Hormonal feminization is an amazing process, even to my experienced eyes & for the trans-woman when properly executed it can be a transformative experience culminating in inner peace, tranquility & the elimination of gender dysphoria.  

The magical nature of a natural transformation.

There is something almost magical about having a patient walk into my office after a year of expertly delivered hormone therapy of the highest quality and becoming bowled over by the remarkable changes I see in her, the natural softening.  And it isn’t just visual; it is about the total, dynamic person, all the way down to the depths of her soul.  Having crossed the river, everything about her now finally feels naturally feminine, both to herself and to those around her including her persona, her vibes and her aura.  She literally glows from it.

Is this a case of gender switching or a shift along the masculine-feminine gender spectrum?

What exactly has happened here?  Has she switched genders?  Is she gender fluid?  Has she become a member of some third gender or is she gender neutral?  These are new words, these new terminologies, dreamed up by the public & the media without regard to science or biology.  Do they have any validity or do they suggest that the people who arbitrarily coined these terms & phrases don’t really understand the true nature of the transgender journey and are falling into the same, dualistic, oversimplifying trap as the sexists they so heartily despise?

Feminization: fake versus genuine.

What exactly is the trans-patient trying to accomplish when she embraces medical treatments, and do all forms of treatment, even those based solely on surgery instead of hormone therapy, actually deliver the goods?  Is she seeking the hourglass figure of some idealized, virtual female, even though real women often do not have such an exaggerated shape?   In fact despite being 100% female ever since their conceptions, many women are a trifle androgynous, & this isn’t a problem for them, nor does it devalue their femaleness or their femininity.  Is it to possess thick, fake-looking, puffed up lips, enormous cheek bones & a broad, hard, mottled set of Silicone augmented buttocks that are not only a health hazard but an oddly-shaped caricature of the female condition, in extremely poor taste? 

The hormonal link between genotype & phenotype.

The best way to answer these questions is by looking at the unvarnished facts, untainted by ideology, political agenda or self-delusion.  It all starts for us by looking at two concepts, that of genotype & that of phenotype.  The genotype means the genetic code located in the chromosomes of our cells.  Thus the human female genotype is 46XX whereas the normal male genotype is 46XY.  There are two & only two genders, the male & the female.  Gender is not fluid & there is definitively not a third gender.  Some people are what is known as intersexed, belonging within neither gender.  For example in Klinefelter’s syndrome the person has inherited, at least in some of his cells, a genotype that is 46XXY instead of 46XY.  This person appears male in the sense that he has male genitalia including a phallus but the breasts are enlarged.  That is the way it is with genotypes. 

Beautiful women awash with testosterone.

But wait a minute.  There are people born with what used to be called Testicular Feminization, & which is now termed Androgen Insensitivity Syndrome (AIS).  These people have either partially or thoroughly inherited a glitch in their testosterone receptors so that, despite possessing testicles (hidden in the abdomen) and lots of testosterone, they are testosterone resistant.  These women are exceptionally feminine and to all outward appearances are females.  Their genotype is male but their phenotype is female.  It would be weird to call them males just because of their inherited genotypes.

One’s phenotype is the form in which one's genotype ends up being outwardly expressed.  So if we were to castrate a male at birth he wouldn’t be able to produce the adult levels of testosterone that generate full, adult masculinity, despite possessing a perfectly normal male genotype.  So the phenotypic expression of our inherited genotype isn't fixed; witness the change in my hair color from auburn to gray with advancing age.  This link between genotype & phenotype is hormonally mediated. Taking this concept a step further, hormones play an obvious role in the determination not only of hair color but hair texture.  Thus many women will attest that the color & texture of their hair are sensitive to stress exposure, notably the natural stress of pregnancy.

How hormones alter the phenotype.

My son had blond hair as a child but as puberty kicked in the color shifted inexorably to brown. In one of my trans-women the link was even more striking.  Her hair had also been blond as a kid but it too darkened after puberty.  In her mid-twenties she underwent gender reassignment surgery and after the testes had been removed her hair returned once again to its original blond coloring.  Several years later she began to experience fatigue, depression & loss of sex drive.  Her testosterone level was way lower even than the normal female level so I treated her with low dose, female-appropriate testosterone therapy along with her other hormones.  Her problems resolved without the appearance of any masculine side-effects but her hair rapidly turned brown once again. 

Gender is digital whereas femininity is analog.

This brings up the need to contrast the dichotomy of male versus female with that of masculine versus feminine.  There are but two genders but many degrees of masculinity & femininity.  And it is femininity rather than femaleness that defines one’s outward appearance & one’s identity.  Returning to the patient with AIS, her genotype may be male & she may possess two testicles, yet her appearance is extremely feminine.  We identify her intuitively as a female because her general appearance & persona are unambiguously feminine.  This woman's emotional & physical presentation rather than her chromosomes or her gonads are what clearly define her gender identity.

Crossing the gender bridge.

Now let’s look at the transgender situation, specifically the male to female one, although some take exception to this term, for no rational reason.  The trans-woman is an individual who inherited a glitch in her androgen receptor function even before birth.  As a result while residing in her mother’s womb her brain was formatted so as to make her naturally perceive herself as being female, even though her hormones and genitalia were of the normal male variety.  From as far back as she can remember this trans-woman has perceived her identity as being female.  So what if her body is of the normal male variety.  There is more to one’s identity than the nature of one’s physical body.  You are not a body, you are a person.  And it is your brain-based mind more than any other feature that defines not only what but more importantly who you are, your individual persona.

To sum up, your sense of gender identity is hard-wired & has been present since life in the womb.  One remembers experiencing this sense of identity reaching back as far as your memory can go, and you first appreciated that there were two different genders in existence.  Cross dressing takes place to some degree during the early years but when puberty takes place & the gender divide becomes more pronounced & apparent, cross drssing increases. 

Between a rock & a hard place; conflict & gender dysphoria.

So the trans-woman has a particular problem that was thrown at her by fate, involving a personal identity that was & is programmed to be female, yet a physical body that is undeniably male.  Although from a genetic viewpoint one is defined by the nature of one’s chromosomes (whether a male or female genotype, one or the other), from a personal viewpoint one is defined to one’s conscious self on the basis of one’s own, honest sense of self-identity, and to others on the basis of one’s degree of masculinity or femininity.   And that is the basis for Trans-Care, the idea of bringing one’s identity and one’s physicality into sync with each other. 

More than skin deep.

But that isn’t all.  There are several further problems, indeed major ones facing the trans-woman, even after she undergoes an idealized surgical transition.  Let’s say that our hypothetical trans-woman discovers a marvelous plastic surgeon, a raving genius.  And let’s say that he does a superb job of making her look like a very attractive woman, with a marvelous figure, a lovely face, a feminized voice and a natural appearing, orgasmic vagina.  Never the less several major obstacles still face this now post-operative trans-woman, ones that surgery simply cannot begin to address.  We will examine them is an article entitled “Gender Dysphoria & the problems only hormones can solve.”