Transitioning is the process by which someone will “transition” from a female to male sex by way of physical appearance.

The first part of the process is often trying to find a way of dressing, talking and behaving to find something you feel comfortable with. This may be something you practise in private and may include wearing clothes, talking and acting (the way you walk and use mannerisms) until you find an identity that you feel better suits you or makes you feel more comfortable.

Once you are sure that you want to transition, it is best to tell people by coming out as you may find it much more difficult to transition without the support of friends and relatives. After you are comfortable with finding support from friends and relatives you can contact your GP who may be able to refer you to a gender specialist, who will be able to provide more advice on the process.

The gender specialist will probably advise you that you will not be able to get hormones (Hormone Replacement Therapy; HRT) immediately. It can take a varied length of time after you’ve started “going full time”; living permanently in the gender you feel comfortable with.

Legally, you can get a name change at any point with relative ease (as long as a few conditions are met such as that the name change is not for fraudulent reasons, etc.). Many trans* people change their name once they have gone “full time”; it may ease the transition for those around you as they may find it easier to assign a gender to a name rather than reassign a gender to an existing name and thereby making it easier for them to use the correct pronoun. To do this you need to get a deed poll (google: “uk deed poll”) or a statutory declaration after which you can legally change your name on documentation (if it is possible, it is worth getting a number of copies at the time of the name change as it may cost more to get copies later on). You should also be able to change your title (e.g. Miss, etc. to Mr) without any proof of gender reassignment.

Try not to rush the process of transitioning. Though it can take a long time, it is worth transitioning at a steady pace so that you can keep up with the way you are changing and can feel comfortable with your body as you progress. Remember that transitioning is about you; don’t try to catch up with other trans* men or cis/bio men. It’s best to find a pace where you feel like you are in control of your own body.

The next part of the process is often hormones. There are a variety of ways to get hormones including from the NHS and privately. Some people also get hormones from the “black market”. It is, obviously, advised not to do this as there is no guarantee that they are good quality and may have long lasting damage.

Through doctors, hormones can be monitored for the correct level and therefore you will be getting the best transition possible. It is worth looking up different types of hormones. If you are not happy with the type you are prescribed, it may be worth having a conversation with your gender specialist to see if you can be switched to a different type. Remember throughout the process to do as much research into all drugs and care as possible so that you know what to look out for and can feel comfortable with the process.

FTM people are usually prescribed injections of testosterone into their muscles (intra-muscluar injections). Testosterone is usually prescribed for the duration of their lives so that hormone levels remain suitable. The first signs of hormones working are increased body hair growth, masculine body odour and a greater sex drive. Within a year, you may also find your voice “breaks” into the male range. The fat from around the hips and buttocks will decrease, aided greatly by more exercise. Exercise will also help build a more masculine body shape. The face shape and jaw will become subtly more masculine and the skin rougher. The clitoris will also enlarge for the first few years and may become around 2 inches (5 centimetres). It takes six months or longer for periods to stop.

While these changes may be exciting, remember that it is important not to rush into this, as you’ll be able to keep up with your body and not feel like you have to catch up with it.

Some of the down sides of hormone treatment are acne during the first few years. It is advised to use anti-bacterial to stop this. There are also many other options that can be found at cosmetics shops. If none of the commercial options suit, you can ask your GP for acne treatment. You may also experience male pattern baldness (you will know to expect this if this is common in the family) though most will just experience the appearance of recession areas around the temples. Testosterone also increases the risk of heart and liver problems so it is best to cut down on heart and liver related risk factors such as smoking, binge drinking, and eating unhealthily. You should get annual check-ups to make sure that the testosterone isn’t damaging the heart or liver. You must make sure that you are getting regular blood tests to check the function of major organs. Early on these may be 6 monthly and later must be done annually. Do not skip these; they are very important.

It is also important to keep healthy in other ways. This includes getting cervical screening (which should be done every three years). The screens determine whether there are any pre-cancerous masses present and so can be treated earlier and prevent a full blown cancer.

The surgery options for FTM people includes both top and bottom surgery. “Top surgery” includes removal of breast tissue and reducing the size of nipples similar to a mastectomy. Unlike a mastectomy, however, the procedure is done to produce a male chest appearance which usually means trying to reduce the breast tissue and leaving as few scars as possible. It is worth researching surgeons as results may vary between them.

“Bottom surgery” includes removal of the uterus, cervix and ovaries. This is the same as a hysterectomy which is a common procedure for gynaecologists. It is also possible to get a different option known as a Laparoscopically Assisted Vaginal Hysterectomy (LAVH) which uses keyhole surgery, leaving fewer scars and has faster recovery times.

A further bottom surgery is the construction of male genitalia. The process is either called a “metoidoplasty” or “phalloplasty”. The difference between the two is that a metoidoplasty is the use of the clitoris as a penis (the clitoris grows due to hormones) and then surgically constructing a scrotum with the labia and adding solid silicone testicles. It is also possible to get the urethra extended to the tip of this construct so that the person can urinate the same way as any other male. The advantage of this is that sexual sensation is less likely to be lost and there is little scaring, however the penile construct is often too small or too downward facing to be used for penetrative sex.

A phalloplasty is the construction of a penis from the arm or stomach area. The urethra can still be extended to the tip and the scrotum and testicles are made in the same way as with a metoidoplasty. A phalloplasty also includes the insertion of an erection device as there is not as much sexual sensation in the construct. A phalloplasty gives a better appearance of a penis, but is a more complex procedure and leaves more obvious scarring. It also takes at least four operations to complete.

For both of these operations, the greatest risk is in the extension of the urethra to the tip of the constructs.