(Note: There are serious risks to any hormone therapy. It should not be taken in the absence of a knowledgeable doctor's ongoing supervision.)
Forgive me while I dip into my prior (male) life for a proper analogy to describe what it was like to have the wrong primary sex hormone coursing through my body. The only way to explain it is that I felt like a car running on the wrong type of gas. That seems very clear after having replaced testosterone with estrogen four years ago. I now have an amazing sense of well-being and harmony that I never knew before. Now my body just hums.
Estrogen has also accomplished physical changes that contribute to my harmony. Because I now carry a higher body fat content, as other women do, my skin feels softer—and I have a few curves I didn’t have before. Of course, all the curves in the world couldn’t hide my broader shoulders and longer waist, but it helps. My rear end is larger now too but still a little smaller than my ideal. In fact, I have on occasion joked with my nontrans women friends that I would gladly trade my shoulders for their butts.
One thing estrogen cannot do is make a male voice rise into female range. There are surgeries that claim to be able to do this, but their success rates are terrible, and because the procedures can actually cause damage they are not recommended. The safer alternative is voice therapy, and results can be quite good. Remember the voice coach at the very opening of the movie Transamerica? Many MTFs know about Andrea James, and some (including me) own her voice course. There are also speech therapists in larger cities that specialize in voice feminization.
Estrogen may make your body hair softer, but it does not get rid of hair in the places women usually don’t have hair. For this reason electrolysis is often sought. In my case, I had so much hair to remove that I chose to make several trips to a legendary establishment, well-known in the MTF community, where external injections of anesthetics are used to permit extended electrolysis sessions. It took five days with two technicians working on me from 9 a.m. to 5 p.m. to remove my facial hair the first time, and 300 hours of electrolysis overall. Others require less and can get by seeing the local electrologist, but it still adds up to a significant expense.
Estrogen also does not grow hair in the places where women normally have hair. If you transition genders later in life, chances are you are suffering from male pattern baldness. Some have luck regrowing hair with hair regrowth medications, but more severe baldness usually requires hair transplantation or a hairpiece in order to meet expectations for feminine hair.
And, of course, estrogen does not give you female sex organs. This is where some turn to sex-reassignment surgery. I say “some” because many people under the transgender umbrella can’t afford SRS, and some actually never feel the need for it. Really! Some achieve harmony with their gender identity after following a few or all of the steps above, without SRS, while others are satisfied just by living as the opposite gender, or somewhere in between, all of the time or maybe even some of the time.
Yet our culture and our laws are very focused on SRS as the defining moment that one switches genders. For example, while the movie Transamerica was generally well done, the advertising and publicity annoy many of us by referring to the main character Bree as “he” in the days prior to her SRS, even though she was living as a woman. Meanwhile, the gender marker on most legal documents cannot be changed without proof of SRS. This is highly problematic for transgender people who need to have legal identification that matches their gender identity and outward appearance. Besides, why are we forced to disclose what’s in our pants in the first place?
But since SRS is of great interest to many, I’ll outline the common procedure for MTFs. As described by Wikipedia.org, “the erectile tissue of the penis is removed, and the skin, with its blood and nerve supplies still attached, is inverted into a cavity created in the pelvis. Part of the tip, still connected to its blood and nerve supplies, is usually used to construct a clitoris, and the urethra is shortened to end at a place that is appropriate for a female anatomy.”
After sex reassignment surgery, one can have vaginal intercourse but, of course, cannot give birth. I’ve been told that 85% of those who have had SRS can achieve orgasm. It often takes a while after surgery, however, to learn what stimulation (and where) works with your new anatomy. MTF SRS can cost as much as $20,000 and require three to four weeks of time off, and unless you are very active sexually it requires dilating the vagina at least once a week for the rest of your life to keep it from closing up. It is not a surgery to be undertaken lightly.
At the same time as SRS, or separately, some may opt for additional procedures to enhance outward appearance. Breast augmentation may be chosen if estrogen therapy has not resulted in adequate breast tissue growth. Others may undergo a “tracheal shave,” a surgical procedure which generally successfully minimizes the prominence of the Adam’s apple.
Ironically, hormone therapy and SRS are usually not allowed without the authorization of a mental health professional, yet few insurance plans cover any aspect of transgender care. Cost is usually cited as the concern, fueled by the false belief that all transgender people want SRS. The result is that beneficial estrogen therapy, covered without question for the well-being of a menopausal woman, is generally not covered for the well-being of a transgender woman. How sad.
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