Gendercraft Helping clients to align their gender expressions with their gender identities

Gary Cordingley, MD, PhD Disclosures

• The speaker and members of the planning committee do not have a conflict of interest in this topic.

• There is no commercial support for this program.

• The speaker will discuss uses of hormonal medications that are well studied, but off-label. Many thanks for contributions and advice from:

Carrie Chandler Jody Davis, RN, MSW, LISW Theodore Hutchinson, PhD Dionysus Mondlich Jacob Nash, MA, CDP Gabriel Pellikka Kaye Plumley, CT Brenda Robson Sarah Taylor, MA, CCC, SLP L. Justin Wheeler, LISW-S Ginger Williams

Participants in an earlier version of this seminar Learning Objectives

• Define “passing” and provide reasons why gender-diverse people often have conflicted relationships with the concept.

• Describe tools available to gender-diverse people who wish to feminize or masculinize their presentations, including by managing , facial , facial appearance, skin care, shoulders, chests, waists, hips, genitalia, clothing, accessories, posture, movement and communication.

• List methods that gender-diverse people can employ to minimize awkwardness and embarrassment while obtaining clothing and other materials associated with a gender different from the sex assigned at birth. What gendercraft is:

• A toolkit of devices, methods and skills available to people who seek gender expressions more consistent with their gender identities • Analogous to “tradecraft” or “stagecraft” • A body of knowledge for people raised in genders incongruent with their identities and who did not receive training and socialization consistent with their identities • A means to compensate for pubescent physical changes of a sex incongruent with gender identity • Helpful for both binary and non-binary trans people to individualize their gender expressions • A menu from which people can choose, whether or not there is concurrent use of hormone or surgical treatments (though hormones and operations can affect the need for or the methods of gendercraft) What gendercraft is not:

• A set of procedures that anyone is required to use • An implication that people who don’t use it are any less valid than people who do • An endorsement of the binary model or a criticism of non-binary identities • Easily found or assimilated even among those who immerse themselves in the trans community Disclaimer and Request

Let me be clear: I am not telling anyone what to do or how they should live their life. If someone doesn’t like a presented idea, then they shouldn’t use it!

What I am doing is providing options. Without knowing one’s options, one might not make the choice that’s best for them.

This list of possibilities is not all-inclusive. Please let me know if there are other tools of gendercraft I might capture for future revisions. Gendercraft: Why of interest to healthcare professionals?

• It is no less important in our patients’/clients’ affirmations of their authentic selves than use of hormones or surgeries, which sometimes attract more attention. • To become aware of the issues being debated inside our patients’/clients’ heads, as well as the awkward and difficult choices that trans people are up against in living their identities • To understand that these are not automatic or effortless decisions • To be able to offer guidance and affirmation to our patients/clients in their efforts to make their outsides resemble their insides • To provide balanced advice concerning the risks and benefits of using a tool versus the risks and benefits of not using a tool Passing

“Passing” = being perceived as a cis-gender person in one’s identified gender. (Historically, this term has also been used in a racial context.)

Passing is not all-or-nothing. Environment affects one’s ability to pass. Crowded spaces contain distractions that make passing easier. Also, success is affected by whether other people are preoccupied with their own activities, such as in gambling casinos, department stores or busy restaurants. In any event, few trans people pass 100% of the time, and even some cis-gender people exhibit confusing gender signals.

Among many gender-diverse people the concept of passing stirs up conflicting emotions. (As we will see, even the term itself is problematic.) Trans people often feel conflicted about the concept of passing. Here are arguments on either side of using gendercraft tools:

Against: For: Passing seems like a form of deception. It’s just the opposite: it’s living one’s truth. One dresses for self, not others. “Blending in” is a less loaded term. It shouldn’t matter how one presents to the world. The reality is that it often does. The only gender police are the self-appointed ones. The self-appointed ones can be vicious. Someone who blends in is more safe from harassment and assault. It can be inconvenient and expensive. It can be worth it. Less costly approaches are available for most options. It can be frustrating when efforts fall short. Even then, efforts can be rewarding – glass half-full. Forgoing use of gendercraft tools may be more Using the tools can be gender-affirming and self- acceptable to others in one’s family and social circle. validating. Gender dysphoria can improve. Internalized transphobia can be a barrier. Living one’s truth fosters emotional growth.

Ultimately, it’s up to the individual to make their own choices according to their own needs. There is no “one size fits all” model. Gendercraft Methods: Outline

Appearance • Managing hairstyle: taking account of the shape of the face; flattering and unflattering styles for MTF and FTM; and treatment for FTM with male pattern baldness from testosterone • Managing unwanted hair: color blocking and covering of ; electrolysis, laser, and comparisons • Facial appearance: skincare, makeup and eyeglasses • Managing the silhouette of the torso: shoulders, chest, waist, hips and legs for MTF and FTM • Managing genitalia: gaffs, tucking, packing and standing to pee Behavior • Posture: gender differences in standing and sitting • Walking

Communication • Pitch, resonance, intonation, word choice and gestures • Active vs. passive listening

Shopping for Clothes • Things to know before you go • Three approaches to getting what you need MTF Hairstyles: Optimized according to shape of the face

• Compared to cis women, trans women are more likely to have squared and long faces. • Curly or wavy hair can compensate for angularity. Volume on the sides rounds out the head’s silhouette and keeps the components in proportion. Images from: thehairstyler.com MTF Hairstyles: Optimized according to Shape of the Face

These styles provide both curves and side-volume.

Images from: amazon.com, thehairstyler.com, thehairstyler.com MTF Hairstyles: Optimized according to shape of the face

Wispy bangs can compensate for high foreheads.

Image sources: allthingshair.com, elipsosalon.com, liebeleben.me, therighthairstyles.com MTF Hairstyles: Choose colors harmonious with skin tone For many skin colors there is a discernible warm or cool tone.

Use this table to categorize your own:

Warm tones Cool tones Blood vessels on inner surface of Blood vessels on inner surface of forearms are green. forearms are blue. A white sheet of paper next to A white sheet of paper next to the face makes it look great. the face makes it look terrible. Gold jewelry is more flattering. Silver jewelry is more flattering.

• Example: Honey blonde goes better with warm tones; straw blonde goes with cool tones. • Sometimes hair colorants or wigs are described as such, but not always. • Knowing your skin tone also helps in choosing flattering colors of clothes. MTF Hairstyles Don’t forget the !

• Eyebrows “frame” the face and their appearance is a key component of gender expression. • Photos of Michael Jackson illustrate common differences between masculine and feminine eyebrows -- masculine eyebrows are lower, flatter and bushier. • Ideally, obtain professional help to trim and shape the eyebrows, and then maintain them at home. • If circumstances don’t permit more extensive changes, a certain amount of grooming may still be possible, such as to trim the lengths of the and to pluck the outliers. Comb the hairs upward and then downward, snipping hairs that protrude through the comb’s teeth by a chosen distance. Images: bookwormroom.com, Sam Villa Hair Tutorials on youtube.com MTF Hairstyles Don’t forget the eyebrows!

• The diagram shows classic locations for the to start, peak and end. • After completion of trimming and , comb the brow from its inside end to its outside end with a wand of clear or tinted eyebrow gel. • While the gel is still wet, pinch the eyebrow from above and below between forefinger and thumb to decrease the brow’s perceived thickness. Images: virtualffs.co.uk, amazon.com FTM Hairstyles To compensate for soft, round faces, go for angles, sharp lines and edges. Plucking or electrolysis can square up rounded hairlines.

High and Tight Medium/Longer Length The Modern

http://point5cc.com/four-great-haircuts-for-trans-mascftms/ FTM Hairstyles

“This is the picture that I've consistently had the best luck with at hair salons. I bring it in and say, `Give me this,’ and even if it doesn't come out the same … the result is usually something I can live with.”

-- Gabriel, in his FTM Guide

Gabriel, The FTM’s Complete Illustrated Guide to Looking Like a Hot Dude, ftmguide.rassaku.net Hairstyles for Male Pattern Baldness (MPB) in FTM Users of Testosterone Trans men under treatment with testosterone can develop gradual MPB, as seen in cis men. Some people are more susceptible to this adverse effect than others.

Clean Shave Short Caesar Shaggy Layers

From: Brett & Kate McKay, Balding Gracefully: Tips and Hairstyles for Balding Men See: artofmanliness.com/2010/07/14/balding-gracefully-tips-and-hairstyles-for-balding-men/ Medical Treatment of MPB in FTM Users of Testosterone

• Finasteride (originally marketed in the U.S. under the brand name Propecia®) can be used by prescription at 1 milligram per day to counteract MPB. It is a pill, so the drug goes everywhere in the body, not just to the scalp. Because it blocks conversion of testosterone to its more potent form, dihydro-testosterone, it might reduce effectiveness of concurrent testosterone treatment. Trans men who might become pregnant should not use finasteride. (Trans men who are no longer menstruating can still become pregnant.)

• Minoxidil (originally marketed in the U.S. under the brand name Rogaine®) is available without prescription for topical use on the scalp. There is minimal spread of drug effects to other parts of the body. It is more effective for at the crown of the head than at the front and temple areas.

• Finasteride and minoxidil can be used in combination.

• Hair restoration surgery can also be effective. Managing Unwanted Hair (in Any Gender) Color-Blocking • In people with dark hair and light skin, does not eliminate a blue-tinted shadow created by the hair remaining beneath the skin’s surface.

• Because orange is opposite blue in the color wheel, use of a light coat of orange pigment (e.g. from lipstick) as the first layer of make- up blocks out the blue color.

• Another approach is to use an opaque concealer such as Dermablend®, but this can create a thicker and less natural appearance. Images from: transoutloud.com, HGTV.com Managing Unwanted Hair (in Any Gender) Essential Facts about Electrolysis

• An electrologist inserts a very fine needle into the natural opening of the alongside the hair shaft. A tiny amount of electrical current is then applied to destroy the hair growth cells.

• Electrolysis can destroy the hair growth cells with chemical energy (galvanic current), heat energy (thermolysis), or both (blend method).

• FDA categorizes electrolysis as effective for “permanent .”

Sources: American Association at electrology.com, silkhairremoval.com Managing Unwanted Hair (in Any Gender) Essential Facts about Laser

FDA categorizes laser as effective for “permanent hair reduction.”

Images from: healthandmedspa.com Managing Unwanted Hair (in Any Gender) Growth Cycles Affect Both Treatments

• Hairs are constantly growing and shedding on independent schedules. After the active growth phase (anagen), the follicle goes through a resting phase (catagen) and then a shedding phase (telogen) during which the old hair falls out in preparation for growth of a new hair.

• Both electrolysis and laser work best on hairs in the growth (anagen) phase.

• Repeated treatments are needed to disable all the hair follicles as they re-enter their growth phases.

Images from: maximedicare.com Let’s Compare Them

Image from: laserhairclinic.com Electrolysis Laser

Effectiveness Destroys individual follicles of all hairs Effective only on pigmented hairs. Hairs must contain regardless of color melanin in order to absorb the laser’s energy Pain More discomfort, especially in the Less discomfort area between the upper lip and nose Preparation Must grow hairs at least 1 mm long Must shave prior to each session prior to each session Process Electric current applied by a needle Flashes of laser light applied to zones of skin, one within follicle, one follicle at a time zone at a time (size of zone depends on laser source) Session Length Multiple hours One hour or less

# of Sessions Depends greatly on length of sessions At least seven. Sessions for faces are spaced about and extent of clearing; produces four weeks apart. Produces less permanent outcome; more permanent outcome. may need re-treatment. Cost Billed by the hour. Billed by the session or by package deal. Prices vary widely. Shop around!

For people who are candidates for either method and at median prices, laser is usually less costly and goes faster. FTM Creation of – Hormonal

A beard may be the most persuasive male gender marker. For trans men, use of testosterone is clearly effective, though the amount of growth depends on genetics, just as in cis men.

Images from: betamaxipad-tumblr.com, reddit.com FTM Creation of Facial Hair – Non-Hormonal Some people are successful with cosmetics or theatric tools, but using these techniques can be risky. If you goof, you are suddenly more obvious than if you didn’t use them at all.

1. Dark brown eyeshadow Brushing brown mascara onto Attaching short Using fiber mascara to brushed onto face; 2. peach fuzz. Note: People who pieces of real create stubble. eyeliner to thicken the don’t use this technique are or fake hair by eyebrows; 3. black pigment better off shaving their peach means of spirit applied to face with a fuzz because adult males don’t gum. stipple sponge. have peach fuzz. Sources: Sailor Cruz on youtube.com, TheSLOfox on youtube.com, Dyson Fraser on youtube.com, Riley JustRiley on youtube.com Skincare – it should be of interest to all genders! (But children raised as boys might be less aware of its importance.)

• Facial cleansers are less harsh and irritating than soaps. • Moisturizers promote softness and prevent chapping. • Sunscreens block the damaging and aging effects of UV light. • Skin that is well cared for provides a better canvas for applying makeup.

All images from target.com MTF: Makeup Common recommendations

• Ideally, purchase a makeover by a cosmetologist who has experience with trans people. Ask the cosmetologist to write down the names of the products that were used along with reminders of how they were applied.

• There are many youtube.com videos you can study involving both cisgender and transgender women.

• Take into consideration your age and the situation for which you are applying the makeup. Explore the space between social expectation and unrestrained individual expression. Experiment (and even go “over the top” on purpose). Gather feedback from trusted sources. Have fun!

• Practice!!! MTF and FTM: Eyeglasses

• Eyeglass (or sunglass) frames are another vehicle for masculinizing or feminizing faces. • Angular faces can be balanced out by rounded frames and round faces can be balanced out by angular frames. • Although many frames are unisex, some styles are more distinctly feminine – e.g. red, blue or multi-colored frames or those with cat-eye shapes. • Eyeglasses (and especially sunglasses) obscure or de- emphasize eyebrows or brow ridges that are less than ideal. • Note that men’s eyeglasses are usually bigger than women’s eyeglasses because of men’s larger head sizes, as well as greater distances between eyes and ears. Many frames are available in more than one size.

Sources: fostergrant.com, globaleyeglasses.com MTF: Smiling Smiling is the greatest and most effective beauty accessory of them all.

Notice the extent to which smiling warms the faces of these trans women.

Sources: allure.com, endhepcsf.org, hornet.com, eurweb.com, dissolve.com, google.com Masculine and Feminine Silhouettes Key points in going from one silhouette to the other

• One of the most recognizable differences is the waist-to-hip ratio. • A healthy masculine waist-to-hip ratio is 0.9, while a healthy feminine ratio is 0.7. • From shoulders to hips, the silhouettes can be likened to rectangles and hourglasses. • We will direct our attention to management of the silhouette at shoulders, chest, waist, hips and their extensions down through the legs. • (These are idealized silhouettes. Hormone treatment, surgery and weight gain can modify the silhouettes and application of gendercraft techniques.) Images: ftmguide.rassaku.net, Kościński in openi.nlm.nig.gov Male to Female (MTF) Torso Management

From Rectangle to Hourglass Unfortunately, the shoulders are not compressible. Male to Female (MTF) Torso Management Minimizing Broad Shoulders with Necklines, Draping and Accessories

These styles all emphasize vertical lines, elongate the torso and draw attention away from the shoulders. Cap-sleeved tops do just the opposite and emphasize the shoulders. Good posture can help: hold the head up and the shoulders down and back.

Images from: jjill.com, northstyle.com, northstyle.com, twighair.com, northstyle.com, dailyconnoisseur.blogspot.com and dailymail.co.uk Male to Female (MTF) Torso Management Minimizing Broad Shoulders with Necklines, Draping and Accessories

Janet Christine Carmen Caitlyn

The principle of emphasizing vertical lines to minimize broad shoulders plays out with varying degrees of success in these famous transgender women.

Images by: 2paragraphs.com, drchristinemcginn.com, out.com, variety.com, Candis Laverne worldlifestyle.com, vh1.com Male to Female (MTF) Torso Management Padding the Chest by Filling Bra Cups

Silicone Breast Forms Foam Breast Forms Birdseed in Pantyhose

From most expensive to least expensive

Images from: truekare.com, Walmart.com and sophielynn1.blogspot.com Male to Female (MTF) Torso Management First method for creating cleavage

• Place bra inserts at the bottoms of a push-up bra. • Gather loose skin upward and inward. • Obtain additional lifting and squeezing from an elevatrix underbra.

Images from: fashionfirstaid.com, leonisa.com, ebay.com, dersertcart.ae Male to Female (MTF) Torso Management First method for creating cleavage

• A transgender woman demonstrates the steps of this procedure. • Cleavage effectively draws the eye away from less feminine features. Images from: unordinarystyle.com Male to Female (MTF) Torso Management Second method for creating cleavage

• A similar strategy is employed with commercial cleavage makers. Over top of them, one wears a typical bra filled with breast forms. • “IT STAYS®” is a roll-on body adhesive that helps maintain traction between loose skin and cloth garments, such as bras, and keeps the gathered skin in place. Images from: glamourboutique.com, discountsurgical.com Male to Female (MTF) Torso Management Third method for creating cleavage

• NuBra® consists of two silicone pads with re- usable adhesive surfaces. (Generic silicone pads are also available.) • One pad is attached to each breast; then the pads are pulled together and linked by their tabs. • Over top of the NuBra®, transgender women often wear regular bras filled with breast forms.

Image from: nubra.com Male to Female (MTF) Torso Management Fourth method for creating cleavage

• Taping the chest can create cleavage by forcing loose skin upward and inward. The tape does not go all the way around the chest, so restriction of breathing is lessened. • Although duct tape is often used for this technique, surgical tape is likely to be safer. • Tape should be removed carefully in order to avoid ripping or blistering the skin.

Images from: glamourboutique.com, patientsleepsupplies.com Male to Female (MTF) Torso Management Fifth method for creating cleavage

Before After Method • Cleavage can be enhanced by means of contouring make-up. • Light colors visually move forward and dark colors recede. • The photo on the right illustrates the starting point, after which the make-up is blended to look more natural. • This method can be combined with any of the others. Images from: look.co.uk Male to Female (MTF) Torso Management Decreasing the Waist with Cinchers, Diet, Exercise and (Questionably) Corset-Training

• Just like high heels, waist cinchers might be reserved for special occasions.

• Ideally, exercise programs target all the muscles of the abdomen and not just the “sit-up muscles” (rectus abdominis).

• Corset-training, aka waist-training, involves prolonged use of progressively tightening corsets in order to re-shape the abdomen semi-permanently. There are no modern studies concerning its safety. Its use might be risky.

Images by: ardyssbodymagicshop.com, catofashions.com Male to Female (MTF) Torso Management Creating a Higher Waist

A belted or structured waist raises it visually to a more usual female height. (“Structured” means that the curves are built into the clothes themselves.) Images by: nyandcompany.com, northstyle.com, xeuee.com, chadwicks.com (last 3) Male to Female (MTF) Torso Management Padding the Bottom and Expanding the Hips

The waist-to-hip ratio is the most recognizable feature of the female torso. One can purchase ready-made garments or save money with DIY approaches on youtube.com.

Images from: ebay.com and joyobsession.com Male to Female (MTF) Torso Management Using Style to Widen the Hips

Flared (A-line) skirts make the hips appear broader.

Images by: adriannapapel.com, chadwicks.com, dillards.com, modcloth.com, dillards.com, modcloth.com Male to Female (MTF) Torso Management Extending the silhouette down through the legs with tapering slacks

• Cis women often wear slacks, especially as day-wear. To blend in with cis women, one needs an effective strategy for wearing them. • Skinny-leg designs are very gendered garments, particularly when paired with feminine shoes. • By narrowing the silhouette at the ankles, they effectively broaden the silhouette of the hips. • High-waisted (“high rise”) pants are preferable to those which are just hip-high, because they are less likely to creep downward as you walk. Images: express.com, polyvore.com, denimology.com Female to Male (FTM) Torso Management

From Hourglass to Rectangle Unfortunately, the hips are not compressible. Female to Male (FTM) Torso Management Dealing with Narrow Shoulders

• Slightly oversized shirts can disguise bulk at the chest, but excessively oversized shirts can make the shoulders look even smaller. • It can be difficult to find a shirt that fits your proportions, but it is worth the hunt. • This diagonal pattern flatters by drawing the eyes upward and outward.

See: Gabriel, The FTM’s Complete Illustrated Guide to Looking Like a Hot Dude, ftmguide.rassaku.net Female to Male (FTM) Torso Management Dealing with Narrow Shoulders

• Shoulder pads don’t work well because they look fake and are more frequently used in women’s clothing. However, epaulets can flatter. • Notice how well the suit jackets square up the shoulders of these trans men. Images from: ftmguide.rassuku.net, dapperq.com (second and third images) Female to Male (FTM) Torso Management Weaves vs. Knits

• In shirts, wear weaves instead of knits. Weaves (such as in buttoned dress shirts) are stiffer and don’t stretch, while knits cling to the curves.

• Vests (waistcoats) are great. They are a weave, provide structure, and flatten the chest. They are cut for men’s bodies so they extend directly from underarms to hips, disguising curves. A tie provides plausible deniability for bulk on the chest.

Gabriel, The FTM’s Complete Illustrated Guide to Looking Like a Hot Dude, ftmguide.rassaku.net Female to Male (FTM) Torso Management Binders, sports bras and athletic wear compress the breasts.

Image by: gc2b.co Female to Male (FTM) Torso Management Binders, sports bras and athletic wear compress the breasts.

Images by: amazon.com, bluestockingsboutique.com, underworks.com (last 2) Female to Male (FTM) Torso Management Common Advice on Binding Safety from Websites by or for Trans Men

Do not use Ace bandages or duct tape for binding -- these can restrict breathing and cause tissue damage. Do not bind for longer than 8-12 hours. Tissues need time to recover.

Images by: point5cc.com, aminoapps.com Safety of binding: what do published studies say about it?

There is only one such study.

Online survey of 1,800 adults assigned female at birth with current or past history of binding. Data included demographics, binding practices, mood changes, and presence of any of 28 adverse health outcomes. Binding Survey: Sample Characteristics

Geographical location: Gender Identity (marking all that apply):

USA 68% Transgender 80% Canada 13% Male or masculine 68% Genderqueer/bigender 34% 38 countries represented Agender 34% Feminine 12% Age: Masculine female 7% 18-24 58% Cisgender 2% 25-34 33% Intersex 1%

Range 18-66 y Median 23 y

Peitzmeier et al. (2017) Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19:1, 64-75. Binding Survey: Binding Practices

Hours per day spent binding (median) 10 hours Days per week spent binding (median) 7 days Duration of binding (median) 2 years

Binding methods used (mark all that apply) Commercial binders 87% Sports bras 33% Shirt layering 24% Multiple sports bras 19% Elastic or other bandages 16% Athletic compression wear 15% Neoprene compression wear 7% Duct tape or plastic wrap 4% Homemade 3%

Peitzmeier et al. (2017) Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19:1, 64-75. Binding Survey: Negative Health Outcomes

Adverse health outcomes by symptom: Surprising findings:

Back pain 54% Days per week spent binding was the factor most Overheating 54% correlated with negative health outcomes Chest pain 49% Hours per day binding was relatively uncorrelated with Shortness of breath 47% negative health outcomes Itching 45% Bad posture 40% Commercial binders were most correlated with negative Shoulder pain 39% health outcomes Elastic or other bandages, duct tape and plastic wrap Any of 28 symptoms 97% showed intermediate correlation with negative health outcomes Sports bras, layering sports bras, and neoprene or athletic compression wear showed the least correlation with negative health outcomes

Peitzmeier et al. (2017) Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19:1, 64-75. Binding Survey: Mood Effects

Q: So with all these negative health outcomes, why would trans masculine individuals subject their bodies to such abuse?

A: Mood rated on a 1-5 scale with 1 as very negative and 5 as very positive:

Mood before binding 2.1 Mood after binding 3.8

Therefore think in terms of harm reduction, i.e. breast symptoms vs worsened gender dysphoria and suicide risk.

Peitzmeier et al. (2017) Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19:1, 64-75. Female to Male (FTM) Torso Management Style Straightens Out the Lines

Layering can be effective. Excessively oversized clothes are needless and unfashionable. Side note: Don’t you just love the individual on the right? Don’t they look perfectly comfortable in their own skin? Self-confidence is the secret sauce that affects how others treat you. Images by: autostraddle.com, rebloggy.com Female to Male (FTM) Torso Management Style Straightens Out the Lines

Images by: dailymail.co.uk, dailymail.co.uk, theguardian.com Female to Male (FTM) Torso Management Style Straightens Out the Lines

Fashion can even hide pregnancy!

Images by: dailymail.co.uk Female to Male (FTM) Torso Management Extending the silhouette down through the legs

• Men’s and women’s slacks are constructed differently. Men’s slacks (expressed in waist circumference and inseam length, e.g. 32 x30) drop straight from waist to ankles. Women’s slacks are narrower at the waist and wider at the hips. So if you have a woman’s body, your waist size in men’s clothing needs to be individualized.

• Wearing suspenders instead of a belt reduces bulk (bunching) at the waist.

• Cargo pants work well because they add bulk at the knees thereby balancing the width at the hips to create a very masculine rectangle.

Gabriel, The FTM’s Complete Illustrated Guide to Looking Like a Hot Dude, ftmguide.rassaku.net Male to Female (MTF) Genitalia Management Using a Dancer’s Belt, Also Known as a Gaff

• Can be purchased at dance or crossdresser stores • Can be worn in conjunction with “tucking”

Images from: dancebelt.info, amazon.com, amazon.co.uk Male to Female (MTF) Genitalia Management Tucking Procedure

• Tucking is a method to minimize the contour of the penis and scrotum.

• It involves pushing the testicles up toward the inguinal canals (through which the testicles originally descended) so they are positioned at the entrance of the canals or within them.

• Then the penis is pushed downward and back between the legs.

• This configuration is held in place with medical tape, a gaff, one or more pairs of undersized underwear, a bikini bottom, shapewear or Spanx®.

• Tucking permits the individual to wear tight pants or swimwear without a bulge. Male to Female (MTF) Genitalia Management Tucking Safety • There are no published studies on the safety of tucking. As a result, all we have are expert opinions and anecdotes.

• “A common cause of scrotal contents pain in transgender women is`tucking.’ … Resulting pain may be traumatic, mechanical or neuropathic. Prolonged tucking may also result in urinary reflux and symptoms of prostatism or even infection such as epididymo-orchitis, prostatitis, or cystitis. Prolonged positioning of a compressed urethral meatus in close approximation to the anus may also serve as a portal of infection.” -- Barry Zevin, MD, Center of Excellence for Transgender Health, University of California at San Francisco

• “Anecdotally, some people have reported pulling or tearing sensitive tissues in their genital region during tucking. This confirms the importance of going slow and listening to your body. Medical supply stores carry medical remover which may be helpful for removing build-up from tape. If you have concerns about the safety of tucking for you, talk to a health care professional.” – Transgender Health Information Program, Provincial (B.C.) Health Services Authority

Sources: transhealth.ucsf.edu, transhealth.phsa.ca Female to Male (FTM) Genitalia Management Packing

• Packing means creating a contour consistent with male genitalia.

• The simulated genitalia can be put together from available materials or purchased commercially.

• The genitalia can be inserted or pinned into ordinary underwear, or held within a jockstrap or a pocket of commercially obtainable underwear, or slung from straps.

Images from: tumblr.com, etsy.com, susans.org and amazon.com (clockwise from upper left) Female to Male (FTM) Genitalia Management Standing to Pee (STP) Devices

• Some trans masculine people find that standing to pee is validating. • Others are content to pee while sitting.

Images from: transguys.com, transitionmtfuk.uk.com Common Gender Differences in Stance, Sitting and Walking

• “You can observe a lot by just watching.” – Yogi Berra

• For trans people who wish to feminize or masculinize their stance, gait or sitting posture, a great place to start is by watching how cis-gender members of their identified gender do these things.

• Let’s see how well we can observe these differences ourselves… Stance Common Gender Differences in Stance

• Curved vs. straight lines • Narrow vs. wide base • Small vs. large amount of occupied space • Equal vs. unequal weight on feet, e.g. more on rear foot • Arms folded or hands near face vs. arms down or hands Image sources: feminizationsecrets.com, in pockets recruitingtimes.org, tutorialspoint.com Walking Common Gender Differences in Walking What did we notice?

• Wide vs. narrow base (width) • Length of stride • Speed • Fluid vs. solid • Heavy vs. light foot-fall • Leading with chest vs. leading with hips • Noticing the scenery vs. ploughing straight ahead • Posture (imaginary string through top of head pulls upward, elongating the neck, rolling the shoulders back and straightening the spine) • Open spaces vs. closed spaces • Elbows in vs. elbows out • Arms swing from elbows vs shoulders Sitting Common Gender Differences in Sitting Postures What did we notice?

• Knees together vs. knees apart

• Occupying smaller vs. larger amounts of space

• Sitting upright vs. slouching

• Hands together on lap vs. hands on knees Gender Differences in Communication

• Voice: pitch, resonance and intonation patterns

• Content: word choice and use of descriptors can vary

• Body Language: gestural systems; active and passive listening styles Vocal Pitch

• Vocal ranges are usually broader than shown on the keyboard above, but most people have “comfort” ranges that are narrower. • Testosterone thickens the vocal cords and lowers the pitch of the voice. • Estrogen does not raise the pitch. • To feminize their voices, MTF people can benefit from vocal coaching. • For FTM people who don’t use testosterone and even for some who do, vocal coaching can masculinize their voices and reduce mis-gendering on the phone. Image from: professionalvoice.org Vocal Resonance

• Resonance refers to how the sound output from the vocal cords (phonation) is modified by vibrating within different air cavities, such as in the chest, throat, mouth, nasal passages and sinuses.

• Chest vibration adds deeper, darker and richer qualities.

• MTF speakers can achieve a more feminine vocal quality by decreasing chest vibration and increasing vibration in the head’s cavities, especially in the front of the head.

• By contrast, FTM speakers can obtain a more masculine vocal quality by increasing chest vibration and decreasing head vibration.

• With hand on chest, a speaker can feel the amount of chest vibration.

See: “Vocal resonation” in Wikipedia Intonation means variation of pitch during conversation. Masculine intonation is flatter in pitch and ends on a lower note, while feminine intonation varies more in pitch and sometimes ends on a higher note. Source: jamiefaye.com Gendered word choices

The upper cluster shows words and phrases on Facebook particularly distinctive of females, while the lower cluster shows words and phrases particularly distinctive of males.

Applying these results to spoken conversation is tricky because comments written in social media may not be the same as those used in face-to-face conversation. Use of these words also needs to be appropriate to context, and not just randomly sprinkled in.

Schwartz HA, Eichstaedt JC, Kern ML, Dziurzynski L, Ramones SM, Agrawal M, et al. (2013) Personality, Gender, and Age in the Language of Social Media: The Open-Vocabulary Approach. PLoS ONE 8(9): e73791. https://doi.org/10.1371/journal.pone.0073791 Gesturing While Talking

• In ordinary conversation, women use more hand gestures. • Though fewer in number, male gestures can be larger, while female gestures are more contained and in front of the body. Gifs from: singleguysays.wordpress.com, tenor.com Active listening is good for all genders, but children raised as boys might be less socialized to its use. Image: slideshare.net Recommendations for MTF speakers

• Ideally, obtain guidance from a speech and language pathologist to feminize pitch, resonance and intonation without damaging your vocal cords.

• If obtaining professional help is not feasible: (1) raise your pitch by a few notes; (2) make your voice soft and light; (3) decrease chest vibration; (4) vary the pitch; (5) avoid profanity; and (6) own some feminine words, e.g. cute, adorable, excited, love and yummy -- but be sure their use is appropriate to context!

• Practice laughing, coughing and sneezing more softly and in a higher register.

• Gesture more but keep the movements contained and in front of your body.

• Listen actively. See: transhealth.ucsf.edu/trans?page=guidelines-vocal-health Recommendations for FTM speakers

• Ideally, obtain guidance from a speech and language pathologist to masculinize your pitch, resonance and intonation without damaging your vocal cords.

• If obtaining professional help is not feasible: (1) lower your pitch by a few notes; (2) increase chest resonance; (3) keep the pitch flatter during conversation; and (4) especially avoid “up-talk” (rising pitch) at the ends of sentences.

• Practice laughing, coughing and sneezing in a lower register.

• Avoid excessive gesturing.

See: transhealth.ucsf.edu/trans?page=guidelines-vocal-health Shopping: Things to know before you go

• Shoulder seams and waist seams are good to know. Find a shirt and a pair of pants that fit you comfortably. Measure their seams in inches, and also measure them against your arm by holding one end with a bent finger and seeing how far up your arm it goes. Later, when you are in a store, you can measure the seams of clothes you like without holding them up against your body.

• Size systems are complicated. You can get a very rough idea of what your sizes will be by checking your measurements against a sizing chart in a catalog or on the internet. Shoes in the U.S. are about 1 ½ sizes different. (A size 9 in men’s shoes is about 10 ½ in women’s shoes.)

• Vendors are there to sell you clothing and help you make the best decision for you. Pretending that the clothes are a gifts or using fake or androgynous names may not be worth the trouble and may not afford you the best shopping experience. Assess your own ability to navigate the difficult terrain between risk and self-liberation. Consult others about who your trusted local retailers are.

• Shopping can be more comfortable and fun when a cisgender ally of your identified gender goes with you and helps you navigate your fashion options! Shopping: The totally avoidant approach

• Buy online, e.g. at amazon.com or payless.com. Try the clothes on at home and send back what you don’t like or that doesn’t fit.

• Shop online at specialty shops that cater to trans people. Expect to pay more than at regular stores. Also, be aware that clothes marketed for crossdressing men tend to be more immodest and revealing than many trans women might care to wear.

• Shop at Walmart dressed in your assigned gender. Don’t try anything on. Use the self- checkout lane. Try the clothes on at home and bring back what you don’t like.

• Keep repeating the process until you get what you want. Don’t feel bad – when you’re ready to take a bolder step, you will! Shopping: The semi-adventurous approach

• Go to a big-box store on a weekday morning in your assigned gender. Look through clothes carefully, knowing that you have every right to be there. If a clerk asks if they can help you, consider saying yes. Sales people often provide great advice! Get a good idea of what will fit by measuring the seams with a tape or against your arm. Put the ones you like in your cart along with another one in the next size up or down.

• Screw up the courage to actually try them on in the store. Throw the clothes over your arm. If it helps your confidence, put a garment of your assigned gender on top of the stack. Enter a changing room of your assigned gender. Try on your clothes. Remember to enjoy the experience!

• Check out in a cashier lane, knowing that the clothes you bought fit you, look good and won’t have to be returned. If the cashier asks if you found everything you were looking for, say yes. And smile! Shopping: The go-for-it approach

• Get dressed at home in your identified gender. Go shopping with one or more friends – the more the merrier!

• Head for the stores. Be mindful that Walmart and Target have friendly bathroom policies in every state of the U.S. – even the red ones. Enjoy trying things on and experimenting with your look. You can even try on undergarments and shoes.

• If you are a trans man who doesn’t find well-fitting clothes or shoes in the men’s section, try the boys’ section. That’s perfectly fine and you are likely to save money!

• You can pay for your clothes with a Visa® or American Express® card showing your preferred name, whether you had an official name-change or not. It is easy to get an add-on card if you already have a card in your assigned name at the same bank. It’s prudent to use the same last name in case you are asked for an ID.

• Go to lunch with your friends and have a great time! Today’s experience is exactly what you have always wanted to do! Feel free to share this presentation with

• health and social service professionals

• trans and gender non-conforming people

• allies

• anyone else who can use it to help trans people!

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