc. It can take a while for search engines to remove you and sometimes it was better to leave up a blog, but without the photo so the search engine would cache it without the photo and later I could delete it so if someone went looking for it and found an archived version they would find the text only version. When I was sure it was all good and done I closed / deleted some old accounts.

Journal

I wrote in a journal (just a plain text file on my computer to be honest.) on my computer almost every day while this was going on. It helped me figure things out as well as being a place where I could write anything down no matter what which helped a bunch. It was also a neat little log book I could go use to look back at how far I have come.

Bank sperm

Learn how it works and start the process before scheduling your Endocrinologist appointment / HRT. Is it covered by insurance?

Clinical Trials

Searching on https://clinicaltrials.gov/ct2/results?cond=&term=transgender I looked for any study that I could be involved in. There is a real lack of medical knowledge around everything transgender and I wanted to help contribute back if possible. Take a look and see if there is anything in your area or that you could contribute to. A few of them require individuals that have not yet started HRT which is why I went looking so early.

Appointments

In general assume any appointment you make will not be for tomorrow, but for weeks to months out so call and book early. There is no penalty for canceling if you end up going elsewhere.

Yearly physical

Call now and book your yearly physical three+ months before when you think you could start hrt (book early to get the date!). Both to make sure you are in good health and to come out to them to see if they have a endocrinologist they would recommend or even if they would give you the prescription.

Endocrinologist

Book your appointment with an endocrinologist ahead of time as they could easily be booked well in advanced. If your doctor wants to give you a prescription you can always cancel the endocrinologist appointment. Learn about the process and what to expect. Do not think your initial prescription is the best and fully understand that after 1-3 months after you get labs and see how things are going it is very common to tweak the prescription. Checkout my Endocrinology 101 post for way more details about what I learned in the months after starting HRT.

Coming out

While I had no plan to come out in general I did come out to a few individuals. The first was to my spouse after I had a few months to digest that yes this was real and it was one of the hardest things I have done in my life. I don’t have any advice about how to come out, but one thing I have learned is that involving your spouse in the process and given them some say can make a world of difference to your relationship.

After my spouse the next group of individuals I came out to were all medical related, my therapist, my GP, the lady doing my laser/electrolysis so I could talk about how cis female sideburns work and later my endocrinologist and eye doctor. The therapist was the easiest as I was blunt, up front why I was there, it was online and the rest were harder as I had to do it in person and other then the endocrinologist they all knew me from before as male and I had to come out to them as female. There was a handful of side individuals I “came out” to in the process such as nurses and whomever I spoke with on the health care line when I was finding out information about what is covered, people I spoke to when booking appointments, etc. Each one was a new experience.

The third group were other individuals, friends, family, work, etc I personally decided to tell individuals in this group well after I had started and only when I could see changes myself so I am saving that for a post-hrt post (Edit: coming out).

Take note when others post their coming out letters and stories to hear what works, what does not work, and what went well. This goes for family, school, work, friend, and social media all seem to have different best approaches. If you do come out understand that they now control who they will tell and no matter how careful you and who you trust someone will tell.

Hobbies

Lastly transition is just a few years, you still have the rest of your life. School, job, hobbies and friends. Do not let them fall aside and make time for them too. Make sure you have some other way to be distracted and don’t let being transgender consume you too much. I have been playing around with setting aside a day a week or one week a month where I don’t do anything trans related to force myself to do other things and not think about trans stuff 24/7.

*This information was written and compiled by r/TransProTips on reddit, please take a look at their website and resources and thank them for their hard work.