See sissification.

A word used to refer to the vagina. Used by TiFs who don’t like to use accurate anatomical terms or ‘culturally feminine’ terms for their vagina. Also: bonus hole, boy hole.

Female-to-male. Used to refer to a trans-identifying female.

The Japanese word for hermaphroditism. Used to refer to manga (Japanese comics) and anime (Japanese animation) featuring characters that have both a penis and a vagina. Possibly the inspiration for Salmacians.

Undergarment, either bought or made out of other items (such as pantyhose/tights), used for tucking away the male genitals/bulge.

Informal language used by trans-identifying people to refer to any resistance they may find from healthcare practitioners to accessing ‘affirmative’ care (medical transition). For instance, a therapist telling a trans-identifying person they will not prescribe hormones right now would be said to be gatekeeping. TRAs generally see gatekeeping as a problem as they want trans-identifying people to have easy access to the drugs and surgeries they want for medical transition.

To have a homosexual sexuality meaning one is only attracted to people of the same sex that they are themselves. Can refer to both males and females. See Lesbian.

A nebulous term used to group people together based on societal roles or behaviours generally associated with being female (femininity) or male (masculinity) but somehow not about being female or male (as these are sexes). In English, the word ‘gender’ and ‘sex’ are often used interchangeably although they do have different meaning, muddying the waters for a sensible discussion and making language less clear.

See Sex reassignment surgery (SRS).

A view in which gender has only two categories: woman and man and that females are women and males are men.

Harmful acts directed at an individual based on their gender. The term is usually used to refer to violence directed at girls and women when it comes to topics such as female genital mutilation (FGM), domestic violence, sex trafficking, etc. However, this term is meaningless when gender does not mean sex because if someone’s gender can be different from their sex, how will a perpetrator know whom to target when he is looking for girls and women to victimise? ‘Sex-based violence’ would be a more accurate term.

Being critical of transgender ideology/transgenderism, meaning that one does not agree at all or not fully with statements made within the context of transgenderism. For instance, disagreeing with the statement ‘transwomen are women’ or differentiating between ‘transwomen’ and women/females can get you branded as gender critical or even a ‘transphobe’. See TERF.

See Sex reassignment surgery (SRS).

See Gender expansive.

People who do not identify as cisgender.

The new term in the DSM-5 for what used to be called gender identity disorder (GID). It refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. This is a mental health condition.

Contrasts with gender euphoria. According to transmedicalists you need to experience gender dysphoria in order to be trans. According to other trans-identifying people, you don’t need to experience gender dysphoria to be trans and experiencing gender euphoria is enough to call yourself trans. Others will consider anyone who identifies as trans for any reason, as trans. Not everyone who experiences gender dysphoria will identify as trans.

A feeling described as experiencing happiness or joy as a result of presenting as the sex that is opposite to your sex. Contrasts with gender dysphoria.

Used for people who have a gender expression or show behaviours that broaden the socially and culturally defined behaviours or beliefs for their sex. Seemingly similar to gender-non-conformity.

The way in which someone expresses their gender identity. This can relate to behaviours, fashion, body shape, and voice.

Someone whose gender identity is not fixed and can change over time, supposedly as frequently as daily or even hourly.

Someone’s own sense of whether they are a woman or a man, or both or neither, or something else altogether. According to transgenderism, most females have the gender identity ‘woman’, and most males have the gender identity ‘man’. However, some people have gender dysphoria and do not feel they are a woman despite being a female, or don’t feel they are a man despite being male. Or a female feels she is a man, or a male feels he is a woman. People with gender dysphoria are termed transgender in this world view. It is not clear how gender identity is different from gender.

See Gender dysphoria.

A diagnostic term used for someone’s ‘marked and persistent experience of an incompatibility between that person’s gender identity and the gender expected of them based on their birth-assigned sex’ (from WPATH SoC 8, glossary).

A term used for people who defy regressive sex stereotypes, such as girls who like to play with trucks or want to have a masculine haircut or men who like to wear makeup or like to collect dolls.

Drugs and surgical treatment to alter the body as part of ‘changing’ your ‘gender’.

An act of parliament of the UK allowing people with gender dysphoria to change their legal gender (see Gender recognition certificate (GRC)).

A certificate people in the UK can apply for if they want their ‘affirmed gender’ (sometimes called an ‘acquired gender’) to be legally recognised in the UK. A panel of people with legal or medical qualifications will review such an application to ensure it meets all the legal requirements. The applicant must have been diagnosed with gender dysphoria in the UK, be aged 18 or over, have been living in the affirmed gender for at least two years and intend to live in this gender for the rest of their life. People can apply even if they have not medically transitioned in any way and do not plan to either.

This means that males who still have their penis and testicles and have typical male strength and libido can legally be recognised as female. Secondly, the language refers to ‘gender’ but what is changed with the GRC is legal sex.

See Sex reassignment surgery (SRS).

Also referred to as sex roles. Behaviours and attitudes that are culturally accepted or appropriate for a person based on their sex. Someone who does not fit the gender roles for their sex is considered to be gender non-conforming (GNC).

Illustration created by Landyn Pan and Anna Moore that explains transgenderism. It suggests that someone’s gender identity, gender expression, sex, physical attraction, and emotional attraction all exist on a spectrum and can vary independently of each other. Very similar to the Genderbread Person.

Illustration created by Sam Killermann that explains transgenderism. It suggests that someone’s gender identity, gender expression, sex, sexual attraction, and romantic attraction all exist on a spectrum and can vary independently of each other. Very similar to the Gender Unicorn.

Refers to people who don’t feel comfortable with the gender binary and who may see themselves as gender fluid or as falling outside of the ‘man’ and ‘woman’ gender categories.

See Gender expansive.

To prefer female or male genitalia. In some circles it is not accepted to say that you do not want to date/have sex with trans-identifying people. If you are a lesbian who only wants to date females and you don’t want to upset people who support transgender ideology by outright saying this, you can say that you are only interested in women and that you have a genital preference for female genitals/vaginas. However, to some people this statement opens the door to TiMs who have had vaginoplasty/vulvoplasty.

‘GIRES is a UK wide organisation whose purpose is to improve the lives of trans and gender diverse people of all ages, including those who are non-binary and non-gender.’

Human female who has not yet reached the adult age.

Slang term used by some TiMs to refer to their penis.

Slang word sometimes used by TiMs to refer to a ‘female’ orgasm that they feel they can experience once they start taking females hormones and/or have had bottom surgery.

A media-advocacy organisation for LGBTQ.

Gonadotropin releasing hormone analogues/agonists. See Puberty blockers.

Slang used in LGBT communities referring to a gay woman who has never had sex with a man. A silver star lesbian has slept with only one man once and in that moment realised she is gay. A bronze star lesbian is someone who has had sex with multiple men but was never aroused. These terms are also used for gay men but with slightly different meanings.

The act of building a relationship, trust, and emotional connection with a minor with the purpose of manipulating, exploiting, and abusing the minor.

Medical specialist for female health issues, mainly revolving around the female reproductive system. Some TiMs who have had bottom surgery may feel they need to visit a gynaecologist, but the typical gynaecologist will not know what to do with a neovagina as it is not part of the female reproductive system or a female body part.

An increase in the amount of breast gland tissue in males. This can be caused by an imbalance in their hormones, and by males taking prescription drugs for medical transition.

According to Rosenthal et al.: "Gynandromorphophilia (GAMP) is attraction to gynandromorphs (GAMs), who are natal males with both breasts and a penis, colloquially known as "she-males." " The researchers stated that GAMP is best considered an unusual form of heterosexuality, and found that men with GAMP scored much higher than controls on a measure of autogynephilia (AGP), which they consider to be a variant of heterosexual attraction. See https://pubmed.ncbi.nlm.nih.gov/27858199/.

Permanent hair removal can be done using laser hair removal or electrolysis techniques. This is generally done on the face for males who want to present ‘as a woman’, and on the genital area for males who want to get bottom surgery. This is also done on females who want to get phalloplasty for which hair needs to be removed from the donor site.

Online nickname for the middle-aged TiM who went off into a rage at a GameStop worker in response to his perception of being called ‘sir’. He kept repeating in an aggressive tone ‘It’s ma’am!’ whilst stomping around and kicking over some of the items for sale. He goes by the name Tiffany Michelle Moore.

The ‘girl’ or ‘woman’ a TiM refers to when he sees himself ‘as a girl/woman’ when looking in the mirror.

An organism that has both kinds of reproductive organs and can produce both female gametes and male gametes. True hermaphroditism, also called ovotesticular syndrome, is an intersex condition in which someone has ovarian tissue as well as testicular tissue and is very rare in humans. People who have this syndrome generally do not produce both fertile sperm and fertile eggs.

The sexuality in which someone is only attracted to others who are of the opposite sex.

The term on the Indian subcontinent for people who are eunuch, intersex, or transgender.

The sexuality in which someone is only attracted to others who are of the same sex.

According to Dr Ray Blanchard’s typology, an effeminate gay male who has ‘homosexual gender dysphoria’.

HRC is an LGBTQ+ civil rights organisation that ‘envisions a world where every member of the LGBTQ+ family has the freedom to live their truth without fear, and with equality under the law. We empower our 3 million members and supporters to mobilize against attacks on the most marginalized people in our community.’

Use of prescription hormones to correct an imbalance. The term is also used by trans-identifying people when they start using cross-sex hormones to achieve levels of hormones that are not within the natural/healthy range for their sex, so this use is technically not HRT. Some slang terms are used online to refer to this kind of use.

In TiMs:

• titty skittles 

• antiboyotics 

• anticistamines 

• Fem&Ms 

• tit tacs 

• breast mints 

• womentos 

• vitamin E 

• the Notorious HRT 

In TiFs:

• T 

• boy juice 

• proboyotics 

The act of giving disingenuous positive feedback just to ‘be nice’ or make someone feel good, generally referring to when people do this in response to someone asking for feedback on their looks (for instance, in the ‘Transpassing’ subreddit). This contributes to people thinking they pass (as the opposite sex) when in reality, they may get clocked (‘found out’) all the time.

Removal of the uterus. This may be accompanied by removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Once the uterus is removed, it is no longer possible for this female to become pregnant. Once both ovaries are removed, it is no longer possible for this female to reproduce. If one of the removed ovaries is saved in cold storage, it may be possible to use one of the eggs in the future using a surrogate if the female no longer has a uterus but there are no guarantees it will be possible to retrieve viable eggs nor is access to a surrogate guaranteed.

When the gonads (in this case, ovaries) are removed, the person will have to take hormones for the rest of her life because her body can no longer make enough of its own sex hormones.

American reality TV show on TLC following the life of TiM Jazz Jennings from when he was a teenager into young adulthood.

Involuntarily celibate. An online/slang term used to refer to people who would like to be sexually active (generally only refers to men) but who can’t seem to find a willing partner and who are part of an online community for people with this kind of sexual frustration. Attitudes to women are hostile, as well as the attitude towards sexually-active men.

The move of some incels to choose to identify as transgender in an effort to improve their life, not out of experiencing gender dysphoria or having a paraphilia.

In the context of transgenderism, this refers to healthcare clinics that provide medical transition to people on the basis of giving the patient what they ask for without much or any further investigation into why this patient asks for medical transition or whether they meet the diagnostic criteria for gender dysphoria.

Photo and video sharing social media platform.

The idea of people having overlapping or intersecting social identities that may affect whether they are oppressed or how much they are oppressed. For instance, someone who is gay and who is also disabled may experience multiple forms of discrimination because of being both gay and disabled.

An older term for people who have a disorder of sexual development (DSD).

A North-American TiM who is the centre of the TLC TV Show ‘I Am Jazz’ and who wrote the children’s book ‘I am Jazz’ and the memoir ‘Being Jazz: My Life as a (Transgender) Teen’. Jazz started medical transition as a child receiving a puberty-blocking arm implant at age 11 and has undergone vaginoplasty bottom surgery at age 17. Additional surgeries to fix major complications from the genital surgery were needed (possibly as a result of the penis being very small due to puberty being blocked from a young age so there was not enough penile material to create a canal). Jazz had a healthy body size throughout childhood, but since his late teens he has gained a lot of weight to the point he became morbidly obese.

TiM who attracted media attention for filing discrimination complaints against beauty salons for refusing to wax his male genitalia. He is accused of being a child sexual predator and as having a menstrual fetish.

Famous British female author and philanthropist who wrote the Harry Potter series (amongst other works). She has been speaking up for the rights of females to have female-only spaces and has been getting a lot of backlash for it from TRAs. The latter portray her as a “transphobe” simply for standing up for the rights of girls and women (females).

A word that is used a lot by trans-identifying people to describe their experiences from realising that they “feel different” from others, the realisation that they think they are transgender, undergoing social transition, and medical transition. The journey towards their authentic self.

English radical feminist writer. Nottingham City Council cancelled a scheduled talk of Julie Bindel over her views on transgender rights the day before the event was to take place. Bindel announced legal action under the Equality Act 2010 and the Human Rights Act 1998 and the Council eventually apologised and admitted they had acted unlawfully. See https://www.bbc.co.uk/news/uk-england-nottinghamshire-63745075 .

Infamous TiM who raped two women outside of prison. He sexually assaulted women in female prison after he was transferred there when he claimed a transgender identity. He is also convicted for stabbing a neighbour and has previous convictions for the following crimes: indecent assault, indecent exposure and gross indecency involving children, animal cruelty and dishonesty.

Identity in Thailand for effeminate gay males and TiMs.

A British woman who started medical transition as a teenager followed by a double mastectomy at age 20. She came to regret her transition and detransitioned soon after her surgery. She became well-known in the UK debate on transgenderism as she is speaking publicly about what happened to her. See https://www.persuasion.community/p/keira-bell-my-story .

Also called the heterosexual-homosexual rating scale. This scale was developed by researcher Alfred Charles Kinsey and is used in research to describe someone’s sexual orientation (0 = exclusively heterosexual; 6 = exclusively homosexual).

Canadian male high school teacher who turned up after summer holidays having ‘transitioned’, presenting with gigantic prosthetic breasts worn under a tight-fitting top. The rest of the outfit consisted of tight shorts, a long blond wig, and makeup. There was seemingly no pushback from the school, and he continued to show up dressed like this. It is suspected that this is a very committed troll and there is an online story about how this teacher “was almost fired for ‘toxic masculinity’ last year, as well as not embracing woke culture”.

TiM weightlifter who competed in the 2020 Summer Olympics in the women’s competition. He was unimpressive in the men’s competition before he came out as trans.

TiM actor from the USA and LGBT advocate. In 2014, Glamour Magazine named him as one of its 'Women of the Year'.

A female whose sexuality only includes other females.

In the context of transgenderism, this is the erasure of butch lesbians by transgender ideology through pressurising these women to identify as transmen.

British advocacy group that opposes policies of the LGBT rights charity Stonewall when it comes to transgender issues.

Annual month-long observance of LGBT history and the history of LGBT rights.

A month (generally June) dedicated to celebration and commemoration of LGBT pride (“the promotion of the self-affirmation, dignity, equality, and increased visibility of lesbian, gay, bisexual, and transgender (LGBT) people as a social group.”, see https://en.wikipedia.org/wiki/LGBT_pride ).

TiM swimmer who ranked 554th in the men’s and then went on doing much better when competing against females. This contributed to the continued debate on whether males have an unfair competitive advantage over females.

British radical feminist and gay-rights activist who does not agree fully with TRAs and has received backlash for this.

An expression used to describe living the life you design for yourself. Sometimes used by trans-identifying people to describe their life after they have started their transition.

Male-to-female. A TiM.

The sex that fertilizes eggs and does not produce babies or eggs itself.

Permanent modifications of the male external genitalia for non-medical reasons.

Adult human male.

American gynaecologist and surgeon who performs surgeries for medical transition. He is a TiM and has made it into mainstream media because he is one of the surgeons who performed genital surgery on Jazz Jennings (when Jazz was just a teenager).

Business and international development researcher who is the claimant in Maya Forstater v Centre for Global Development. The outcome of this case was that gender-critical views are protected as a belief under the Equality Act 2010, and that she was discriminated against by her employer because of her gender-critical views.

A way to describe what some trans-identifying people may wish was the case with their bodies: that they could swap out their genitals/body parts for those of the opposite sex as if humans were made of meat Lego bricks.

The process in which a trans-identifying person uses drugs and/or surgeries to make changes to their body in an effort to look less like their sex (and it is hoped, more like the opposite sex). This can include use of puberty blockers and cross-sex hormones as well as invasive cosmetic surgeries.

Men who disagree that men as a group have institutional power and privilege and think that instead, men are victimised and disadvantaged compared to women.

From Wiktionary: “A movement or philosophy, often presented satirically, in favour of the rights and interests of men.” See https://en.wiktionary.org/wiki/meninism .

British charity and advocacy organisation for transgender, non-binary, and gender-diverse children, young people, and their families. Susie Green was Mermaid’s CEO for six years and is the mother of a TiM. She took her then 16-year-old son to Thailand to get bottom surgery. In 2022 the charity was the subject of an investigation by The Daily Telegraph for allegedly offering chest binders to youth without parental consent. The charity also states that puberty blockers are ‘physically reversible when treatment is stopped’ despite a lack of evidence for this statement and more and more evidence appearing that some possible effects of puberty blockers are irreversible.

A kind of bottom surgery for TiFs in which the T dick (enlarged clitoris from use of testosterone) is moved higher up on the pubic area, the labia majora are used to create a sack (to put implants in at a later surgery to mimic testicles), the urethra is extended through the T dick hoping the patient can stand to pee, and the vagina is closed up (in a vaginectomy). Centurion metoidioplasty is a variation of metoidioplasty that uses the round ligaments from the labia to give extra girth to the surgery result.

There are variations to this surgery such as not having the urethra rerouted/extended or not opting for a vaginectomy. The result is a ‘micropenis’ of sorts which is likely not able to penetrate a vagina or anus. This surgery does not take a full-thickness skin graft at all so there will be no scars elsewhere on the body (unlike in phalloplasty bottom surgery).

Men going their own way. Antifeminist community of men who want to separate themselves from women and a society they feel has been corrupted by feminism.

Sold under the brand name Rogaine. It is a drug used to treat high blood pressure and hereditary hair loss (it is an antihypertensive vasodilator). It can be administered via an oral tablet or a topical cream/foam. TiFs may use it to promote hair growth.

Using pronouns that are used for someone’s sex against the wishes of this person, because this person wants you to perceive them as the opposite sex with the demand you use the pronouns used for this opposite sex for them.

Hatred of, contempt for, or prejudice against men (males). A form of sexism.

Hatred of, contempt for, or prejudice against women (females). A form of sexism.

Men who love men; men who have sex with men. Males who have sex with other males.

Male-to-female. Used to refer to a trans-identifying male.

Outburst of intense anger (or silence) exhibited by some people with narcissistic personality disorder. Sometimes seen in trans-identifying people, mainly TiMs, when they are challenged on their claims that they are a ‘real woman’, a ‘female’, that they should have access to female-only spaces, or that whomever they are attracted to should be sexually available to them.

See sex.

A surgically-created roll of skin attached to the pubic area with the aim of it replicating a penis. Performed on TiFs in the phalloplasty bottom surgery.

Newly-invented pronouns that someone who feels they have a unique or special gender identity may ask or demand to be used for them. Examples are: xe/xem, ze/zir, and fae/faer. In the wider population, almost no one uses neopronouns, so they are not part of general vocabulary.

A surgically-created tunnel or canal (a blind pouch) in the groin of a male with the aim of it replicating the aesthetics and some of the functions of a vagina: the only function being penetration by something/someone else. Performed on TiMs in what is referred to as vaginoplasty bottom surgery.

“An umbrella term to describe when someone's gender is somehow linked to their neurotype, mental illness, or neurological conditions.” See https://gender.fandom.com/wiki/Neurogender .

National Health Service of the UK. A ‘free at point of care’ healthcare service paid for by UK taxpayers. They offer medical transition and have done so to minors but the wait times have increased to be years long in some cases.

A gender (identity) that is not ‘woman’ or ‘man’ and either sits between the two or fully outside of the sex stereotypes. This is different for every person who has adopted this identity. Can include Neutrois (a gender identity characterised by gender neutrality).

Non-operative. Someone who identifies as transgender but who does not want to undergo bottom surgery.

Someone who has had nullification surgery that removes the external genitalia so all that is left is a smooth groin (usually done on males). When the gonads (in this case, testes) are removed, the person will have to take hormones for the rest of his life because his body can no longer make enough of its own sex hormones. When the gonads are removed, someone is no longer fertile.

The female sex hormone mainly produced in the ovaries with some produced in other tissues. Males also naturally have some oestrogen in their body. TiMs who wish to medically transition often take oestrogen as a form of hormone replacement therapy (HRT) either by pill, a gel, spray, or patch, or as an injection. The hope is that it will reduce body hair, stop or reverse male-pattern baldness, change where bodyfat is located to a less masculine distribution, and grow breasts. Other effects may include soften skin, smaller testes, a decrease in libido. It is not possible to know what the effects or extent of effects will be so it is not possible to pick and choose oestrogen’s effects. Risks may include:

• blood clots
• heart problems
• discharge from the nipples
• weight gain
• type 2 diabetes
• stroke
• infertility (but oestrogen is not a form of birth control)
• high blood pressure
• high levels of triglycerides (a kind of fat), potassium, and the hormone prolactin in the blood
• increased risk of breast cancer

See https://www.mayoclinic.org/tests-procedures/feminizing-hormone-therapy/about/pac-20385096.

Internet personality. A British white male who has undergone plastic surgeries to look more like a Korean pop star. In 2022 he came out as a transgender woman, but this was short-lived as he detransitioned soon after. He wrote the book ‘Detransition – a memoir’.

Wikipedia describes this in a very clear way: “Oppression Olympics is a characterization of marginalization as a competition to determine the relative weight of the overall oppression of individuals or groups, often by comparing race, gender, socioeconomic status or disabilities, in order to determine who is the worst off, and the most oppressed. The characterization often arises within debates about the ideological values of identity politics, intersectionality, and social privilege.” See https://en.wikipedia.org/wiki/Oppression_Olympics .

Some people engage in this by broadcasting all of their perceived disadvantages on their social media profiles or by bringing them up in discussions or debates. Anyone who is an ethnic minority is seen as being oppressed vs others who are of the dominant ethnicity. Anyone who has a non-straight sexuality is seen as being oppressed vs others who have a straight sexuality. A trans identity ‘trumps’ not having a special gender identity. Having a mental illness trumps not having a mental illness. Having a physical disability trumps being able bodied, etc. Having multiple ‘disadvantages’ makes you more oppressed: a gay black male is more oppressed than a gay white male; a disabled person who identifies as trans is more oppressed than a disabled person who does not identify trans, etc. This ‘game’ of supposedly being the most oppressed is won by the person highest on the totem pole of oppression. However, it is not clearly defined who this is when people with an equal number but different perceived disadvantages ‘compete’: Is a religious-minority gay black male more or less oppressed than a trans-identifying disabled white female?

A kind of bottom surgery for males which involves removal of both testicles. When the gonads (in this case, testes) are removed, the person will have to take hormones for the rest of his life because his body can no longer make enough of its own sex hormones and he will be infertile. The scrotum may or may not be removed. If the patient may want SRS in the future, the scrotum is best left in place to use during SRS to create the ‘labia’.

The act of telling third parties about someone else’s trans status or non-straight sexuality.

A prosthetic penis worn by some TiFs to create a bulge in their underwear. Some of these packers can be used to stand to pee (STP), others are just decorative. Small packers for children are being sold online too.

A disorder where the person has a preference for sexual activity with a prepubescent child. In most countries it is illegal to act upon this because of the inability of minors to consent to sexual activity (with adults) and the harm such sexual activity does to children.

A sexuality in which someone is attracted to people regardless of their sex or gender identity. It is not clear how this differs from bisexual although it may explicitly mean that the person is also attracted to trans-identifying people.

“Persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature.” (From StatPearls, Kristy A. Fisher; Raman Marwaha, ‘Paraphilia’.) Examples are: exhibitionism, voyeurism, sadism, masochism, fetishism, and transvestic fetishism.

Also called adult baby syndrome. A sexual fetish that involves role-playing as a baby/young child. Sometimes combined with crossdressing.

The act of presenting as the opposite sex so convincingly that other people will not notice that the trans-identifying person is not the sex that they appear to be. Some trans-identifying people may never pass whereas others may sometimes pass or may pass in certain clothes or certain situations but not in others. For instance, they may pass when on the phone but when another person sees them, that person will notice (‘clock’) the trans-identifying person is of the sex opposite of that which they are trying to convey.

When someone has finally ‘peaked’, achieved ‘peak trans’: having realised that the extent of transgender ideology means they can no longer tolerate, accept, or support it.

Removal of the penis. This is part of genital surgery as part of medical transition for males.

A kind of bottom surgery for males that is the same as a vaginoplasty but with the difference being that the penis is preserved, meaning penile-inversion vaginoplasty is not an option.

Organisation in the USA for anyone involved in LGBTQ+.

Also called ‘bottom surgery’ for TiFs. This surgical process aims to create something that looks like a penis and scrotum out of female body parts using the female genitalia for the scrotum, and uses another donor site on the body to harvest a full-thickness skin graft to create the ‘neophallus’ (a skin roll attached to the groin):

• Radial forearm free flap (RFF) phalloplasty uses tissue of one of the forearms leaving a big hole on the forearm. 

• Anterolateral thigh flap (ALT) phalloplasty uses tissue of one of the thighs leaving a big hole on the thigh. 

• Musculocutaneous latissimus dorsi flap (MLD) phalloplasty uses tissue from the back leaving a big hole on the back area. 

• Abdominal (‘abdo’) phalloplasty uses tissue flaps from the abdominal area that are flipped around and stitched together to close the hole created by removing this tissue. 

• Single-scar phalloplasty (SSP) uses a skin expander on the thigh that needs to be regularly filled to create excess skin. This extra thigh tissue is then used to create the neophallus. The patient is left with a line scar only as opposed to a big hole at the donor site. 

• Superficial circumflex iliac artery perforator (SCIP) flap phalloplasty uses skin and tissues in the waist area to create the neophallus, leaving a single scar. 

• Gracilis muscle flap phalloplasty uses the gracilis muscle (located on the inside of your upper legs) to help build the neophallus in an effort to prevent fistulas from forming. Other donor tissue may also be used. 

The neourethra will be created from another full-thickness skin graft that is taken from, for instance, the forearm, or may be created from a buccal graft (the inside of the mouth), the labia minora, or the vagina. The clitoris can be buried underneath the skin at the base of the neophallus or left exposed on the outside of the body.

When using one of the techniques that leave a big hole at the donor site, this hole will need to be covered with a split-thickness skin graft from another part of the body. Such a graft only takes a thin layer of shaved skin from the donor site for this graft, leaving a relatively faint scar once healed.

Testicular implants can be inserted into the ‘neoscrotum’. Of course, these are cosmetic only as they will not create sperm.

It is possible to have some kind of erectile functionality in the neophallus by getting a penile implant. There are three types of implants:

• A non-inflatable, semi-rigid implant that can be either malleable or non-malleable. This provides some rigidity to the neophallus but there is no option to go from ‘flaccid’ to ‘erect’: the neophallus will only have one rigidity state and can be bent up or down to create an ‘erection’. 

• A 2-piece inflatable implant. 

• A 3-piece inflatable implant. 

The inflatable implants are composed of cylinders, a pump, a reservoir, and a control toggle. This makes it possible to alternate between a ‘flaccid’ and an ‘erect’ state. These implants are at a higher risk of malfunction and may need to be replaced several times over the course of someone’s life.

There are risks associated with a penile implant, such as erosion of the implant through the penile tissues (when parts of the implant make a hole in the skin through constant pushing onto the skin; once the skin is broken, there is a risk of infection). The cylinders may also come lose from the rest of the implant meaning a surgery is needed to try to put them back or replace the whole implant.

These surgeries are not like typical cosmetic surgeries in that they are experimental and aim to add a function that the patient never had (meaning these procedures done in females are not reconstructive (a phrase that is sometimes used): you can’t reconstruct something that was never there and never meant to be there in the first place).

For a longer description including photos of some phalloplasty procedures, see https://tau.amegroups.org/article/view/26419/24265 ('Phalloplasty: techniques and outcomes', by Aaron L. Heston et al. in Vol 8, No 3 (June 27, 2019) of Translational Andrology and Urology).

Also called neophallus. A ‘penis’ created from tissue harvested from one of various areas of the body.

A USA non-profit organisation that provides reproductive and sexual healthcare and sexual education. They also provide hormones to people who want to medically transition on an ‘informed-consent’ basis (meaning that people do not need a diagnosis of gender dysphoria).

Post-operative, designating someone has had all the surgeries they want (usually refers to having undergone bottom surgery).

Pre-operative, referring to someone before they have been able to have all the surgeries they want (usually refers to someone who wants bottom surgery but who has not yet undergone it).

When puberty beings too early in a child, at an age that is inappropriate (before age 8 in girls and age 9 in boys). This is a medical condition and has nothing to do with transgenderism. Puberty-blocking drugs may be prescribed to children with precocious puberty but this is not without risks.

The pronouns that a trans-identifying person may request or demand others to use when referring to them, not only in their presence but also in their absence. This is generally the pronouns used for the opposite sex but may also be newly-invented words. Also see Pronouns and Neopronouns.

A hormone important for females. It is produced mainly in the ovaries and plays a role in menstruation and pregnancy. It is sometimes prescribed to TiMs hoping it will act as an anti-androgen and help with breast growth but it is not well know what it does in males as the action of this drug has only been studied in females. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160650/ .

Words that are used instead of a noun or a noun phrase. In English, these are: she/her for females and he/him for males. They/them is used for groups of people and for a single person provided the sex of that person is not known or the person can be of either sex. In English, they/them has not been used for a single person whose sex is known for a long time.

Gonadotrophin-Releasing Hormone (GnRH) analogues/agonists that stop puberty. The GnRH agonist binds to the GnRH receptors in the pituitary (see hypothalamic–pituitary–gonadal (HPG) axis) which then releases the hormones FSH and LH (as normal). After the initial flare response, if GnRH agonists remain present through use of puberty blockers, the pituitary gland becomes desensitised (‘hard of hearing’/‘deaf’) to the GnRH agonist and it releases less FSH and LH meaning the testes or ovaries are not stimulated as much and do not produce as much of their sex hormones. Used in some children who identify as transgender so they can ‘pause’ puberty so they have ‘more time to think’ whether they want to continue transition with cross-sex hormones and surgery. These drugs are not indicated for use in this population making this kind of use experimental. Puberty blockers are advertised as being harmless and simply pausing puberty, insinuating that once a child stops taking these drugs they will continue to develop as if nothing happened. However, it is becoming more and more clear that the effects of these drugs may not be temporary nor fully reversible. There are concerns about fertility, sexual abilities, bone density, and cognitive development. A 2022 research paper discusses current concerns, see see https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2121238.

A catch-all term for people who have a non-straight sexuality and/or identify as trans in one way or another. Used to be seen as a slur but has since been reclaimed.

Wikipedia describes this clearly: “Queer theory is a field of post-structuralism that emerged in the early 1990s out of queer studies (often, formerly, gay and lesbian studies) and women's studies.[1] The term can have various meanings depending upon its usage, but has broadly been associated with the study and theorisation of gender and sexual practices that exist outside of heterosexuality, and which challenge the notion that heterosexual desire is ‘normal’.” See https://en.wikipedia.org/wiki/Queer_theory

Someone who is unsure of their sexuality and/or gender identity.

The perceived sudden onset of gender dysphoria in an adolescent or young adult, possibly influenced by factors such as the person’s ‘in real life’ peer group and/or through interaction with others online, as observed by parents. See Dr Lisa Littman’s website: https://littmanresearch.com/ and her publication in the scientific journal PLOS ONE : https://doi.org/10.1371/journal.pone.0214157 .

The trial period of social transition (living ‘as’ the opposite sex fulltime) before medical transition to see if this is what a trans-identifying person really wants. This used to be a requirement before a doctor would prescribe drugs or surgeries as part of medical transition. In the current day, such a test does not seem to be required in many places and some people choose to be on drugs as part of medical transition for a while before they intend to socially transition.

Social news aggregation, content rating and discussion website. ‘Groups’ revolving around a specific interest have their own area of the site called a ‘subreddit’ or ‘sub’. Trans-identifying people are very active on this platform, and you can find many ‘subs’ for trans-related topics. Amongst all other topics of interest, there are many subs where people post/share pornography.

International group composed of women of all walks of life who aim to uphold and further rights of women in the UK and Ireland.

The second or subsequent gender transition. For instance, a male ‘transitions’ to another gender identity, then detransitions back to male/man, but later retransitions to a gender identity that is not male/man.

The feeling of gender dysphoria one supposedly gets if they transition but are not ‘actually trans’. For example, a female who is not ‘genuinely trans’ socially transitions and takes hormones to transition to ‘transman’ but feels dysphoria from the virilising changes to her body from the testosterone.

Usually used to refer to surgical revision. This refers to additional surgery to try to correct a complication or an issue arising from an earlier surgery. It is common for TiMs who have had vaginoplasty to choose a revision surgery once they have healed from the first surgery to improve aesthetics (the look of the vulva). Revisions may be needed/wanted after any of the transgender surgeries.

Surgery that removes parts of the floating ribs with the aim to create a more-defined waist. Sometimes performed on TiMs although it is not a common surgery.

Rupaul Andre Charles, a famous American drag queen going by the name RuPaul. He is known for his TV show RuPaul’s Drag Race.

An altersex identity for people who wish to have a mixed genital set, generally refers to wanting to have both a vagina and a penis. According to the description on the subreddit for this community, both trans-identifying people and people who do not identify as trans (‘cis’ people) can be Salmacian.

Self-identification (self ID) in relation to legal sex. The act of being able to identify as the opposite sex, legally, without needing therapist letters or undergoing/having undergone medical treatment as part of transition. TRAs generally advocate for self ID, even in the face of the obvious safety and safeguarding issues this would cause, mainly for females and children.

Sometimes called ‘biological sex’ or ‘natal sex’. The condition of being either female or male. In humans, this is an immutable (unchangeable) characteristic.

Misnomer. This term is used by TRAs to refer to the sex of a person, which according to them is ‘assigned’ at birth. This phrasing suggests that there is no objective basis or rationale for this. However, sex is observed and recorded at birth (and sometimes earlier, on an ultrasound) based on the appearance of the baby’s external genitalia. There is no assignment: there is an observation that is being recorded. The term 'sex assigned at birth' only makes sense when used to refer to someone with a disorder of sexual development (DSD) who has ambiguous genitalia and where the doctors could not tell with 100% confidence what the sex of the person is.

Rights awarded to people based on their sex. For instance, the rights of females to have access to female-only spaces. This right is based on being female. Males have the right to male-only spaces. Males don’t have the right to female-only spaces because they are not female, and vice versa.

A scientifically-inaccurate statement about the nature of sex in humans. This statement suggests that there are more than two sexes, possibly even as many a there are people on earth or that there is some gradient of sex between female and male. However, that is not the case. In humans there are only two sexes: female and male. People who have a disorder of sexual development (who have an intersex condition) are still either female or male.

Surgery on the genitals that involves rearranging the existing genital tissues (and sometimes other parts of the body) in such a way that the genitals no longer look like they are of the sex of the patient and resemble, cosmetically, the genitals of the opposite sex. For females the typical options are metoidioplasty and phalloplasty and generally includes a hysterectomy (removal of the uterus) and vaginectomy (removal/closure of the vaginal canal). For males, the main options are orchidectomy (removal of the testes), vulvoplasty (creation of a vulva), and vaginoplasty (creation of a vulva and a canal, with various techniques to choose from).

The preconceived ideas about how someone should be, act, or behave based on that person’s sex. For instance, the idea that females are more emotionally sensitive, passive, and more caring and that males are more aggressive, strong, and better at leadership.

An enduring pattern of sexual/romantic attraction to people of the opposite sex and/or same sex.

English former Olympic swimmer who has spoken out against TiMs competing in female sports. For this, she has faced backlash from TRAs.

Slang term used by some TiMs to refer to their penis.

Irish plastic surgeon working in the USA who heavily promotes surgery as part of medical transition on her social media pages (such as on the TikTok platform). She made it into mainstream media outlets at the end of 2022 when a patient of her spoke out about how she almost died from complications following a double mastectomy (that she had for cosmetic reasons) and describing how all of her concerns after surgery were ignored or downplayed by Dr Gallagher and her team. This patient was obese and went to Dr Gallagher because her BMI was too high for many other surgeons to be willing to perform this cosmetic surgery on her.

Slur for males who do not show stereotypically masculine traits. Also used for males who dress up in stereotypically effeminate clothing for sexual pleasure.

Short sexual videos where images of attractive women are interspersed with images of erect/ejaculating male genitals and slogans to encourage the viewer to be sexually interested in males and serve these males sexually.

The sexual act of turning oneself or someone else into a ‘sissy’.

Standards of Care (SOC) is a document released by WPATH at an irregular interval. In 2022, SOC 8 was released. According to WPATH: “The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment.” See: https://www.wpath.org/publications/soc .

UK LGBTQ+ rights charity that runs the ‘Diversity Champions programme’ for employers. In 2021, there has been a debate about this program following accusations of the charity stifling free speech and pushing employers to adopt policies that could negatively affect women. Consequently, several high-profile employers have ended their partnership with Stonewall.

The aspect of transition that does not include medical changes to the body. This usually includes going by a different name than the person’s birth name (the birth name is called someone’s deadname), changing the way they present themselves (fashion, hair, accessories), and using the pronouns that are used for the other sex.

The situation in which a trans-identifying person is trying to live without outing themselves, i.e., they are not open about their trans status. They may not be out to anyone currently in their life, or they may be out to the people closest to them such as their partner and close friends but choose to keep their trans status hidden from people less close to them such as acquaintances and co-workers. Some people aim to not tell anyone, not even people they intend on dating or having sex with. In some regions, not disclosing your trans identity to someone you have sex with is classified as rape by deception, which is a crime.

Stand to pee, either as the act of urinating whilst standing upright, or as a name for a device that helps females to urinate whilst standing upright (such as some packers, or a Shewee (a funnel)).

A forum for a specific topic on the Reddit platform.

The term ‘super straight’ was coined by a young man in a TikTok (short video clip) in which he states he is only attracted to girls/women who are female, meaning that his sexuality does not include any males irrespective of a male’s identity. This term got a life of its own as others claimed to be super gay, super lesbian, or super bi. This got backlash from trans-identifying people as in their eyes, it is transphobic to be a straight man who does not want to date a TiM (or for a lesbian to not want to date a TiM), etc. Few people use ‘super …’ to seriously describe their sexuality, but the origin of this term is possibly a direct consequence of trans-identifying people trying to pressure others into dating/having sex with them. According to trans ideology: “You are a straight man, and I am a transwoman, and transwomen are women, so you should date me.” But for many if not most people, their sexuality does not work like this.

A clitoris that has grown in length and/or circumference through use of testosterone. Growth can be 1–5 cm (0.5”–2”) and the process of growth may be painful or uncomfortable. Also called ‘bottom growth’. Considered to be an irreversible change. This ‘T dick’ is used in the process of metoidioplasty, a type of bottom surgery for females.

A scale for physical development of children into adulthood defining physical measurements of development of primary and secondary sex characteristics. The word ‘Tanner stage’ is often used by TiMs when discussing their gynaecomastia.

Used as a slur to brand anyone (but mainly women) who does not fully support transgender ideology whether that person is a feminist or is radical. ‘TERFs’ themselves generally prefer to be called gender critical.

The male sex hormone produced in the testes and produced to a lesser extent in the ovaries of females. Testosterone (or ‘T’) is the cross-sex hormone prescribed to minor and adult females who want to ‘transition’ to ‘male’. It is a powerful drug also used by some athletes and bodybuilders to enhance athletic performance and body building capabilities. Testosterone use is banned from sporting competitions because it gives people an unfair competitive advantage over people not using this performance-enhancing drug.

Testosterone use in females can have the following effects and side effects:

• Skin will thicken and become more oily, pores will become larger 

• Increased sweating 

• Change in odour of sweat and urine 

• Acne 

• Increase in body hair and in thickness of the hair, facial hair growth, and possibility of male-pattern baldness or complete hair loss 

• Redistribution of bodyfat away from thighs and hips and towards the belly; fat in your face will distribute differently, somewhat changing your facial features 

• Increase muscle definition and increase in muscle mass depending on exercise 

• Veins become more prominent 

• Voice will lower due to thickening of the vocal cords 

• Vaginal atrophy similar to post-menopausal women (dryness, irritation, bleeding during penetration) 

• Loss of menstrual period (but testosterone is not a form of birth control) 

• Weight gain 

• High blood pressure 

• Increase in cholesterol (possibly increasing risk of heart problems) 

• Sleep apnoea 

• Type 2 diabetes 

• Pelvic pain 

• Infertility (but testosterone is not a form of birth control) 

• (Painful) growth of the clitoris 

• Blood clots 

• Producing too many red blood cells (polycythaemia) 

It is not possible to pick and choose which effects a female will experience. Some females use a relatively low dose (‘microdosing’) in an effort to prevent too much virilisation (virilisation is the process in which a female develops characteristics associated with male hormones) but that is not a guarantee for preventing a full beard or male-pattern baldness, for instance.

Testosterone can be administered in different ways. A common way is injection but there are also ‘pellets’ (a small implants placed under the skin), a patch that is stuck onto the skin, oral capsules, and gel. Use of testosterone gel can be harmful to people around the user as the gel can rub off on others (called secondary exposure; the drug can affect people of all ages, including children of any age, and can cause premature puberty and genital enlargement in children).

The FDA has only approved testosterone products “for use in men who lack or have low testosterone levels in conjunction with an associated medical condition.” The use of testosterone by females is thus experimental.

A TiM. This term is mainly used by and for adults despite having the word ‘girl’ in it.

A social media platform for short-form video hosting. Users can post their own short videos and/or browse and react to videos created by others.

Surgery performed to correct common defects of the toes. Additionally, this surgery is also performed for the purpose of reducing the size of the foot in TiMs, but this is not very common, and it may only be possible to reduce the foot by one or two shoe sizes.

A girl (a female minor) who doesn’t adhere to sex stereotypes for females.

See Double mastectomy and Breast augmentation.

Removal/reshaping of part of the thyroid cartilage (the Adam’s apple). One form of FFS.

Trans incel (involuntarily celibate).

A TiM who is attracted to females. A straight male who sees himself as a lesbian.

A trans-identifying female (TiF) who is underaged.

Online platform to share transgender surgery results/experiences. The site was taken offline in 2022 by the owners but came back towards the end of that year.

An unofficial term used to refer to a parent who is confused about their own gender or has an emotional agenda of their own and uses their child in their trans activities, to the detriment of the child, whilst claiming the child’s trans identity is coming from the child themselves.

A female who identifies as transgender/as a man or as a male. A ‘transman’ or ‘transboy’. May also include females who identify as non-binary but they will generally not describe themselves as ‘transman’ or male.

A male who identifies as transgender/as a woman or as a female. A ‘transwoman’ or ‘transgirl’. May also include males who identify as non-binary but they will generally not describe themselves as ‘transwoman’ or female.

Another word for transgender.

International transgender day of remembrance takes place on November 20. This is to memorialise trans-identifying people who have been murdered solely for them having this identity and to draw attention to violence against this demographic.

International transgender day of visibility takes place on March 31 to celebrate trans-identifying people and their contributions to society, and to raise awareness of discrimination these people may face.

An umbrella term that appears to encompass anyone who does not identify as cisgender. Trans(gender) is an identity that people choose for themselves. Some people who choose this identity experience gender dysphoria, a mental health condition, whereas others who choose this identity do not experience gender dysphoria.

Transgenderism, transgender ideology, or trans ideology is the worldview that asserts that humans have a gender and that in some people, this gender does not align with the person’s physical sex (despite sex and gender supposedly being two different things).

An underaged TiM.

A word used to describe TiMs; males who do not identify as a man and who may identify as a woman.

A word used to describe TiFs; females who do not identify as a woman and who may identify as a man.

The act of a male choosing a trans identity not because he ‘feels’ like a girl/woman but because he is sexually frustrated as an incel and thinks presenting as a TiM will improve his dating prospects and his life overall.

The process of social changes (social transition) and medical changes (medical transition) aimed to ‘live as’ the opposite sex. The aim is to be perceived as (passing) the opposite sex by others.

Celebrating a transgender identity.

A trans-identifying female (TiF). Also: ‘man of trans experience’.

Wikipedia has a clear definition: “Transmedicalism is the idea that being transgender or transsexual is contingent upon experiencing gender dysphoria or requiring medical treatment to transition.”

A merging of the words ‘trans’ and ‘hyperbole’. Refers to the hyperbolic language often used by TRAs when they are trying to advocate for their cause, such as claiming trans-identified people are at a high risk of murder.

When someone identifies as a different race than what they are, e.g., when a white person identifies as black (such as Rachel Dolezal). This is not commonly accepted as a ‘real’ identity by the wider public nor in trans spaces.

Activists, generally trans-identifying people but also their allies, who try to advance what they perceive to be rights for trans-identifying people. This could mean anything from males being allowed to enter sports competition in the female division to males being allowed in female-only toilets, prisons, or domestic-violence shelters to males being accepted for women-only shortlists and prizes. It can also mean advocacy for any and all desired medical treatments for trans-identifying people to be covered by state healthcare or private healthcare insurance, or demanding representation of trans-identifying people in areas such as politics and media. Other areas of activism are administrative, in demanding that people can self-identify (self ID) legally, meaning that people can legally change their sex without the requirement for therapist letters or having undergone medical treatment as part of transition. The call for females to use male-only spaces is much less loud possibly because fewer TiFs feel entitled to male-only spaces and/or fewer TiFs want to use these spaces. It is also possible that TiFs who do use male spaces pass more often and/or are not causing any trouble and are thus not commonly seen as a problem. Finally, male violence is a threat to everyone, in particular to females, whereas female violence isn’t the same kind of issue nor of anywhere near the same magnitude.

Someone who feels their gender identity does not match their sex (experiencing gender dysphoria) and who transitions socially and medically. This now seems to be an outdated term and ‘transgender’ is used more commonly. Some people still use this term to describe themselves, generally when they feel that they are a ‘real’ trans person because of experiencing gender dysphoria and for having undergone all of the medical treatments including SRS.

Term used by ‘real’ trans-identifying people for others who identify as trans for reasons other than being ‘true trans’ (i.e., experiencing gender dysphoria), such as for attention, for social brownie points, for fun, because they think it will make them more popular or ‘cool’, etc.

The (ex) partner (usually a woman) of a trans-identifying person (usually a TiM).

A trans-identifying male (TiM). Also: ‘woman of trans experience’.

A type of tape used for flattening parts of the body that trans-identifying people don’t want to stick out, i.e. breasts and male genitalia.

An online/slang term for a trans-identifying person who is also an incel. Generally refers only to TiMs.

Transphobia/transphobic is used to refer to ideas, attitudes, policies or people that TRAs consider to not be fully supportive of transgender ideology. For instance, not wanting to date someone who identifies as trans is considered transphobic by some. A school policy that does not allow any males into female-only spaces (such as toilets and changing rooms) is considered transphobic by some, because it excludes ‘transgirls’ from the toilets and changing rooms they want to use and they feel entitled to use.

Having a sexual or erotic interest in cross-dressing.

A cross dresser (CD). See Cross-dressing.

Slang term for a male who is not transgender but who cross-dresses because he gets turned on when straight men mistake him for a woman and fall in love with him.

Used to describe someone who experiences negative emotions as a result of something else, such as hearing another person’s opinion, seeing a piece of art they find offensive, or learning of others’ actions they disagree with. For instance, telling a TRA that ‘transwomen’ are men will likely trigger them (make them upset, angry, sad, etc.).

Internet slang for a transmedicalist.

When a male tries to reduce his genital bulge to achieve a flat front. The testicles can be pushed into the inguinal canals and the penis can be pushed into the crotch region, using tape to fix it all into place. This can be painful and cause build-up of sweat and body odour. It is also possible to damage the skin, and tucking can make it time-consuming to use the toilet as the tuck will have to be undone to urinate. Alternatively, tighter underwear (a ‘gaff’; compression underwear) can be used to flatten the male genitals.

Internet slang for a person who believes that gender dysphoria is not an essential trait to being transgender (from ‘too cute to be cisgender’).

Medical specialist that treats conditions of the urinary tract system (kidney, bladder etc.) and male reproductive organs. Some urologists perform phalloplasty and metoidioplasty surgeries (TiF bottom surgery).

Surgery that removes all or part of the vagina. This requires a hysterectomy (removal of the womb/uterus) which may be done as a separate surgery before vaginectomy.

A kind of bottom surgery for TiMs that includes removal of the penis and testes and aims to create a canal (called a neovagina) inside a hole created in the perineum and pelvic area with the aim of making penetrative sex in that canal possible. Part of the glans of the penis is used to create the ‘neoclitoris’ and the scrotum is used to create the ‘labia’ and sometimes also for part of the canal. Different tissues can be used to create the canal:

• In penile-inversion vaginoplasty (PIV) the skin of the penis is used to create the canal. 

• In peritoneal pull-through (PPT) vaginoplasty, peritoneum (lining of the abdominal wall) is used to create the canal. 

• Tunica vaginalis (tissue that sits around the testes) can be used to create the canal. 

• A part of the sigmoid colon can be used to create the canal in a technique called intestinal vaginoplasty. 

A less common form of this surgery is penile-preservation vaginoplasty (PPV). The penis is left alone whilst other tissues are used to create a canal in the perineum. This can include removal of the testes and using the scrotum to create ‘labia’. Alternatively, the testicles and scrotum are left intact, and the patient only has a canal in the perineum without any ‘labia’.

When someone has undergone this surgery, they will need to dilate to prevent the canal from closing up. This means that the person will need to use hard plastic/glass dildos to keep the canal from closing up in several sessions a day in the first weeks/months after surgery. The frequency of dilation can usually be reduced to a couple of times a week once the person has healed.

When the gonads (in this case, testes) are removed, the person will have to take hormones for the rest of their life because their body can no longer make enough of its own sex hormones. The patient is also infertile after the testes are removed.

This surgery creates a canal that ends in a dead end: there will not be a cervix or uterus. Uterus transplants are experimental in females and even more experimental in males. This is not something offered currently or likely ever as a uterus transplant is for the purpose of pregnancy. This would involve a foetus who did not consent to being part of a medical experiment.

These surgeries are not like typical cosmetic surgeries in that they are experimental and aim to add a function that the patient never had, meaning these procedures done in males are not reconstructive (a phrase that is sometimes used): you can’t reconstruct something that was never there and never meant to be there in the first place. This also applies to the TiF genital surgeries.

An adjective often used with ‘argument’, meaning that the argument has a sound basis in logic or fact, is reasonable, or cogent. However, TRAs use this word a lot to refer to people’s identity being ‘valid’, to mean: a real thing, or: legitimate, even when not being rooted in logic or fact.

TiM competitive cyclist and TRA who competed in the women’s and won first place. He has a PhD in philosophy, not in a medical or natural science, yet this does not stop him from commenting on the physiology of humans. He denies the link between testosterone and athletic performance. He also misrepresents data to fit his narrative that males do not have an unfair competitive advantage over females.

Surgery to the voice cords aiming to give the patient a higher-pitched voice hoping the voice will sound less male and more female.

A kind of bottom surgery for TiMs that involves removal of the penis, scrotum, and testes and aims to create a vulva. No canal is created, so penetration is not possible. This also means dilation is not possible and thus not required. A canal can be added in a later surgery although penile-inversion vaginoplasty will not be possible then as the penis was removed in the first surgery.

An approach in healthcare in which a patient is closely watched but no treatment is given unless symptoms appear or change. This approach has been applied to people who seek help for gender dysphoria: they are not undergoing transition, but they are followed over time to see how they are doing. In most of these people, the gender dysphoria resolved over time.

A Korean spa in Los Angeles (CA, USA) involved in a controversy when they allowed a TiM (a male with a penis, allegedly a middle-aged man going by the name Darren Agee Merager) into the female-only facilities where he allegedly exposed himself to girls and women. Women complained about this to the spa staff, with one of these women recording the exchange. This video was spread online via social media. Darren Agee Merager is a registered sex offender and has previous convictions for indecent exposure.

Adjective that means ‘alert to racial prejudice and discrimination’, derived from African-American English. It is used to refer to people and ideas that are aware of and often aim to resolve societal issues such as sexism, racism, and other forms of discrimination. This is frequently attempted by the pendulum swinging too far to the other end using other forms of discrimination to achieve the aim of more representation, such as by using affirmative action for women, ethnic minorities, sexual minorities, and trans-identifying people, at the expense of possibly more-capable candidates who do not tick off a minority box.

Adult human female.

The term used by some gender-critical people to refer to drag queens. In their eyes, drag queens wear womanface, like some white people wore blackface: both are an offensive caricature of people based on a protected characteristic (sex, race).

Formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA). This organisation releases Standards of Care (SoC) documentation for transgender health.

See Cross-sex hormones.

A Japanese term for manga (Japanese style comics or graphic novels) featuring sexual romance between men and is created mostly by and for women. Also known as ‘boy’s love’ (BL).

Video-sharing social media platform. Pornography is not allowed but content about (niche) sexuality is easily found.

All medical treatments and procedures can have unintended effects/side effects. It might be difficult to fully understand what some medical terms mean and how experiencing such a complication might affect your health, especially if you are young and/or have never had to deal with health issues before. For this reason I am including a small, basic dictionary of medical complications. Not all people will experience complications, and some complications are (very) rare, but as some of these rare complications can have devastating consequence for someone's body and their life, it is vital that people understand what they are choosing to risk when they undergo cosmetic interventions (drugs, surgery). Always read all information provided to you and ask your endocrinologist or surgeon all your questions before you start taking hormones/blockers or undergoing a procedure!

You can find a lot of first-person accounts of medical transition (use of drugs and cosmetic surgeries) on YouTube, in Reddit communities, (closed) Facebook groups, and sometimes in news articles.

Blood clot
Blood can form clots during/after surgery. These can cause problems when they get stuck in an artery and prevent blood from reaching certain tissues or organs (such as in the case of a pulmonary embolism, where a blood clot blocks blood flow to a lung, or in an ischaemic stroke where a blood clot blocks bloodflow to the brain) or when they prevent blood from flowing back to the heart (such as in deep vein thrombosis). It is possible to lose a limb to a blood clot. You can have permanent brain damage from an ischaemic stroke (caused by a blood clot). It is also possible to die from a blood clot that is not treated in time.

Blood loss
Losing blood is a risk for any surgery. When too much blood is lost the patient may need to receive a blood transfusion (where blood from other people is given to the patient to replace the blood the patient lost).

Bone health
Bone development takes place throughout childhood and puberty is one of the periods of rapid bone growth and mineralisation. Sex hormones are essential for bone maturation during puberty (see https://www.frontiersin.org/articles/10.3389/fendo.2022.967711/full). Use of puberty blockers (gonadotropin-releasing hormone (GnRH) analogues (GnRHa)) or progestins to block the body's own production of sex hormones can affect bone development and increase the risk for osteoporosis later in life (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9150228/). A review from 2022 states: "Results consistently indicate a negative impact of long-term puberty suppression on bone mineral density, especially at the lumbar spine, which is only partially restored after sex steroid administration." (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578106/). The NY Times dedicated an article to puberty blockers used in transgenderism and shared an anecdote about a Texas teenager who had very low bone density in the lumbar spine (the lower back) after a year on puberty blockers. No scan was performed at baseline (before the treatment) so it is possible this child had a low value to begin with, but because no scan was performed before use of the blockers, they will never know. The story of another teenager was also included. This teen took drugs from age 11 to 14 and no scans were performed until the last year of treatment. This patient developed osteoporosis and experienced a compression fracture in the spine with continued back pain as a consequence of this permanent disability caused by puberty blockers (see https://www.nytimes.com/2022/11/14/health/puberty-blockers-transgender.html).

Breast implant illness (BII)
This is a systemic complication associated with breast implants. Signs and symptoms can include joint and muscle pain, chronic fatigue, breathing problems, anxiety, depression, headaches, hairloss, memory and concentration problems. Women who have silicone gel-filled implants were more likely to be diagnosed with auto immune conditions such as Sjogren syndrome, scleroderma, or rheumatoid arthritis. Find more information here: https://www.breastcancer.org/treatment/surgery/breast-reconstruction/types/implant-reconstruction/illness/breast-implant-illness.

Catheter
A suprapubic (SP) catheter is inserted into the bladder through a hole made into the abdomen (belly); a Foley catheter is inserted through the urethra (the tube that transports urine from your bladder to the outside of your body) and held in place in the bladder by a water-filled balloon. Depending on the type of genital surgery and whether you have complications, you may only need a catheter for a few days or in extreme cases for months at a time.

Colostomy, ileostomy, urostomy
An ostomy is surgery to create an opening (stoma) from an area inside the body to the outside. This is done when there are issues with the tissue further down so the damaged area is avoided by funelling the body fluid out of the body before the problem area.

A colostomy is an opening from the colon (large intestine) to the outside through the abdomen (belly). A colostomy bag is then attached to catch the fecal matter (poop, stool). This bag needs to be emptied/replaced several times a day to every couple of days depending on the type of bag and consistency of stool. You may need a colostomy for a shorter period of time or for the rest of your life depending on what the reasons are. A temporary colostomy may be needed after colon surgery to remove cancer, for instance. You may end up with a permanent colostomy if a certain part of the colon had to be removed or permanently rested, or if you can not undergo more surgery due to other health problems. Information on living with a colostomy: https://www.nhs.uk/conditions/colostomy/living-with/.

An ileostomy is an opening from the small intestine to the outside through the abdomen (belly). This is performed when the colon needs to be removed of rested after surgery or treatment. A stoma bag is then attached to catch the fecal matter (poop, stool). This bag needs to be emptied/replaced. Information on ileostomy: https://www.nhs.uk/conditions/ileostomy/.

A urostomy is performed when someone's bladder is removed or urine can't pass through the bladder and urethra (for instance due to damage to the urethra after surgery). The procedure creates a stoma for the urinary system by using a bit of intestine. Also called an 'ileal cinduit urinary diversion'. The urine is collected in a pouch on the outside of the body.

Death
Every surgery comes with the risk of death either from the anaesthesia or the procedure itself, but usually death is a very rare surgical outcome. Certain factors may increase the risk of death from the surgery, such as in emergency operations, when the patient is of an older age, or when the patient undergoes a major procedure. See https://pubmed.ncbi.nlm.nih.gov/24021395/ for information in mortality (death) risk in various surgeries.

Death is a possible consequence of genital surgery for gender reasons, as described in a case study on an 18-year-old male who underwent vaginoplasty, who died from the results of an E. coli infection, see https://www.sciencedirect.com/science/article/abs/pii/S1083318816301747.

Dilating difficulties
Dilation is the process of using hard dildos to keep open the neovaginal canal/tunnel. This is required after vaginoplasty surgery to ensure the canal does not heal shut or shrink in length or width. It is possible to experience a lot of pain during dilation. A YouTuber ('Adea') who had vaginoplasty explained how he was in so much pain he was sweating and nearly passed out from dilation. Other people may experience less pain or even no pain but this might be due to nerve damage. This could result in them being rougher with their canal than is good for it, damaging the canal in the process (of dilation, or sex). It may also be impossible to dilate enough to not lose depth (length) or width because at some point you no longer have time to spend 4 hours a day on dilation and the cleanup. It may become impossible to dilate if the canal has gotten so shallow or narrow that the dilators are all too big, this can also make it hard to douche to clean out the canal. The result may be that the canal ends up with a pocket at the end that collects mucous, lube, body fluids (from sexual intercourse) and if it is not possible to douche well, this might result in infections and discomfort.

Diverticulum
Small sacs or pockets that can form in the (neo)urethra (urethral diverticulum) that fill up with urine. This may be accompanied by pain, frequent urinary tract infections, incontinence, or blood in your urine. This needs to be corrected with surgery.

A female who underwent phalloplasty genital surgery experienced a lot of complications including urethral diverticulum in her urethra. The diverticulum keeps filling and got infected so needed to be drained requiring her to wear a catheter again (see Exulansic's video 'Phalloplasty Philes: Your Own Portable Lake Lanier').

Embolism
This is when an artery is blocked by a foreign body such as a blood clot or air bubble. One cause of this is when a blood clot from the deep veins in your leg (deep vein thrombosis, DVT) breaks off and travels to another part of the body where it blocks blood flow. A pulmonary embolism is a blood clot like this that gets stuck in your lung artery where it blocks blood flow to your lungs. This is an emergency. See https://www.nhs.uk/conditions/embolism/. One patient who had phalloplasty genital surgery experienced a host of complications including bilateral pulmonary embolism (blood clots in both her lungs, but also her legs and pelvic area, she also had a urinary tract infection that developed into a kidney infection, it was bad; see Exulansic's video 'Phalloplasty Philes: Requiem for a Peen (Gruffin)).

A female reddit user describes how she underwent phalloplasty genital surgery and ended up with bilateral (on both sides) pulmonary embolisms with the beginning signs of tissue damage, at only 24 years old. She had to stay in the hospital for three additional weeks and ended up with a relatively short phallus at 3" in length 'on a good day' but the urethra hole at the top healed over so she needs another surgery to fix that (see Exulansic's video 'Phalloplasty Philes: The No-Eyed Trouser Snake').

Erosion or fracture of erectile device/implant
Some people who have undergone phalloplasty choose to have an inflatable erectile device implanted in the neophallus to imitate an erection. These devices are developed for males with erectile dysfunction so naturally their use in a surgically-created ‘penis’ will be experimental: a neophallus does not have the same anatomy as a penis. However, a new erectile device is being developed currently (in 2023) specifically for the neophallus. With the devices developed for males it is possible for the implant to erode out of the phallus, meaning that parts of the implant put pressure on the tissues and skin to the extent they are ‘working their way out’. This will need to be corrected in a surgery to prevent the skin from being broken and the parts of the device sliding out through the open wound (with the risks of infection that come with an open wound). One reddit user who posts on the phallo subreddit has seemingly had over 25 procedures related to her phalloplasty including several replacements/fixes of her inflatable erectile device, and this was all when she was in her late teens to early/mid 20s. As of July 2023 her phallus has failed after about 5-6 years since the first surgery because of a lot of internal scarring due to use of the erectile device, so the device had to be permanently removed leaving a short, creased neophallus. She is now considering a complete redo of her phalloplasty to try again... It is also possible to instead of an inflatable erectile device choose the semi-rigid rod implant (also called malleable penile prosthesis). This is a pair of rods that are implanted into the 'shaft' of the phallus and are anchored to the pubic bone. The implant is bent upwards for sex and downwards to be 'flaccid'. The rods themselves can fracture, although this appears to be rare, see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811081/.

Fistula
This is when an abnormal tunnel forms between two internal organs or an internal organ and the outside of the body. A fistula usually does not heal on its own and will usually require surgery to resolve. It is possible to have multiple fistulae at the same time. If one forms between your urethra (pee tube) and the outside of your body, you will leak urine from it when you pee. This is very common in women who choose phalloplasty with urethral lengthening. The result is that they will pee from one or multiple sites aside from the tip of their phallus, spraying urine everywhere. It is also possible for a fistula to form between the rectum or colon and the neovagina. The person may then leak faeces through the neovagina and/or get infections in the neovagina because poop bacteria are getting inside the canal. They wil also have problems with foul odour.

One story of a male who had a vaginoplasty who developed a fistula resulted in a temporary loop ileostomy causing him to become suicidal (see Exulansic's video 'Vaginoplasty Volumes: Tuck Everlasting (Reddit Chronicles)').

A female reddit user who underwent metoidioplasty genital surgery four weeks prior ended up with a fistula at the base of her 'scrotum' that leaks when she pees even if she tries pushing toilet paper onto it. Another user chimes in saying she experiences the same issue having developed a fistula after the initial surgery, but in her case she also had two failed repair surgeries so now 16 months after the initial surgery she is still dealing with a fistula (see Exulansic's video 'Metoidioplasty Moments: A Fistful of Fistula').

A female TikTok user who underwent phalloplasty genital surgery seemingly developed a fistula with urine coming out from around her 'scrotum' that required additional surgery to fix (see Exulansic's video 'Phalloplasty Philes: Pissing into the Windmill').

Another story is that of Ryan James, a female who had phalloplasty surgery. She developed a fistula and had to have a colostomy as a result of the vaginectomy (removal of the vagina) as part of the phalloplasty procedure (see Exulansic's interviews with Ryan James).

Granulation
Granulation tissue is a type of new connective tissue. This can form when healing from surgery. Pink granulation tissue is considered an indicator of healing. But unhealthy granulation tissue is dark red, often bleeds when touched, and may indicate the presence of wound infection. The latter may need to be treated. If it doesn't heal and causes other issues with the vaginoplasty, a repair surgery may be needed such as in the case of a male who had undergone rectosigmoid neovagina surgery but who had genital granulation tissue and also stenosis (narrowing) of the introitus (opening of the canal). The patient had two surgical revisions but this didn't help. The surgeons then used pig bladder tissue to try to fix the neovagina, see https://pubmed.ncbi.nlm.nih.gov/30413867/.

Haematoma
A form of localised bleeding, a bruise. This occures when veins or arteries are damaged (for instance, by a direct hit) and blood collects outside of the veins/arteries. This can result in a hard mass that changes colour over time as it heals. It is possible to develope a haematoma from surgery and when severe, the haematoma may require surgery to drain the blood that collected and/or control the bleeding. There is an infection risk associated with haematomas. See https://sanaramedtech.com/blog/treating-post-surgical-seroma-hematoma/.

A female who had metoidioplasty genital surgery developed a haematoma that kept refilling that needed to be squeezed/drained. Based on her own video it seems this was a very painful and traumatic experience (see Exulansic's video 'The Artery of War'; she also had an arterial bleed).

Hair growth inside neovagina/neourethra
During genital surgery the surgeons may use skin that grows hair to create the neovagina canal or the neourethra (such as base of the penis, the scrotum, the arm or leg or abdomen, or groin). Even when the patient underwent permanent hair removal of this skin before surgery, it is possible for some hairs to still come back and grow inside the neovaginal canal or the neourethra of the phallo. It is very difficult if not impossible to remove such hairs when the surgery has already been performed. It is possible for those hairs to grow as ingrown hairs and become infected, or for the hairs to cause infections even when not ingrown. There are stories of people being able to feel hairs inside the neovaginal canal, or for hairs to come out of the phallus. Sometimes hair may not have been removed permanently from the phalloplasty donor site resulting in hair growth on the phallus and a need to shave the phallus.

Implant rupture
It is possible for implants to get a tear and break open, such as breast implants or testicular implants. This will require surgery to correct by removing the implant. Testicular implant rupture is rare, but it is conceivable for this to be less rare when done in females if their 'scrotum' is positioned further down in between the thighs/with thicker thighs.

Incontinence (urine and/or faeces)
Incontinence is the inability to retain body fluids. Urinary incontinence is the unintentional passing of urine. Faecal incontinence, or bowel incontinence is when someone struggles to control their bowels. Both conditions can result from transgender genital surgeries due to these surgeries working with urogenital tissues and with/near the intestines. These conditions are often embarrassing and upsetting and can cause people to smell of urine or poop even if they frequently bathe. It may be difficult to deal with incontinence and sometimes surgery might be required. If you have run out of surgery options for urinary incontinence, you may need to use pads and pants or a catheter for life. For bowel incontinence there are pads to wear or a plug to insert in your rectum, drugs to change your stool, or surgery to fix damage or place an electronic device to help the anus work better (for sacral nerve stimulation) or injection of bulking agents to help make the anus stronger. Sometimes a colostomy is the best solution. There are several women who have undergone transgender genital surgery who ended up with a colostomy long-term and possibly permanently. There is a male patient who underwent vaginoplasty who ended up unable to empty his bladder and with an inability to pass stool which required such a sacral nerve stimulation implant (see Exulansic's video 'The Piss Toll').

Infection
The invasion and growth of germs (bacteria, viruses, yeast, fungi) in your body. Whenever your body is cut there is a risk of infection and although a lot of measures are taken during surgery to reduce the infection risk, it is possible to end up with an infection from surgery. It is possible to get sepsis from an infection.

In 2017 a research paper was published describing a case study of an 18-year-old trans-identifying male who underwent vaginoplasty surgery resulting in a severe E. coli infection that caused septic shock and multi-organ failure resulting in death, see https://www.sciencedirect.com/science/article/abs/pii/S1083318816301747.

There is a story of a female who underwent a phalloplasty genital surgery who experienced a lot of complications including numerous infections: urethral infection, staph infection, MRSA infection, septic shock, and Clostridium difficile infection. She may have had to undergo 10 surgeries as part of this effort to get a penis. She also had pulmonary embolisms and has hair growing on her phallus (see Exulansic's video 'Phalloplasty Philes: #1 Fan').

A female who underwent phalloplasty surgery developed an abscess on her arm at the site where surgeons placed a rod/tube under the skin hoping the surface of the rod would scar over so that this newly created 'tunnel' could later be used as the 'urethra' in the neophallus, see https://onlinelibrary.wiley.com/doi/full/10.1002/cia2.12137.

Infertility / sterility
Blocking puberty and/or using cross-sex hormones can affect someone's fertility whilst taking the drugs. It is not that clear whether this kind of drug use affects long-term fertility if someone were to stop taking these drugs. Time will tell. What is clear is that when the gonads (ovaries, testes) are removed, the person is permanently sterile. This means a male will not be able to father children, and a female will not be able to mother children. If a female has her uterus removed she will not be able to carry a pregnancy using another woman's egg either. Some trans-identifying people 'bank' sperm or eggs before they start using hormones in case they want to have their own child in the future. Some people stop their hormones for some months to start producing their own sperm/eggs to then 'bank' them, before continuing their hormone use. Creating a sperm sample is very simple as it requires maturbation into a collection cup if the male is able to do so. If this is not possible, the doctor can extract sperm directly from the testes but this is a medical procedure and thus more invasive than masturbation. Females will need to undergo hormone treatment to produce multiple eggs that are then collected using a needle that goes into the body. Embryos survive better than eggs when they are frozen so some females choose to have the collected eggs fertilised with someone's sperm (either their partner's or a sperm donor). This may mean that an underage female is using a sperm donor to fertilise her eggs so she has embryos for the future, meaning that the sperm donor's sperm is used to create embryos with eggs taken from a child. More experimental medical procedures include taking some ovarian tissue and keeping it in the freezer to try to use later to create eggs.

It is important to consider that there are no guarantees with fertility methods. Especially in the case were a female no longer has her uterus (but she does still have her ovaries or she has already banked eggs or embryos), her options to become a parent may be limited as gestational surrogacy (where another woman carries a baby that is not genetically related to her as she did not provide the egg) may be illegal in some countries or it may be illegal to pay a woman for this 'service' resulting in very few women wanting to be a surrogate (this also applies to gay male relationships where by definition there is no female). Even if commercial surrogacy is available, this may not be covered by insurance and the costs may be around $50k-100k (2023 estimate).

Loss of sensation
The loss of the ability to sense with a part of your body, for instance due to nerve damage from surgery. The affected area or body part may no longer be able to feel any touch or may not feel hot/cold or may not feel pressure anymore. This may only affect a small area or might affect a larger area. If this is only a small area on your leg, this may not be such a big deal. But a small area in your genital area may encompass most of your genital so the damage may have a much larger effect on your life. Loss of sensation in your hand may be dangerous if you can no longer feel hot/cold or pressure as you might end up hurting yourself without realising it.

Necrosis
Permanent death of tissues due to a lack of blood flow to this tissue. It is possible for parts of the neovagina or neovulva to become necrotic and fall off or requiring removal. It is also possible for this to happen to part or all of the neophallus (called ‘flap failure’ or ‘flap loss’). This can also happen to tissues in the area of the phalloplasty donor site if blood flow to it has been affected such as in a reddit user who had tissue in her leg (her donor site for phalloplasty) rot.

A case is described in which a male who received what was considered a successful recto-sigmoid vaginoplasty 18 months prior experienced a life-threatening small bowel obstruction. The authors warn that it is possible to get such a life-threatening complication at any point after the surgery: "The rate of adhesive small bowel obstruction is highest in the early period of any intra-abdominal post-operative surgeries, but the risk remains life-long. Transgender women receiving complicated vaginoplasty should be instructed to continue long-term follow-up to ensure early detection and management of post-operative complications." (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232285/). This suggests that after such a surgery the patient may at any point in the future need specialised urgent/emergency care. How would this knowledge affect someone's life? If patients are made aware of this risk, will they still go on backpacking holidays where they may be hours away from the nearest road? Will they be worried about any periods during which they may not have healthcare insurance and will they go into major debt if they need this surgery during such a period without insurance? Are patients even told about this life-long risk before they undergo this surgery?

Neovaginal prolapse
This is the term for when the neovaginal canal is not properly attached inside the hole in the pelvic area and partially or fully comes out of the opening in the perineum. This will require surgery to correct and may mean loss of the canal. A study published in 2014 reported that between 4-12% of males who had vaginoplasty experienced a partial or total prolapse dependent on the the technique used to attach the canal, see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033431/.

Nerve damage
It is possible for nerves to be damage during surgery. This can result in changed sensation such as tingling, numbness, burning, loss of sensation, muscle weakness, or pain. This can resolve over time or be corrected with surgery, or may be permanent.

Pain
It is expected to experience pain after a procedure when you have maxed out your pain medication or are coming off of pain medication, and healing can hurt too. But this is expected to get better over time over a period of weeks and a couple of months. However, it is possible to keep experiencing pain or dyscomfort after surgery even months or years later.

Shape Shifter experienced intestinal cramps during sex in his colon vaginoplasty because, according to his knowledge, the colon used to create the neovaginal canal remains part of the digestive system, at least with regards to the nerves and how the brain interprets pain in that tissue. The colon is adapted to process (soft) stool as part of the digestive process, not to be touched from the inside with fingers, dilators, dildos, or a penis. He talks about his experiences undergoing several vaginoplasty surgeries and revisions on his YouTube channel.

A TikTok user who underwent metoidioplasty genital surgery still had a lot of pain 2.5 months after her surgery. Based on her video it is also clear she did not fully understand the surgical technique, underestimating how invasive the surgery was going to be and not being prepared for the amount of pain she was going to be in (see Exulansic's video 'Metoidioplasty Moments: Angry Camel Pose').

Patrick, one of the persons being interviewed as part of the 'Zembla' TV show on transgenderism, explains how years after his vaginoplasty he still experiences pain and dyscomfort in his pelvic area and bladder. He no longer identifies as a transwoman and instead now sees himself as a gay male. He no longer has male genitalia so he feels like his life is ruined by the medical interventions he underwent as part of his gender transition.

Pregnancy whilst on testosterone
Testosterone is a teratogen meaning that it can cause birth defects when a pregnant female uses the drug. In sheep, exposure to testosterone affected development of female foetuses (see https://academic.oup.com/endo/article/146/7/3185/2500473). In mice, testosterone affected development of the genitals in female foetuses (see https://www.pnas.org/doi/full/10.1073/pnas.1610471113).

There are suggestions that prenatal and neonatal testosterone exposure may affect human behaviour (see https://pubmed.ncbi.nlm.nih.gov/17084045/; for a study on monkeys, see https://www.sciencedirect.com/science/article/abs/pii/S0018506X09000658).

Replacement of erectile device/implant
Erectile implants are developed for males who have a penis but suffer from erectile dysfunction. These devices/implants are estimated to have a life expectancy of 5 to 20 years . This data will come from male patients, possibly older on average than the females who opt for phalloplasty with an erectile implant. It is also conceivable that male patients are less active with the implant if they are on average of older age than the females who get this, so it is conceivable that the implant will last less long as it is used more. Moreover, the neophallus is not a penis so possibly higher risks of erosion may limit the lifespan of the implant in females. If you get the implant at age 20 or 30 and you may need to get it replaced every 10 years, this means 3-5 more surgeries later in life, possibly a lot more if you wear out the device faster.

Revision surgery
If the initial surgery did not leave you with the aesthetics you wanted and/or there are functional issues with your surgery results, you may want/need a revision surgery. Another surgery means another general anaesthesia and another situation in which you are taking risks. Moreover, there is no guarantee that whatever the issue is that makes you choose/need a revision will be solved for good.

Sepsis
Septicaemia, blood poisoning. A life-threatening reaction to an infection resulting in damage to your tissues and organs. This needs treatment in the hospital immediately.

A male who underwent vaginoplasty surgery and then revision surgery for it, and some month later got larger breast implants (he already had implants before) was found grey, cold and unresponsive by his boyfriend. His implants were very infected causing a kidney infection and then sepsis and kidney failure causing him to 'nearly die'. He got a secondary infection in his chest too. If he had been found any later, he may very well have died (see Exulansic's videos 'Vaginoplasty Volumes: Through the Eye of the Needle' and 'Get well soon, Ruby Fiera!').

Seroma
A seroma is a sterile collection of fluid under the skin, usually at the surgery site. The body may do this to fill up space after tisse has been removed. When a seroma is large or causes pain, it may need to be drained by needle and syringe and a drain may be put in. It is possible for a seroma to come back and to need to get it drained multiple times. A seroma may become infected or turn into an abscess. See https://sanaramedtech.com/blog/treating-post-surgical-seroma-hematoma/.

Sexual dysfuction
Surgery to the genitals may affect sexual function. A study on males who had undergone robotic peritoneal flap vaginoplasty showed that of those who had this surgery at least one year before the study was conducted, 14% were not able to experience orgasm, this was not correlated with orgasmic ability before surgery but was negatively related to smoking history, see https://pubmed.ncbi.nlm.nih.gov/35337785/. A 2018 study that included males who had undergone penile inversion vaginoplasty found that 26% were unsatisfied or highly unsatisfied with neoclitoral sensitivity and that a 33% were unsatisfied or highly unsatisfied with neovaginal depth and 10% of patients did not experience orgasm, see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994261/. A meta analysis (reviewing many studies who report on patient outcomes) showed that the ability to achieve orgasm was 76% in patients who had undergone vaginoplasty surgery meaning that 24% of those patients were not able to experience orgasm. This low average was mostly due to penile inversion vaginoplasty, the most common form of vaginoplasty, with 73% being able to have an orgasm. The patients who underwent a form of intestinal vaginoplasty had better results with 95% being able to achieve orgasm. The patients who underwent intestinal vaginoplasty had a higher proportion of fistula, stenosis and strictures, and prolapse than the males who underwent penile inversion (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984836/). From this study it is not clear whether the studies they included managed to follow up on all the patients on who they performed this surgery.

Then there's the story of Jazz Jennings who after puberty blockers and cross sex hormones had a botched vaginoplasty surgery (because he did not have enough genital skin to work with due to his puberty being blocked; he needed multiple revisions and the surgeons ended up taking skin grafts from his upper thigh area). Jazz seems to be struggling with sexual funtion. Trans-identifying male surgeon Marci Bowers was involved in some of Jazz' vaginoplasty surgeries and is reported as having stated that if a someone has never experienced orgasm before surgery and their puberty has been blocked, it is very difficult to achieve that afterwards. He acknowledges this is an overlooked problem and he wonders how this will affect the patient's long-term happiness if they are not able to be a responsive lover (see https://www.psychologytoday.com/gb/blog/women-who-stray/202111/does-affirmative-treatment-impair-sexual-response-in-trans-youth).

A story of a female reddit user who underwent metoidioplasty genital surgery describes how at four months after the surgery she is still struggling with sensations in her genital area. She can only feel half of her micro "penis" and the sensation she does have she describes as 'half pleasurable and half just uncomfortable' (see Exulansic's video 'Metoidioplasty Moments: The Piss Nick').

Oestrogen use by males is associated with a decreased libido and can cause erectile dysfunction. This can result in the penis shrinking. The testicles are also expected to shrink. Vaginoplasty may rely on the penile and scrotum skin to create a 'convincing' neovulva and neovagina so shrinking of this 'source' material may pose issues when the patient wants to undergo vaginoplasty.

Testosterone use by females can cause vaginal atrophy (thinning and drying of the vaginal tissue making it more fragile) and pain during sexual intercourse.

See the following paper for a discussion of affirmation-only treatment for transgenderism and the role of the placebo effect (including a discussion on sexual function): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886596/.

Stenosis, stricture
A narrowing of a structure. It is possible to have stenosis in the neovagina canal making it painful and/or difficult or even impossible to dilate and have sexual intercourse. This can make it difficult to clean the inside (douching) which may result in unpleasant smell or infections.

Shape Shifter is a male who has medically transitioned but regrets his genital surgeries. He developed stenosis of the canal almost immediately after surgery. Three revision surgeries to help correct the stenosis resulted in him developing a colorectal fistula. This fistula was torn back open during his fourth revision surgery and no surgeon will help him now as they suspect that another revision surgery may leave Shape with a colostomy bag, see https://reduxx.info/opinion-the-boy-who-shifted-shapes/ (and see Exulansic's video 'Vaginoplasty Volumes: The WPATH of Least Dehiscence' and the videos in which Exulansic and Shape Shifter interview each other).

Another male who underwent vaginoplasty experienced vaginal stenosis, requiring the canal to be replaced in an additional surgery, 8 months after the initial surgery (see Exulansic's video 'Update on Rumer Has a Clit Dude').

It is also possible for a (neo)urethra made as part of a metoidioplasty or phalloplasty to become too narrow. This restricts the flow of urine and may cause diverticuli and infections such as urinary tract infection. Stenosis or stricture may make it impossible to fully empty the bladder which might make the patient not drink enough water because they have such difficulty passing urine, which can in turn cause kidney stones or bladder stones. This also increases the chances of getting a urinary tract infection (UTI).

Stroke
An ischaemic stroke is what occurs when the blood flow to part of the brain is cut off. This can be due to a blood clot or air bubble (embolism) blocking the flow of blood. A hemorrhagic stroke is when an artery in the brain ruptures or leaks putting pressure on the brain which damages the brain cells. A mini-stroke (a transient ischemic attack) blocks blood flow only for a short time (less than 5 minutes). It is possible for a stroke to be a surgical complication.

A 30-year old male experienced a stroke during facial feminisation surgery. His complaints were ignored by hospital staff and when he eventually did get appropriate medical care elsewhere (emergency services), he had lost the ability to use one of his arms, from which he never recovered so he now has a permanent disability. It turns out that during his facial feminisation surgery they severely damaged his carotid artery and that as a result he had suffered a stroke in his right frontal lobe resulting in brain damage (see his reddit post titled 'I thought FFS would change my life, but not like this... (Dr. Alex Kim)' and Exulansic's video 'Facial Feminization Fumbles: A Sense of Humerus').

Suicidality
Despite activists claiming that gender transition is the only way to prevent transgender people from wanting to exit this world, there are people who after medical transition remain/become suicidal. Patrick, a Dutch man, is one of these people. He is interviewed in the 'Zembla' documentary on transgenderism in which he shares his lifelong struggles with severe mental health issues and substance abuse. He was failed by the medical system who on his first attempt to get help for transgenderism recognised he was not transgender, but when he tried again at another clinic some years later he, in his experience, was affirmed and encouraged to medically transition. He underwent vaginoplasty surgery that he now deeply regrets. He now no longer identifies as a transwoman but as a homosexual man. He no longer has male genitalia and he experiences dyscomfort in his pelvic area and his bladder and he is struggling with severe mental health issues to the point where he is contemplating assisted suicide, for which he has been approved (in the Netherlands, assisted suicide is allowed in certain circumstances).

Some scientific data suggests gender-affirming treatment may reduce suicide-related outcomes (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10027312/ for a narrative review), but some of these studies suffer from issues such as no data on suicidality before treatment, not controlling for other mental health issues, or loss to follow up (not being able to contact every person that underwent gender-affirming treatment in your clinic; it is possible that the proportion of people with regret, a bad outcome, or the worst outcome: suicide, is higher in those patients the clinic is unable to contact). These studies usually only look at people who received affirmation treatment (drugs and surgeries) and do not compare the outcomes for this group to a group with the same diagnosis who get no treatment or who get another kind of treatment (such as talk therapy or any other kind of therapy/treatment for mental health). It is then not possible to say which kind of treatment is superior when it comes to reducing suicidality (or compare any other kind of outcome).

Testosterone gel transfer
One method for taking the drug testosterone is by a gel that is applied onto the skin. The testosterone will be absorbed from the gel into the skin. One practical problem with this is that it is possible for others around the patient to be exposed to this testosterone by touching the patient's skin where the gel was applied or possibly through sharing a towel or bedding on which the gel is rubbed off. This testosterone exposure can be harmful to children of both sexes and to women. A case in the literature describes a 31 year old woman who had grown more body hair in the past year. Her testosterone level was measured as being 6.7 nmol/l at the highest when less than 2.5 nmol/l is considered normal. Her partner used testosterone gel for a medical condition but he was not aware of the recommendation to take a shower or cover the area where he applied the gel before having physical contact with others. When he stopped using the gel, her testosterone level went back to normal. When he started using the gel again, despite explicit instructions to cover the application site or shower before contact, the woman's testosterone level increased again. The male then switched to injecting testosterone and the woman's testosterone went back to normal (see https://academic.oup.com/humrep/article/24/2/425/808493). This illustrates that apparently instructions were not given or followed, and that even after the partner was exposed to testosterone and explicit instructions to reduce transfer, the female partner was still exposed to testosterone.

A publication describes two cases of transfer of testosterone gel from fathers (males using this gel for medical reasons) to their children. The first case involves a two year old boy whose penis had grown, who was experiencing frequent erections, who was growing pubic hair, and who had grown taller in the past few months. The penis was at Tanner class (stage) III which is usually seen in boys around age 13. He had a very high level of testosterone for his age and his bone age had advanced by three years. The changes seemingly reversed once he was no longer exposed to testosterone gel. The second case involved a 6 year old boy who had started growing pubic hair and growth of the penis in the past few months. He was also tall and had advanced bone age. His exposure was suppressed but he nevertheless started puberty. Read about both cases here: https://www.elsevier.es/en-revista-endocrinologia-diabetes-nutricion-english-ed--413-articulo-potential-consequences-in-children-testosterone-S2530018017300768.

The UK government includes information on this topic on its website stating a risk of harm to children following accidental exposure to Testogel (a testosterone gel). They warn of premature puberty and genital enlargement in children who were in close physical contact with an adult using testosterone gel and who were repeatedly exposed (see https://www.gov.uk/drug-safety-update/topical-testosterone-testogel-risk-of-harm-to-children-following-accidental-exposure).

Urination / voiding issues
It is possible to severely damage the ability to urinate with gender genital surgeries. There is the story of a male who got vaginoplasty surgery and now has to use the bathroom to pee every one or two hours including when he wants to sleep (see Exulansic's video 'Jacob's Bladder'). There are also the stories of many females who had gender genital surgery who ended up with urination difficulties such as Gruffin (covered extensively by Exulansic) who developed bladder stones (in addition to nearly losing a leg and nearly dying from blood clots). Many females who get phalloplasty appear to struggle to complete urination and after peeing always have some urine dribble out of the phallus no matter how much they squeeze and push and jump and wiggle.

UTI
UTI stands for urinary tract infection. It encompasses infections of any part of the urinary system: the kidneys, ureters, bladder, and urethra. If someone struggles to urinate or can not fully void their bladder they might be at a higher risk of developing a UTI. This may start in the urethra and if not successfully treated can develop into a bladder infection or even a kidney infection.

Vocal damage
It is possible for males who get so-called vocal feminisation surgery to end up with damage to their voice losing part of their vocal range and for their voice to seemingly stop working as described by one such patient posting on reddit (see Exulansic's video 'Tracheal Troubles: Falsetto Hope').

Wound dehiscence / wound separation
This is the term for when a surgery incision reopens. This can be the result of an infection, pressure on the sutures, poor suture technique, or decreased blood flow. This may require medical attention to resolve. This is seen in some people who undergo gender genital surgeries and wound separation can increase the risk for infection, can cause more scarring, and can change what the end result looks like.

One such example of a patient with wound separation is Rylan who chose to undergo a cosmetic double mastectomy for gender reasons. Because of her obesity she had few surgeons to choose from (surgery is more risky on obese people so most surgeons will have a BMI cap for (cosmetic) surgeries). The surgeon that removed her healthy breasts neglected her concerns about issues with healing and wound separation despite frequent communication from Rylan to the surgical team. Rylan had to find emergency medical care elsewhere when she had a golfball-sized blood clot fall out of her wound whilst out in public. By this time she had been bleeding from the wounds for days. She then had to undergo another surgery to have over half a foot of flesh that had become infected with a bacterial infection removed. One of her nurses told her she could have gone septic had she not gotten this 'repair' surgery. You can read all about the surgeon who removed Rylan's healthy breasts here: https://lilymaynard.com/wielding-the-sidhbh-gallagher/, and view video content about this case in Ella Androphobia's video titled 'Dr. Sidhbh Gallagher - Necrotizing Gaslighter'.