On the Science of Changing Sex

Advice to Transkids


CloudyMy pen name is Candice Brown Elliott.  I “came out” as transsexual when I was in high school, in the early 1970’s.  In some ways, I was alone and lonely.  I had only read about “transsexuals” in the very few snippets in magazines and a couple very incomplete references in a few library books.  This was the dark ages before the internet became available in every home, now in every hand, given smart phones today.  But you don’t have to be so alone as I was.  There are a number of resources available.

If you are having thoughts of self-harm or suicide, please contact the TREVOR PROJECT right away!  Suicide is not a noble act.  There are people who love and need you… even if you don’t yet know who they are.  Be there for them!

This page is for “early onset” gender dysphoric teens, “transkids”.

It’s important that you make your own choices in life.  Its important that they be good ones FOR YOU.  Being “trans” vs. “gay” or “lesbian” is not always an obvious demarcator.  Allow yourself to consider your options.  In no way am I a “cheer-leader” for being “trans”… being a transkid is neither better, nor worse, than simply being gay, lesbian, or straight.  We all have our own life to live.  Make it a good one, FOR YOU!

If you are a teenager who is a “cross-dreamer”, that is, someone who is sexually aroused by cross-dressing or imagining you are the opposite sex, this material may not be very much help to you.  But you will likely find most material for adult transitioning transsexuals or cross-dressers available on the web to be useful.  Again, there are many options available to accommodate being autogynephilic.  Make sure you make your life a good one FOR YOU!

Good Luck

– Candice

A bit of history, personal history that is?  I won’t bore you with how girlish I was a child.  If you are who I expect you are, you were too… or you were “one of the guys” as an FtM?  Doesn’t matter, you’re like me.  But you might like to know that I was sent to a psychotherapist when I was ten years old.  No, he didn’t try to “cure” me.  He was more interested in helping me learn to “play”… in a room filled with only boys toys ;-).  But I was also sent to another psychotherapist when I was 16 years old.  That time, my mother expected him to “cure” me by talking to me about things.  I stonewalled him.  In desperation, my folks sent me to a relatively new and little known (at the time) clinic at Stanford, when I was 17.  Little did my parents know that the Stanford Gender Dysphoria Clinic would support my desire to transition, to live as a girl!  I was at that time, not the youngest that they had seen…  but I was close to it, as the second youngest!

My folks did not support nor encourage me in my transition.  In fact, I was kicked out right after I graduated from high school and told to stay away from the family so I wouldn’t embarrass them any further than I already had.  So I have largely made my own way since.

My folks divorced when I was a teen.  I was the oldest of four kids.  Since I left home, I have had almost no contact with my younger two siblings, and only intermittent and strained contact with the elder of my two brothers.  Though, not all was lost.  It took some years, but my Dad finally came to terms, proud of me in fact.  Though I sincerely tried, my relationship with my mother has been much more strained and I haven’t spoken to her, or my siblings, in years now.

Kay, Jeff, Liz, & Reese

Kay, Jeff, Liz, & Reese

It was a rocky start in life, but I got SRS when I was 23 years old.  I went on and earned a college degree and was admitted to graduate school, ironically at Stanford University!  I have worked and supported myself since soon after I left home as a teen.  I am married.  I have had two official foster daughters, (natal females) one of whom I legally adopted.  These days, for the past couple years I’ve been a Court Appointed Special Advocate (CASA) for an FtM teen in foster care, now an adult.  I’m old enough to be a grandmom now (hint to my daughters… hint), well established and settled, with a good career, a loving husband, and two grown women that call me Mom.  My husband and I are called “Uncle Jeff and Aunt Candice” by my best friend’s children.  We’ve had a number of transkids come into our household as ‘unofficial foster daughters’ over the years.  I was a Court Appointed Special Advocate for an FtM transkid in foster care / group home.  I’ve had a great life.

So can you.

So, my advice begins with family…

Do everything in your power to hang onto them.  If you have family that loves and understands you, cherish them!  Tell them you love them, early and often!!!

Some of the folks in your family still love you, but may be very confused, hurt, maybe even seem angry with you?  Don’t give up on those folks.  They will likely come around.

But if you have a family member who is deeply embarrassed by you, ashamed of you, even despises you (join the club)…  Too bad for them.  Seriously, that’s their loss.  Oh, I won’t pretend, nor should you, that it doesn’t hurt, because it does.  But you are who you are… and you are beautiful and wonderful… and don’t you forget it!  Don’t waste any of your energy trying to change the way they think or feel.  It won’t help.  Trust me, been there, done that, the T-shirt is now a dust rag!

If you are still pre-transition and haven’t told your folks, trust me, they likely already know, or at least suspect.  They may wish and are hoping “you will grow out of it”.  They may believe that if they don’t talk about it, it will go away on it’s own.  You know better.  The time to talk to them is when you are ready.  Only you will know.

If your folks aren’t receptive to talking about things, consider writing a long, heartfelt, letter telling them how you feel and how they can help you.  Sometimes a little emotional distance can reduce the barriers to hearing what you have to say.  You must keep in mind that your folks may hold the notion that if you are trans, that they somehow “failed” as a parent.  You must let them know that they didn’t… and that you still love them.

If any of your family becomes physically abuse, for ANY reason, confide in an adult in a position of official authority such as a physician, school nurse, or school administrator.  They must, by law, report the incident to the appropriate authorities.  Sadly, I do NOT recommend approaching the police directly, as they are not well equipped to handle the issue, and often harbor distrust of teens, being regularly exposed to criminally behaving teens and young adults.

In talking to your parents or other adult relatives, you may want to share my Advice to Parents of Transgendered Children.

You may also wish to view this vid… (Kendal, thanks for the shout out!):

Next up:  Hormone Replacement Therapy (HRT)… 

Its not just for your grandmother’s hot flashes!  I’m sure that you feel as I did when I was a teen.  You need to be on hormones yesterday!  No joke, tic tock, the clock is ticking.  Being on hormones now is worth far more than being on hormones later.  Your body is changing rapidly during your teen years; most of these changes are permanent; make sure that the changes are the ones you want!  Every day you are not on HRT is a day you are on the opposite hormones!  I used to stare at the mirror and tell my body, “Don’t you dare!”  Talk to your doc!  I had to wait until I was 18, because that’s the way it was back then.  You don’t.  These days, most docs are fairly sympathetic, but may need a push.  Here’s the magic words, “Harm Reduction”, as in “If I don’t get them from you, I’ll get them on the street.”  Don’t give up, don’t take “no” for an answer.   Talk to another doc… and if you have to, find a clinic in a large city where they are known to help trankids.  If your folks are supportive, have them talk to your doc; they can smooth the way.

For transkids in their ‘tweens and very early teens, delaying puberty with expensive drugs is all the rage now among “official” transgender endocrinologists.  Unless you are still trying to make up your mind, this option is not in your best interest; it’s to let the docs sleep better.  If you are certain, and you feel ready, don’t let the docs decide for you.  Take the initiative and insist on full HRT starting right now.

You may stumble across websites or links that hawk “herbal hormones”, such as Black Cohosh, or some such.  Don’t bother with them.  Save your money.  They don’t work.

For MTF transkids, I strongly recommend using “bio-identical” HRT of estradiol and micronized progesterone in combination with an androgen blocker, beginning around age 12.  Avoid estinyl-estradiol, Premarin, Prempro, Provera, or anything else with synthetic progestins such as medroxyprogesterone; These products are less effective and possibly carcinogenic and neurotoxic.  Given that you will be on a higher dose than natal women typically are…  and for your entire life, it’s important not to be taking anything but the best available, especially given that they may actually cost less.  It is best to maintain a constant dosage, that is to say, that it is not only not necessary, but actually counter productive, to “cycle” HRT.  Monthly cycling of HRT is sometimes practiced in the mistaken belief that it mimics female menstrual cycles.

If started young enough, facial hair growth is avoided.  If you have had some growth, but is still not fully developed, HRT may reverse some of the growth.  A physician can also prescribe eflornithine topical cream (Vaniqa) which combined with HRT may control the facial hair.  Otherwise, electrolysis and/or laser treatments may be needed.

Don’t use silicone injections; they may look good at first, but lots of kids have problems with them later.  It may sound like one of those false internet memes, but it really is true, some transkids have died from silicone injection related complications.

If the dose of estrogen pill your physician prescribes is “too low”, as is often the case for teens, you may increase the bioavailability (absorption) by taking them with ruby grapefruit juice.  The “bitter” taste in the fruit is from nangerin, which will block an enzyme that breaks down estrogen in the intestines.  If you are taking birth control pills or estinylestradial, taking low dose (one tablet) of acetminophen (tylenol) will also help.  Similarly, you may wish to drink spearmint tea, which is a mild anti-androgen.  Avoid green or white tea, as these increase the effectiveness of testosterone in the body.  Similarly, avoid raw white “button” mushrooms; brown ones are OK.

If you aren’t able to get HRT, as well as drinking fresh spearmint tea, you may also take advantage of a quirk of biology.  The reason that testicles (male gonads / testes) are on the outside of the body in mammals is to allow them to be kept about four degrees (2 degrees centigrade) cooler than body temperature.  If you “tuck” them inside of the body cavity, by rotating them and inserting them upwards through the inguinal canal and keep them there using tight panties or girdle, they will be warmer than normal.  This will cause them to produce less testosterone!  Doing this as part of your pre-op tuck of your, ahem, you know, back between your legs will also help you pass by eliminating an unsightly bulge.  The reduction of T production by these two methods isn’t a substitute for HRT, but as a teenager, every little bit of reduction helps delay unwanted masculinzation.

For FtM transkids, although not typically known, due to lack of research into the special needs of FtM transkids, consider delaying puberty until age 14 with puberty blockers (e.g. Lupron), possibly in combination with low dose testosterone, then adding Human Growth Hormone to the traditional testosterone treatment from age 14 to 22, so as to reach average male height and build.  Boys typically start their growth spurt later and continue to grow taller in their later teen years.  The delayed puberty and then added growth hormone will help duplicate this process.  If facial and body hair is lacking and desired, consider using minoxidil, available over the counter as Rogaine, topically on the face and limited body areas.  (Caution:  minoxidil can lower blood pressure, which should be monitored.)

Avoid spearmint tea and all mint candies, etc., as they are mild anti-androgens.  You may wish to drink green or white tea, as this will increase the effectiveness of testosterone in the body.  You may also wish to eat significant quantities of raw white “button” mushrooms, as they contain a modestly potent compound that blocks estrogen production.

At School:

Stay!  Seriously, stay in school.  Too many of my transkid friends dropped out of school, either high school or college; They all regretted it.  You need to have the best possible education you can get, so that you can earn more money and respect.  While money won’t make you happy, not having it can make you miserable.  Having a good education, with both depth and breadth, will give you more options in life.  You might even find you have a great career in the future.  Who knows?  But you won’t know unless you first stay in school.

Want to get good grades?  Here’s a trick my Dad taught me:  Study for the term ahead.  Seriously, obtain the books for the term ahead of the one that your presently taking and read and study that.  It will make the stuff in your present class seem like child’s play.  Stay ahead of the curve by doing this for every term, even your Senior Year, study as though you were a graduate student.

Be socially active at school.  Join a club or two.  Make friends.  Be nice to everyone, at least be kind and polite to everyone;  Casual friends come and go, enemies remain.  Find opportunities to volunteer.  Make a difference in the world.  Smile.

Yes, I know that you may be bullied at school.  I certainly was.  Speak up about the bullying with responsible adults.  If they can’t or won’t help, remember, “It gets better“.  Life will get better.


OK, at some point, you are going to want to socially transition, if you haven’t already.  You will likely need to transfer to a new school so that you can live ‘stealth’, that is, so that no one will know of your transgender status.  But don’t leave your best friend behind to do it, especially if they are cool about your transition.  You will want someone you talk to about stuff, openly and honestly.  I am grateful that I still have a friend I’ve known since third grade (a girl, of course); so will you some day.  Today, email and cellphone calls are cheap.

Don’t kid yourself.  Your transition will put a very great strain on your family.  You may be lucky and have folks that fully support you and will go to the ends of the earth for you.  I sincerely hope that they are.  However, it will still be hard on them.  Do what you can to make it easier for them.  Talk things over.  Make reasonable plans.  Be patient.  Be kind.

It might make sense for you (and easier on your family) to move in with other relatives while you transition.  This will allow for an easier social transition with new neighbors and new school.  But be sure to call and write to your parents and siblings.  They will miss you and want to know how you are doing.

The best time to begin social transition is at the beginning of summer vacation.  You will have a whole summer to get used to everyday places and events and such before you head to your new school.  This will mean that you enter your new school at the same time as a whole ‘nother batch of incoming kids do.  You will be just one more face to learn as everyone rushes from class to class.  In contrast, transferring to a new school at mid-term means everyone knows that you are new… and will be under greater scrutiny.

As you make new friends and acquaintances, you will be asked questions about yourself.  Keep it simple.  Tell the simple truth, save for the obvious, which shouldn’t even be an issue as it shouldn’t really come up.  Yes, you will have to edit some stuff, but keep it to a minimum, as it’s hard to remember an elaborate backstory.  If someone does tumble to the truth, keep calm.  Most folks will be curious and want to remain your friend.  If you find that rumors are going around, that may not be fun, but its amazing how quickly they can die out if you don’t react.  If someone confronts you in public about such rumors, your best defense is to laugh, roll your eyes, and regard the matter as silly and ridiculous, “What a joke!  Who told you that?!”  Your attitude of self-confidence will signal that it can’t possibly be true, or if true, is irrelevant.

Legal Stuff:

Changing your legal identity is a hassle, but here are a few tips to help.

First, many states allow you to use what ever name you wish, so long as you are consistent.  To that end, get as many “IDs” as you can in your new name.  Go to the library and get a new library card.  Join clubs and and associations that issue ID / membership cards.  Get bills sent to your house with your new name.  Open a checking account with your new name.  Get a debit card.  Think of as many places where you can create your new public identity as possible.

Get your doc / therapist to write a letter explaining that you MUST use your new name as part of your medical treatment and asking that any and all who read that letter help in this matter.  This will help establish that you are following doctors orders and that all officials should help.  With your new IDs and such in hand, get your state issued ID changed.  Then, get your Social Security card changed.

You may also be able to get your US or UK passport with your new name and sex, even if your US state (some states are still backwards) refuses.

Good Luck!

Social Media:

In a word, “don’t”.  Don’t post anything about your status as transgendered using your old or new names.  You don’t want that to be public knowledge forever.  You don’t want future employers snooping into your medical history.  And you really don’t want creepy older men who have a thing for transkids to be stalking you.

Join or establish exclusive “closed” online support sites.  Be very leery of older transitioning transsexuals online.  They aren’t like us, and many of them also have a thing for young transkids.


I won’t be a hypocrite and tell you I never took drugs.  But I was lucky, or smart, or something…. such that I very quickly figured out that using is DUMB!  Same for drinking more than a glass of wine with dinner.  I’ve seen drugs and drink destroy a number of lives.   I especially grieve over one of my unofficial foster daughters who I’d known since she was 15, later as an adult she became a serious addict and made some very stupid choices, losing her job, going to jail, etc.  Your life, your choice.

Oh… and if you care about your looks, don’t smoke.  Smoking ages the skin, horribly.  Also, limit your exposure to intense sunlight or tanning salons, they also age the skin; wear hats and sunscreen.


I’m sorry that I can’t offer much advice to my FtM readers.  I simply don’t have the experience (obviously).  That said, for my MTF readers:

I still remember the total disappointment I had on my first date with a young man.  We went to a dance at the JC.  He was shy, had two left feet, and was the worst kisser, ever!  Oh well.  Life is not a fairy tale.

First, the bad news:  Dating while pre-op is frustrating and potentially dangerous.  I’m not saying don’t go out.  I’m saying, be careful.  Some young men can get very squigged and angry if they find out you are pre-op on a date.  Obviously, if your date doesn’t know that you are transgendered, you will want to keep it that way.  So, it’s best to stay in public spaces, double date, and for goodness sakes, keep your cellphone with you.  It is a really good idea to tell your folks where you will be going.  In fact, I recommend the very old-fashioned practice of introducing your date to your folks when he comes to pick you up.  If you are away at college, be sure your roommate or somebody knows where and who you will be with.

OK, so you’re a bit older now… and you have a boyfriend who “knows” and hasn’t run screaming.  I’m sure your folks would rather you didn’t, but we all know you will… so… go to the store and buy condoms.  Seriously, keep a couple in your purse at all times.  Paraphrasing a very amusing World War II training film on sexually transmitted diseases, “Be sure he puts it on, before he puts it in!”  —  While many today are fully aware of HIV/AIDS and other dangerous STDs are out there, my generation was stupid, including myself.  We all knew that antibiotics could cure anything we might get; then HIV/AIDS snuck up on us.  I sometimes wonder how I personally survived… a lot of transkids my age didn’t.  Don’t join them.

Just in case you don’t already know how:  http://www.avert.org/condom.htm

Oh, one more thing, today, we can take meds that will prevent HIV transmission.  It’s called PrEP.  Read more about it here.


If worse comes to worse, and your folks kick you out, remember, this is not the end of the world.  You can and will survive.

If you are still legally a minor, you will want to contact your local child protective services.  Be sure to tell them that you are transgendered.  Also, contact a local LGBT center.  They may be able to help steer you to a good foster home or LGBT friendly group home.  Another avenue is your best friend’s house.  They can put you up for a while… and if they are cool, they may be able to be your foster family.  Getting an emergency placement with this family is usually pretty easy since there is always a shortage of good foster families ready to take in teens, especially transkids.  (My brother’s high school girlfriend stayed at my apartment for a short while until her best friend’s family became her formal foster-family.  My first foster daughter was obviously butch lesbian  at 14 years old… child protective services was overjoyed to have me take her in!)

If you are no longer a minor, you won’t need child protective services, but I would still recommend contacting your local social services agency AND your local LGBT center.  Once again, your best friend’s family is your best hope.  They don’t have to become any sort of legal foster family to serve as one.  If you don’t have such close connections that can help you, perhaps the LGBT center folks can find you a place.

However, though this advice may be counter-intuitive, don’t agree to stay with an older transitioning MTF transwoman unless she has a stable natal female partner also living with her.  Older transitioning transwomen often have a very inappropriate sexual attraction to transkids, sometimes both MTF and FtM.

Another possible place for you to live is with a more distant relative; seriously, your grandparents, your aunt or uncle, an older cousin.  (I was stupid.  I learned from my youngest cousin only this year that her parents, my uncle and his wife understood I was “different” as a child and supported my transition as a teen, but my mother didn’t tell me that!  I could have transitioned earlier and not been kicked out.)

What ever happens, don’t, don’t, don’t consider living on the street.  Don’t consider “survival sex” (trading sex for food or a place to stay).  Don’t become a sex worker or “escort”.  Too many teens and early 2o-somethings end up badly through that route, transkids, gays, or straight.  Its a hard and dangerous life.  Don’t be fooled by current or ex-sex workers, transkid, gay, or straight, who may say how great that life is, or how “empowering” or “glamorous” it is, because it isn’t!  (I’ve seen it up close and personal.  This isn’t moralizing, this is just sad experience and observation.)

Finally, don’t consider shoplifting, check-kiting, credit-card fraud, or other illegal means of supplementing your income.  Having a good life ultimately involves trust:  trusting others and others trusting you.  No one can trust a thief.  Jail time never looks good on a resume and is never fun.

Although it will be hard, you need to get a regular job and continue in school.  It can be done.  I know, I did it.

Marriage and Family:

Someday you will find the love of your life.  You will be married.  Your folks and your spouse’s folks will hopefully share the joyous occasion on your wedding day.  (On our wedding day, my Dad proudly gave me away, my Uncle, a minister, officiated, my nephew was ring bearer.)  Sometime after that, you and your spouse will likely want children of your own.

FtM:  Likely, your future wife will be able to have children, in the traditional manner… but you will need help from a fertility clinic in the form of artificial insemination.  If you have a close male relative around your age, who is willing, you may use his sperm, so that your child will be the union of your wife’s and your family’s genes.  If not, you may elect to use an anonymous sperm donor.

MTF:  Sadly, science has not yet advanced to the point where you may bear your own children.  I sincerely wish it were so, since I would have been first in line!  But, you and your future husband do have options, same as many other couples.  You may foster/adopt as my husband and I did.  Not all countries or US states are equally comfortable with transwomen adopting, but I know from personal experience that it can be done, even if you have to be the first in your country/state.  Another option is surrogacy.  This can be very expensive, but if you can afford it, this may be your best option, especially as it will allow your husband to be the birth father, using his sperm.  If you have a sister or cousin would would be willing to be an egg donor, you may then have a child that will be the union of your husband’s and your family’s genes.  If not, an anonymous egg donor may be chosen.

I have every hope, and a very good idea how it can be done from interesting conversations with medical  and scientist friends, that we will someday soon have the ability to allow MTF transwomen to bear children.  But it won’t be cheap… and it will involve some risks.

To be Continued…

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