Different trans women will be at different stages in their journeys – you may not be planning to transition or you may have done so a long time ago. The following information is for you if you're planning to take the route of physically changing your body so that your physical body matches your gender.
In order to go ahead with treatment on the NHS you'll need to see your GP who will be able to refer you to a gender identity clinic. You'll have to be diagnosed with gender dysphoria before you'll be able to have treatment. Usually you'll have an assessment with a psychiatrist who will make the diagnosis.
If you're diagnosed with gender dysphoria, you'll be prescribed hormones – this is called cross-sex hormone therapy and means that as a trans woman you'll be able to take oestrogen and possibly hormone blockers to stop the production of testosterone.
Oestrogen will feminise you - it might reduce facial and bodily hair growth and increase the fat on your hips and breasts. It may slow down or stop male-pattern baldness and will often cause your penis and testicles to shrink and reduce your muscle strength.
If you're taking oestrogen you might also be taking a hormone blocker, (an anti-androgen) to stop your body producing testosterone. This is to make sure that your oestrogen treatment is as effective as possible.
Living in the gender role that is congruent with the individual’s gender identity (sometimes known as real life experience)
Before you'll be able to have gender confirmation surgery you'll have to live full time as a woman for at least a year. This is called living in the gender role that is congruent with your gender identity and it will help you to be sure you're making the right decision.
During this time you might explore ways to dress, make up, hair styles and other things that might be different for you as a woman. Some trans women find that their real life experience confirms that they want to go ahead with surgery. Others might find that they feel happy to be a woman without hormones and surgery. If you're having your surgery privately, you won’t need to go through this process.
Gender confirmation surgery
If you decide, after living in the gender role that is congruent with your gender identity, to go ahead with surgery, the next stage will be to talk to your surgeon. Many trans women do not have surgery – in fact there are more trans women who haven’t had any surgery. Other trans women decide to take hormones but not have any surgery.
Surgery can involve upper and/or lower surgery. Trans women are advised to carry on taking hormone treatments for at least 18 months before having upper surgery. This is because the oestrogen you're taking will increase the breast tissue – but this can be a very slow process. If you choose to have breast implants, they will look more natural if they're implanted onto existing breast tissue rather than onto a flat chest.
Lower surgery will involve some preparations such as having the hair from your penis and testicles removed permanently. The surgery itself will take a few weeks to recover from and you may need help around the house or with shopping during this time.
After you have surgery, you may feel a range of emotions from relief to elation.
Your new genitals will also mean you need to know more about safer sex.