FTM Consigli Logo di Chiara Polo
Despite their young age, when talking to Eric and Elia you can sense that they are two people who have already taken on the role of mentors for their community. Their instagram page, @ftm_consigli, aims to fill in the lack and disorganisation of information about the transition path for transmasculine people, and it's no surprise that the community around it is constantly growing, when in fact it is still difficult to shed light on such a complex path as gender affirmation (in Italy). In addition to the creation of informative content on the page, the two boys receive hundreds of questions every day from transmasc people who want to begin the transition process, or have begun it but are not clear about the next steps, or are in the middle of questioning, and who find in this reality a safe place to turn to for clarity. It is therefore not just a question of dissemination, but of a real support project that stems from Eric and Elia's desire to make up for the lack of mentoring figures with which they themselves had to deal at the beginning of their journey.
We therefore interviewed the two boys and asked them to talk about their personal experience and about the page in general.
Would you like to tell us a bit about yourselves?
Elia's self-portrait
Elia: I am a 22-year-old trans boy, I have been in transition for about two years and in hormone therapy for more than a year and a half. I work as an educator. I share info through the instagram page because I wanted to be that reference person, which I didn’t have when I started my journey years ago. But actually, outreach has also helped me come out of my shell and understand myself better.
Eric, curtesy of ©Matteo Semprini
Eric: I'm 24 years old, I live in the province of Rimini and, like Elia, sharing my story helped me a lot: I was able to exchange information with other people and meet people with similar paths to mine and who could understand me.
Can you tell me about your transition path?
Eric: I realized that something was different when I was 18, although I didn't know how to name this feeling because there was much less information at that time. I started naming what was happening by watching TV shows and identifying with some of the experiences that were being shared on social media. It took me 3 years before I started the psychotherapy: I was afraid of the outside world and what could happen to me. I was still far from accepting myself. Seeing some guys on American social networks helped me, but I didn't know any Italians.
But then at a certain point I had to take courage because my dysphoria got worse, so I started the psychological process at MIT when I was 21 and started testosterone at 22. I was lucky with my family: my mum sensed a change in me, seeing that even before therapy there had been a change in how I looked. So she started pestering me with questions until I confessed everything to her. At first she cried and felt as if she was losing her daughter, but gradually she accepted the situation. Besides the fear of the irreversibility of the change, she was afraid that I would be unhappy and that society would be hostile to me. I didn't tell my father this until shortly before I started at MIT, but he actually took it well almost immediately: he told me that the important thing was that this was what made me feel good.
Of my whole journey, perhaps the most important step was the mastectomy: seeing myself in the mirror after the operation was the moment when I really felt aligned with the image I had of myself. The next step for me is to have the hysterectomy, and with that I will have finished my journey, because I don't feel the need for phalloplasty.
Elia: I have always felt different from the people around me, even when I was little. I've always perceived myself as a child but the other people around me, they would refer me to something different. From junior high school onwards, even though I was already bandaging my chest, I started to think that I had to adapt to the label that the outside world had put on me in order to be "like all other people". I thought I was alone in my suffering and that no one else shared the discomfort I felt. It was in third or fourth grade that I came across a trans guy on instagram who was showing the before and after hormone therapy. At first I didn't understand what it was and when I read the caption where he explained gender dysphoria, a world opened up to me but at the same time it also fell on me because I found myself in it. Having finally the words to define what I felt, I understood what was happening to me but, on the other hand, I found myself at odds with the person I had been until that moment and the person others saw in me. All the perspectives I had at that moment collapsed. Realising that I was transgender at the age of sixteen, therefore in the teenage period, did not make me accept it right away; so much so that I tried in vain to live pretending nothing happened, despite this awareness. Until, partly because of my increasingly persistent negative ideations, I asked my parents to start psychological therapy, without telling them about the problem. I started in the fourth year of high school with good professionals but, when I came of age, they not only did not respect my privacy and professional secrecy but also outed me to my parents. Moreover, these professionals had forced me to use the masculine in sessions when I was not yet feeling it and even to choose a name, pushing me to face many pieces that I was not yet ready to face: faced with my finding it difficult to do so their conclusion in response had been that then maybe I was not really trans. As a result, months later I decided to give myself some time to explore my identity on my own and I have to say that year was vital in understanding myself, facing all those fears and consolidating my identity. After a year I was ready and felt I needed to start a transition path, also because the dysphoria had increased anyway.
I started in October 2019 at Niguarda Hospital in Milan, under the advice of my general practitioner, even if, starting, it was complex because of the long timeframe and the lack of information on how to access the necessary medical services.
What were some good or bad episodes of the transition that you particularly remember?
Eric: I remember well how I felt the first time I wore the binder when I saw myself flat in the mirror. I put on the tightest shirt I had that I usually avoided wearing. Another great memory was the first Christmas after I came out to my family, and even though I was pre-t they made an effort to address me in the masculine form and my aunt made the place card for me with the name Eric. That's when I felt accepted.
Elia: In retrospect I can't find many negative things. A beautiful moment is when, after nine months of therapy, I looked at myself in the mirror and it was the first time in which I recognised myself in the reflection I saw. The last one that comes to mind was when my father, after the court hearing, called me by my name for the first time since coming out.
How did the page come about?
Eric: I created the page because I felt very lonely as I didn't talk to other trans guys because I didn't know any, and I wanted to share personal experiences and information. I wanted to create a page that could help, and initially it was more of a column where I would give information, telling my experiences. But then, because a lot of guys were writing to me for advice, I created a special box for questions. Then Elia came in and we helped each other a lot with the management of the page: we gradually structured it better, so as to provide information in the most orderly way possible.
Elia: I wanted to help because I also felt terribly lonely and not only did I need to feel part of a community, but also to give me confidence in who I was and what I was feeling. Working on the page for me was also therapeutic, because every time I had to inform myself to give answers, I was also helping myself. In addition, I thought I would also like to find someone who did this when I was starting out. We have now been working together for three years and we have seen the page grow as well as the more and more specific information we were asked for.
Has there been a change in terms of questions from what they were asking at the beginning, also in response to a greater understanding of the issues surrounding the trans community?
Elia: I hadn't really thought about it, but I think so. I think there's been a change - although some of the basic questions that you could google are still there. As more trans people are coming out and sharing their experiences, there is more information available. In general, compared to before, I have seen there has been two changes: the lowering of age - the people who ask us questions are younger - and more personal research that makes people being "more prepared".
But is there any downside to this overexposure of information? For example, doesn't having international examples through social media lead to somewhat distorted expectations?
Elia: In my opinion, yes, there are. First of all, the positive side is that you have more possibilities to know many more things, but even if you have a lot of information, you often have little awareness. So you're faced with people who have information but they're just "going for it", and maybe they write "I've been trans for a month" or "I've been male for a month, how can I take my hormones?". This shows that there is little awareness not only of the transgender reality in its entirety but also of the path in Italy. To be so overexposed basically means to be bombarded by information often without logical connection and if your identity is based on so much disconnected information and an absence of introspection, it takes very little to dismantle it. In the beginning, I would come across negative information and stop for a moment and think, "OK, let's understand the basis of this information and how it impacts me as a person," and I would ask myself, "Does that information invalidate my identity?" And the answer was "no." But if you haven't taken the time to examine your identity and it's not solid, it's easy for it to fall apart as soon as you come across that one negative video - and everyone comes across one of those during the journey-, and that you spiral into crisis.
Another danger is that of basing standard on foreign standards and then coming up against the Italian reality, which leads to the fall of one's own expectations. So when it happens that we interact with kids who feel so ready, but don't know many important things - such as the fact that you can't start with hormones as soon as you decide to do it - we feel like putting a brake on them by explaining the various steps and that reality is not so simple.
Added to this is the need for one's own identity to be consolidated. A common mistake is also to think that testosterone solves all your problems, as happened to me in my teenage years. If you start testosterone while you are not well, it can be even more damaging: for example misgendering during hormone therapy often has a much stronger impact, because you see yourself changing but you realise that others still don't recognise you. If you're not ready, the world collapses on you.
Eric: I totally agree. A lot of people think that testosterone is the magic wand that solves everything but then you run into a lot of other difficulties: from work, to everyday dynamics. This also relates to social media, which can be a good thing because you have a lot more information, but also a bad thing, because maybe very young trans people see videos of trans guys on TikTok or Instagram happy about the transition, without seeing the difficulties they face. Reality is not only made of what is shown on social media. Sure, there are beautiful moments, but transition is not just that. Some very small boys write to us wanting hormone therapy right away and also want to have surgery right away. Even if it is good that you discover your identity first, it is important to be ready psychologically for the transition. In fact, in my opinion it is important to have a psychological process to accept and understand yourself before starting.
Are there recurring themes among the questions you are asked?
Eric: One recurring theme is how to put the tape in place even though we've created a post about it and a specific highlight section: it comes back every day. We are also often asked about packers, binders and operations.
Elia: We often get asked about things that you can't find any answers to online, such as being trans in the armed forces. In these cases we have to refer to the experience of other people who follow us and decide to share their own experience. Lately we have been asked more and more for opinions as well as information.
What were the questions you were most surprised to receive?
Elia: Oh my God, I could think of a few right away. Once we were asked "but when I die, who will give me testosterone shots?" We replied that if it was a joke, it wasn't funny. But he was serious and really wanted that information. Another time we were asked if, by having genital surgery, you could get a person pregnant. Here we find gaps not only in basic knowledge about the human body but also in a lack of knowledge about sex education, which is a big problem in Italy. We made some informative posts about trans sexuality, but we had to use information taken from international experts - because sexology for trans people in Italy is non-existent.
Eric: Besides the lack of basic knowledge, these questions make you understand that these are very young people who don't have basic information.
Elia: Or you also understand that they started too fast thinking already about the genital operation but actually need to take a step back and gather more basic information.
The steps of transition
Since your page focuses on dissemination, let's talk about finding information. What was it like to find information at the beginning of the transition? How did you do it? Because I guess Infotrans didn’t exist.
Elia: No, Infotrans wasn't around until a few years ago and many people still don't know it exists. Nowadays there is a lot of information circulating and it can be found through different channels. When I started my path to awareness, around 2015, the only information in Italian that I could find was random Italian people willing to talk about their experience, which, however, is always individual and subjective and therefore there is a risk of giving false information unconsciously. In English you could and do find more, but it is still a foreign language that you have to know at a fairly good level to understand what you are reading. However, at the same time, if you read in English, you have information calibrated to other states and, once you come to terms with Italy, you have to recalibrate all your goals and all the steps you may have already thought of doing because the Italian regulations are different.
There was a need for someone willing to tidy up and put together the information for those who need it and to do it in an impartial way: that's why the page was born as it is today. We remain impartial unless specifically asked for personal opinions. Impartiality is essential to give information in a sincere way. We do not give opinions.
Eric: It's hard to find information without giving opinions. It's also difficult to find people who will give you their personal opinion while admitting that it's their personal journey, without wanting to invalidate other people's journey. So we try to give practical information, such as where the gender clinics are located, how to start the bureaucratic process, how to look for a job, how to write a CV... and so on. Returning to the initial question: at the beginning, I had googled "gender dysphoria" and I was given a list of basic information, with some things written that were not up to date or that were false. Since some of these things didn't feel like they belonged to me, I didn't know what to do for some moment. So I called the association Agedo, where I was given the number of a psychotherapist who is an expert in gender dysphoria.
Do you agree with compulsory psychological therapy before taking hormones?
Elia: I can't be extreme on either side. It's not all black and white, and I think there needs to be a grey scale in between because the transition path is totally personal, even if in Italy this is not understood in any way and you can see it also from how the transition path is structured. Completely removing something or forcing to do it does not allow you to have that range where you can move according to your needs. I don't think it is right that someone else should give you permission or not to start. However, even if it is rare, it can happen that some people have other problems that have pushed them to think they are trans, when in reality they are not. In these cases psychological support can help them to discern and not to start a therapy that would also be harmful. For example, on this page there was a girl who had confused as dysphoria what in reality was a non-acceptance of her homosexuality and had tried to deal with this block, giving it this meaning.
Going back to the psychological path, it should not be a net obligation because, let's face it, if a person is fully aware of his own identity, keeping him for six months in stall (as per ONIG protocol) means only to prolong their discomfort. As is going to court to change documents, which is the extreme, because it completely takes away your self-determination. In my opinion, we need to consider how to create an intermediate situation.
Also because everything is relative: for example, talking about compulsory psychological therapy, the compulsory six months of therapy could differ between people. I used to have one visit a month, whereas in other parts, which always follow the ONIG protocol, you have one session a week. In six months this means a huge disparity in the number of sessions. What's the point of putting these limits in place if there's such a difference between people who follow the same protocols?
Eric: A lot of things should be changed and, in some cases, the time should be accelerated. But I think the psychological process is essential for understanding yourself. It doesn't have to be a process that tells you who you are, because you have to do that yourself, but it has to be a process that accompanies you through the transition. Some of the things that happen to you during the transition leave you unsettled, and maybe you didn't expect them, so it's better to have support to deal with them. Obviously, I don't think it's right that someone else should decide whether you can start or not, but I do think it's important that there is someone else there to support you and open your eyes, even to different paths. Then, it doesn't make sense that there are gender clinics that make you wait years before starting. I mean, a constant psychological support would not hurt also for cis people. However, it's a different matter as far as the path to court is concerned: it makes no sense for a judge to tell you what you can or cannot do with your identity.
Pros and cons of the psychological process?
Eric: Eric: For me, the psychological process should be tailored to the person. The pro is that you are in a situation where - often - you feel understood for the first time and you feel listened to. The psychological journey helped me to understand so many things, also about what would come later. But a negative side is also the distance that often exists between the person in need and the clinic where they can find support.
Elia: For me, the psychological process - but the transition process in general - doesn't work as it is structured right now, because it lacks the component of self-determination. And the individual suffers as a result. For example, on the day of the court hearing I wasn't happy about having to go: I felt tired, exhausted. They take us to the point of exhaustion in a process that should make us feel better. Sure, thanks to testosterone I feel better, but not thanks to the course they forced me to take. So the psychologist has given me support in dealing with the steps of a pathway that has been wrongly structured by our state.
Pros and cons of taking testosterone?
Elia: I don't think I can find cons, because my experience is totally positive. Testosterone has been a lifesaver for me.
Speaking generally, in Italy the two types of administration available are injection or gel. For many years it was thought that the gel was qualitatively inferior to injections, under the influence of the US example, where injections are mainly used. In reality, gels and injections have the same effects, although obviously the changes that occur with gels or injections vary from person to person. But it also depends on the brands. Abroad, there is also a kind of capsule that is implanted in the buttocks, which lasts six months and releases a quantity of testosterone every week. However, there are also risks here: for example, there is a risk that the skin will reject the implant or that the wrong amount of testosterone will be injected due to a malfunction in the capsule.
From 2020, hormone therapy will be available in Italy free of charge thanks to an AIFA notification. However, in reality, you can only get it if you do the endocrinological course in the public and I don't understand why there is a need to make this difference, public documentation is just as good as private.
A related topic to testosterone is that nowadays many more people feel free to admit that they have stopped testosterone for various reasons-such as hair loss-once they have achieved the desired changes and once they have consolidated. There is still some prejudice in front of these stories, but more and more people are being open about it.
What is a mastectomy? Pros and cons?
Eric: Mastectomy is the surgical removal of the breast. First of all, you have to keep in mind that the type of mastectomy is decided by the surgeon, which is based on the elasticity of the skin, the width of the breast, the shape of the nipples, and so on. One drawback is that waiting lists in the public sector are always long, often reaching two to three years. Fortunately, some surgeries give the possibility to put oneself on the waiting list even before having the decision of the court so that the time is reduced a little bit. However, if you want to and can, you can have the operation done privately. Beside this, honestly, I cannot think of any other cons of mastectomy: I felt extremely well after having it.
What is a hysterectomy? Pros and cons?
Eric: A hysterectomy is the removal of the uterus and other structures around it. I decided to have it for health reasons. Over time, taking testosterone goes against the production of hormones by the female organs, and there is a higher risk of complications such as cancer. But you can also decide to check yourself more often and not have a hysterectomy.
Cos’è la bottom surgery? Pro e contro?
Elia: Bottom surgery in the case of AFAB people is the reconstruction of the male genital organ, and can be achieved by phalloplasty or metoidioplasty. I think the pros and cons are personal. Phalloplasty compared to metoidioplasty, which is less invasive, has higher risks but leads to the creation of a larger phallus than meto. Some people do the metoidioplasty first and then decide to go ahead with the phalloplasty; others, however, have so much dysphoria that it is essential for them to have the phalloplasty in order to be well, so all the cons are a lower risk than not having the operation.
A major drawback of such an invasive operation is that after having it done the psychological impact is generally very significant, especially for phalloplasty also given the long post-operative phase and the need to do several operations spread over a period of years. In the case of phalloplasty, there is also the need to change the penile implant (if it has been inserted) every so often. That's why it's important to be ready psychologically even before doing it.
Eric: I would also add the risk of loss of sensitivity as a drawback. Another thing is the fact that you can't always have a real resemblance to the sexual organ of a cis man. Obviously, depending on one's feelings and needs, each person assesses the consequences they are prepared to tolerate. Some people operate out of a social urge, rather than a genuine personal need. To conform to the binary idea of what a male or female body should be.
What are the biggest difficulties of the transition in general?
Elia: For me, the biggest difficulties are the timing. For example, my clinic uses the ONIG protocol, but not very effectively. To begin with, you need a doctor's referral (with a wording that changes over time and is not available in any official setting), you have to call to be put on the list, and if it goes well, you have your first interview after a couple of months, if it goes badly, you wait more than six months, as happened to me. So you have to wait a really long time because of their internal protocol. After that they do the day hospital, and another six months can pass between the first visit and the day hospital, which marks the beginning of the psychological process. I had to change clinic for hormone treatment, as I risked being without therapy for three months.
Eric: There's something not working in the system, which makes us arrive at the end of the process exhausted. Years and years go by in which we have to collect certificate after certificate confirming who we are. But why should we convince an unknown person in a court of law that we are who we say we are?
Transmasc: a person assigned female at birth (AFAB) whose gender falls on the male pole of the gender spectrum (whether they are non-binary or male).
Interview and translation by Enea Venegoni