A lot of the specifics of my medical transition are not as relevant to male-assigned-at-birth (MAAB) people. Since I haven’t yet found an equivalent transition blog that covers all the facets in detail, it is hard for me to refer readers who request this information to a specific outside source. But I have done lots of research! From articles to surveys to personal inquiries, here’s what I’ve compiled thus far.
If you have no idea how hormone replace therapy works or even what it is, I recommend starting with this very detailed article from Open Minded Health.
The hardest thing about being neutrois/agender/androgyne and taking hormones is that we have to compromise. Your body needs sex hormones – estrogen or testosterone – primarily for bone health but for a myriad other reasons as well. Therefore, you will have to gain secondary sex characteristics of the opposite sex in order to lose or mask the ones of your natal sex. Ideally we achieve a middle ground where we have lost enough and not gained too much, a place where we find comfort in being less physically gendered.
For female-assigned-at-birth (FAAB) people, this is not as much of a problem, because estrogen is produced naturally, but estrogen does not continue to feminize the body once puberty ends. That is, breasts don’t keep growing indefinitely. So, there is really no need to block estrogen. To masculinize this body towards androgyny, one only needs to take testosterone, which affords flexibility in dosage and frequency. One can stop taking testosterone and it will leave the body with most of the permanent masculinized changes (like lower voice, and hair) and the body will not feminize further (again, breasts won’t grow, even with continued endogenous estrogen and no additional testosterone I have written about this in my hysterectomy posts, which deal with hormones or the lack of.)
For MAAB persons, it gets more complicated because testosterone masculinizes indefinitely. This means your voice will continue to deepen, hair will continue to grow, skin will thicken. To stop this masculinization, you get block your endogenous testosterone production by taking an anti-androgen. Consequently, because it is unhealthy for the body to remain without any sex hormones, you will need to take estrogen as well. And estrogen will feminize your body, including breast growth, curviness, softer skin, lower libido, among other effects. This is where the compromise comes in.
As with testosterone HRT, you can take low-dose estrogen, and feminize very gradually, slowly, at your own pace. However there is added complexity in that you are balancing this with an anti-androgen to block testosterone (not to mention some people have reported bad side effects with anti-androgens). Although I know there are a lot of people who use forums online and self-regulate their dosages successfully, I always recommend approaching HRT with the guidance of a doctor, preferably one who is attuned to your physical goals and/or identity.
There are some “neutralizing” genital surgery options for MT* people.
An orchiectomy removes the testicles and scrotum sack (see Open Minded Health again for a more info on this surgery). The primary benefit of an orchiectomy would be to remove endogenous testosterone production, so you do not require an anti-androgen anymore and there will be no further masculinization of your body. The side effect, as we saw before, is that you will need to be on HRT for the rest of your life, and this will most likely be estrogen (which can be low-dose). There is also the aesthetic benefit of less bulk, which some people seek as well.
A penectomy removes the penis as well as the scrotal sack. It is sometimes considered a full castration (search for “eunuch” and you’ll find much more on this). This would essentially leave your genital area neutral. But one potential complication is long-term urinary problems. From the self-reports I’ve gathered, this is quite difficult to obtain, primarily because surgeons will insist on building a vagina, and are incredulous or uncomfortable of leaving this area neutral and devoid of genitalia (even if it’s what you want). There are one or two cases I’ve read about who have gotten a neutral or “nullification” option, but I don’t know the details.
This is where my knowledge officially stops in terms of bottom surgeries. I am going to make a big assumption that there are other viable options which a skilled surgeon could be willing to explore. The catch is in finding that open minded skilled surgeon. [Update: Dr. Crane, a well-known surgeon in the trans community, is open to discussing these options.]
How to Access This
As I’ve previously summarized, WPATH Standards of Care no longer encourage therapy as a requirement to access hormones. You just need to find a clinic or a trans-friendly general practitioner (it does not even have to be a specialized endocrinologist) who will prescribe these for you.
Bottom surgery is a much more serious undertaking. Doctors will often require a letter (or two) from a therapist and/or medical doctor, along with ongoing hormone treatment. The prior hormone therapy is necessary considering you will have to be on HRT afterwards.
Financially speaking hormones can be cheaply obtained through insurance if you have a plan that covers them, and doctor and/or therapist visits can be covered as well. Bottom surgeries are usually never covered by insurance, and even if they are it’d be strictly for MTF/FTM GRS procedures, usually requiring a long and arduous process of paperwork. I do not know exact costs, but orchiectomies can be from $5K (in Thailand) to $50K in the United States. Also bear in mind this information is very US-centric, and does not apply to countries with national healthcare systems.
I encourage you to do more research on this, including in MTF as well as Eunuch forums. Do not fret if people say it is impossible or can’t be done, they just haven’t done enough research :)
Corrections are more than welcome, as is any additional information. If you are willing to share your experiences about this with someone (I know some of you who are), please leave a comment and/or privately email me so I can have your information handy for future referrals.