Generally physical transgender-treatment involves hormonal replacement therapy (to maintain normal hormonal levels for the experienced gender), surgery and some other currently not medicated procedures such as hair-removal. Obviously the type of treatment is completely different for male to females than it is for female to males, however it is also very individual from person to person. Some people do not use hormones but have various surgeries, others use hormones but do not have any surgery. For some people genital surgery is the most central parts of treatment while others are not interested in this at all.
Because of this diversity (which is in fact so vast that the treatment different transsexuals seek may well be mutually exclusive) it is impossible to put all these needs into one single frame of reference or to encompass everything with one view, one treatment or one interpretation! This is simply individual, there is no "one fits all solution", even though a great number of medical practitioners seem to believe otherwise. In my opinion this actually goes as far as to preclude any single individual from understanding the entire scope of the problem. What is possible is acceptance and empathy. But then again, the medical system works on professional distance and emotional detachment.

On the other hand this doesn't mean that there aren't be general points of interest when it comes to "body modifications" of any sorts, including any and all medical treatments:


When it comes to understanding hormonal treatment and surgery (any surgery) it is important to keep some of the basic concepts of biology and medicine in mind:

(1) From the perspective of evolutionary biology all individuals from a species, no matter if they are male or female, COME FROM THE SAME BLUEPRINT. In humans male individuals typically have a little less of that blueprint than females do (males usually have an XY-pair as their sex-chromosomes while females usually have an XX-pair, the other 22 pairs are "identical pairs", once again usually), however both male and female individuals can develop from either an XX or XY fertilized egg, this just doesn't happen equally as often as the "normally expected case".
Before the appearance of sex-chromosomes (at some time during the age of the dinosaurs) individuals of a gendered species were either hermaphroditic or the sex of an individual was determined by environmental factors (such as incubation-temperature in reptiles). Then the 'Y'-chromosome developed as a variation of the 'X'-chromosome in that now the mere presence of it made the individual male. Over time more traits that were beneficial to males but disadvantageous to females were located on the male 'Y'-chromosome, however the contents of the 'X'-chromosome remains vital for both males and females, nobody can live without it. This means that THE BASIC EVOLUTIONARY BLUEPRINT OF GENDERED LIFE IS FEMALE, males have developed as "an adapted version of females" by assembling predominantly male traits on the 'Y'-chromosome over time.

(2) Biologists differentiate between primary and secondary sexual characteristics. Typically the primary sexual characteristics would include all organs which directly relate to reproduction, this would internal gender-specific organs as well as in females the vagina and the vulva (which includes the clitoris), in males the scrotum (with the testicles) and the penis. The secondary sexual characteristics are typically defined as features that distinguish the sexes other than the primary characteristics.

(3) Very fundamentally for a biological system (cell growth) it is easier TO ADD SOMETHING while for the medical professional (the surgeon) it is easier TO REMOVE SOMETHING - at lest as long as we remain within the realm of natural biological structures (meaning that we do not consider "adding silicone" as biological). However while the surgeon is free to cut away as much tissue as he pleases at any time (up to and including entire organs), biological growth will typically be somewhat limited to limited if it does not occur in the right order and at the right time. After birth biological growth is limited to "increasing existing structures", entire missing organs for example cannot be created.

Keeping this in mind it becomes understandable that it is easier for the female to male transsexual to obtain visual secondary male characteristics because many of these can be induced biologically (i.e. through hormonal therapy by means of testosterone) than it is for the male to female transsexual to get rid of the male characteristics after these have formed. One notable exception is breast growth as these grow in females during puberty but this growth does not happen in biological males: Male to female transsexuals will typically grow breasts from hormonal treatment (although often somewhat smaller than a biological female). Female to male transsexuals will almost always require surgery to have their excess breast-tissue removed (unless treatment is started very early in life).
On the other hand it also becomes clear that it is easier for the male to female transsexual to achieve acceptable primary sexual characteristics than this is for the female to male. The problem is that no amount of hormonal treatment will ever change primary sexual characteristics, so the only way to get these is by surgery. Considering male and female anatomy it is simply a lot easier for the surgeon to remove excess tissue in male to females than it is to 'create' tissue in female to males.

Considering all this I believe it is fair to say that usually it is easier for female to males to "socially look male", hormonal treatment alone is typically enough to achieve this while for male to females this sometimes remains difficult even after years of hormonal treatment. Therefore interventions such as facial surgery are a lot more common in male to females than these are in female to males. On the other hand achieving sexual functionality is a lot easier for the male to female than it is for the female to male. In fact today's surgical methods for male to females usually allows full sexual and intimate function while even the best female to male techniques still leave to be desired and some sexual practices (such as anal intercourse) remain difficult or impossible.


Hormonal treatment works slowly, typically over years. I personally have been on HRT for more than 4 years now and I still experience physical changes. This appears to be normal as HRT basically induces puberty and a normal puberty lasts anywhere from age 9 to age 17 or thereabouts, so a time-range of 8 years during which physical changes may occur seems reasonable. Typically mayor physical changes will not occur before at least a couple of months into treatment, it was also my personal experience that these changes increased rapidly after genital surgery, which would confirm that the suppression of testosterone is biologically not the same as not having it in the first place.
What exactly will change through hormonal treatment and by how much is very individual, just as puberty is for people who have the hormones naturally. Any predictions are, in my opinion, worthless.

Like every medical treatment HRT has risks and benefits. It is important to understand these and I would like to encourage everybody who considers HRT to seek the advice of a professional, preferably somebody with extensive knowledge in the field. Unfortunately many doctors have never treated a transsexual so it may be difficult to find a knowledgeable practitioner.
As so often in life the key here is information. Information for the medical practitioner but also for the patient. A well informed transsexual will get better treatment (and likely more personally satisfying results) than somebody who doesn't get involved in his/her treatment. This starts with selecting a medical practitioner who is accepting to the particular needs of an individual. Much information is available on the internet, do your research, it may be key to your life!


Surgery, especially visible body modifications, are sometimes referred to as "warp-drive transition". The fact is that in particular extensive facial surgery for the male to female transsexual and breast-reduction or chest reconstruction surgery for the female to male transsexual has the potential to make a significant difference in a short time. However any surgery is an invasive procedure, has risks and side-effects, most notably any invasive surgeries will come with some level of pain and discomfort and the need for more or less extensive recovery. For facial or breast/chest surgery this could mean a few weeks off work and a few months of recovery, assuming everything goes well. For m/f genital surgery (vaginoplasty) I would personally recommend to plan for 8 to 12 weeks off work and a minimum of 6 months of reduced activity (which may interfere with work as well). The complete healing time for this surgery is typically given as one year, however it will likely take longer until it is completely invisible. Unfortunately f/m genital surgery is a lot more invasive and typically takes several interventions and a couple of years to complete.
Unlike hormonal treatment surgery can alter bone-structure, this makes rhinoplasties, chin, mandible or even forehead modifications possible, liposuction can reduce unwanted body-fat. The result of surgery is more predictable than hormonal treatment, particularly if it is done by somebody who has a lot of experience in the field. Again, information is key. Choose your surgeon wisely is the motto.


Permanent hair removal is something the male to female transsexual will have to investigate if the individual has facial hair-growth before the onset of treatment, which would likely include everybody who starts treatment as an adult. There are two methods our there which promise permanent hair removal, laser treatment and electrolysis. Both are painful, time-consuming and expensive. Both also have the potential to permanently damage the skin, so once again, either way it is important to do the research and choose the provider wisely. There are however a few important differences between these methods:

First and foremost ELECTROLYSIS. It been around for a very long time, basic galvanic electrolysis for over 130 years, thermolysis for now nearly a hundred years. Electrolysis works by the electrologist inserting a fine probe along the hair-shaft all the way to the root of the hair and then destroying the hair matrix-cells either with heat (thermolysis) or with sodium hydroxide which is locally created by chemical electrolysis from an electric current (hence the name of the procedure). Millions of people have been treated with electrolysis, the practice has an excellent safety record and because it has been around for so long we actually know that there are no adverse long-term effects (everything from skin-discoloration to over-sensitivity to light to premature aging of the skin to increases in skin-cancer), we also KNOW that the hair-removal is indeed lifelong, in fact as of March-2010 Electrolysis is THE ONLY METHOD of hair removal for which the FDA allows the term "PERMANENT hair removal".

Around the 1990-es LASER HAIR REMOVAL became popular. Its proponents state that it is faster than electrolysis and less painful. While excessive pain in both procedures can be alleviated by use of dermal anaesthetics the fact that laser-treatment is faster is obviously a great incentive. On the other hand the technique has only been around for 20 years and even this is highly misleading as nobody would use a 20 year old laser-epilator today. Most systems in use today have in fact only been developed in the past 5-10 years (or less), in my opinion it is highly questionable if 5-10 years of use is an adequate time to determine that the procedure has no long-term side-effects (such as early aging of the skin or the promotion of skin cancer) which may take DECADES to show and then longer to be diagnosed and scientifically linked to the cause. In some countries laser salons claim that their procedure "guarantees permanent hair removal" while in others they are only allowed to claim that it provides "permanent hair reduction". This too we will only truly know in a few decades.
What is known already is that laser treatment by design does not work on very light coloured hair and that it does not work at all on very fine hair. This is because laser treatment works by light being absorbed by dark pigments (melanin) which causes local heat that then destroys the follicle. Obviously if the follicle isn't dark or very small then this doesn't work, also if the skin is dark or very spotted then there is the danger of damaging the skin as the skin itself will absorb the heat instead of the hair.

Once again as with surgery the motto here is to be informed and to choose wisely!

My personal experience with hair-removal was that I first and foremost put my own safety above every other consideration, which is why I chose electrolysis for myself, even though laser-treatment was available at the time. Generally electrologists will state that it takes approximately 2 years to completely remove male facial hair, laser practitioners often say that this can be done in just one year. For electrology a typical male face will take something in the neighbourhood of 100 hours of treatment while laser treatment may run at maybe 25 treatments (largely depending on how much area can be safely treated in one session, facial hair may require a dozen treatments on the same area for satisfactory results, the same area cannot be re-treated before it is completely healed which requires treatments to be a few weeks apart). The decisive factor here is not the amount of time one is willing to sit in the chair but that it takes time for the hair to grow before it can be removed and that many follicles are dormant, so treatment has to wait until they actually start producing a hair!
I have done my own electrolysis very quickly, during the initial weeks I spent 6 hours each week in treatment. This means that after 6 months this was down to weekly treatment of some minor re-growth (which is very fine) as well as the removal of all these dormant follicles that had decided to start growing over the week - all of which was no longer an issue when it came to be "passing all day long". It did take me two years to have this done completely, however by the end of the second year this was a question of 5 minutes every 4 weeks with hairs to be removed nobody except I myself and my electrologist ever noticed...
It can be done in so short a time, but it takes some determination and a very competent electrologist who is willing to provide treatments lasting several hours - my result I think speaks for itself!