How to Change Your Gender

Tom Gabel, lead singer of Against Me!, announced this week that he will transition to living as a woman, and will change his name to Laura Jane Grace. Today, Argentina passed a Gender Identity law that will allow adults seeking sex-reassignment surgery and hormone therapy to have their expenses covered by private or public health insurance plans without approval from a doctor or a judge. With all this talk about transgender people in the news, one might wonder how people actually change their gender.

First, people identify with their biological sex in various ways. Transgender individuals can usually be broken down into one or more of these following categories. Crossdressers, who have previously been called "transvestites," are individuals who are content with their birth gender, but who enjoy dressing up in clothing typically worn by the opposite sex. They are often distinct from drag performers, and they are not necessarily gay and they do not necessarily want to undergo sex reassignment surgery (SRS). Drag performers are individuals who dress up and use the mannerisms of the opposite sex for entertainment purposes. Some identify as transgender; some do not.

Transsexuals are individuals born into one gender but who identify emotionally and psychologically with the other. The medical term often used to describe this situation is “gender dysphoria” or “gender identity disorder.” People in various stages of transition may refer to themselves in very different ways. Essentially, transsexuals believe they were born in the wrong body and they will often attempt to transition to the sex to which they identify using surgery or hormone therapy. Intersexed people were born with ambiguous genitalia, so doctors assigned him/her a specific gender at birth. Sometimes this assignment doesn’t correlate with the biological XX or XY gender. These individuals are socialized as their given gender, but sometimes wish to transition in adulthood to another gender.

Finally, androgynes are individuals who identify as transgender but do not fit themselves into any other category that we list above. They might display "typical" attributes of both genders.

Again, sex and gender are two distinct concepts. Sex refers to ones biological sex. Gender refers to the social constructs around sex. All transgender individuals seek expression of their preferred or identified gender differently. Some are happy to take on the dress and mannerisms of another gender at times, others want to fully transition into living as their identified gender. For those who wish to fully transition, a number of steps must be taken. Here's how you change your gender.

Hormones can be prescribed after an individual has either lived three months in the gender to which they wish to transition or they have undergone psychotherapy for, generally, a minimum of three months. Biological males will take estrogen shots, which will feminize their voices, affect their fat distribution, increase their breast size, and shrink their penis. For biological females taking testosterone, changes include deepening of the voice, increased muscle mass, shrinking breasts, enlargement of the clitoris, and increased libido. Some of these changes are reversible, while others are not.

Some trans men and women will also wish to undergo SRS, also known as gender reassignment surgery or sex affirmation surgery. Trans women (biological males transitioning to female) will sometimes surgically construct a vagina. This is most often achieved by inverting the penis, while leaving the blood supply and nerves intact. In this way, surgeons can create a fully sensitive vagina. If additional tissue is needed to construct the vagina, skin can be grafted from the colon, which (apparently) results in sensations comparable to a biological woman's vagina. The glans of the penis can be used to form a clitoris and excess skin from the scrotum can be used to form the labia. Trans women do not possess a uterus, cannot menstruate, and will need to continue hormone therapy over the course of their lives to maintain their secondary sex characteristics.

Trans men usually undergo mastectomies or “top surgery” to remove their breasts. Trans men can undergo phalloplasty, the surgical procedure that constructs a penis. There are many ways to construct a penis, but most often the "neopenis" is constructed using skin from the abdomen, groin, or thigh. The clitoris can be repositioned on the neopenis to maintain sexual sensation. While the constructed penis does not become "erect" in the way that a biological penis will, a prosthetic can be implanted to simulate erection or external support can be used. A scrotum can be created using labial tissues, into which testicular implants can be placed. Trans men must also continue hormone therapy. (Here are some NSFW pictures of pre and post op trans men.)

In the United States, the prerequisite for SRS is often one year of hormone therapy, one year of living "full-time" as the identified gender, two letters of recommendation from doctors, and a clean bill of mental health.

Finally, after all that, transgender individuals can petition to change their sex on their government documents. Restrictions vary by state, but here's a helpful run down of what you would need to provide in each state. They are many additional surgeries that trans men and women may undergo after SRS, such as Facial Feminization Surgery. SRS can cost tens of thousands of dollars and the process of transitioning can take years. By no means do all trans men and women necessarily undergo all or any of these procedures — a reminder that gender is flexible, and there are lots of ways to skin a penis.

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