I am frequently asked for advice on how to start the process of gender reassignment. To avoid having to repeat myself again and yet again, I decided to put the basics up here, providing a brief outline of what I did to get to SRS, and perhaps what I might have done differently knowing what I know now.
1) Know Yourself - you can't think you will be happy after surgery just because of a few physical changes. If you hate yourself, you need to overcome that hate first. True, you didn't ask to be born as the gender you are, but it isn't your body's fault either. Hating it is not going to help. It is the only body you will ever have in this lifetime, and like it or not, you both make up a whole being - and so you need to make peace with your body first. Yes, it's the wrong gender for you, but you need to take a holistic approach to the change. In order for you to live and find happiness, it needs to change - but in order for it to go on living, you need to be good to it. It's like any machine - if you look after it, it will look after you.
Don't let people discourage you by telling you that you "won't make a 'good-looking' woman". That's bullshit. They don't know that. Some really stunning females today were not quite as stunning as males before.
Don't let people break you down or try to convince you of your 'mistake' by beating you up with religion or by calling you an 'abomination' in the eyes of "God". They don't know any more what is right and what is wrong than anyone else does. What is wrong hurts other people through real and measurable harm, not through the application of selfish guilt in trying to change your mind to suit them. If it's right for you, then it's right - end of discussion, and fuck them if they don't like it. "God" is a big boy - after all, if you believe in "God", then you believe it made you this way - if he, she or it doesn't like it, he, she or it will get over it - and so should everyone else. It's none of their business anyway.
Don't let people break you down or try to convince you of your 'mistake' by beating you up with religion or by calling you an 'abomination' in the eyes of "God". They don't know any more what is right and what is wrong than anyone else does. What is wrong hurts other people through real and measurable harm, not through the application of selfish guilt in trying to change your mind to suit them. If it's right for you, then it's right - end of discussion, and fuck them if they don't like it. "God" is a big boy - after all, if you believe in "God", then you believe it made you this way - if he, she or it doesn't like it, he, she or it will get over it - and so should everyone else. It's none of their business anyway.
2) Be Realistic - Know what sort of changes will suit you, make up your mind how far you you want to go with this process. Will you be happy without surgery? Will you be happy going all the way with surgeries and documentary changes? Work out what kind of resources you have to facilitate the changes. You will need to pay for medical costs, doctor's fees, medication, surgeries. Will your medical aid or health insurance cover any of these costs? Can you afford it? Society isn't kind to trans people who do have all their surgeries and documents changed - and even less so to those who don't.
3) Educate Yourself - Read About SRS, GRS, SCS or whatever they call it these days, watch videos about the treatments and the surgery, read the testimonials of others. Know what it's all about. Don't go into the thing blind or you will fall victim to the con artists and hacks out there who will take advantage of your ignorance - and you may end up with an unsatisfactory result. Look up resources by Melanie Anne Philips - her sex change bible "Everything you ever wanted to know about sex change but were afraid to ask" is a definite MUST READ especially if you have to win over "gatekeepers" like therapists, shrinks, social workers or other people who need to be convinced you know what you're talking about before helping you reach your goals.
4) Do What You Can First - Being female is more than just about what is between your legs. Start by changing your wardrobe according to what you feel you can realistically get away with in terms of style and your current physical appearance.
Some girls are really lucky in that they are either feminine already, or that they appear fairly androgynous to begin with. Some of us are not so lucky, and would look like a guy in a dress. Use common sense - especially if you expect difficulties in passing, or if hostility from friends, neighbors, co-workers etc is a real possibility. Don't be stupid and go looking for trouble. Trans people - even beautiful, passable and stealthy girls get killed every day around the world - and usually by people they know intimately and trust. Contrary to the memes that say "it gets better", the truth is, it's getting worse.
Train your voice using the numerous guides online, practice make-up technique, go for electrolysis or laser treatments to remove beard and unwanted body hair - all the things you don't need doctor's permissions for. If you're struggling, or if like me, you have damaged vocal chords or nodules on yours - and sound like Bea Arthur - don't worry too much about it. Girls have all kinds of voices - I once met an 18 year old feminine cis-girl who had a much deeper voice than mine. Believe in yourself.
Some girls go for breast implants, I never thought it worth the bother. Having naturally grown breasts is worth the wait, but some girls lose the plot and go overboard with DD's, forgetting that they want to be women - not over-exaggerated drag queens. Some plastic surgeons will fit you with implants no matter who or what you are, as long as you can pay and sign the waiver. If you go this route, DO NOT go for water or silicone-filled implants, they leak. Go for a "jelly-tot" implant that suits your height and build. DO NOT agree to a technique where the surgeon works through the nipple - this technique means they remove the nipple, put it on ice, insert the implant through the hole, and then re-attach the nipple. Yes, there will be less scarring, but your nipple will lose sensation, and may even die and need to be removed later. DO NOT agree to a procedure where the surgeon cuts under the breast to insert the implant, there is a significant risk of loss of sensation. Preferably choose a surgeon who will insert the implant from under the armpit.
Grow your hair or buy a wig. If you don't know yet how to walk or move like a girl, tuck or shave or wax or shape your eyebrows, start learning to. Watching other girls around you is an easy way to learn. Or just ask one for a little help or advice.
Some girls are really lucky in that they are either feminine already, or that they appear fairly androgynous to begin with. Some of us are not so lucky, and would look like a guy in a dress. Use common sense - especially if you expect difficulties in passing, or if hostility from friends, neighbors, co-workers etc is a real possibility. Don't be stupid and go looking for trouble. Trans people - even beautiful, passable and stealthy girls get killed every day around the world - and usually by people they know intimately and trust. Contrary to the memes that say "it gets better", the truth is, it's getting worse.
Train your voice using the numerous guides online, practice make-up technique, go for electrolysis or laser treatments to remove beard and unwanted body hair - all the things you don't need doctor's permissions for. If you're struggling, or if like me, you have damaged vocal chords or nodules on yours - and sound like Bea Arthur - don't worry too much about it. Girls have all kinds of voices - I once met an 18 year old feminine cis-girl who had a much deeper voice than mine. Believe in yourself.
Some girls go for breast implants, I never thought it worth the bother. Having naturally grown breasts is worth the wait, but some girls lose the plot and go overboard with DD's, forgetting that they want to be women - not over-exaggerated drag queens. Some plastic surgeons will fit you with implants no matter who or what you are, as long as you can pay and sign the waiver. If you go this route, DO NOT go for water or silicone-filled implants, they leak. Go for a "jelly-tot" implant that suits your height and build. DO NOT agree to a technique where the surgeon works through the nipple - this technique means they remove the nipple, put it on ice, insert the implant through the hole, and then re-attach the nipple. Yes, there will be less scarring, but your nipple will lose sensation, and may even die and need to be removed later. DO NOT agree to a procedure where the surgeon cuts under the breast to insert the implant, there is a significant risk of loss of sensation. Preferably choose a surgeon who will insert the implant from under the armpit.
Grow your hair or buy a wig. If you don't know yet how to walk or move like a girl, tuck or shave or wax or shape your eyebrows, start learning to. Watching other girls around you is an easy way to learn. Or just ask one for a little help or advice.
5) See A Shrink - Sadly there is a need to see at least one clinical psychologist to get a diagnosis of gender dysphoria, which should not take a year to achieve. A professional who really wants to help you will not drag your sessions out for 6 months or longer to fund his expensive golf habit, but will cut to the chase and give you a series of personality tests to determine that you are sane, responsible and adult enough to know exactly what it is you are asking for. If they prolong the matter, or seem to keep on rolling more obstacles into your path, move on to another one. They just like to play "God" and enjoy the smell of your money.
Don't bother to see people advertising themselves as "Christian social workers" or "Christian counselors" - their qualifications are bogus, usually obtained from some offshore diploma mill or some worthless religious fundamentalist "bible college" in the Cayman Islands - and besides, rather than help you, they're more likely try to talk you into getting shipped off to some right wing religious nuttery (like an 'ex-gay' boot camp), and then you really will be screwed - and probably more literally than figuratively. Additionally, if you have gone to see a REAL mental health professional (someone with a qualification from an actual university, and not some 'faith-healing' bullshit-peddler that got his certificate in a lucky packet endorsed by some 'divinity school') and they start trying to persuade you to change your mind, to "pray" about your "sinful feelings" etc - get your shit together, and walk out - you have just wasted whatever you paid that quack for his time, but if you entertain that idiot by wasting more of your time, it will all be on you. Consider reporting him or her to a mental health ethics council or board, or at the very least, make their transgressions known on social platforms like Facebook.
Psychology is pretty much a guessing-game masquerading as a science - but a science it is not. It's not like actual medicine where they can do a blood test or take your temperature and diagnose an actual illness. They need to base their diagnosis on what you TELL them - and therein lies the crux - you need to tell them what you want them to hear. You need their approval to get your surgery - just so the surgeon feels safe that he or she won't get sued afterwards if you have regrets, or if they screw up - and face it, it does happen. Oh hell yes, baby, it does - but the onus to know what you want, and to know the consequences of your choices and decisions - is always on YOU. But the mistakes of other people should NOT be used to slow YOU down or crash YOUR hopes and dreams.
Don't bother to see people advertising themselves as "Christian social workers" or "Christian counselors" - their qualifications are bogus, usually obtained from some offshore diploma mill or some worthless religious fundamentalist "bible college" in the Cayman Islands - and besides, rather than help you, they're more likely try to talk you into getting shipped off to some right wing religious nuttery (like an 'ex-gay' boot camp), and then you really will be screwed - and probably more literally than figuratively. Additionally, if you have gone to see a REAL mental health professional (someone with a qualification from an actual university, and not some 'faith-healing' bullshit-peddler that got his certificate in a lucky packet endorsed by some 'divinity school') and they start trying to persuade you to change your mind, to "pray" about your "sinful feelings" etc - get your shit together, and walk out - you have just wasted whatever you paid that quack for his time, but if you entertain that idiot by wasting more of your time, it will all be on you. Consider reporting him or her to a mental health ethics council or board, or at the very least, make their transgressions known on social platforms like Facebook.
There are a few very good reasons for having "gate-keepers", but there are more good reasons to find gaps in the fence to slip through.
Psychology is pretty much a guessing-game masquerading as a science - but a science it is not. It's not like actual medicine where they can do a blood test or take your temperature and diagnose an actual illness. They need to base their diagnosis on what you TELL them - and therein lies the crux - you need to tell them what you want them to hear. You need their approval to get your surgery - just so the surgeon feels safe that he or she won't get sued afterwards if you have regrets, or if they screw up - and face it, it does happen. Oh hell yes, baby, it does - but the onus to know what you want, and to know the consequences of your choices and decisions - is always on YOU. But the mistakes of other people should NOT be used to slow YOU down or crash YOUR hopes and dreams.
In the end, THE gatekeepers work for YOU, not the other way round. YOU should call the shots, not them.
6) See A Urologist - Once you have your papers from the shrink, head over to a urologist and have a chat to him/her about a bi-lateral orchidectomy (castration). This surgery will make it far easier for you HRT (Hormone Replacement Therapy) to effect changes to your body - and since you will need far less medication it will work out far cheaper and also less traumatic for your liver and kidneys. If the doctor is willing to do the surgery (some aren't, but don't be disheartened - there are plenty who will), he or she will probably ask you to sign a waiver or indemnity form to show that you understand exactly what you're asking and paying him for. If done at a public hospital with no overnight stay, this minor 15 minute surgery should cost in the region of 6 to 10,000 ZAR.
6) Start HRT - ask the same urologist for a repeat script for hormones. A balance of estrogen and progesterone should work nicely for breast development and general feminization. Consult a gynecologist for more precise dosages. Ensure that proper blood tests and hormone level tests are administered 6 monthly if you have any doubts about your health. If you have liver or kidney problems, you need to ensure they check liver function and kidney function among other things - HRT can be a strain on the health, especially if you have health problems with liver or kidneys.
7) Find A Surgeon - if you're in South Africa and if you have around 100,000.00 ZAR to spare, instead of buying a new car cash, you could get that volksie-bonnet you always wanted. If you haven't got that kind of money, rather save up for it - DO NOT BE TEMPTED to running to any of the state's so-called academic hospitals to join their (literally) cut-rate training programs for plastic surgeons.
I've heard way too many disturbing stories from former patients of theirs who told me how harshly they were treated by the doctors on staff, who seemed more to be experimenting on them to see how well a particular new variation on a procedure works out than actually doing what they wanted them to do.
Sure, it will probably cost you much, much less - but remember, you get what you pay for. If you want a fully functioning tool-box, go to a private surgeon who will give you the tried and tested penile inversion procedure with sensate clitoris. If you can't find the same one I found in Johannesburg (Dr. Ladas) that cost me 50 g's in 2006 (that man is a genius, can feel everything), then look in Thailand. They have complete packages available, including accommodation for yourself and your companion during your recovery as well as getting psychiatric approval 24 hours before surgery with their staff psychiatrist. Just make sure you pick one of the top SRS surgeons there, and not one of the bottom-ranked cheapie's - do your research!
A friend of mine went over to have her SRS as well as FFS done all at once - it was a lot of pain to put up with all at once, but well worth it in the long run - besides, there're painkillers.
DO NOT waste your time on jumping through flaming hoops and over unnecessary obstacles - rather save yourself all the drama, save your money and skip the bullshit - go have it done in Thailand. Bangkok isn't called "the sexchange capital of the world" for nothing - there are some really good top-surgeons there who know exactly what they are doing.
I've heard way too many disturbing stories from former patients of theirs who told me how harshly they were treated by the doctors on staff, who seemed more to be experimenting on them to see how well a particular new variation on a procedure works out than actually doing what they wanted them to do.
Sure, it will probably cost you much, much less - but remember, you get what you pay for. If you want a fully functioning tool-box, go to a private surgeon who will give you the tried and tested penile inversion procedure with sensate clitoris. If you can't find the same one I found in Johannesburg (Dr. Ladas) that cost me 50 g's in 2006 (that man is a genius, can feel everything), then look in Thailand. They have complete packages available, including accommodation for yourself and your companion during your recovery as well as getting psychiatric approval 24 hours before surgery with their staff psychiatrist. Just make sure you pick one of the top SRS surgeons there, and not one of the bottom-ranked cheapie's - do your research!
A friend of mine went over to have her SRS as well as FFS done all at once - it was a lot of pain to put up with all at once, but well worth it in the long run - besides, there're painkillers.
DO NOT waste your time on jumping through flaming hoops and over unnecessary obstacles - rather save yourself all the drama, save your money and skip the bullshit - go have it done in Thailand. Bangkok isn't called "the sexchange capital of the world" for nothing - there are some really good top-surgeons there who know exactly what they are doing.
WHATEVER YOU DO - empower yourself through RESEARCH in order to make the wisest decision possible - and above all, make your own decisions. If you want it badly enough, you will make it happen - one way or another. Good luck!
All material copyright © Christina Engela, 2021.
