Frequently Asked Questions

Now that Gender Outlaw has matured as a blog and is gaining traction every day in terms of search engine visibility and traffic, I have started to receive emails regularly from other transguys wondering about certain aspects of my transition and how it might play out for them. I have to admit that I am pretty bad when it comes to promptly replying to emails, so I decided to start this FAQ page in the hopes of giving people what they want, when they want it. I will continue to add to this page as I determine which questions I receive can be deemed “frequently asked.”

Have a question for me? Please try doing a search of this blog first. If you don’t find what you’re looking for, feel free to drop me a line at genderoutlaws [AT] gmail.com. Depending on the volume of email I have, it can sometimes take me 2-8 weeks to reply. You can also ask me questions anonymously on Formspring.

I want to transition. Where do I start?

Everyone transitions in a unique way, and each of us may have different goals and objectives. That makes it hard to recommend a specific plan of action, but here’s my advice based on what I’ve gone through so far:

Get healthy. I recommend getting fit and clean for a few reasons. Good physical health is very helpful in terms of preparing for surgery (if that’s in your cards) and getting lean and muscular will provide better results with testosterone (if a masculine frame is one of your goals.) I certainly enjoy beer and other party favors, but I quit them outright when I was starting my transition so that I could make sure that I was making decisions with a clear mind. It was also a serious advantage when going through the initial psychological evaluations to be able to say that I didn’t drink or use drugs. Plus, booze is fattening! I dropped 10 lbs really quickly by simply quitting drinking. And, the money saved can go directly towards surgery savings.

Get informed. Learn and read as much as you can. I recommend the following:

Medical Therapy & Health Maintenance for Transgender Men by Dr. Nick Gorton et al This is an excellent medical manual that will help you understand the more technical/medical aspects of FTM transition, allowing you to have very informed conversations with doctors. I’m a firm believer that individuals need to take their health care in their own hands. Doctors are great, but the only person who really, truly and deeply cares about your health is YOU.
VCH’s TransHealth Library This is an excellent resource. Some of the information is British Columbia-specific, but most of it is general. Lots of great downloads there to print off and read.
The Testosterone Files by Max Wolf Valerio This is an intense and gritty book that I totally enjoyed. I read it at a pivotal point in my transition and highly recommend it.
Becoming a Visible Man by Jamison Green Another very important FTM book, this one is less intense than Valerio’s, and helped me to understand more about how I might fit into the trans community. It’s well-written and informative, and also highly recommended.

Get connected. Blogs, transition journals, YouTube channels, forums and mailing lists are all excellent ways to get connected to the global FTM community, and have proven to be instrumental with my own transition. See where I hang out: Finding trans community online.

Get a good doctor. I know this one can be a challenge. My family physicians (yeah, I’m lucky to have two of them!) have been my go-to professionals, despite the fact that they had no previous experience with transmale health care. They’ve provided me with sound advice and made referrals to the right practitioners when required. Navigating all of this without a doctor would not only have been difficult, but I would not have been able to see an endocrinologist without their referral. Your doctor doesn’t have to be a trans health expert, but they do need to be trans-friendly, open-minded, and willing to have two-way conversations with you about your health. If this doesn’t sound like your doctor, get a new one, one you can really trust to be your advocate.

Get a therapist. Most doctors and endocrinologists who prescribe testosterone will require you to have at least one session with a therapist who specializes in gender issues. For my own reasons, I wanted to avoid a psychiatrist, so I found a psychologist who is a gender specialist. I have greatly valued her expertise and non-biased feedback, and am very thankful to have her as a professional advocate who can write support letters for me when required. I happen to be one of those people who thinks therapy is pretty cool, and it’s an essential element to my own transition.

I’m thinking about starting on testosterone, but I don’t know if T is right for me. How do I tell?

When I was making these deliberations, I remember wishing that there was a bloodtest I could take that would tell me if I was trans or not. I also hoped that my psychologist would tell me in yes or no terms if T would be right for me, but instead she said the choice was mine alone.

Deciding whether or not to proceed with testosterone therapy is a BIG decision. As frustrating as it can feel, take your time with this one.

I recommend doing some reading, in particular check out these books, I found them very helpful:

Personally, I was very certain about wanting top surgery but less sure about T. During the time that I was contemplating whether or not to go on T, I found the XXboys gallery where there are a few guys who went the surgery-no hormones route, which I found interesting. The site has some interesting perspectives from transmen of all different flavors and is worth checking out.

Another interesting perspective comes from YouTuber, MeikoEliasXavier, who stopped T after about a year and a half. He has two in-depth videos where he talks about his decision:

Why I Stopped Testosterone: Part 1 | Part 2

While my Testosterone self-assessment blog post series appeared to have come to a grinding stop when I started on T, I do actually plan to finish it. Stay tuned!

What is the peri-areolar concentric circle top surgery method all about?

The first surgeon I consulted about top surgery recommended double incision for me. Dr. Bowman however thought this was overkill considering the size of my breasts: a small B/large A. Instead, he recommended peri-areolar concentric circle. This procedure is not the same thing as keyhole. In fact, Dr. Bowman does not practice keyhole because he thinks it doesn’t provide as good a male chest contour as PACC.

I’m extremely pleased that I was a candidate for PACC and didn’t require nipple grafts or the larger scars that are the result of double incision. I didn’t think I’d be able to get anything other than double incision, and due to the apparent lack of information about the PACC procedure (it’s often confused with keyhole) I know a lot of guys also assume that double incision is their only option. Even if you are not a candidate for keyhole due to the size of your chest, you might still be able to have PACC. It’s suitable for A and B sizes. Skin elasticity is also a determining factor. Years of binding or age can negatively affect skin elasticity.

Of course, only a qualified surgeon is going to be able to determine if you’re a candidate or not for PACC. The following surgeons are among those who practice PACC:

Dr. Cameron Bowman – Vancouver, BC, Canada
Dr. Christine McGuinn – Doylestown, PA, USA
Dr. Daniel Medalie – Cleveland, OH, USA
Dr. Beverley Fischer – Timonium, MD, USA

Learn more about PACC on page 16 in this PDF.

Check out photos from my post-op healing and results with PACC.

Who was your surgeon for your top surgery?

My surgeon was/is Dr. Cameron Bowman in Vancouver, BC, Canada. Dr. Bowman is an excellent doctor who really cares about the trans community. I highly recommend him for his skill, professionalism and kindness. Read more about him on his UBC faculty page. Also, check out the VCH Trans Health library where he has contributed articles about FTM surgery. If you would like to request information from his office, contact his clinical assistant Ali via email. If you are not Canadian be sure to mention this in your initial contact, as I believe there are some insurance issues.

Read about my top surgery experience and other top surgery related posts.