Yavari Caralize, 2017; updated in November 2023
(Disclaimer: This post is for informational purposes only. I am not a medical professional and am not qualified to give medical advice. This advice is based on personal experience. If you want official medical advice about transition, please talk to a doctor.) This is written primarily for people living in jurisdictions that allow some form of physical, legal and social transition (especially the US, since this is our context). If actively transitioning is impossible where you live, I’m extremely sorry and hope that that can eventually be changed. Russia, I’m looking at you.
Many systems identify as transgender or have system members of many genders sharing day-to-day responsibilities. This article is for groups considering transition, whether it’s physical, social or both.
We actually came to terms with being trans around the same time we realised we were plural, back in our late teens and early 20s. A number of us had been feeling dysphoric over the years, both about our social role and bodily appearance, and we ended up undergoing physical and social transition. The dysphoria just kept getting worse and worse over the years, and it was harder to push it away, even though we’d tried for a while. We had similar issues with our plurality, where we noticed things going on in our childhood but thought everything would go away when we got older. Neither the dysphoria nor the sensation of being more than one went away with time – in fact, it all got stronger as the years went by – and we realised we had to do something about it.
We’ve been male-presenting for about 11 years [now 17 years], have been on testosterone for almost nine years [now almost 15 years], and just had top surgery a couple of weeks ago [now six years]. We’re mostly happy, though sometimes people will get frustrated at how restrictive binary gender roles are. Most of us are men, though there are a few women and non-binary people as well.
For systems who are considering medical or social transition, here are some things to consider:
- Have some system meetings about what your goals are in transitioning. Make sure to hash out disagreements and come up with the best compromise you can. Most of us are men, so there weren’t too many arguments about starting hormones, getting surgery or changing gender presentations, but every system is different and has a different gender composition. Be sure to come up with a workable compromise if there’s disagreement about what different system members want to do. For example, we’re friends with a system who got top surgery and went on testosterone very briefly before stopping, based on a collective agreement.
- Is your dysphoria physical, social or both? This can affect the changes you want to make. Some systems may want to change their public presentation without taking hormones or getting surgeries. Others may want to take hormones or have surgery without changing their public gender presentation. We did both.
- If you’re interested in starting hormones, look at resources on oestrogen, testosterone, progesterone and other hormones and their effects on the body during transition. Some effects are permanent and some will reverse themselves or stop if you stop taking hormones for any reason. Make sure none of the effects of hormones are deal-breakers for anyone there – for example, testosterone can cause male-pattern baldness. Does anybody refuse to have a receding hairline? (Ours started receding when we were 28!) Oestrogen can cause permanent breast growth. Does anybody not want to have breasts? We did extensive research on testosterone and its effects before starting treatment.
- If you’re under 18 (or whatever your jurisdiction’s age of legal responsibility is), you may need a parent’s permission before making concrete steps to transition. Some trans youth use puberty blockers to keep their bodies from changing before they’re old enough to start hormone therapy. In general, you won’t be able to start hormone therapy or get surgery until you’re legally old enough to make these decisions on your own. Doctors want to be as cautious as possible, since young people can change their minds as they get older. Of course, this works only if you have supportive parents. If you don’t, the best we can tell you is to hold on as long as you can and rely on your inner resources until you get out. That’s what we had to do, though we came out at 20, rather than in our teen years. We figured out that we needed to transition when we were 11, but we decided to use a wait-and-see approach, since we thought it would go away when we got older – and because it was highly unlikely anybody would understand or accept what was going on in a deeply anti-LGBTQ area in the late 1990s.
- Some doctors have different policies for prescribing hormones or performing surgeries. Some will prescribe hormones using informed consent, where you sign paperwork saying that you understand the effects of hormones and agree to start treatment. Others may require you to be in therapy or psychiatry. We had our hormones prescribed at an informed-consent clinic, though we were also in therapy at the time. Many surgeons or healthcare systems (either private or public) will want a letter from a mental health professional like a therapist or psychiatrist.
- Do you want to transition to a more traditionally masculine or feminine presentation, or do you want to look more androgynous? We mostly look traditionally masculine or androgynous, though some of us have more femme tastes.
- How do you all want to change the body? Do you want to take hormones? Do you want to get gender confirmation surgeries? Talk these things out so everyone is happy or at least comfortable with the changes.
- Do you want to legally change the system’s name? If so, make sure to come up with a consensus on a name that people in your system don’t mind answering to. It took us about two years before Jack proposed something we could agree on. Some jurisdictions have restrictions on what kinds of names you can choose if you transition. Also, legal name changes can be expensive depending on where you live, though sometimes you can have fees waived if your income is low enough. You’ll also have to change your name with government entities, banks, educational institutions and workplaces. Deciding to get rid of the deadname in court was easy for us – we all hated it – but it took us a while to get all the paperwork in order.
- If it’s possible where you live, do you want to change your legal gender (that is, changing the gender label on your regional/national ID, driver’s licence, birth certificate or passport)? Changing some of these can be easier or harder depending on what your local, regional/state/provincial or national laws are. Some places just want a doctor’s note. Some are stricter and may want evidence of any physical transition, and some go even further and want proof of sterilisation. And in some jurisdictions, it’s impossible—some don’t have a process, and others outright ban it (especially in certain West African, Caribbean, Middle Eastern and Eastern European countries). You may have to be old enough to make your own decisions (usually 18) to start making any legal changes.
- If you’re currently in the mental health system, does your therapist or psychiatrist know you’re plural? Are they trans-friendly? See if you can work with them to support your transition if you need their cooperation to start any irreversible physical changes. If you’re having a hard time with them, try to explain that you’ve collectively come to a consensus. If they’re still stonewalling and you’re all sure that you want to start physically transitioning, see if you can find a better mental health team. Larger cities in the US sometimes have LGBTQ-specific clinics or may have directories that list trans-competent mental health professionals.
- Do you all have any health conditions that may affect your ability to take hormones or get surgeries if you’re interested in physically transitioning? Be sure to talk to a doctor about their effects to make sure you’ll be safe. Some trans people may not be able to start hormones because of health conditions, for example.
I’m not listing these considerations to discourage any systems from transitioning, of course. We did it and I think our quality of life is much better than it would have been if we hadn’t. It’s just important to take into account the effects of any major life change, especially if those changes affect several people. Good luck!