Whether you are transgender, genderqueer, non-binary / nonconforming, or perhaps you are currently questioning your gender. One thing is for certain, your health is of upmost importance. Finding resources and individuals who are experienced or understanding is often somewhat of a daunting task, but fear not! We are here to help.

Understanding Transgender People

Understanding what it is like to be transgender can be hard, especially if you have never met a transgender person.

The term transgender is a broad term that can be used to describe people whose gender identity is different from the gender they were thought to be when they were born, “Trans” is often used as shorthand for transgender. With that said, not all people whose gender identity is different from that which they were assigned at birth identify as transgender.

To treat a trans person with respect, it is important that you recognize their identity and treat them according to their gender identity, not their sex at birth. So, someone who lives as a woman today is called a transgender woman and should be referred to as “she” and “her.” A transgender man lives as a man today and should be referred to as “he” and “him.” A genderqueer, nonbinary or nonconforming person identifies outside of the binaries of male and female and should be referred to by the pronouns they identify, which are often “they”, “them”.

Gender identity is your internal knowledge of your gender – for example, your knowledge that you’re a man, a woman, or another gender. Gender expression is how a person presents their gender on the outside, often through behavior, clothing, hairstyle, voice or body characteristics.

When a person begins to live according to their gender identity, rather than the gender they were thought to be when they were born, this time period is called gender transition. Deciding to transition can take a lot of reflection. Many transgender people risk social stigma, discrimination, and harassment when they tell other people who they really are. Despite those risks, being open about one’s gender identity can be life-affirming and even life-saving.

Possible steps in a gender transition may or may not include changing your clothing, appearance, name, or the pronoun people use to refer to you (like “she,” “he,” or “they”). If they can, some people change their identification documents, like their driver’s license or passport, to better reflect their gender. And some people undergo hormone therapy or other medical procedures to change their physical characteristics and make their body match the gender they know themselves to be. All transgender people are entitled to the same dignity and respect, regardless of whether or not they have been able to take any legal or medical steps.

It is important to use respectful terminology, and treat transgender people as you would treat any other person. This includes using the name the person has asked you to call them (not their old name) as well as the pronouns they want you to use. If you aren’t sure what pronouns a person uses, just ask politely what pronouns they would like used. It is also respectful to ask all individuals what pronouns they would like used, instead of only asking those which you are unsure of.

Learn more about how gender relates to identity, trans awareness, the gender map and more with Lindsey Doe, Sexoligst. Check out her full catalog of videos on YouTube.

Looking for a doctor, a therapist, a hair removal specialist, etc in Montana?

Check out our NEW Montana Trans Resource Guide

The Western Montana Community Center strives to provide the best resources to all of Montana’s LGBTIQ+ community and our allies. If you would like to see a resource added or have updates or information about any of our current resources, please contact us at (406)543-2224 or by email at transhealth@gaymontana.org.

Looking for resources on how to legally change your name in Montana, Idaho or Washington?

Montana Trans Legal Name Change Guide

Idaho Trans Legal Name Change Guide 

Washington Trans Legal Name Change Guide

US Passport Gender Change Guide

Social Security Gender Change Guide

The Western Montana Community Center is currently working to add youth versions of these name change guides and is hoping to have those posted by mid June. If you would like to help be a part of this project, please contact Bree at bree.sutherland@gaymontana.org.

If you have questions about these guides, or about additional resources, etc., please feel free to contact us at (406)543-2224 or by email at transhealth@gaymontana.org

Looking for Resources outside of Montana?

The Western Montana Community Center is more than happy to assist if you are seeking resources outside of Montana. If you need help, please contact us at (406)543-2224 or email us at transhealth@gaymontana.org

Trans Resources in Montana

Montana has an active and supportive community for persons who identify as a gender other than that assigned to them from their sex at birth.  Many persons fit this broad category which ranges from those who are transsexual to those who like to cross-dress at home or out in the world. Transgender after all means to “trans” or go across the gender lines which society has defined.

The Western Montana Community Center hosts a weekly trans support and discussion group for individuals of gender diversity in Missoula. If you are interested in attending the group, please contact the Center at 406-543-2224 or email us at tgroup@gaymontana.org.

In addition, there are support and discussion groups across the state, including Bozeman and Helena.

  • Montana Gender Alliance Bozeman – Contact Kael Fry at (608) 234-8763 for location and details
  • Montana State University Queer-Straight Alliance  – http://montana.edu/qsa/
  • Montana Gender Alliance Helena – Contact Kael Fry at (608) 234-8763 for location and details
  • Glacier Queer Alliance – Flathead Valley – http://glacierqueeralliance.org

Print versions of the Montana Trans Health Resource Guide are also available at no cost at many healthcare centers and LGBTQ+ community centers throughout Montana.

Medication Resources & Assistance

Often, medications are difficult for individuals of gender diversity to access, and as many insurance companies more often than not do not cover many of the costs associated with transition, including but not limited to medication.

For this reason, we want to provide you with the knowledge and know how to get your medications for a reasonable price.

Our resource guide lists pharmacies which we have found to be inclusive and friendly, in addition to providing reasonably priced medications, as well as resources for those who cannot afford their medications.

Safer Sex for the Trans Community Post-GRS

This article is written to address questions about sexual safety after genital realignment surgery (GRS). This is not because we assume everyone has or wants GRS, or that surgery is required in order to be fully female or male. When doing research, we discovered that there’s not much information available on post-surgical sexual health, so we figured we should try to put some out there. We encourage readers with first-hand experience (whether that’s your own hand or someone else’s) to let us know what’s been working for you with regard to safe post-op sex, or what you know works well for clients—this article is only a start, and we look to the experts (you!) to share more information.

A word also about language used in this article: We deliberately avoided pronouns and “FTM/MTF” designations as much as possible, so as to better focus on body parts and sexual activities. This is because tissues heal more or less the same way in everyone, and viruses and bacteria don’t care about gender identity, sexual orientation, or how a person calls themselves before or after GRS. They only care about setting up shop in the human body, and whether what we’re doing with our bodies helps or hinders them in that goal. With that in mind, let’s take a cruise down GRS Lane.

Surgical stuff

In order to discuss post-op sexual activities and risk factors, we need an understanding of what genital realignment surgery (GRS) entails. GRS comes in many packages—some people opt for the full range of “top” and “bottom” procedures, while others pick and choose according to their priorities and needs. Below is a chart providing very basic information on GRS procedures, including healing times and post-op concerns.

Since healing from GRS can be a slow process, you need to keep your new parts safe while they’re getting used to the world. Risk of infection is a major concern for all who undergo GRS, but even more so for those living with HIV. GRS involves major surgeries performed on delicate parts of the body, and healing requires your body to re-wire nerve responses and recover from blood loss in addition to repairing tissues. Take care of yourself after surgery! Do not push yourself past your limits, work-wise or sex-wise! You’re going to have your genitals for the rest of your life, so no need to jump on the horse before your body says it’s ready to ride (if you know what I mean).

If you are HIV-negative, we highly encourage you to speak with your provider about PrEP to help keep you HIV-negative.

PrEP, or pre-exposure prophylaxis, is a daily pill to help keep you HIV-negative. When taken as prescribed, PrEP is highly effective. PrEP is safe and generally well tolerated. Most insurance plans (public and private) cover PrEP. Want to know more? 

Ask your medical team when it’s safe to experiment with sexual penetration, and listen to your body when you start out. If you are living with HIV and/or Hep B and C, it’s especially important that you wait until your post-op bleeding and wound drainage is over before resuming sexual activity, both for your own health and that of your partner. This includes anal sex as well as genital sex, since the muscles and tissues of the entire anal-genital area are involved in GRS and must be allowed to heal too. Follow your medical team’s post-op instructions carefully for optimal healing, take it slow, and use lube when you start having sex again. Traditional or Reality condoms are good protection against blood and wound fluids that might not be easily visible. For those who use sex toys, clean your toys properly before and after penetrative sex, and change condoms if alternating between anal and vaginal penetration.

ProcedureHealing TimePost-Op CareMain Post-Op Concerns
Feminizing
Breast Augmentation
(augmentation mammoplasty)
Saline-filled implant surgically inserted under chest muscle1-2 weeks for normal activity; strenuous activity after 3-4 weeksKeep surgical site clean; start implant displacement massage 3-5 days after surgeryInfection— check for redness, tenderness, heat, and/or discharges at incisions
VaginoplastySurgical creation of female genitals— includes creation of a “neo-vagina” through penile inversion or with lining from the colon, plus one or more of the belowVariableKeep surgical site clean; use Betadine douches as recommended; daily dilation exercises as recommended; follow-up exams to monitor healingInfection; loss of neo-vaginal depth/length if dilation isn’t done; skin tears and pain with rough dilation or sexual penetration
OrchiectomyRemoval of the testesSee aboveSee aboveInfection
Penectomy(“nullification”)Removal of penile tissue + urethral shortening. Can be done solo if you don’t want a penis or a neo-vagina.See aboveSee aboveSee above
ClitoroplastyCreation of a clitoris out of glans penis tissueSee aboveSee aboveSee above
LabiaplastyCreation of labia majora and minora out of scrotal and penile skinSee aboveSee aboveSee above
ProcedureHealing TimePost-Op CareMain Post-Op Concerns
Masculinizing
Chest surgery   —subcutaneous mastectomy or breast reduction surgeryRemoval of breast tissue and inframammary folds1-2 weeks for normal activity; 3-4 weeks for strenuous activityKeep surgical site clean; tensor bandage around chest for 1 monthInfection— check for redness, tenderness, heat, and/or discharges at incisions
HysterectomyRemoval of part or all of the uterus (full hysterectomy = no cervix)Same as for natal women— about 6 weeksKeep surgical site clean; follow-up at six weeks to check healing and remove staplesSee above
OophorectomyRemoval of the ovariesSee aboveSee aboveSee above
VaginectomyRemoval of vaginal tissue, repositioning of muscles, and vaginal closureVariableKeep surgical sites clean; follow-up to check healing and function of genitals and donation sites (forearm, leg, etc.)See above
Urethral LengtheningUses vaginal or bladder mucosa to lengthen urethra and allow urine to empty through the neo-phallusVariableSee aboveInability to urinate; infection
PhalloplastyCreation of a “neo-phallus” out of vaginal mucosa and forearm skinAbout 1 year before penile prosthesis can be implanted.See aboveSee above
MetaidoioplastyHormonally-enlarged clitoris, labia minora skin, and lengthened urethra create small “microphallus”Variable— follow-up to check healing and functionSee aboveSee above
ScrotoplastyCreation of scrotal sac from labia majora and minora tissue and skinAbout 1 year before scrotal implants can be placedSee aboveInfection


Vaginal stuff

Contrary to myth, neo-vaginas are not more resistant to infections than natal vaginas. Whether your neo-vagina is constructed out of your former penile and scrotal skin or from a section of your colon, your genitals are delicate and limited in their stretch capacity—your dilation exercises will give you a good sense of what’s comfortable and what is too much. While women have been known to experience some natural lubrication from urethral tissue or Cowper’s and prostate gland secretions, most neo-vaginas are not self-lubricating. Therefore, lube is an even better friend than it was before GRS! The more lube used, the more comfort and the less risk of tearing.

All vaginas can end up playing host to vaginal and bacterial infections, sexually transmitted or naturally occurring. Vaginas are among yeast and bacteria’s favorite places to live—the dark, warm, enclosed environment is perfect for their breeding needs. Close proximity to the anal area also increases the odds of bacterial vaginal infections, so get used to wiping front to back now if you aren’t already. Your partner/s should also use condoms on their penises or on sex toys to help further reduce your risk of neo-vaginal infection.

Herpes simplex virus (HSV I or HSV II) can be transmitted to your new genitals via oral or genital sex, or an old HSV infection may flare up as your immune system prioritizes healing from surgery. Keep an eye out for discharges, odors, tissue irritation, small sores, and/or itching or pain—skin irritations and sores can bleed, as well as leave open pathways for HIV and bacterial infections. Douches will be prescribed to help speed your surgical-site healing, but douching can’t be counted on to clear up a yeast or bacterial infection, and it won’t help with herpes. If your vagina was constructed out of penile skin, you may also experience itching and discharge related to hair growth in your neo-vagina. Given all the possibilities, it’s worth a visit to your doc or clinic if you notice anything unusual.

Phallic stuff

Condoms are an important part of sexual safety for all men, including those who don’t produce semen (ejaculate, jizz, spoo, cum, etc.). Neo-phallus skin needs protection from HSV and HPV, as well as yeast infections of the skin and bacterial urinary tract infections. If you have a penile prosthesis implanted as part of your GRS, condoms will also help reduce the risk of infected micro-tears as you learn how your new penis skin stretches during erection and penetrative sex (put the condom on after inflation, just like you would with any other erection). Men with ”trannycocks” resulting from metaidoioplasty may find traditional condoms too large for fun or safety. A suggestion from James Cullen’s “Safer Sex for Transguys” pamphlet is to “…cut a (latex or polyurethane) glove along the thumb side from the wrist down to about where your first thumb knuckle would be. The thumb of the glove becomes your condom, and the rest of the glove hangs free to cover all the other important stuff from your cock to your ass.”5 Another option is to cover your own or your partner’s genital or anal area with a dental dam, and then enjoy yourselves.

Everyone’s stuff

Anal sex can be enjoyed safely post-GRS healing with a few precautions. Lubricants and condoms are the easiest way to keep skin happy and body fluids contained—water-based lubricants must be used with latex condoms, but oil- and silicone-based lubes are safe for use with polyurethane traditional or Reality condoms. Bottoms of any gender can use Reality condoms to protect their butts and their partner’s penis. Tops can protect their natal- and neo-phalluses—as well as their partner’s vagina or ass—with traditional condoms. Also use fresh condoms if alternating between anal and vaginal penetration, to reduce the risk of vaginal infections caused by butt bacteria and STIs in any area.

Sharing hormone syringes and other injection equipment carries the same risks as sharing equipment for recreational drug use, even though hormones are injected into muscle instead of a vein. Hepatitis C is of particular concern, since this virus is much more durable and easily transmitted than HIV. Please don’t share equipment! Many syringe exchange programs can provide hormone-grade syringes if you run out or don’t have a prescription. Please also consider the risks of using street hormones, even if you have an ongoing relationship with your supplier and bring your own injection equipment or see the equipment packages being opened. As with recreational drugs, you never know for sure what you’re going to get on the street. Injected silicone can cause severe health problems, along with injection-related scarring and infections. Regardless of where you get your therapies, please keep up with regular clinical monitoring so any health complications can be addressed quickly.

Extra stuff

Another note: Some of what you’re born with, you keep. If you were born with a male body, you have a prostate gland up there in your rectum. Your prostate remains even if you have GRS, so remember to get that checked once a year and anytime you notice rectal pain, frequent urination, or any other sign of prostate trouble. If you were born with a female body and have not had a full hysterectomy, you have a cervix that needs to be screened for cervical cancer. If you are HIV-positive, follow the guidelines for prostate exams and Pap smears that are suggested for your natal gender: once a year for prostates over age 40, and once a year for cervixes (more often if you have a history of abnormal Paps). If you have no cervix, natal or neo, an annual pelvic exam is recommended, though the value of vaginal Pap screening is unclear at this time.6

Speaking of Pap smears, anyone who has receptive anal sex is now encouraged to get an anal Pap to screen for HPV-related anal cell changes and cancers. HIV-positive people are at especially high risk for developing anal cancer, due to the immune system’s compromised ability to keep HPV under control. Butts are butts are butts no matter what your gender, so don’t shy away from the anal probe! Once-a-year screening is recommended for everyone with a history of receptive anal sex, regardless of HIV status.

Just as everyone has a butt, everyone has breast tissue. This means everyone needs to think about breast cancer. Even if you’ve had chest/top surgery to remove breasts, you need to do monthly breast self-exams and get a checkup if you notice unusual lumps or growths, especially if the lump sticks to your chest wall and can’t be wiggled around. If your breasts are created via hormone therapy or “boob job” augmentation surgery, you too need to do a monthly breast self-exam. Neither testosterone nor estrogen therapy appears to increase the risk of breast cancer, but breast cancer is becoming increasingly common in general—can’t hurt to check yourself out, even if you consider your risk to be low.

That’s it for now, friends. Send us some feedback from your own experience, and take care of your parts!

Safer Sex for the Trans Community For Pre-Op / Non-Op Individuals

For some transgender people, the idea of sex may trigger feelings of gender dysphoria. For others, they are fine with their genitalia, regardless of their gender identity. It depends on the individual and when they are ready to have sex.

Safe sex practices for pre/non-op transgender people correspond to the same concerns that cisgender people have when it comes to safe sex. For penis to vaginal/anal penetration, be sure to use condoms and lubricant, and to change condoms when switching between the anus and the vagina. When practicing oral sex on a vagina, be sure to use a dental dam. If you use toys (non/pre/post-op transmen in particular often use strap-on dildos for penetrating their partners), be sure to clean and disinfect them properly, and to cover them with a condom during penetration, especially if you are sharing toys.

If you are sexually active, be sure to get tested at least once a year. These services are often available at low to no cost through clinics like Planned Parenthood and other family planning clinics. You should also get tested for HIV regularly and whenever you change partners or sex practices. HIV testing is available at no charge through clinics throughout the state. For more information about these services and availability in your location, please email transhealth@gaymontana.org

Online Resources

TSRoadMap.com “Transsexual transition is simply a journey. Just like a trip, you decide your destination, the time you’ll need to get there, and the money you’ll spend.” Transsexual Road Map is a travel guide to set priorities and choose your route. Its about making informed purchasing decisions and setting realistic, achievable transition goals.  http://tsroadmap.com

Hudsons Guide
This Guide is intended to provide information on topics of interest to female-to-male (FTM, F2M) trans men, and their friends and loved ones. Non-trans men have also found the pages on men’s grooming and clothing to be helpful. Transsexual, non-transsexual, intersex, transgender, genderqueer, questioning, and “just plain folks” are all welcome.
www.ftmguide.org

PinkEssence
A Social Network of Trans Identifying & Gender Expressive Individuals, Partners & Supportive Allies. The site features a moderated chatroom, forums, trans-inclusive resources and other social networking features.
www.pinkessence.com

TLDEF
Transgender Legal Defense & Education Fund is committed to ending discrimination based upon gender identity and expression and to achieving equality for transgender people through public education, test-case litigation, direct legal services, community organizing and public policy efforts.
www.transgenderlegal.org

Trans Literature

Jessica Kingsley Publishers was founded in 1987 in London by Jessica Kingsley and is committed to publishing books that make a difference.

Helping Your Transgender Teen

Helping Your Transgender Teen

This book offers essential guidance to parents of transgender and non-binary teens to help them support and understand their children. It alleviates common concerns parents have and gives advice on hormones and surgery, use of pronouns and how to transition socially. It also includes sample family letters, case studies and further reading.BUY ONLINE

Transgender Health

Transgender Health

This guide shows how to sensitively treat and care for transgender patients in healthcare settings. Distilling cutting edge research into practical advice, it covers everything from referral procedures to respectful language and insights on the wider social and ethical issues experienced by this growing client group.BUY ONLINE

To My Trans Sisters

To My Trans Sisters

An empowering, heartfelt collection of letters from celebrated trans women addressed to those who are transitioning. Each letter offers honest advice from their own experience on everything from make-up and dating, through to deeper subjects like battling dysphoria and dealing with transphobia.BUY ONLINE

Supporting Young Transgender Men

Supporting Young Transgender Men

There is a current shortage of information for professionals on the specific needs of transgender men. Exploring the obstacles that trans men face across health and social services, and addressing common myths and misconceptions about transitioning, this book solves this shortfall.BUY ONLINE

Resources for Transgender People in Crisis

Transgender people in crisis should contact the following resources:

Transgender Organizations

Transgender Programs at LGBT Organizations

General Information and Resources

  • The 2015 U.S. Trans Survey is the largest survey of transgender people ever conducted. The data has also been broken down by race, ethnicity, and geography. The survey’s results detail the extent of the poverty, discrimination, and violence faced by transgender people. The results are also available in Spanish.
  • Transgender Lives: Your Stories is an interactive campaign created by The New York Times to allow transgender people to tell their own stories in their own words.
  • I AM: Trans People Speak is a campaign created by the Massachusetts Transgender Political Coalition (MTPC) and sponsored by GLAAD to raise awareness about the diversity of transgender communities. It lifts the voices of transgender individuals, as well as their families, friends, and allies.
  • The Trans 100 was an annual list of 100 amazing and inspiring trans Americans who are visible within their communities.
  • We Happy Trans is a website devoted to sharing positive stories from trans people everywhere.
  • TSER, Trans Student Educational Resources, provides trans information on school issues and supports efforts for creating policy change in school districts.

Transgender Vloggers

Recommended YouTube Channels (FTM)
http://youtube.com/user/ALionsFears
http://youtube.com/user/jeyyounit11

Recommended YouTube Channels (MTF)
http://youtube.com/user/Grishno
http://youtube.com/user/PrincessJoules
http://youtube.com/user/ThePrinceSane

Recommended YouTube Channels (Non Binary)
http://youtube.com/user/MissPancake52