Transitioning is the process by which someone will “transition” from a male to female 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. Mr to Miss, etc.) 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* women or cis/bio women. 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.

The hormone treatment for MTF people varies greatly depending on the individual. Some need only oestrogen while other will get oestrogen with progesterone. A further group will also get anti-androgens to reduce the amount of testosterone. For the latter group, the anti-androgen is used short term. The combination of oestrogen/progesterone continues throughout the lifetime.

The first signs of the hormone treatment working include an increase in emotional mood swings, as well as a possible weight gain from increased water retention. In the later months, breasts may also start to grow (though they may not be the same size as cis/bio women’s) and body fat distribution will move to the hips and buttocks and muscle strength will reduce producing a more female body shape. The face shape will also become subtly rounder and the skin softer. The testicles will also decrease in size and eventually stop functioning and erections reduced.

Sometimes body hair also reduces but often electrolysis or laser treatment is needed to remove facial and/or body hair. Male pattern baldness will also cease to continue though the effect of any baldness will most likely remain the same.

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

The pitch of the voice will not change and therefore speech therapy is used. There are also surgeries to shave the trachea to raise the pitch of the voice.

The downside of hormones is that it increases the risk of breast cancer, high blood pressure and blood clots. There is also a smaller increased risk of liver disease. In order to ensure that you are not taking any risks, you should try to cut the risks of these by, for example, stopping smoking and binge drinking , and eating healthily. It is also important to get regular checkups. You must make sure that you are getting regular blood tests to check the function of major organs. Do not skip these; they are very important.

As the breasts develop due to the oestrogen levels, usually surgery is only needed for the genitalia (though some will also get breast enlargement if they are not happy with their breast size). The process is called a “penile inversion vaginoplasty”. In this, the testicles and erectile tissue are removed and a vagina is created and lined with the skin from the penis. The urethra is shortened, and the scrotal skin used to create a labia. The appearance of vaginoplasties are usually very good. A further procedure can be done to give the appearance of a clitoris which also gives increased sexual pleasure. This involves retaining part of the glands penis including its nerve and blood supply and creating a clitoris from it.

A further procedure is sometimes carried out (mostly in America; the UK has only one [in 2007]). This procedure is the labioplasty which creates the clitoral hood and labial juncture. If done, it is done some time after the original procedure.

Other surgical possibilities are breast enlargements (implanting of silicon or saline as with other breast augmentation), reduction of the Adam’s apple (“thyroid cartilage reduction”) as well as facial feminising surgeries (when female hormones may have limited effects on the facial appearance, further surgery can be carried out to produce a more feminine looking face by altering the nose, jaw and brow).