Imagine my confusion, then, when I first realized I might be transgender. I didn’t yet know what it means to transition. I didn’t understand the extent to which hormones gender our bodies, and how medical treatment can drastically feminize my body’s biology. I didn’t know anything about transgender surgeries or how gobsmackingly well surgical results can look and function like natal genitals. As far as I knew, my body was immutably male – in fact, it was not.

In this article, I want to share with you my process of transforming my body – both physically and biologically – over the course of the past two years. It has truly blown my mind, completely changing how I think about the science of sex and gender. It has been extraordinarily painful, terrifying, expensive, time-consuming, and bureaucratically nightmarish. But it has also drastically improved both my health and my quality of life, being considered by both my doctors and my health insurance as a medically-necessary treatment for gender dysphoria. You may not agree with my decisions, though as a matter of pikuach nefesh (medical necessity), I hope that you would. Regardless, my goal is for you to at least understand the process that I’ve gone through, and thereby, in the name of ahavat Yisrael (love of fellow Jews) and lo ta’amod al dam rei’echa (not standing idly by the blood of your neighbor), feel a greater sense of compassion and empathy for trans people like me.

Hormone Replacement Therapy

On December 23, 2019, I commenced hormone replacement therapy. I began taking daily estrogen supplements, along with a twice-daily anti-androgen pill called Spironolactone. Five months later, I added daily progesterone to my treatment. As a result, in less than a year, I almost completely eradicated testosterone from my body, while boosting my estrogen to average female levels.

Altering my biology in this way has drastically feminized my body. My skin and my hair became softer and thinner. My body smell changed, and my fat redistributed. My face has taken on a more feminine shape, my feet got smaller, and I’ve even shrunk two inches. My breasts have grown to a D-cup size, my rear end has become more padded, and my center of gravity shifted. My muscles have weakened, and I bruise much more easily.

I was astonished – and perhaps you will be, too – at how much my genitals have changed simply as a result of flooding my body with female hormones while suppressing my male hormones. My penis got significantly smaller, softer, and squishier. Erections became extremely painful, and I am no longer able to penetrate or ejaculate. My testicles have shrunk, and I am no longer fertile. Surprisingly, my experience of orgasms also completely changed. When driven by testosterone, they felt like a single, sudden burst in the groin. But now, driven by estrogen, they are a slow, exhausting, full-body experience that leaves me totally drained of energy. But even more surprising than that? My sexual orientation changed, and for the first time in my life, I began to feel sexual attraction to men.

My emotions changed. It feels as if I had previously experienced the world in grayscale and suddenly everything is bursting with color. Every emotion feels a thousand times stronger. I cry. I have mood swings.  I crave  deeper 

friendships, and I feel an intense need for physical and emotional intimacy. In a very real sense, my body is going through puberty – but this time, a female one. Emotionally, I feel and behave like a teenage girl.

Clearly, I don’t have a uterus. But apparently, my hormones don’t know that. I have experienced several month-long hormonal periods, with all the symptoms minus the bleeding: bloating, headaches, fatigue, mood swings, and OH MY GOSH the CRAVINGS! (I would eat capers from a bowl with a spoon, and stuffed grape leaves by the can.)  As it turns out, estrogen does not only cause the uterus to cramp – it causes ALL smooth muscle in the abdominal region to cramp, including my intestines. (This is why “period poops” are a thing.)

Surgery

Now that I’ve changed my body’s physical appearance and hormonal balance, the next step for me is surgery.

There are three common types of surgery for transgender women.

• Facial feminization surgery (FFS) transforms masculine features into feminine ones: shaving the brow ridge, shifting the hairline, augmenting the cheeks, diminishing the nose, narrowing the jawline, and more.
• Top surgery involves augmenting the breasts.
• Bottom surgery involves surgically transforming male genitals into female ones.

Thanks to the success of hormone replacement therapy, I have not needed to undergo FFS or top surgery. My face and chest have naturally feminized to the extent medically needed for treating my gender dysphoria. Next month, however, I will undergo bottom surgery.

Bottom surgery – in my case, penile-inversion vaginoplasty – is a major operation with an intense recovery. No, contrary to popular myth, surgeons do not cut off trans womens’ penises. Rather, my penis and scrotum will be transformed into a vagina, labia, and clitoris. My penis will be inverted into my body, the erectile tissue removed, and the glans repurposed as a clitoris. The skin will be used to create labia and a vaginal canal. My urethra will be rerouted inside my body to a new urethral opening above my vagina. If the procedure is successful, I will have a self-lubricating vagina, an erogenous clitoris, and realistic labia – in short, a vulva that is physically indistinguishable from that of most women.

Preparing for this surgery has been one of the most intense experiences of my life. Simply scheduling it has taken forever. Because it is a major, specialized procedure, very few surgeons are trained to perform it. I had to research a handful of surgeons in my area of the country, discovering in the process that one is undergoing lawsuits for malpractice, another doesn’t work with insurance, and two more have little experience. But one of the greatest surgeons in the world for transgender surgeries, Dr. Bella Avanessian, works just a few hours away at Mount Sinai Hospital in New York City.

The long and complex bureaucratic process began in October 2020, when I had a phone consult with a social worker at Mount Sinai. In order to even schedule a consult with the surgeon, I first had to prove that I would be able to stay with a friend within driving distance of the hospital for a full month following my