September 10, 2026 Your medical transition roadmap

A fact-filled, illustrated, expert guide to the most common options available to trans women, femmes, and transfeminine nonbinary folks in the U.S. for physically transitioning. It guides you through a process for determining what, if any, changes are right for you, and how to access the care you require.

Amelia Simone Hanrahan gives a clear overview of the WPATH standards that determine the types of care available and teaches you how to navigate the gatekeeping of that care. Hormone replacement therapy, breast augmentation, facial feminization surgery, bottom surgery, and hair removal and regrowth are described (with medical illustrations so you know what to expect and advocate for), and preparation and aftercare tips are provided. Hanrahan also offers guidance on social transition, dealing with dysphoria and dysmorphia, insurance, and how to pay for everything—all with an anti-capitalist lens and a trauma-informed approach. 

Most of all, this book provides straightforward information so you don’t need to sift through misinformation and bias on the internet in order to get the healthcare you need and deserve. 

Experience gender euphoria with the following excerpt from Amelia Simone Hanrahan‘s The Transfeminine Guide to Physical Transition: For Trans, Nonbinary, and Other Feminine Folks, available now on our site or anywhere cool Microcosm titles are sold!

Introduction

“I just don’t know where to start.” As I sit with clients who are coming to terms with their trans identity, I frequently hear this refrain. People often talk about trying to research online but finding contradicting information (often with little or no citations for further research), unverified anecdotes on Reddit, differences in treatment based on country and age, and of course, mountains of fearmongering misinformation.

One trans client I worked with was looking through the bookshelf in my office and picked out The Transmasculine Guide to Physical Transition by Sage Buch and while flipping through it, she asked, “Where’s the transfeminine guide?” The need for a comprehensive and reliable guide on where
and how to start, and the most common interventions available, was clear.

The goal I have for this book is for it to be the resource I wish I had when I began my transition. Very early in my transition, I knew that medical intervention was going to be part of my journey. In fact, the nurse practitioner who prescribed my hormone replacement therapy (HRT) was the third person in my life to learn I am trans.

But before that appointment, I tried to get clear information about what I was asking for, and that left me more confused than before I started. I knew I wanted the effects of HRT, but some people online were saying estrogen comes in pills, others injectables, and still others patches. One medical website said my estrogen levels should be 200–300 pg/ml, another said over 300 pg/ml, and the WPATH standards (more on them later) said “under 200.” But how much under 200 was never defined, nor was a minimum given. And, how did they plan to measure that after all, and what in the world was “pg/ml”?

So, I hope this book can be a resource for answering those types of questions and give you, the reader, a way to know both what to expect and what is available. I hope that you don’t have to try and piece together an understanding of your possible options for transition from years-old Reddit comments and the vague language found on some university hospital and plastic surgeons’ websites like I did.

Throughout the book, we will look at how to consider what possible interventions might be right for you, the WPATH Standards of Care, and how to access medical services, as well as information about hair removal, HRT, facial feminization surgery, breast augmentation, bottom surgery, other medical interventions, and how people pay for these procedures. We’ll also take a quick look at things that fall on the boundary of social and physical transition, like clothes, makeup, tucking, speech therapy, and language use. Lastly, I hope to send you off with lots of resources for further learning. I also want to note that this book is almost entirely focused on physical transition in the United States. It is broadly applicable to people in many other countries, but I want to be straightforward that I’m not making an effort to be inclusive of other countries’ medical systems and considerations, as the multitude in the U.S. are overwhelming enough. Similarly this book does not look at other cultural approaches to transition outside of the mainstream American medical approach. These are important topics that I hope other people, who are more competent than I am on those topics, cover in other books.

The focus of this book is to provide the reader with information to help them make more informed decisions about their transition; it is not an overtly political book. But, it is impossible to avoid politics when discussing trans healthcare. Attacks on trans healthcare have been relentless over the past few years, and painfully, those attacks have been more effective than the attempts to stop them.

There have been some bright spots in protections passed as of 2025 in many states. The Movement Advancement Project, which tracks legal issues relating to the LGBTQ+ community, reports that Washington, Oregon, California, Colorado, New Mexico, Minnesota, Illinois, New York, Vermont, Maryland, Maine, Massachusetts, Rhode Island, Connecticut, and Washington, D.C. all have shield laws in place to protect trans people’s access to healthcare. There is significant work to be done in regaining the ground that has been lost in recent years and in working toward trans liberation more generally.

One way to help is to volunteer or donate to a national organization like Advocates for Trans Equality or GLAAD, and every single state has at least one LGBTQ+ advocacy organization you can support and work more closely with. Ensuring we have access to life-saving medical intervention will require us to advocate, march, call our representatives, and vote. And please vote for candidates who don’t only give lip service to LGBTQ+ rights, but who actively work to support the intersectional liberation of all marginalized people.

Lastly, a quick note on passing, being seen as cis or not identifiable as trans by most or all people, and transmedicalists, meaning people who believe some amount of medical transition has to happen before someone is “really” trans. For many transfemme folks, passing is a significant reason for accessing medical transition. Most folks with that goal hope that passing will relieve aspects of their gender dysphoria, but there are other reasons too, including seeking increased safety. Being a visibly identifiable trans person in our society puts you at risk of violence, and passing helps alleviate that risk. This puts the consensuality of passing into question and blurs the line between whether I am feeling gender euphoria in my body or relief from the threat of violence. So, this is my way of saying whether you are engaging with this material to pass and/or live stealth, or to relieve dysphoria without consideration toward passing, this book is for you.

Relatedly, this is not a book for transmedicalists. Throughout the book I will affirm and encourage people who decide not to pursue medical transition. If you read this book and decide to do no medical intervention at all, you are still trans, you are still a woman, or femme, or enby.

Gatekeeping trans identities hurts people in our community by invalidating them and by upholding harmful colonialist beliefs about gender essentialism, and frankly, we as a community have been harmed enough by those beliefs already. Many transmedicalists believe that by proving they’re “really” trans through medical intervention, they’ll win the approval of the bigots who keep our community marginalized. Personally, I don’t want those people’s approval and I hope you don’t either.

In conclusion, thanks for picking up this book—it’s deeply meaningful to me to be of help in your transition. I hope this book can help you clarify what would be helpful to you, and what might be best left on the table. Whether you’re a transfemme and reading this for yourself, or you’re a person reading this to support someone in your life, thank you for making the world a more full place with more gender euphoria in it.

For more gender euphoria, get your own copy of Amelia Simone Hanrahan‘s The Transfeminine Guide to Physical Transition: For Trans, Nonbinary, and Other Feminine Folks, available now on our site or anywhere cool Microcosm titles are sold!