How to Transition MtF: Everything You Need to Know

How do I transition? Where do I even start? These are the questions we often ask ourselves after we’ve begun to accepted our transgender identities.

Today I will be providing a step-by-step guide on how to transition MtF in the United States from the perspective of a trans woman living in New York.

Though the framework for transitioning in other states is pretty much the same. Aside from the states that have unfortunately banned gender affirming care. I will be writing a blog post soon discussing what transitioning may look like in these outlier states.

For now, what I know from my experience is the best guidance I can provide.

Everyone’s Transition is Unique!

Even though this is a step-by-step guide, there is no set order you have to follow. I will be writing it in the order that made the most sense to me and I’m happy I did it in said order

But feel free to skip around this article and take what you need. I have a table of contents below for easy navigation.

How Do I Transition: Table of Contents

Am I Even Trans?

Growing up I had always thought about how I wished I was a girl. I thought about how my life would be so much easier if I was one.

I don’t want to play into “the narrative” too much but I love barbies, princesses, and anything pink. However you can be a trans girl even if you loved monster trucks, video games, and hanging with the boys.

There are so many different avenues when it comes to discovering your womanhood and what that looks like for each of us is different. I will say though if you have been wondering, “Am I trans?”

If you are scouring the internet for resources listening to the stories of other trans girls… more than likely.. you are lol.

As I got older I tried to suffocate those feelings with drugs, alcohol, and sex. But it didn’t help anything, I just got more depressed.

A common theme with trans people before we live as our authentic selves is not being able to imagine a future as our assigned gender. We tend to feel hopeless, or that we can’t imagine ourselves getting older.

Once I realized I was trans and I was gonna go for it, I had hope again. I had finally admitted to myself and bawled like a baby because it had felt like something I had robbed myself of for years.

That being said it’s never too late to start. It’s never too late to choose yourself. It’s never too late to save your own life.

Transitioning Socially

Boymoding

Even though I had just admitted I was trans there was a huge part of me that was ashamed or didn’t feel validated. Sometimes, depending on our circumstances, we have to “boy mode” before socially transitioning.

Boy moding essentially means pretending to be a boy during our transition. Sometimes people boy mode at work, family gatherings, in their day-to-day as they figure things out.

It can be for safety reasons, it can be because you’re not ready to come out yet. The important thing is to not feel guilty for boy moding if it is something you have to do.

Shit is real transitioning mtf and it can feel like you are dropping a bomb in your life. And yes that’s true. You are uprooting everything you thought was true and rebuilding an entirely new version of yourself.

The thought of this is terrifying but I think it is one of the most beautiful aspects of transitioning.

Exploring Your New Identity

Toxic Shame

In the beginning I felt awkward. I felt like I was just a boy in a dress appropriating womanhood, this is a TOXIC mindset that unfortunately results from our socialization.

Transphobia is deeply engrained in our culture/ the media we consume. So unlearning all of that transmisogyny takes time. Just remember to please be kind to yourself because this is a process!

I’m still unlearning transmisogyny, like I have to check myself consistently and challenge negative self talk. Simply noticing when you’re talking poorly about yourself is a great place to start.

Then start asking yourself why? Why am I speaking to myself this way? When you start to interrupt these patterns of self deprecation you begin to rewire the brain.

Mental health hygiene is so important throughout your transition, it’s not always easy. Like you really have to make sure you’re taking care of yourself, mental health should be your number one priority!

Finding your style

One of the most exciting parts of transitioning is getting to discover this new version of you! You get to experience with so many different styles.

I’ve done it all from 80’s granny to grungy. And I still love trying new things! When you’re first experimenting with different styles wear whats comfortable for you.

Don’t feel like you have to wear a mini skirt and heels if you’re not ready for that kind of attention and don’t feel guilty for wanting to play it low key. Like at the end of the day we all just want to be left alone lmao.

The amazing thing about fashion is that it is constantly evolving and changing with you. How I dress now may not necessarily be how I’ll dress a year from now.

The important thing is to have fun! Yes looking back you may look at outfits and go, “WTF was I thinking.” But like girl you’re going through puberty for a second and have to learn how to be a girl from the ground up.

Shopping!!

When it comes to shopping, clothes for girls (especially quality garments) are soooo expensive. Like do not invest a bunch of money into a wardrobe when you’re just starting. I would HIGHLY recommend thrifting.

What’s great is you have access to much cheaper clothing in an endless amount of styles. So one day you can be goth, the next day you can try the coquette look, rockstar girlfriend etc.

Amazon is also a great resource if you want to be more discrete. I have a bunch of gender affirming outfits I put together for fall/winter here. You may find some inspiration!

Below I’ve linked a video for additional shopping tips, the Chloe Connection is an amazing resource you should totally check out her channel!

Living Openly

Some clinics require that you have transitioned socially for a year before starting HRT. I believe you should be able to be on HRT whenever you feel like it.

Some girls start HRT before transitioning socially. I had decided to take my time and make sure HRT was right for me. That being a CTG was something I really wanted.

So for a year or so I had grown out my hair, tried to incorporate feminine clothes into my wardrobe, and stuffed my bra (that was a crazy era).

I came out to my family little by little, I took my time finding a girl name, and before I knew it I felt ready for the next step in my transition.

Though as I said before not all of our journey’s are the same and if you do not have the capacity to live as an openly trans woman please do not feel guilty for that!

MtF Hormone Replacement Therapy (HRT)

Starting HRT

At a certain point during my social transition I noticed my twink-esque features were starting to disipate and I was starting to look more masculine.

Dysphoria started to become rampant and my desire to be more feminine had outweighed my fear of starting HRT.

In New York, you have the option to go to an informed consent clinic, where you can receive hormones without a letter from a therapist.

However multiple states provide informed consent clinics. Informed consent clinics provide access to hormones on a sliding scale that can adjust the cost for your income, making it more affordable.

I went to Planned Parenthood in Washington State (where I was living at the time). I sat down with one of the doctors and was written a letter of approval.

I had a consultation and then came back the following week for a follow up and to pick up my prescription.

If you do not have insurance there is sliding scale! If you don’t have insurance or income you are eligible for free HRT at Planned Parenthood!

Check out the Trans Resource Phonebook to book your Planned Parenthood appointment in greater New York!

I also have other clinics listed in New York City as well like Callen Lorde and Mt Sinai!

Your Prescription

Disclaimer: I am not a medical professional, I am speaking from my own experiences. Please consult a doctor about starting HRT and your proper dosage!

Estradiol

These are the hormones that our bodies do not produce enough of. As humans we have both testosterone and estrogen being produced but as a trans women our bodies do not produce enough estrogen.

More than likely your doctor will start you off on tablets, like 2mg and slowly increase your dose over a couple weeks.

Though after you reach your full dose on tablets and your body has adjusted, I would recommend switching to injections. They are a lot more effective in my experience.

With tablets, estrogen doesn’t stay in your body for nearly as long so you will notice a spike and a drop every day. Whether as with the injections you slowly taper off between your weekly dose.

Spironolactone

Spironolactone is an anti-androgen that helps suppress testosterone. Essentially, it’s your testosterone blocker. You’ll probably start off at 50 mg and then they’ll boost you to 100mg twice daily but for me that was excessive.

Spiro is also a diuretic which means that it causes your body to lose sodium which means you crave more sodium. As a result you will pee a lot more frequently.

This is how I combat those transgender salt cravings!

Progesterone

A hormone often prescribed in transgender hormone therapy, but research on its effectiveness is limited. A lot of girls swear up and down that it helps with breast growth.

I didn’t particularly care for it, I felt like it made me neurotic. Also I’m flat chested af so take that as you will.

The Timeline of MTF HRT

The timeline of HRT is different for everyone but I began noticing a difference in the first two weeks when my skin became visibly softer, my pores were’s non existent!

Then everything else began to happen slowly but after a year was when I noticed thickening of hair, body fat redistribution, and members of my family began to comment on how my face had changed.

After that I just got a little bit prettier every year.

Here’s a table that has the variable timeframes of the changes you will begin to notice.

Changing Name and Gender Identifier

Choosing Your New Name!

Another one of the most exciting things about transitioning is finding a new name!! I scoured baby name websites like Nameberry and bounced between names like Cora, Lux, Persephone but Aria was the one that just kept popping up.

It can feel stressful trying to find a new name but I’ve noticed with other girls when they’re choosing usually have one that they feel a little bit more drawn too but are scared of committing.

Naturally, you wanna be sure it’s the right name for you don’t want to feel you’ll be stuck with it forever. I’d reccomend asking friends and family thoughts on various names.

You can choose names based on characters in TV/Movies (mine is Aria from Pretty Little Liars lmao). Or maybe there was this girl who you thought was so gorgeous in high school and loved her name. Or maybe you have a relative you want to honor like there are so many options!

I would reccomend saying the name out loud to yourself something else I would do is, okay I know this is crazy but I would imagine somebody talking shit about me and I would say, “God, I hate that bitch Aria!”

And I was like wow okay thats cunty, slay. Okay now lets get into the legal shmeegal stuff.

Step 1: File petition for a legal name change/sex designation at your local courthouse.

This process takes 2-4 months

First you’ll navigate to your county of residency website example you would Google, “(Your county) Court petition for name change.” You will be directed to the county website and they will tell you how to get your DIY paperwork. You may be directed to another site where you will then obtain your form.

I’ve embedded the form for New York below!

You will fill out that paperwork and put together an application with your requested documents. Documents needed are variable but the most common requested documents will include

• A copy of your birth certificate
• Proof of identification
• Proof of residency (documents with your name and address, such as a utility bill)
• State and federal criminal background checks
• Payment for the required fee

After you gather your documents with your completed application you will go to the court house and get your application notarized. This is a formality saying you’re good to go and then you will get a date where you will petition in front of a judge.

You will them why you are petitioning for your name change. They’ll hit the gabble, it will feel very official, and then you will go file your notarized petition in the courthouse. It will cost you about $200 to file after your petition is stamped by the court.

You will want to have at least two officially stamped forms for your other applications.

Step 2: Changing Your Name and Sex Designation with Social Security

Unfortunately you have to change your name on all your paperwork and Social Security is as always the most annoying and time consuming.

I did mine via mail and phone because of the pandemic so it took a million years. Not only that but all the offices were closed so it took like 5 months to process. I want to say in person would be way more efficient.

First you’ll fill out this SS-5 Form which is the standard nationwide.

After you fill out this application you will of course gather your supporting documents which will include the following…

• Proof of Identity
• Official Order of Name Change (above mentioned)

You will go to the social security office and let them know you would also like to change your sex marker file your application and you will get a new social security card mailed to you. I would follow up if you don’t receive your new social security card after a month.

I will also link the phone number for the Social Security Office Below.

Step 3: Changing Your Name and Sex Designation with the DMV

To change your gender marker on your ID, you have to file a Gender Marker Change Form with the DMV. You can do this at the same time as changing your name. Though if you’re just changing your gender marker in the state of New York. You can do it online here!

If you’re changing both you will need the following…

• Your new SS card
• Your old ID/License
• Your official order of name change

From then on it’s pretty straight forward, you’ll just go through the motions of being at the DMV. Smile big for the camera cause your ID says F for FISH!

Note: Kansas will not let you update your sex identifier on your license whatsoever.

The following states will not let you update your sex identifier without either a court order, an amended birth certificate, or proof of sexual reassignment surgery (nobodies business)

• Iowa
• Oklahoma
• Texas
• Louisiana
• Tennessee
• Kentucky
• Georgia
• South Carolina

Step 4: Changing Your Name and Sex Designation on your Passport

If your renewing your passport you will have to submit the usual DS82 Form, linked below

When you renew your passport you will bring the usually required documents along with your official proof of name change.

As for changing your sex identifier it’s as simple as checking two boxes on your DS82 form. As of 2021 it is no longer required for trans people to have a physicians letter.

Step 5: Changing Your Name and Sex Designation on Your Birth Certificate

Okay lastly changing your name on your birth certificate, you will have to go to your state of birth’s vital records office website.

If you live far from your home state you’ll fill out whatever amendment form is required and mail it along with your supporting documents which will include your official order of name change. They will send you back the original copy.

Amending your Birth Certificate in NYC

You will have to make an appointment with NYC Department of Health Corrections and Amendments Units, go ahead and click the link here!

You can also do it via mail but it’s easy, you will more than likely have to follow up.

Amending your Birth Certificate in the State of NY (not NYC)

You will submit this form along with your official order of name change and old birth certificate if you have it available. After you mail in your application you should have your new birth certificate within two months. Follow up after a month if need be.

It’s important to note that unfortunately a few states will not let you amend your birth certificate’s sex designation whatsoever…

• Tennessee
• Oklahoma
• Kansas
• Montana
• North Dakota

And that some states will not let you amend your birth certificate’s sex designation unless you have proof of sexual reassignment surgery. Which is such a morbid and gross invasion of privacy…

• Utah
• Arizona
• Nebraska
• Iowa
• Missouri
• Arkansas
• Louisiana
• Wisconsin
• Kentucky
• Alabama
• Georgia
• New Hampshire

How to Get Free Gender Affirming Surgery in 2024

This next section I will be providing a step-by-step guide to getting your free gender affirming surgeries in New York. However this process will be virtually the same for any state medicaid that covers gender affirming care.

Medicaid is a great resource for trans women who are looking to undergo gender-affirming healthcare treatments.

Medicaid is a state-funded healthcare coverage plan that provides medical assistance to those with limited income and resources. Many gender-affirming procedures are covered by state medicaid.

This includes…

• Facial Feminization Surgery
• Breast Augmentation
• Sexual Reassignment Surgery
• Laser Hair Removal and Electrolysis
• Body Contouring
• Post Surgery Care
• Fertility Procedures (banking)

Step 1: Making Sure You Qualify for Medicaid

Before applying for Amida Care, ensure that you meet the eligibility criteria for Medicaid in New York. Eligibility is based on factors such as income, citizenship status, and residency.

There are two paths we can go down here. Marketplace (where you purchase your plan based on income) or Access HRA (where you apply for free benefits).

I will be discussing if you make little to no taxable income which means going through Access HRA.

Step 2: Applying for Medicaid/Benefits Online

Once you determine your eligibility, you can apply for Medicaid through Access HRA. The online application process is straightforward, and you will need to provide information about your household, income, and other relevant details.

You also have the option to apply for food stamps and financial assistance at the same time so take advantage of that as well. If you’re just applying for medicaid you will be redirected to marketplace.

I will talk about how to navigate marketplace in a separate article.

Step 3: Gather the Necessary Documentation

As you progress through the application process, you will have to provide additional documentation to support your eligibility and need for free gender affirming surgery. These documents will include:

• Proof of identity: A government-issued ID or driver’s license, SS Card, and Birth Cerificate.
• Proof of residency: A utility bill or lease agreement (both if your asking for financial assistance)
• Proof of income: Pay stubs, tax returns, and bank statements.

The easiest way is download the Access HRA Mobile App where you will be prompted to submit certain documents and upload them via your camera roll. It saves you a lot of time.

Step 4: The Phone Interview

Additionally you will need to do a phone interview to determine your eligibility for benefits after you submit your documentation. Your phone interview is a chance for you to talk about your current situation.

Prepare for a 1hr+ Hold Time

Maybe you lost your job a while ago and have been living off of your savings but your funds have dwindled. Or maybe you’re a freelancer who hasn’t been able to work due to a tragedy. Maybe you’ve had to resort to selling some of your personal possessions in order to get by.

You will get a phone call from a private number, make sure to answer. If you miss the call or are not able to take the call you will have to call the Access HRA phone number (linked below) and wait for an interview.

Don’t bother calling after 10am unless you want to wait three hours. Even if you call at 8am when they’re just starting their day you will likely be on hold for an hour give or take.

After you complete the interview successfully your application is complete and you should have your benefits in four weeks…

Step 5: Following Up

HOWEVER… more than likely you will have to follow up multiple times. 40% of applicants are left in the dark. Hundreds of thousands of people are applying or dealing with other things and there are not enough workers to take care of it all.

How to Follow Up

So you will need to call at least once a week though I would recommend going to a Human Resources Office in person to follow up with your application.

You may have to do this multiple times and it will be taxing but its the cost of free gender affirming surgery.

If its been over four weeks ask to file a complaint over the phone. Also you need to be patient and kind with everyone during this process even if they don’t have a great attitude.

They have a difficult job and will be more apt to help you if you remain unbothered. At the Human Resources Office you can also ask them to send an email on your behalf. And if they say they can’t, they’re lying.

The Waiting Game

For me I waited about three and a half months which in the grand scheme of things isn’t long but when you’re dysphoric it feels like an eternity. Though a lot of my girlfriends had theirs approved faster.

Try to be patient and kind to yourself throughout this process. Surgery is not going to make all your problems go away. You have to do the work on the inside as well.

Step 6: Setting Up Your Insurance & Choosing Your Provider

Okay after you complete step 5 give yourself a pat on the back cause its a lot. But you are finally enrolled in Medicaid and you’re one step closer to free gender affirming surgery!

Choosing the Right Insurance Plan

The next step is to call the Medicaid phone number. The hold time isn’t too bad. When you’re on the phone with them you’ll let them know you were approved for Medicaid and you’d like to select Amida Care. I will link the Medicaid CHOICE number below.

If you’re not a New Yorker I would do some independent research on figuring out which medicaid plan specializes in gender affirming care. You could also ask the agent at Medicaid CHOICE.

Then you’ll have to wait another week or two to get your insurance card mailed to you. Once you have your insurance card call the number on the back of your medicaid card so you can do your phone orientation. This is crucial in setting up your healthcare and they also give you $20 just for doing it.

Finding the Right Provider

So now you finally have your insurance, next is to find the right surgeon for you. Though I’m sure you’ve done your research.

Basically just give their office a call just as you would with trying to book any other kind of medical appointment. Make sure they accept Amida Care, all of them should though.

Step 7: Preauthorization/Prior Approval

After you find your surgeon you’ll book your consultation, you will need to have your letters of recommendation at the consultation though some require before you even book your consultation.

Getting Your Letters

You will need two letters stating that you are diagnosed with gender dysphoria and have been on HRT for at least a year, two in some cases. One letter will be from your primary care doctor and the other has to come from a mental health professional.

You should honestly get those letters while your waiting for your application to process.

Book an appointment with your primary care doctor. You should be able to get both of those letters same day. You’ll give them to the provider and they will submit the letters to insurance on your behalf for approval.

Let Insurance Know Your Plans for Surgery

Before undergoing any gender-affirming surgeries, it’s essential to obtain preauthorization and prior approval from Amida Care. You can do this on the phone during your Amida Care Orientation.

Just let them know you’re trans and you’re looking for gender affirming surgeries, they will be able to support you.

Step 8: Post Surgery Care and Support

After your free gender affirming surgery, Amida Care continues to provide support for your post-operative care needs. The plan covers follow-up visits, medications, and any complications that may arise during your recovery period.

Additionally, Amida Care offers various support services, such as mental health counseling and support groups. They also offer post op care by covering caregivers during your recovery. Though I would also try to lean on the support of your community.

There are unfortunately states that explicitly exclude life saving gender affirming care from their medicaid program…

• Florida
• Kentucky
• Missouri
• Nebraska
• Ohio
• South Carolina
• Tennessee
• Texas

It is grossly negligent to ostracize a group of people for being visibly trans. Then on top of it deny them the care they need in order to integrate themselves into society. Right now there are 393 active bills targeted at restricting trans healthcare have been introduced in 2024 with 21 being enacted It is up to us who have the privilege of gender affirming care to fight for our brothers and sisters.

Transitioning MtF Conclusion

Well there you have it, a girls go to guide for transitioning start to finish. Transitioning is a long and arduous process but it makes you grow in so many powerful ways.

The important thing to remember is that everyones transition is different so go your own pace in whatever order you feel is right for you.

You are strong and capable and you can do this! Best of luck in your transition sis <3

Xoxo

CTG Aria