Trans and Non-Conforming Health
What is Trans?
The term trans has emerged as an umbrella term for those who identify with a gender identity that differs from that assigned to them at birth, including gender-nonconforming, transsexual and transgender individuals. Whereas trans is a term that applies to gender identity, sexual orientation describes the gender of one’s sexual preferences. Trans people may seek medical interventions to make their physical appearance match their gender identity. However, not all trans individuals undergo procedures or therapies to change their bodies and appearance, and transness does not necessarily require surgical, hormonal or other intervention. The trans identity is unique to each individual, and whether one has or has not had surgery or is undergoing hormone treatment does not define how they may identify and express their gender.
Some different Trans Identities:
- Trans* FTM
- Trans* MTF
- Gender Fluid
- Gender Nonconforming
- Transsexual Female
- Transsexual Male
Mental health describes the conditions of our emotional and psychological wellbeing. Just as our bodies can fluctuate between states of wellness and illness, so too can our minds. Likewise, there are practices that can help us maintain good mental health the same way we might try to maintain good physical health. A healthy state of mind is just as important to our overall health as a healthy state of the body is.
Transphobia contributes to mental-health challenges for many in the Trans Community, and for those of us living in societies that are less accepting of who we are, the pressure can be more intense. For those who wish counseling in exploring their gender identity or in dealing with their mental health.
Also note that if you begin hormone therapy, there could be effects on your mental state, mood and interactions with people for the first few months. Be sure to discuss concerns regarding these changes with your endocrinologist and a mental health specialist if you feel it is necessary.
Ways to maintain mental health
Being mindful of our mental state is a good way to know when we should try to engage in activities that help us stay healthier. Of course, when possible and when needed, seeking professional help from a mental health provider is ideal, but there are other ways that we can try to maintain good mental health.
Community (Safety net)
Seeking support from friends, family and other members of your community are important to maintaining good mental health. Surrounding yourself with people who will allow you to share your experiences and discuss your thoughts helps to alleviate symptoms of stress, anxiety, loneliness and depression. A trusted friend or family member who can offer support as you explore your gender identity and expression and navigate transitioning can help keep you in a positive state of mind. Friends also allow us to focus on things other than what might be troubling us most.
Diet and Exercise
The mind and body are not divorced from one another, so engaging in behaviors that promote physical health will also promote mental health. Habits such as moderate exercise for at least 150 minutes a week, or vigorous exercise for at least 75 minutes a week, remaining generally active, and avoiding harmful foods are important components of any total-health regime that helps both the body and the mind. Limiting alcohol and nicotine consumption can also reduce anxiety and stress levels, especially if one experiences withdrawal-craving cycles.
Prioritizing quality sleep and making sure to get the appropriate number of hours of rest each night are cornerstones of mental health. During visits to your primary care provider, discuss ways that you can incorporate mind and body health in your daily life, and ways to improve the health conditions unique to you.
Mindfulness helps to reduce levels of anxiety and stress, allowing you to better manage your mental health. Mindfulness involves being fully attentive to the moment you are in, the senses you experience, what is happening around you and your current mental and emotional state. While it sounds trivial, many of us do not practice this in-the-moment attentiveness often enough and are therefore not reaping the benefits of being present in the here and now. Common mindfulness practices include paying attention to the sights, sounds, smells and sensations around you, focusing on your breathing, and taking note of the way each part of your body feels. Practicing mindfulness for even a short period of time each day can help improve your emotional and mental wellbeing.
Transitioning refers to the process of living in the gender with which one identifies, bodily, socially and legally. Often this process takes time and can require a number of legal and medical procedures before living in one’s gender identity. The legal process for changing one’s gender varies from country to country and may not always be easy or possible. However, legal, bodily and social changes are not necessary steps for living in one’s identified gender.
A number of gender-affirming treatments and practices exist in order to help trans people acquire secondary sex characteristics that align more closely with their true gender identity. Transitioning practices and medical interventions can be feminizing/demasculinizing or masculinizing/defeminizing and include hormonal therapies, surgical treatments, and speech therapy among other things. There are also non-surgical and non-hormonal practices that members of the trans community engage in in order to affirm their gender identity.
The process for hormone therapy begins with an appointment with a psychiatrist. To find a psychiatrist experienced in this process.
Once the psychiatrist has determined that hormone therapy is an appropriate path forward, your endocrinologist will perform a number of general tests to make sure that your overall health is in good condition. Once therapy begins, there is another set of assessments after 3 months to make sure that the therapy itself is working and to check for any side effects. In another 6 months, you should check up with your physician again. For any surgical interventions, one needs 12 months of continuous hormonal treatments.
Feminization and De-masculinization
The goal of such therapies and practices is to promote the development of female secondary sex characteristics their appearance and minimize male secondary sex characteristics.
Feminizing hormone therapies often involve the combination of a biological equivalent to estrogen and an androgen blocker. This results in physiological changes in accordance with the hormone. The general effects of this therapy involve:
– Development of breasts (usually to Tanner Stages 2 or 3)
– Feminization of body fat distribution
– Reduction of muscle mass and strength
– Reduction of body hair
– Some reduction in facial hair
– Modifications in odor and sweat patterns
– Reduction in erectile function, sperm count, ejaculatory fluid and testicular size. However there can be a viable sperm count up to three years after treatment.
– Changes in Libido
– Changes in emotions and behaviors
One note about estrogen and androgen-blocking therapies is that they do not change the pitch of the voice post-puberty, since pitch is determined by the physical shape of the vocal chords, which will have already developed post puberty. Surgical interventions do exist to change the vocal chords, and speech therapies that coach people on how to modify patterns and tone of voice are also gender-affirming processes that one may pursue.
Licensed medical-providers are the most capable and safest path towards seeking hormone treatments. Medical professionals can help determine the best way to pursue gender-affirming treatments, including the proper course for hormone therapy or surgery. Hormones purchased online may not be medical grade and do not come with the most accurate information for your body on how to transition. Non-medical grade needles, or injections performed outside of a medical setting can transmit bloodborne illnesses.
It is important to remain in contact with your physician during hormone treatment for regular checkups, at least every six months, to make sure you are taking an appropriate dose and that you are in good health, and to know the reversible and irreversible effects of hormone therapy. Sometimes hormone therapies can affect other aspects of your psychology and physiology in negative ways. The following are some of the risks associated with estrogen therapy/androgen blocking therapy. Be sure to discuss with your healthcare provider:
- Cardiovascular Issues
- Increased risk of stroke
- Changes in liver Enzymes
- Increased risk for type 2 diabetes
- Weight gain
Tucking refers to the practice of changing the contours of one’s genitals to outwardly appear more feminine. Tucking is a gender-affirming practice for transfeminine people that can be safely done with the proper precautions.
It is important to take care of the skin in the area to avoid irritation and infection. Removing pubic hair and using surgical or athletic tape minimizes discomfort when tucking using a tape-method. Tape will also irritate the skin over time, so covering the skin of the penis with a gentle cloth or tissue can limit irritation. Keeping the skin dry, clean and cool can also reduce the risk of superficial fungal infections. Take breaks from tucking if you are comfortable and/or alone or wear looser pants and skirts.
An important note is that one cannot urinate while tucking. Avoiding urination for extended periods of time may cause UTI’s or kidney and bladder damage if one keeps resisting the urge to urinate. People who tuck sometimes elect to drink less water in order to go for a longer period without the urge to urinate. This can lead to dehydration, so it is important to be aware of symptoms of dehydration which include:
– Rapid heartbeat
– Extreme thirst and dryness of the mouth
– Lethargy and confusion
Tucking can also affect reproductive health for those who are not taking hormone therapies since tucking involves exposing the testicles to a higher temperature than is ideal. The role of the scrotum is to keep the testicles slightly cooler than internal body temperature to maintain sperm-health, so tucking for extended periods of time can result in a reduced sperm count.
Silicone and Filler Use
Silicone and filler injections refer to soft tissue fillers used to sculpt the body in order to provide an outward appearance that more closely aligns with one’s gender identity. Filler and silicone injections can be dangerous, resulting in a number of complications including granulomas, blood and skin infections, metabolic issues, cosmetic defects and silicone migration, ulcers and nodules. In some instances, improper administration may lead to disability or death. Unlicensed injections may not contain medical grade silicone, or may contain other, often unknown, substances including aircraft lubricant, sealants, cooking and mineral oils or other substances. Sharing needles and participating in “pumping parties” where multiple people inject silicone or soft tissue fillers pose the greatest risk for the transmission of bloodborne illnesses.
Masculinization and De-feminization
The goal of such therapies and practices is to promote the development of male secondary sex characteristics their appearance and minimize female secondary sex characteristics.
Masculinizing hormone therapy involves the administration of a biological equivalent to testosterone in order to promote the development of male sex characteristics. The general effects of this therapy involves:
– Development of facial hair
– Masculinization of the voice
– Masculinization of body fat distribution
– Increased muscle mass
– Increased body hair
– Modifications in odor and sweat patterns
– Hairline recession
– Increased Libido
– Clitoral growth
– Cessation of menses after 1-6 months of treatment
– Thinning of the vaginal wall
– Changes in emotion and behaviors
– Skin Oiliness
Licensed medical-providers are the most capable and safest path towards seeking hormone treatments. Medical professionals can help determine the best way to pursue gender-affirming treatments, including the proper course for hormone therapy or surgery. Hormones purchased online may not be medical grade and do not come with the most accurate information for your body on how to transition. Non-medical grade needles and injections performed outside of a medical setting can transmit bloodborne illnesses.
It is important to remain in contact with your physician during hormone treatment for regular checkups, at least every six months, to make sure you are taking an appropriate dose and that you are in good health, and to understand the reversible and irreversible effects of hormone therapy. Sometimes hormone therapies can affect other aspects of your psychology and physiology in negative ways. The following are some of the risks associated with testosterone therapy. Be sure to discuss with your healthcare provider:
- Cardiovascular Issues
- Increased risk of stroke
- Changes in liver enzymes
- Increased risk for type 2 diabetes
- Weight gain
Binding refers to the practice of changing the contour of the chest through flattening it such that it appears less feminine by making the breasts less visible. While this gender-affirming practice can help trans-men look more like their gender identity, it is important to bind properly and safely. Address your binding practices and concerns with a trans* friendly doctor. Binding incorrectly can lead to skin irritation, infections, and scarring as well as underlying tissue damage. Musculoskeletal and respiratory symptoms including shortness of breath and posture changes. Back, chest, shoulder and rib pain have been reported due to binding as well. Some tips to avoid these complications when binding include:
- Limiting time spent binding to 8 hours a day, and take days off when possible. Binding continuously and daily can lead to the aforementioned skin, tissue and musculoskeletal problems. For those considering top-surgery, binding too often may lead to skin-stretching which may affect the final cosmetic outcome of the surgery and can complicate the surgery, so be sure to take breaks as often as possible.
- Use a commercially designed binder or sports-bra and avoid things like duct tape, bandages or elastic material. When using a binder of a bra, it is important to get one that matches your chest size and is not too tight. If the binder causes pain, lesions, seriously restricts breathing or has little air circulation/breathability, consider increasing the size or finding one made from a different material.
- Avoid binding when exercising to allow for maximum respiratory capacity.
- Using skin powders when binding and taking breaks when possible throughout the day help to reduce chafing, irritation and discomfort.
Packing and Packing-hard
Packing refers to the practice of creating a male-looking or feeling bulge above the crotch. This is accomplished through the use of home-made or store-bought prosthetics that mimic the appearance and feel of a penis. “Packing-hard” refers wearing an erect penis prosthetic like a dildo for sexual play. Packing prosthetics must be cleaned frequently, especially when using them for sexual play. Packers made from non-soft silicone materials are porous and therefore cannot be sterilized by boiling. Instead, wash them with soap and warm water and rinse well. Prosthetics made from 100% soft-silicon are non-porous and can be boiled for sterilization. Prosthetics used for sexual play should always have a condom on in order to prevent the transmission of STI’s and STD’s and to keep the devices clean.
Fertility and Reproduction
Transmen who have not undergone reassignment surgeries or removed their reproductive organs can get pregnant; likewise, transwomen, especially if they are not undergoing any hormone therapies, can impregnate a sexual partner.
Nonetheless, fertility can be affected by transitioning practices, so those who are considering reproduction should understand the effects of transitioning on their fertility, many of which have been outlined on this page in the “Transitioning” section. Some effects of transitioning are not always reversible, and fertility may be permanently affected. In Lebanon, sperm and oocyte banks can allow one to preserve their fertility in case they decide that they wish to reproduce later.
For the first few months, it is possible to get pregnant but after a few months of treatment, once progesterone levels are below a certain threshold, you cannot get pregnant. A test for progesterone levels in the body can indicate whether or not there is a chance for pregnancy while taking hormone treatments.
High levels of testosterone in the body during pregnancy can cause birth defects. As a result, trans-masculine people taking testosterone will have to cease taking hormone therapies for the duration of the pregnancy, although it is suggested to use a surrogate. To do so, make sure you discuss with a healthcare provider about the best way to do so to minimize any effects of modifying your hormone therapy.
Even when taking hormone therapies, sperm counts may be viable for up to three years after beginning treatment, so it is important to practice sex in a way that avoid pregnancy if you are having sex that may lead to reproduction, such as using birth control or condoms. To be sure that the sperm count is not viable, one must have a test done.
Notes on Testosterone Hormone Therapy
– 1 – 6 months following hormone treatment, cessation of menses will occur
– Cramping during and after orgasm may occur
– Vaginal wall can begin to thin out, causing increased bleeding and STI/STD transmission
Transmen who still have a cervix, ovaries or a uterus are still susceptible to cancers of these organs and should therefore try to get examined as often as possible. Transwomen who still have a penile organ will also be susceptible to cancers of this organ.
Transmasculine persons having vaginal sex should take care with penetration such that the walls of the organ do not tear, especially when using hormone treatments. If the vaginal wall thins out following testosterone therapy, application of a low-dose estrogen cream to the inside of the vagina can help prevent too much thinning. This can prevent tearing and bleeding in the vagina, thus also reducing the probability of STD/STI transmission.
Those using strap-on sex toys should keep them clean by washing with soap and warm water and proper rinsing. Condoms placed on strap-on toys provide barriers against STI’s and STD’s.
Transwomen taking estrogen treatments may experience changes in libido and erectile function.
To avoid STD’s or STI’s:
– Use a condom and dental dam whenever engaging in vaginal, anal or oral sex.
– Get tested frequently, and speak to your health care provider about any concerns you have regarding STD’s and STI’s. Not all STIs are symptomatic, so you may be carrying a disease without knowledge thereof.
– Be sure to get treated as soon as possible in the case that you do end up exposed. Many sexually transmitted illnesses are curable if treated early. Delaying treatment if afflicted with a disease can complicate the process of recovery later down the line. It is important to follow physician instructions regarding treatment to make sure that it is effective.
After Reconstructive Surgery
Surgically created Vagina:
– Surgically created vaginas do not self-lubricate, so always be sure to use sufficient amounts of body-safe lubrications when having sex
– Surgically created vaginas also do not stretch as easily or quickly. They may also take longer to stretch out sufficiently before sex
– Following vaginoplasty, the use of dilators, devices meant to stretch out the surgically constructed part, are often prescribed in order to keep the surgically constructed vagina from contracting and shrinking. Using a dilator a few hours before sex can help prevent pain and tightness during intercourse. While dilators may be painful to use at first, over time this pain will decrease
– Surgically created vaginas are closed so there could be a higher chance for bacterial skin infection so it needs to be cleared immediately
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