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Your wellbeing

older woman with pearl necklace

Some advice and resources to help us stay happy and healthy as trans women.

  1. Body image
  2. Help
  3. Mental health
  4. Ageing
  5. Community

Body image

As you go through your transition, your body confidence and self-esteem might change or fluctuate. Some trans people’s confidence will increase as they transition and feel they're now the person they were born to be. Others may need to build up their self-esteem over time.

Even though transitioning signals the start of your new life and you feel you ‘should’ be happy, it can also be a time of mixed emotions – some of which can be very confusing. On the other hand, you may have transitioned many years ago, feel confident as the woman you are and have a fulfilling sex life.


Having confidence in your body

Becoming who you are as a woman can be exciting, although you may have anxieties. You might initially lack body-confidence or feel vulnerable, but learning new skills can help you to negotiate safer sex and increase your sexual confidence.

If you're starting to date new people, this can feel like a testing ground to see how you are ‘received’ – especially if you've had upper or lower surgery. If you've had surgery, you'll need to get used to new areas of your body and learn how they work and what you like and don’t like. Similarly, if you haven’t had any surgery, you still have to adjust to life as a woman, which can be a time of mixed emotions.


Building your sexual confidence

You may need to learn new skills to negotiate safer sex and increase your sexual confidence. Embarking on sexual relationships, or even dating, as a woman may feel very different than it did before. If your sexual orientation has changed, it will probably feel a bit strange, although exciting, to be starting ‘over again’ or developing new ways of being who you are.


Having your confidence knocked

Unfortunately there's still stigma and discrimination toward trans people in society. Many people will be accepting and supportive but you can face prejudice from family, friends or from people you pass in the street. Developing confidence in yourself and your body is important and will help when embarking on your new life as the woman you are.


Developing your self-esteem

Meeting other trans people and getting support can be really helpful for many in developing a sense of belonging (socially and/or politically). Many trans people find other ways of developing a positive sense of self - either from friends and family, or during the process of becoming who you really are.

Another solution for some people is to go to an assertiveness training course – these can give you useful tips to deal with other people while protecting and increasing your self esteem at the same time. You should be able to find assertiveness training at a local college or evening school. There are lots of good books on the subjects as well. If you're worried about how you might be ‘received’ at something like this, phone or meet the facilitator for a chat beforehand.


Talking it through

Developing self-esteem and feeling accepted as a woman can take time, especially if you have experienced prejudice. It may help to talk to other trans women, a counsellor or another health professional.

You might also find this guide, How to Increase Your Self- Esteem, by the mental health charity Mind useful.

Help

There are times when we all need someone to talk to. 

Counselling can help you to make sense of your feelings, especially if you’re feeling unhappy or unsure of what to do. A group can help with these things too but can also just give you the feeling that there are other people who will understand your situation.

If you decide you want to see a counsellor, it might be important to ask them some questions on their awareness of trans people. Not all counsellors are aware - this doesn’t mean they will not be able to support you or explore your feelings and concerns. However, it can also be useful to have a therapeutic relationship with a counsellor who ‘gets it’ and who you are not having to ‘educate’ in the sessions.

Whatever stage of your transition the following organisations can help:

a:gender is the support network for staff in government departments and agencies who have changed or need to change permanently their perceived gender, or who identify as intersex.

The Beaumont Society is a national self help body run by and for those who cross-dress or are trans.

The Beaumont Trust operates a helpline and has resources to support people with gender identity problems or problems arising from cross dressing. They also support professionals working in the field of gender dysphoria.

cliniQ Dean Street Soho is a sexual health and wellbeing clinic for all trans people and their partners, family and friends.

Depend offer free, confidential and non-judgemental advice, information and
support to all family members, spouses, partners and friends of trans people in the UK.

Gender Identity Research and Education Society (GIRES) provides a range of medical and social information for trans people, including guides to lower surgery and hormone treatment.

Gender Trust provides information and a membership scheme for trans people.

Gendys Network is for anyone who has encountered gender identity problems.

Gendered Intelligence work with young trans people under the age of 25.

Mermaids provide family and individual support for teenagers and children with gender identity issues. 

Press For Change provides legal advice, training, and research to trans people, their representatives and public and private bodies.

The Scottish Transgender Alliance aims to improve the lives and experiences of all trans people living in Scotland.

The Sibyls is a UK-based confidential Christian spirituality group for trans people and their supporters. They offer companionship along the journey and information and advocacy to churches.

TransEquality can advise you on human rights law relating to trans issues.

TranzWiki Net attempts to be a comprehensive directory of the groups campaigning for, supporting or assisting trans people across the UK, and has been developed by GIRES.

Women of the Beaumont Society operate a helpline from their personal experiences and knowledge of being in a relationship with a gender dysphoric person.

Mental health

As trans people we can often have a sense of isolation and social exclusion. The lack of understanding within families, the workplace and society as a whole can contribute to low self-esteem and a lack of self-care.

Ongoing therapeutic support which doesn’t pathologise trans people can be important for wellbeing and can help reduce the risk of self-harm and depression.

If you have thoughts of self-harming or discomfort and difficulties around your gender identity, try to get help.

Helplines such as Samaritans offer confidential, non-judgemental emotional support. Their number is 08457 90 90 90 and you can contact them 24 hours a day. You can also email them: jo@samaritans.org

The Gender Trust  also has a directory of counsellors and support groups.


Someone to talk to

If you want to talk to a counsellor about being trans, it might be important to you to ask them how ‘aware’ and experienced they are of trans issues and identities. Counsellors often have very little, if any, training on trans awareness so some trans people feel as if they are the ones educating their therapist.

You can find a counsellor near you here

You might want to see a counsellor for issues unrelated to your identity and it might be important to let the counsellor know this too - that is, if you want to disclose to them that you're trans (or someone with a trans history).


Facing discrimination

Discrimination can be one of the main issues that can impact on mental health for trans people. A report entitled Engendered Penalties: Transgender and Transsexual People’s Experiences of Inequality and Discrimination by Stephen Whittle, Lewis Turner and Maryam Al-Alami surveyed 870 trans people.

It found that:

  • 73% experienced some form of harassment in public, ranging from comments and verbal abuse to physical violence.
  • 21% stated that they avoided going out because of fear of harassment. 
  • 46% stated that they had experienced harassment in their neighbourhoods. 
  • 64% of young trans men and 44% of young trans women experienced harassment or bullying at school by pupils, staff and teachers. 
  • 28% stated that they had moved to a different neighbourhood because of their transition.

Working on your self-esteem

Developing your self-esteem and wellbeing can really help you feel good about who you are and help you to value yourself more. Having social contact with others who have been on a similar journey can provide valuable support – put simply, other trans people are more likely to ‘get’ who you are. However, making friends and social contacts outside the trans communities can be just as important.


More information:

NHS website page on transgender wellbeing.

Ageing

As trans people we will have potentially the same age-related health issues as cis gendered people. However some issues will mostly be relevant to trans women.


Health issues related to hormones

If you transitioned early on in life and you're now over 60 you may have been on oestrogens for well over 40 years. There are possible issues with the longer term use of oral oestrogens and it could be useful to have your hormone levels checked regularly, to make sure you are on the correct dose of oestrogens for you. You might also want to consider using an oestrogen patch rather than taking it orally.

Many older trans women who had lower surgery when younger have been led to believe that they can greatly reduce or stop taking oestrogens completely. However, too low a dose of hormones might not offer you protection against osteoporosis, which causes thinning of the bones.


Hormone level checks

If your GP offers you hormone level testing, along with a yearly general health check, it's important that they understand the correct hormone levels for you as a trans woman.

Endocrinologists (endos) specialise in understanding hormones. Your GP can refer you to an NHS endo – however, they don’t all understand or specialise in trans peoples’ hormonal issues, so it's important that your GP refers you to the appropriate specialist.

As trans women it's important to know all of your hormone levels - testosterone (T) is just as important as oestrogen. We all need a balance of hormones that is correct for us as individuals.


Breast screening

Taking oestrogen can increase the risks of breast cancer, so it's important to regularly check your breasts for lumps. A nurse will be able to explain how to do this if you're unsure. If you notice any lumps or discharge from your nipples, see a doctor as soon as possible.


Prostate checks

It's worth remembering that you'll retain your prostate and will need to have this checked periodically.


Experiencing problems with libido

Libido refers to a person's sex drive or desire for sexual activity. The desire for sex does not have to decrease as we get older and some people’s libido will remain the same throughout their life. Some older people find their sex drive seems to decrease - some are happy with this but others may find it distressing.


Vaginal dilating – getting older

As we get older skin starts to lose its elasticity, so it's important to maintain regular dilation as this will keep your vagina open and maintain depth. Dilation will also help you to cleanse your vagina. If you find dilation becomes difficult, it's important to speak to your clinician.

You can find more information about later life and trans women here:

Opening Doors

Growing Old Gracefully: The Transgender Experience

Community

While the percentage of the UK population who are transgender or transsexual isn't known, it can safely be said that trans people are in a minority. Because of this, many of us don’t know anyone else who is trans. Some aspects of ourselves will be shared by someone we know but being trans is often unique to us, which can make it feel wrong or make us feel isolated.

For that reason, meeting other trans people can have a very positive effect on your self-esteem and wellbeing. Other trans people will be able to empathise with your situation, they will know how to articulate feelings that may be harder to convey as a cis person, and they may have experiences and advice that can assist you in your life.

Many trans communities exist online, giving you an opportunity to talk and potentially arrange to meet in person. Different sites will have their own cultures and audiences, so you might want to look around to find one that suits you.

Larger cities are more likely to have a trans support group. These groups may advertise in lesbian, gay, bisexual and trans (LGBT) spaces or you will be able to find them by searching for ‘trans support group [your city]’ on the internet. LGBT spaces in general can be good places to meet fellow trans people, even if they aren’t exclusively trans spaces.

Groups exist for trans people of all ages:

Mermaids support young children and teenagers with gender identity issues. 

Gendered Intelligence - supports trans teenagers and young adults.

Opening Doors -  supports older LGBT people in London.

Trans London supports all trans people third Tuesday of every month.

T on Tuesdays - for all trans people.

CliniQ is a service for trans people, their partners, families and friends.

 

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The Information Standard: Certified member

This article was last reviewed on 23/3/2015 by Anna Peters

Date due for the next review: 23/3/2018

Content Author:

Current Owner:

More information:

American Journal of Public Health.Enhancing Transgender Healthcare. Emilia Lombardi, PhD. June 2001

National Center for Biotechnology Information. U.S. National Library of Medicine. National Institutes of Health. Collective Self-Esteem as a Coping Resource for Male-to-Female Transsexuals. Francisco J. Sánchez and Eric Vilain. UCLA School of Medicine. 2009.

Mind. How to Increase Your Self Esteem. 2012

Press For Change and Manchester Metropolitan University. Engendered Penalties: Transgender and Transsexual People’s Experiences of Inequality and Discrimination. Stephen Whittle, Lewis Turner and Maryam Al-Alami. February 2007  

Age UK. Factsheet 16. Transgender issues in later life. October 2010

University of California, San Francisco. Centre of Excellence for Transgender Health. 
Ageing issues – special considerations. Mentions the importance of breast screening. 2012

University of California, San Francisco. Centre of Excellence for Transgender Health. General prevention and screening. 2012.

GIRES (Gender Identity Research and Education Society). A guide to hormone therapy for trans people.Trans wellbeing and healthcare. 2007.
 
NHS Choices. Osteoporosis. 30/4/10

Vancouver Coastal Health, Transcend Transgender Support & Education. Society and Canadian Rainbow Health Coalition. Trans care medical issues. Trans people and osteoporosis. February 2006 

 Laura’s Playground.Forum page. SRS Dilate? 30/4/10

Medline plus. Aging changes in skin. 19/4/12


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