The Excitement of Medical Transition

Many people, I’ve found, think that the medical interventions are the hard part of being transgender.


In fact they are often the most exciting part.


The hardest things to deal with, usually, are hiding your identity before deciding to transition, or dealing with discriminatory behaviors from those around you. And these pains are invisible. If you can’t see something, it’s hard to understand how difficult it is. The pre-transition times are usually the most damaging times for a transgender person.


The results of surgery can be liberating and thrilling. I liken it to having a large growth on your face. Many people would tell you it doesn’t matter what other people think. Even if people don’t stare at it, you will be very self conscious and would rather it wasn’t there. Now if a surgeon comes along and says they can remove it for you, you’re going to be very excited by that prospect. Yes, it will leave a visible scar, but that is far preferable than living with the growth. And I think this is pretty close to how a transgender person feels about surgery, and hormone treatment too. Things will never be 100% perfect, but will be greatly improved for sure. Most people who need surgery or need to take medication, do so to stop something bad from happening, in the hope of continuing life at the same level as before. This is why most medical interventions carry a negative feeling. But for a transgender person, everything that happens with treatment brings positive changes and is raising their life to a higher level.


One of the most risky periods for a transgender person is often between asking for help and then receiving medical intervention. They’ve reached a point where they are ready to make huge changes, but now they are faced with a long period of time before those changes start to happen. There are guidelines [W-Path Guidelines] that physicians the world over follow before initiating treatment, and as a result of these guidelines the assessments can be a lengthy process. The wait to even begin the process can be lengthy, thanks to long waiting lists or the need to raise funds before seeking treatment.


A great comparison is a child waiting for Christmas. If it’s a long way off, it’s easy to wait. But as the time approaches, the waiting can become almost painful. When you’re ready to make huge, fundamental changes to your life, and to remove such heartache from it, time seems to pass slower. It also becomes psychologically harder to cope with the bad things. Stresses already there can be heightened; any risk of self-harm or suicide may be increased during this period. This is one reason GP’s can prescribe bridging prescriptions for hormones during this vulnerable time, to reduce the risk of harm to their patient.


Not everyone wants to follow the same path, some people may choose hormones and all the surgeries that are available, while others may choose just some of these. Some people decide not to have any medical intervention at all, choosing just to transition socially. Each of these choices are as valid as the others.


For those who take hormones, this can be a very exciting part of transition. Hormones are a very effective way of changing and maintaining secondary sexual characteristics. They change the shape of the face, muscle mass, fat distribution, texture of skin and hair, and much more.


Hormones can have drastic effects on the appearance. But there are still a lot of people who have no idea quite how effective hormone therapy is, even including many within the medical profession. I once heard of a trans man (that is, he had transitioned from female to male) whose status as ‘transgender’ had been revealed to a work colleague; the colleague, convinced he was born physically male and was wanting to transition to female, told him he’d never be a real woman because he looked too much like a man! Just goes to show!

It’s the inside that counts


I am saddened to hear yet again of trans-women facing this type of abuse.


The old me is often described as ‘HORRIFIC’!

In the talks I give I often show a picture of me at 16 wearing a skirt as part of my Police Cadet Uniform. I’m lucky to be blessed with a body that easily passes as male, even before testosterone, so this image is often received with shock, and has even been described as ‘horrific’.

For most people all they can see is what they perceive as a 16-year-old male forced to wear a female Police Uniform.

Once they’ve seen this and I’ve described what life was like, they really begin to understand how disturbing it was to be a male who was forced to live as female.

This horrific situation of living life in the wrong gender, is absolutely no different for any trans person. As trans people we all begin our lives living the wrong gender and it’s just as stressful for each of us whether we pass or not.

Yet some people think it’s OK to victimize others based on their own perceived notion of what a particular gender should or should not look like. But remember gender comes from within.



I think the lesson here is that people sometimes find it hard to imagine things they can’t see. Because my outward appearance matches me on the inside people can’t help but understand my situation. In fact they wouldn’t be able to understand me NOT transitioning!

The fact is though that I am no different to the many trans-women and trans-men who are attacked, discriminated against and abused simply for being transgender.



Remember as with many things in life, don’t judge a book by it’s cover, it’s what’s inside that truly counts!


Clothes and Gender: Life Sentence or Liberation?

Imagine taking a child, dressing them in clothes that are strongly the opposite gender and taking them out or forcing them to school like this?

How distressing would this be? Not to mention the detrimental psychological effect, especially if done long term.

Yet this is exactly what happened to me (and many other trans people) every day of my life, for years!


Clothes are an expression that trans people miss out on

The choices we make with our appearance (inc. hairstyle, tattoos etc) convey information to those around us about who we are and what we stand for.

So consider the implications for a trans person who’s spent most of their life living within the wrong identity, and whose entire wardrobe simply can’t reflect who they are.

After nearly 40 years living this nightmare, I know this all too well.


Coping strategies

For each trans person you ask you’ll hear a different story, but for me, once I was old enough to choose my own clothes I went along the ambiguous route.

I simply couldn’t do feminine so lived as a tomboy, but I also felt too uncomfortable going any further along the masculine route than society deemed acceptable, so couldn’t wear most of the clothes I yearned to. I lived in jeans and sweaters, as this was the only way I could survive.

I would wear baggy tops to hide my breasts and would suffer for as long as I could in the heat of summer before removing my jumper to reveal an oversized t-shirt. Then I’d slouch forward, being far too uncomfortable at the thought of anyone seeing the rounded shape of my chest.

I very clearly remember the occasion, aged around 5, that I’d noted boy’s waists sat lower than girl’s, and looking at myself in the mirror, I positioned my trousers onto my hips. I felt this looked much better. They have sat there ever since! Although I have taken them off occasionally to wash them!


Impact on career

As clothes become more formal and move away from jeans they typically become more gendered.

Because of my inability to wear anything formal/feminine I made career choices that enabled me to wear casual, gender neutral clothes such as jeans. This had huge implications on the direction my whole life took, and also affected my income and therefore my standard of living.


Fitting rooms

It’s great to try clothes on before you buy; it saves the hassle of returning any unwanted articles. But unfortunately these spaces are usually gendered, and gendered spaces often cause distress for a trans person.

This adds to the numerous problems around clothing, for myself not least because with a female shaped body, buying men’s clothes meant it was harder to find clothes that fitted, so I really wanted to try them on first.



At school in the 70’s/80’s I was forced to wear a skirt, and hated every moment. I was very jealous of the boys who, simply because they’d been born into a boy’s body, could wear trousers. It seemed dreadfully unfair.

I did used to wear boys shoes however, as there were no rules prohibiting this. I am very surprised I wasn’t bullied, as this was a time before any female fashions were styled on men’s designs, as many are today.


Police cadet

I was a Police Cadet at 16 and to my horror, although at this time Police Women were allowed to wear trousers on certain occasions, my uniform was issued with only a skirt and no option allowed for trousers. I left the cadets shortly before my 19th Birthday and that was the very last time I ever wore a skirt!

Matt’s Police Cadet Hat – He hated wearing this too!

Formal occasions

Even the mere mention of a formal occasion would distress and panic me with instant thoughts of “But what will I wear?”. I dreaded things like weddings or funerals, or even parties.

I was called for Jury service and this posed particular problems. As you can’t ‘opt-out’ I was feeling particularly trapped simply due to the problem of what to wear, and this distressed me.


Finally Free

Imagine my relief upon finally becoming Matt and being able to wear just what I wanted. Before I used to walk past the men’s clothes sections in stores knowing they were out of bounds for me. I just had to switch off, suck it up, and accept it wasn’t allowed.

Then all of a sudden this changed. As a male, society now gave me ‘permission’ to wear these clothes.

At first it felt like a dream, or even a game, and that it was going to end. But slowly as my mindset changed, I began to realise that this was actually real, and was forever!

I now long for formal occasions so I can get suited and booted.


Getting fads out my system

There were many male clothes I’d wanted to wear when I was younger which weren’t always the best fashion choices, and of course fashions have changed a lot since then too. I still find that I want to wear these things and can’t see past that until I’ve got the fad out my system. So I’ve ended up buying clothes that in fact I never actually wear, or at least not for very long before I replace it with something more current.


Topman Personal Shopping

I’ve done a few Topman Personal Shopping Experiences, which have been amazing.

I’ve found myself in a trendy men’s clothes store, with my own fashion expert, whose job it is to make me look good. And they’re good at their job! Picking out styles you’d never have chosen but that suit you to a tee.

I’d highly recommend this experience to trans or cis people alike. Topman’s clothes (or Topshop for women) are trendy, look great, are very reasonably priced and with no minimum spend you’re not obliged to purchase anything. I guarantee you’ll want to though. You’ll feel like a celebrity being styled and made to look stunning.

As a trans-man who’s life long struggles with clothes had a very negative impact and who hadn’t found his style/look, this experience was truly liberating and literally LIFE CHANGING!


Please note: I have no sponsorship from, shares in, or affiliation with Topman!

(I was honored to witness other’s delight too at being liberated with their clothes after organising Topman Personal Shopping for the trans support group FTM London when I was co-chair.)



Matt, Topman 2018


Matt, Topman 2018


Matt, Topman 2014

Health risks of cross-sex hormones? Or can transition reduce risks?

As there are such strong differences in the appearance of the sexes and because cross-sex hormones bring about such radical physical changes, I can understand how some might think that doing something which appears so extreme to the body must be very unnatural and will cause it stress or even harm. But it’s not a completely alien thing that will cause all sorts of weird and wonderful things to happen. We won’t suddenly sprout a second head!

Think about the very beginning of our life, just after we’re conceived. At this point our bodies are gender-neutral and are capable of becoming either male or female, or occasionally even a mix of the two. What determines how masculine or feminine we develop are the levels of sex hormones running through our blood. This is initially from our Mother while growing in the womb. This step determines which genitals we grow. Then later our own genitals produce these sex hormones. They are a natural substance that the body is supposed to contain. As long as they are within the correct parameters for either male or female our bodies will be healthy.


HRT for all

A male with low testosterone will likely have many undesirable symptoms and may be prescribed testosterone (male HRT). Raising his testosterone to within the normal male range will have many benefits for him, helping his body and mind function healthily while reducing the unwanted symptoms.

This also applies to a post-menopausal woman on female HRT, but I am using the male example as he may be on lifelong HRT from a younger age. No one would bat an eyelid or question what the long-term implications are for him to take this drug for decades. I imagine simply because it seems to be ‘natural’.

It is no less safe for a transgender person to be on HRT. The fact it is cross-sex HRT has no health bearing on their body. The body will just react and grow according to the hormone it is receiving from the blood. It’s just a chemical reaction within the cells. As long as levels are within male or female ranges this is a very natural and healthy state for the body. This is unlike many other prescription drugs which the body wouldn’t usually have inside it. Again no one bats an eyelid about these because they feel ‘needed’. There appears to be something very emotive about treating for gender dysphoria, which causes some people to think something really bad will happen. I even had these feelings from my first GP, which made accessing treatment very difficult and stressful for me.


Side effects

As with any medication there are potential side effects but most feel the benefits outweigh the risks, and there may be no side effects at all. The patient would be monitored and any treatment adjusted or halted as required.


Real risks

As a transman myself I know one of the potential side effects when taking testosterone is polycythemia. This is an abnormally high red blood cell count, and it’s symptoms can be serious if not treated.

It is easily diagnosed via a blood test, and any male on testosterone will have their blood monitored regularly. It is very easily treated.

The risks, diagnosis and treatment of polycythemia is the same for both trans-men and biological men on testosterone treatment.


What about effects on gender specific organs receiving cross-sex hormones?

It is still unknown what the full implications and risks are to gender specific organs receiving cross-sex hormones. For example what might happen to a womb or cervix when receiving male levels of testosterone over a long period of time? This doesn’t mean there is greatly increased risk though. Very often these organs are removed meaning it’s not a concern, but if not then appropriate monitoring can be carried out to catch potential warning signs and allow treatment before problems develop.


Gender transition frequently results in reduced health risks

Cancer is a considerable threat to humans, with an estimated one in three people developing the disease. Some of the more common forms can be gender specific. E.g. prostate, testicular, cervical or breast cancer.

As a transgender person the risks of gender specific cancers are often reduced or even eliminated. A trans person will often have those organs removed, thus reducing or removing that risk, and of course they can’t develop cancers of their acquired gender because they don’t have those organs.


Desirable side effects of cross-sex hormones

The physical changes that happen on cross-sex HRT could potentially be considered a side effect. Of course these are very much desired, and can lead to a happy, healthy and contented life.


Hormone blockers: No trans-man should have to live with scars on their chest, and no trans-woman should have to live with a man’s voice!

You might assume if you’re listening to a qualified, experienced and well-respected psychiatrist, such as Dr Lucy Griffin, that what she has to say about an area of healthcare would be well informed and correct. Especially when the points she makes sound like common sense. [See Daily Mail article here]

But without working regularly with high numbers of transgender patients over a period of time, it’s impossible to have full insight into the difficulties this patient group experience and therefore how best to successfully treat those patients.

First off my warning bells were alerted by the fact she is calling trans-women men and trans-men women. Mistakes such as these are often the first tell-tale signs of someone with little knowledge or experience of this patient group.

Here is an analogy that I hope will help people understand why you need to be a gender specialist to comment on the care of transgender patients.

If it appears someone has broken their back, medical advice is not to move them. Common sense, yes? Then we see a group of Dr’s who start quickly pulling the injured away from the scene of the accident, risking paralysis! Other Dr’s publically chastise these actions, sighting their many insights from their professional knowledge and training as to why this is wrong and is ‘risking harm’ to the patient. The public agree with what seems like common sense coming from a qualified source.

Without the full picture, what the chastising Dr’s, and the public, don’t realise is that in these particular cases the patient needs to be moved quickly because of a greater risk. For example, maybe they are in a car which is on fire – one risk can outweigh another.

Transgender people can be harmed immensely by having to live the wrong life year after year. By waiting until they are 18 for medical intervention, not only have they already experienced great distress at seeing their bodies change in ways that is not correct for them but they then have permanent physical changes that are either difficult or impossible to correct.

To ‘do nothing’ is not always the best way to ‘do no harm’. Early intervention for a transgender patient is often life changing with very positive long-term outcomes.

Gender transition is a big step and certain questions do need to be asked and addressed. But the reasons against hormone blockers that Dr Griffin sights are not an informed view – she hasn’t seen the fire, so to speak!


So let’s take a look at some of the issues:

Age of consent

Many people still believe that a child is too young to make such a life affecting decision.

Gender dysphoria is not something that develops, it is something you are born with. Gender specialists are trained and experienced in diagnosing true gender dysphoria and distinguishing it from a passing phase. They also see the possible devastating consequences suffered when treatment can’t be accessed or is delayed.

The problem with waiting until transgender patients are adults is that irreversible changes have already happened to the body by going through the wrong puberty and these changes usually have a very negative affect on quality of life.

What if it’s a phase?

Children can go through phases of cross-gender play and dressing, many girls are tom-boys etc. This is very different to gender dysphoria although the two can be confused if you don’t know what to look for. So any treatment for gender dysphoria does need to be carefully considered.

Normal Spack is a US endocrinologist with vast experience of treating transgender patients with hormone blockers. He states that if a child is going through a phase they will almost certainly have grown out of the phase by the time they reach puberty.

You can watch Norman Spack’s very informative Ted Talk on this topic here

Stringent assessments performed by trained gender specialists ensure that before patients can access any irreversible treatment that they do indeed have true gender dysphoria and are not simply going through a phase.


Safety net

The use of hormones blockers provides a safety net and ensures no harm is done. Rather than induce the patient’s desired puberty at the age puberty would normally be experienced, blockers temporarily hold off or slow any form of puberty. This is fully reversible and buys time. While on hormone blockers professionals can assess the patient who can also receive counselling. When they reach the age of consent for treatment if they still feel gender transition is right for them they can start treatment and begin their desired puberty. If at any point the patient or the gender professionals decide that transition is not the right step, the blockers can be stopped and the patient will go through their biological puberty with no harm done. They will develop just as they would have, just at a later time. And to address Dr Griffin’s concerns over fertility, they will still be fertile.

Benefits of blockers

When we reach puberty our body starts developing secondary sex characteristics and many of these changes are irreversible. Some changes can be corrected with surgical procedures, but of course this means undergoing that procedure, which isn’t pleasant, and then living with the scars it leaves behind.


Unfortunately some of the changes can’t be altered at all, and the transgender person has to live for the rest of their lives with sexual characteristics that are not in keeping with their gender identity.

Some of these changes include:

  • Height
  • Voice breaking
  • Width of hips
  • Size of hands
  • Size of feet
  • Breast growth
  • Body and facial hair growth
  • Bone structure (including facial)


Other than being distressing and triggering, many of these irreversible characteristics also hinder the transgender person’s ability to pass in their acquired gender. This plays a huge role in quality of life due to how society perceives and accepts them. It can make life highly challenging, and is something they have to deal with day in, day out for the rest of their lives. Yet such distress is preventable with the use of hormone blockers.



Hormone blockers are an effective way to slow down the changes that happen at puberty. There is a safety net because they are reversible and buy time while the patient and the gender specialists work out what the best course of treatment, if any, is for the patient.

By preventing the distressing and irreversible changes that occur during puberty hormone blockers can greatly improve long term quality of life. They enable a transgender person to develop in a way that is correct for their internal gender. This can reduce distress and allows them to live the rest of their lives in the ‘right’ body. The benefits they bring help with passing and therefore to alleviate problems that still occur in today’s society’s due to misunderstanding and non-acceptance.

Who or what defines you as a women? Are men invading women’s spaces?

Personally speaking I think this is a relatively simple question to answer and I find it frustrating as to why people find it so difficult to understand.


If a woman had breast cancer and had to have a double mastectomy does this make her any less of a woman? No of course not!


Now let’s say, hypothetically of course, you took any of the feminist women in this video and gave her full gender reassignment surgery, with hormones, so her appearance outwardly appeared male, would she be a man? Would she feel like a man? No! She would feel like a woman stuck with a male body. What a horrible situation to be in, right? Gasp!
Gender is not that fragile and is something you cannot change. It comes from an inner sense of who you are and no matter what your body looks like, how you were born or what you do to your body you cannot change your gender.
So here’s the point……. if you inwardly identify as one gender but your birth sex doesn’t match that, there is nothing you can do to change your gender identity, however you can change your body to match your gender identity.


Remember gender is defined as who you identify as, sex is defined by your external anatomy. So a trans woman who was born with male anatomy is actually mentally just as much of a women as any of these female feminists are and there’s nothing you can do to make them male. So I would define that person as a women, whether they were pre or post transition.


Also remember the physical aspects of being transgender, although very important, are only part of the difficulties trans people experience. Different genders have quite different social roles, are treated differently (a simple example is being called ‘mate’ or ‘love’) and also dress differently.


The purpose of the medical interventions available to transgender people is not only to make them feel more comfortable in their own skin, but they have a huge impact on social behaviors and acceptance from others and this is just as important as correcting body dysmorphia.


As a trans man myself, who luckily for me is gendered male 100% of the time without fail, I find it fascinating that if I met any of these feminists who are complaining about ‘men in women’s spaces’ they would certainly not want me in their women’s space, and rightly so, I have NEVER felt like a woman despite living for 39 years in essentially a female shaped body. Yet by their own definition I will only ever be female in their eyes. If they met me I think they would certainly have a hard time seeing me as female!

Would you want Matt in your female space?


The toilet debate
I certainly know what it feels like to be nervous about using public toilets. Even pre transition when I went into a women’s toilet I would be stared at and have people tell me I was in the wrong place, so I would avoid this situation at all costs, even to the detriment of my bladder and it’s health. It becomes a huge problem whenever you’re out for the day and don’t have access to a basic human right as simple as a toilet. Post transition I’ve never had anyone so much as bat an eyelid at me in a male toilet, but even so it’s complicated and still comes with it’s problems. I can guarantee using a public toilet causes far more anxiety for the transgender person than it will ever will for the cis people sharing that space with the transgender person.


Transition is also not all about ‘passing’, some of us are lucky to be able to pass, but not everyone does or will pass. No one would question my masculinity because they are essentially judging the book by the cover. However no matter what the cover looks like we all feel the same on the inside whether we pass or not and should be afforded the same respect.


Every human being has a right to feel comfortable and accepted, transgender people are not harming anyone by transitioning and just want the same rights as those lucky enough to be born with their gender and birth sex matching.


……..and sometimes our bladders just won’t wait!




Trans people need less treatment not more!

Imagine if to get a flu jab, anti-depressants or a broken leg fixed you had to have 4 or 5 separate Dr appointments and at least 2 specialists confirm your diagnosis and give you a signature before you could get your prescription or any treatment.

Wouldn’t that be a waste of resources?

Waiting times would soar, costs to the NHS would rise and patients’ physical and mental health would suffer.

Decades ago being transsexual (now more commonly referred to as transgender) was very much considered a mental health issue, and required several evaluations by psychiatrists. There were many hoops to jump through because the medical profession needed to make absolutely sure that the patient was indeed transsexual before they were allowed to have their ‘sex change’. A term now very outdated and considered derogatory. Many faced being sectioned just for thinking they might be in the ‘wrong body’. After all who in their right mind would want to change gender?

These days things have moved forward. Well they have a little, but I very much feel the medical profession are strongly dragging their heals back to those times. Patients still require several assessments and signatures from trained professionals to get the go ahead for every single step of treatment and in the UK the NHS typically require more steps than the latest WPATH guidelines. This means treatment for many can take a decade or more to complete. As you can imagine the process of gender transition is all-consuming and patients lose years of their life to this process, years that could have been spent