Frequently Asked Questions

I receive emails regularly from other trans guys wondering about certain aspects of my transition and how it might play out for them. I’m not always able to be prompt at replying to emails, so I’m hoping this  FAQ page gives at least some people what they want, when they want it. I’ll 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.

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 and 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 trans male 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 been 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 blood test 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 trans men 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:

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.

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

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

Who was your surgeon for your top surgery?

The surgeon who performed my top surgery was Dr. Cameron Bowman in Vancouver, BC, Canada. Dr. Bowman is an excellent doctor who 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.

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



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About

Joshua Riverdale

Joshua Riverdale

I’m just another transsexual and this is my FTM transition blog. My journal is an important personal development tool: I use it to track and observe the complex, challenging, and sometimes wondrous aspects of being transgender. I’m pleased that other trans men find this public navigation helpful.

I’m 41 years old and live in rural BC, Canada with my longtime girlfriend. I was diagnosed with GID by a school psychologist when I was five years old (1979), but I didn’t think of myself as trans until October, 2007. (Honestly, I didn’t know I had options. I didn’t really know that trans men existed.) Learn more about my transition process here.

If you’re new here, check out the most popular pages of my blog:

Feel free to comment on my posts (comments policy), and if you’d like to get in touch directly, please contact me here. If you have a question about surgery, please post it in the FTM Surgery Support Forums where I’m a moderator.

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Disclaimer

The opinions expressed herein are those of the author and do not necessarily reflect the views of other trans men or transgender people. I make no claim to speak for anyone but myself.

This website and all of the information it contains are provided “as is” without warranty of any kind, whether express or implied. All implied warranties, including without limitation, implied warranties of fitness for a particular purpose and non-infringement, are hereby expressly disclaimed. Under no circumstances will the author of genderoutlaw.wordpress.com, Joshua Riverdale, be liable to any person or for any direct, indirect, special, incidental, consequential, or other damages based on any use of this website or any other website to which this site is linked.

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This work (text and images) is © Joshua Riverdale and Gender Outlaw, 2007-2015. All rights reserved worldwide. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and owner is strictly prohibited. This includes academic and commercial use. Text excerpts and links may be used, provided that full and clear credit is given to Joshua Riverdale with appropriate and specific direction to the original content.

I take the protection of my copyright and privacy seriously. If I discover that my copyright materials have been used in contravention of the license above, I will issue cease and desist orders and DMCA notices to appropriate parties, and also reserve the right to begin legal proceedings. Please note that the open-ended concept of fair use is not observed under Canadian law, and for the purpose of venue, any legal proceedings will be filed in BC, Canada. If you become aware of any use of my copyright materials that contravenes or may contravene the license above, please contact me.


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