Transmasculine Guide to Physical Transition, The: For Trans, Nonbinary, and Other Masculine Folks

By Sage Buch

This in-depth exploration of all aspects of physical transition is an accessible and supportive guide for transgender men, transmasculine people, and nonbinary people. Drawing on their personal experience and extensive research, Sage Buch walks you through a wide array of safe transition options. Inside, you'll learn about non-medical interventions like chest binding and packing, explore the varieties and effects of hormone replacement therapy, and get a comprehensive primer on choosing, preparing for, and recovering from top and bottom surgery. Medical research and jargon is made accessible, side effects and pros and cons are clearly spelled out, and empowering perspectives help you consider what transition path is right for you. Everything always comes back to checking in with yourself at every step of the way so that you can enjoy the unique self-expression that comes with finding yourself and who you are meant to be. Reading can be enhanced by working through The Transmasculine Guide to Physical Transition Workbook as you read.

• Language: English
• Publisher: Microcosm Publishing
• Release date: Feb 7, 2023
• ISBN: 9781648410734

Sage Buch

Sage Buch (they/them) is a writer and trans activist currently residing in Salt Lake City, Utah. Their work, both in activism and in writing, is focused on creating an open and inclusive space for people to learn to express themselves in the way that is most true to them. In their free time, Sage enjoys blacksmithing, hiking, ice climbing, and making bad puns at every opportunity.

Book preview

9781648410734.jpg

The Transmasculine Guide to Physical Transition: For Trans, Nonbinary, and Other Masculine Folks

© Sage Buch, 2023

This edition © Microcosm Publishing, 2023

First Edition, 2,000 copies, First published February, 2023

Design by Joe Biel

Edited by Lydia Rogue

eBook ISBN 9781648410734

This is Microcosm #626

For a catalog, write or visit:

Microcosm Publishing

2752 N Williams Ave.

Portland, OR 97227

[phone]

For more copies of this book and the accompanying workbook:

www.Microcosm.Pub/TransMasc

Did you know that you can buy our books directly from us at sliding scale rates? Support a small, independent publisher and pay less than Amazon’s price at www.Microcosm.Pub

About the Publisher

Microcosm Publishing is Portland’s most diversified publishing house and distributor with a focus on the colorful, authentic, and empowering. Our books and zines have put your power in your hands since 1996, equipping readers to make positive changes in their lives and in the world around them. Microcosm emphasizes skill-building, showing hidden histories, and fostering creativity through challenging conventional publishing wisdom with books and bookettes about DIY skills, food, bicycling, gender, self-care, and social justice. What was once a distro and record label started by Joe Biel in a drafty bedroom was determined to be Publisher’s Weekly’s fastest growing publisher of 2022 and has become among the oldest independent publishing houses in Portland, OR and Cleveland, OH. We are a politically moderate, centrist publisher in a world that has inched to the right for the past 80 years.

Global labor conditions are bad, and our roots in industrial Cleveland in the 70s and 80s made us appreciate the need to treat workers right. Therefore, our books are MADE IN THE USA

Please note:

This book contains every option that is currently available for physical transition for transmasculine and nonbinary people. It does not contain any of the information surrounding social transition. This is not because social transition is in any way more or less important, but because there is so much necessary information that needs to be discussed for both physical and social transition that could not feasibly be condensed into one book without leaving something out.

This book does not contain any information for people who were assigned male at birth (AMAB). Because I’m not AMAB, I do not feel confident or competent speaking to those experiences.

An important legal disclaimer:

I am not a medical professional. I am a transgender person who has personal experience with these topics and who has been reading peer reviewed journals and gathering community knowledge over the last ten years. Always consult your medical providers, therapists, and surgeons before taking any meaningful steps toward transition. The information in this book is meant to be a general guide and introduction, and to provide helpful information on options for physically transitioning. This book is not meant to be used, nor should it be used, to diagnose or treat any medical condition. This book is not intended as a substitute for consultation with a licensed healthcare professional, such as your PCP, therapist, or surgeon. Before you begin or change any healthcare program, hormone treatment, or change part of your lifestyle in any way, you should consult your physician or other licensed healthcare professional to ensure that you are in good health and that the examples contained in this book will not harm you. The publisher and author are not responsible for any specific health or allergy needs that may require medical supervision and are not liable for any damages or negative consequences from any treatment, action, application, or preparation, to any person reading or following the information in this book. References are provided for informational purposes only and do not constitute endorsement of any websites or other sources. Readers should be aware that the websites listed in this book may change. This book provides content related to physical and mental health issues; as such, use of this book implies your acceptance of this disclaimer.

Contents

Introduction •

Checking In with Yourself •

Safer Chest Binding •

Packing •

Finding and Working with Providers •

Hormone Replacement Therapy •

Top Surgery •

Bottom Surgery •

Other Aspects of Physical Transition •

Resources •

Conclusion •

Acknowledgments •

References •

Introduction

When I first realized I was trans, the journey of transition felt like a never-ending uphill battle to me. As I’m white, US-based, and currently able-bodied, this did not bode well for everyone else in my position but without my privileges. The amount of information was simultaneously overwhelming and nonexistent. I found pieces here and there that felt fitting for me, but so much of the information I found felt so exclusionary, and did not account or allow for the experiences and desires of people like me—those of us who don’t want to follow the typical path that is set out for a binary transition. It felt like I was never able to truly pull together all of the information that I needed or wanted, and what information I was finding was only for what was commonly done, never truly what all the options were.

Because of that, I spent the last ten years doing a deep-dive into all aspects of physical transition through not just reading peer-reviewed scientific research, but through my own personal experiences, interviews and interactions with providers, fellow trans people, parents/families, and attending large gender-affirming care conferences such as the Philadelphia Trans Wellness Conference (Philadelphia, PA), and Genderevolution (Salt Lake City, UT). As I collected all of the information I could, I pooled my notes together and created what is now this book. Because I spent so long gathering all of this information, and I frequently check and read new medical articles that are released, at the end of the book I list recent resources and readings for your reference (these sources are not referenced in the main body text).

I have personal experience with nearly every aspect of this book, and I wrote my experience with each at the end of its respective chapter. I created what is, I hope, a one-stop reference for not just all the potential aspects of physical transition, but also a guide to figuring out what you may personally want out of your transition and your physical self, while allowing for the unique self-expression that comes with finding who you’re meant to be. It will give you questions and considerations for every aspect of transition to help you determine what your goals are and how to get there.

Long story short, I wrote this book for you. So you will have a basis to learn about the current options. So you don’t have to slog through the mire of information that feels so never-ending and so incomplete the way I did. I wrote this so that you know there’s someone else in the world who is fighting for you, who sees you, and supports you no matter what.

Checking in with Yourself

No matter the reason why you’re reading this book, the goal here is to answer as many of your questions as possible and to give you a launching point to do any additional knowledge-seeking that’s specific to you. Remember, medical knowledge is always changing, evolving, and advancing. Doing additional reading that you feel you need to make a fully informed decision is highly encouraged.

So, how do you begin your journey when it comes to physically transitioning?

The most important thing is constantly checking in with yourself, which is something we’ll be doing a lot of in this book. It’s important to figure out your wants, needs, desires, and what is important to you. Before you start, let’s first remind ourselves of a few things:

1) You do not need to physically transition to be your gender.

2) You do not need to physically transition to please anyone but yourself.

3) You do not need to physically transition to prove anything.

4) You do not need to physically transition to be trans.

5) No matter what options you want or need, they do not invalidate your gender.

Something that you’ll read a lot of in this book is how to check in with yourself to see what you want and need. When it comes to changing and altering your physical self, it’s important to determine what is right for you and what meets your needs. It is the unfortunate truth that, as a trans person, you may feel pressure from providers, family, and even friends to transition in the way that they think determines your gender, or seems right to them. No matter other people’s feelings, it’s important to check in with yourself about what makes you happy and fulfilled, regardless of what anyone else says.

In addition, if you need space to write down and think through the questions brought up in this book, there is a partner workbook available. I kept the workbook separate from this book so that this can be a resource multiple people can use (such as one shared by friends, or kept at an LGBT Resource Center or therapist’s office). That way, people can take notes and answer questions in their own separate space, and this book can remain a resource to be shared.

Some Terminology

Throughout the book, I will be using community terms to define and describe information. I define most of them in the moment, but here are a few terms that I am defining up front, because they may differ from their definitions outside of this book or in other publications:

Transgender: I use this to refer to anyone who’s gender does not align with the sex they were assigned at birth. This includes nonbinary, agender, and gender-expansive people.

Cisgender: This means anyone who’s gender aligns with the sex they were assigned at birth.

Assigned/Designated Female at Birth (AFAB/DFAB): This phrase includes anyone that was assigned, or designated, by a physician at birth the sex female. Generally, physicians will take a look at a baby’s genitals at birth and will designate a sex, which comes with all the complications of the attached gender. For people who are intersex and may have genitals that do not fit the gender binary, physicians may surgically assign that person a sex by recrafting their genitals to fit the gender binary. I tend to use AFAB, though the terms are interchangeable. You may see this described as the Sex Assigned At Birth.

Transmasculine: I use this to refer, in a very general way, to anyone who is transitioning to have a more masculine body, and for people who are transitioning to male.

Nonbinary: I use nonbinary in this book specifically to refer to anyone AFAB who does not fit into a binary gender (man or woman), including but not limited to people who are: genderqueer, nonbinary, agender, demiboy, etc. I limit this term to AFAB people in this book not because only people who were AFAB can be nonbinary, but because every aspect of physical transition that I discuss in this book is specifically for people who were assigned female at birth. I use the term nonbinary separately from transmasculine in order not to exclude anyone. Some nonbinary people do not feel as though they are transitioning to become more masculine, but that they are transitioning to become more themself, myself included!

Chest: I use chest to describe everything a person’s chest or torso might include, which might also include breasts or breast tissue.

Dysphoria: Dysphoria is used in this book to describe the physical and mental discomfort that comes with the knowledge that something on your body is not meant to be there, usually something that all other people think is normal for your Sex Assigned at Birth. It should be noted: you do not need to have dysphoria to be trans.

Provider: I use Provider to talk, very generally, about a person who provides your medical or mental health care. You can think of this as your Primary Care Provider (PCP), General Practitioner (GP), Mental Health Provider (i.e., therapist), or whomever else you receive access to healthcare from.

WPATH Standards: The WPATH is the World Professional Association of Trangender Health. It is an international, nonprofit, interdisciplinary organization formed by (mostly cisgender) medical professionals and supporting members around the world to create professional, evidence-based guidelines for the treatment of transgender and gender-nonconforming people. As an international organization, it is considered an authoritative body on the treatment of transgender people, and it periodically releases a publication defining requirements for physical transition: the Standards of Care (SOC). The SOC sets the standard for when and how transgender people can undergo medical intervention for their transition (have surgery, start hormones, etc.), and it is considered the guideline for surgeons and other providers to follow. In theory, the SOC are what health insurance companies (and public healthcare) should follow. Many health insurance companies and public health care agencies, however, do not follow the SOC. Because it is considered an authoritative resource, the SOC can be used to challenge trans-exclusionary insurance policies. Throughout this book, I will list what the WPATH SOC states when it comes to surgical or hormone requirements.¹

Safer Chest Binding

Chest binding is the action of wearing something to make your chest appear flat. There are a number of different ways that you can safely bind, and there are many ways out there that are not safe and may cause long term damage. We’ll go over your options in this chapter and highlight guidelines for safe binding.

One aspect of dysphoria that is talked about a lot in trans circles for transmasculine and nonbinary people is chest dysphoria, the feeling that the tissue that is currently on your chest does not belong, or should not be there. This dysphoria may look like wearing sports bras so that the bulge of chest tissue doesn’t appear in a tee shirt, or feel more specific to the physical sensation of the tissue. I know, for me, this was the largest source of my dysphoria before having top surgery. For some people, though, top surgery is not an option that is readily available to them due to cost, living situation, or more. For others, they may not want top surgery and enjoy their chest in certain instances, but want it flat in others. Whatever reasons you may have behind needing your chest to be flat, binding your chest is what creates this flatness.

As always, be sure to check with a medical professional to be sure that binding will be safe for you. Some people may have aspects of their health that make binding impossible for them (think: chronic pain), or may require a closer look and closer consideration on what will be healthy for them (think: asthma, Ehlers-Danlos, etc.). What may work for you may