Appendix B: Transfeminine-Specific Details
Medical Transition
This section is for those who have a need or desire to medically alter their bodies to become more feminine. Again, medical transition is not required to be trans (Golden Rule). Some or all aspects of medical transition may require the consultation of a doctor and may not be available to minors without parental consent. [2]
Effects of feminizing HRT (Estrogen Monotherapy or Estrogen + Testosterone Blocker) [1, 2, 3]
Note: Prior to starting HRT you may want to do fertility preservation. [2]
Effect | Maximum Effect |
|---|---|
Breast development [4] | 2–5 years |
Softening of skin / decreased oiliness | 3-6 months |
Decreased libido | 3–6 months |
Decreased spontaneous erections | 3–6 months |
Decreased testicular volume | 2–3 years |
Decreased sperm production / fertility | >3 years |
Redistribution of body fat (hips, thighs, face) | 2-5 years |
Decreased muscle mass / strength | 1–2 years |
Decreased terminal body hair (density/growth rate) | >3 years |
Slowing / stopping scalp hair loss | 1–2 years |
Surgeries
Surgery | What it does |
|---|---|
Orchiectomy | Surgical removal of the testes; reduces testosterone production (often lets patients lower or stop anti-androgens). Prior to this procedure you may want to do fertility preservation. |
Vaginoplasty | Constructs a vagina, vulva, clitoris, and labia; the testes and penis are removed and existing tissue is reused. Penile inversion is the most common technique; peritoneal pull-through is increasingly used, particularly where there is limited penile/scrotal tissue. Requires lifelong dilation. Prior to this procedure you may want to do fertility preservation. |
Vulvoplasty / Zero-depth vaginoplasty | Creates external vulva (labia, clitoris, urethral opening) without a vaginal canal; less intensive aftercare, no dilation. Prior to this procedure you may want to do fertility preservation. |
Breast augmentation | Enlarges the breasts using implants or fat transfer to achieve a fuller chest. |
Facial feminization surgery (FFS) | Umbrella of procedures reshaping facial bone and soft tissue toward feminine proportions, including reducing or reshaping the brow bossing and forehead, hairline adjustment, rhinoplasty (reshaping the nose), genioplasty (reshaping of the chin and jaw), zygomatic contouring (reshaping of the lateral cheekbone), tracheal shave (reduction of the “Adam’s Apple”), and lip augmentation (adds volume for a fuller upper lip). |
Voice feminization surgery (VFS) | Alters vocal fold length/tension (e.g., Wendler glottoplasty) to raise vocal pitch. |
Hair transplant | Relocates hair follicles to restore or reshape a feminine hairline and density. |
Liposuction or body contouring (fat grafting / BBL) | Removes fat where it isn’t desired (e.g. belly) or redistributes fat to enhance hips and buttocks for a more curved silhouette. |
Non-surgical procedures or therapies
Procedure | What it does |
|---|---|
Fertility Preservation | Preserves sperm in case sperm production is disrupted by hormones or surgery |
Laser hair removal | Uses light to target pigment in hair follicles, reducing hair over multiple sessions. Works best on dark hair with lighter skin; not permanent for all follicles. |
Electrolysis | Inserts a fine probe into each follicle and destroys it with electric current. The only method that is considered permanent hair removal [12] and it works on any hair color. |
IPL (intense pulsed light) | Broad-spectrum light used for at-home or clinical hair reduction; similar principle to laser but less targeted. |
Botulinum toxin (Botox) | Injected to soften facial lines, relax the jaw (masseter reduction for a slimmer face), or lift the brow. |
Dermal fillers | Injectable gels added to cheeks, lips, or jawline to soften or feminize facial contours. |
Chemical peels | Exfoliating treatments that improve skin texture, tone, and reduce roughness or hyperpigmentation. |
Microneedling | Creates tiny controlled skin injuries to stimulate collagen, improving skin smoothness and texture. |
Scalp micropigmentation | Tattoo-based technique that creates the appearance of density or a defined hairline. |
PRP (platelet-rich plasma) injections | Injected into the scalp to support hair growth and thickness, often alongside minoxidil. |
Nonsurgical body contouring | Devices (e.g., CoolSculpting, radiofrequency) that reduce or reshape fat deposits without surgery. |
Vocal / speech-language therapy | Voice feminization training with a therapist targeting pitch, resonance, and intonation without surgery. |
Cosmetic tattooing / microblading | Semi-permanent pigment for brows, eyeliner, or lip color to enhance feminine features. |
Non-Medical Strategies for Feminine Presentation
These strategies will help you appear more feminine and are listed in order of estimated cost.
Strategy | Est. Cost (USD) | How it feminizes |
|---|---|---|
Take a free voice-training program | $0 | Follow a structured course (e.g., free TransVoiceLessons videos) to raise pitch and shift resonance toward a feminine voice. |
Practice feminine posture, gait & gestures | $0 | Use free tutorials or a mirror to adjust how you stand, walk, sit, and gesture. Free but takes deliberate practice. |
Grow out your hair or wear a wig | $0–$800 | Longer feminine hair frames the face. Growing it out is free but not an option for everyone (e.g., baldness). A well-fitted wig gives length, density, and a feminine hairline immediately. |
Build a feminine wardrobe that fits your body | $0–$1,000+ | Clothes can highlight the waist and soften shoulders. Can be free via clothing swaps or hand-me-downs from friends, cheap via thrifting, or more via retail. |
Remove/manage body & facial hair at home | $10–$50 | Shave, wax, or epilate to reduce visible masculine hair. |
Use shapewear & foundation garments | $40–$250 | Breast forms, padded bras, hip pads, and gaffs create feminine curves and smooth the silhouette. |
Learn and apply makeup | $50–$300 | Cover beard shadow, contour to soften the jaw and cheeks, and reshape brows/eyes. One of the highest-impact non-medical changes; a paid one-on-one lesson can speed up the learning curve. |
Obstacles
These are obstacles commonly encountered by those who are exploring gender identities which contain aspects of transfemininity.
“It’s a fetish” / attraction to oneself
Many of those with gender identities that contain aspects of transfemininity find they are attracted to themselves during self-discovery and at some point conclude that their exploration with transfemininity is nothing more than a fetish.
However, being attracted to yourself has nothing to do with gender identity! Your gender identity does not care if you are attracted to yourself or not.
Facts:
- Sexual attraction to oneself has nothing to do with being trans
- Many who identify as trans report that they are occasionally attracted to themselves
- Many cis women are sexually attracted to themselves at some point
Body aspect-specific obstacles:
These obstacles involve specific aspects of one’s body which might lead one to conclude that they don’t pass or shouldn’t identify as trans.
Face: This is a common one because HRT in no way alters bone structure. Your jawbone and brow ridge are going to be where they are unless you have them surgically adjusted. However, most underestimate the effects of fat redistribution on the face and how much it can feminize some women. [5] Unfortunately, this process takes time, often at least a year or two to see a meaningful effect and sometimes more. For bone adjustments, there is Facial Feminization Surgery (FFS).
Baldness: Feminizing HRT (sometimes also in combination with Dutasteride) slows androgenic alopecia (male-pattern baldness) by slowing the production of Testosterone which slows the production of a chemical in the body called DHT. In combination with Minoxidil (Rogaine) either taken topically or orally, it is possible to regrow hair from miniaturized follicles. There are also a number of other hair regrowth practices commonly utilized such as microneedling. [1, 13]
Body hair: Feminizing HRT slows or stops body hair growth once testosterone levels are correct because body hair is activated by testosterone. For permanent body hair removal there is laser hair removal or electrolysis.
Facial hair: Having to shave a lot can be an obstacle for some women. This obstacle is more prevalent in those whose skin tones/hair aren’t treatable with laser hair removal. Electrolysis is the only method considered permanent hair removal [12] and will work on any hair of any color! Electrolysis can be done on a “large volume” basis in some clinics.
Extremities: Feminizing HRT can lead to muscle mass loss and fat/connective tissue redistribution, making arms, legs, shoulders, and feet all smaller. [5]
Height: HRT cannot alter bone, but I have seen anecdotal reports of height loss of up to 2 inches. There is no actual scientific evidence of this.
Hips: Fat redistribution from HRT will move male belly fat into the hips slowly over time. [5] This can be an obstacle for those who want their male belly gone right away, and they will often inquire about weight loss for this. The unfortunate reality is that weight loss and then regain (known as “weight cycling”) does not cause fat redistribution, as only new fat cells get created in the right places while a person’s estrogen level is in the correct range. There are medical procedures available to help redistribution happen faster (e.g. liposuction or body contouring)
Weight: Some women will tell themselves they can’t be a woman because they are overweight. This is simply not true, there are plenty of wonderful curvy women out there!
Voice: A masculine voice can often be an obstacle. While voice training to obtain a more feminine voice can be difficult, most voice coaches will claim anyone can do it over time. There are a great number of free online resources and tools to help with this
Sexuality:
While this one is covered in the Obstacles chapter, sexuality is of particular concern to some who have transfeminine gender identities because they think they have to be straight. This is not true, there are plenty of trans lesbians who are attracted only to other women!