Transition
A person whose genuine nature is a gender other than the one they were born to is understood through the same philosophy as everyone else, and the world's medicine can do a great deal about it.
The chemistry
The strong part. Physicians prepare compounds that shift a body toward the other pattern — breasts, softer skin, and fat moved for one; the beard, the shape changed, and the courses stopped for the other — ordinary pharmacy in a world whose chemistry is far better than its machinery. Nothing is given to a child; a young child who says what they are is believed and left alone, and lives as they say they are in name and dress and everything that costs nothing. The compounds come at eighteen or twenty, when a person answers fully for their own choices, and they cost less to wait for here than anywhere else: preparations that work slowly on bone itself can bring a jaw or a brow some way back over two or three years of patient dosing. Clearhold wants an examination and a written record first, as it does about everything.
The surgeons
Removing a breast is routine. The genital surgeries are within reach of a world that does vascular work under magnification with the finest thread anybody has, and they are real operations with real risk. Bone work on a face is harder, because no surgeon can see soft tissue through skin and plans by what he can feel. The cost sits where abdominal surgery sits — a year of a laborer's wages — and the same funds cover it that cover anybody who cannot pay.
The voice
The stubborn one. The compounds that bring a beard will drop a voice and never lift one; a larynx that has grown does not ungrow. A surgeon can work on the folds themselves under an endoscope, which raises the pitch some way; he will not cut at the cartilage from outside, blind among the vessels of the neck. So most of the result is taught: pitch is only part of a voice, and resonance, weight, and shape are learned. A good voice teacher in Shining Reach earns what a physician earns and has a waiting list.
Not vanity
Medicine#Age and vanity disdains a man asking a surgeon to help him lie about what he is. This is the reverse — a person making the body agree with what they already are — and the same test, applied honestly, gives the opposite answer. Shining Reach argues about it anyway, by people who all agree on the conclusion.
See also
- Outside the Pattern · Medicine · The Slave Market#Reading a slave at market — the butterfly charm