Massage therapist Jimmy Gialelis shares what he learned about a transgender massage client and the effects of this process on his client’s body.

I first met Sam* in 2016 as a referral from his friend.

Our first two massage sessions were ordinary sessions involving me treating the usual bodily suspects (neck, shoulders and low back).

After our second session, Sam reserved scheduling a third session indicating he may be having surgery and wanted to wait to reschedule if this surgery took place.

I lost touch with Sam for several months. In the spring of 2017, the same friend who referred me to Sam informed me Sam was undergoing a gender transition and asked me if I would be willing to work on Jasmine*, Sam’s new name. I agreed to see Jasmine at her earliest convenience.

A New Client

Several weeks went by before I was able to see Jasmine in my practice.

Before Jasmine’s arrival, I researched gender transition procedures. I learned about the surgical procedures as well hormonal treatments. Sex or gender reassignment surgery (SRS or GRS) is the procedure used to aid gender dysphoria, the medical term describing one’s desire to match physical anatomy to the intuitive sense of one’s gender.

Although the terms transgender and transsexual have only recently become popular in the mainstream, the incidents of procedures to alter physical anatomy witnessed is nothing new. A conservative estimate based on recent research shows that 390 per 100,000 adults in the U.S. were transgender in 2016.

Christine Jorgensen (1926–1989)was among the first U.S. citizens to undergo a male-to-female SRS procedure. The initial removal of the male genitalia was performed in 1952, followed in 1954 by a vaginoplasty procedure. Mainstream press vilified Jorgenson in the 1950s.

Harry Benjamin, MD (1885–1986), was a leading medical figure in the 1950s and 1960s, and instrumental in helping the medical community realize a distinction between cross-gender identity and homosexuality. He helped remove “sexual deviant” stigmas from those experiencing cross-gender identity.

French gynecologist Georges Burou (1910–1987t), in the 1950s, developed the main premise of modern-day SRS procedures, which involves using male genitalia as the source of skin and erectile tissue to create new female genitalia. Burou’s work in Morocco facilitated many successful SRS cases.

The Role of Estrogen

I reviewed Jasmine’s name aloud before her arrival to not accidentally call her Sam. I felt it important to ensure she knew I would acknowledge her name properly. Upon her arrival, we began the intake in a normal fashion. The usual bodily suspects (neck, shoulders and low back) needed work again.

This intake felt very familiar. Although her voice quality and facial structure had changed, Jasmine still exhibited the same calm demeanor as before.

As I placed my hands upon Jasmine’s body, still covered by the top sheet and towel, I recalled what I learned about the estrogen therapies Jasmine had received in recent months.

Due to the increased estrogen levels, physical changes expected in a client who has transitioned from male to female may include thinner and drier skin; pain and temperature perceptions may change; new sensations may develop due to budding tissue beneath nipples; there might be a redistribution of adipose tissue; thinning hair; and changing facial features.

There are three types of estrogens: estrone (E1), estradiol (E2) and estriol (E3). Estrone is weaker in effect and the only type within a woman after the onset of menopause. Estradiol is what is typically known as estrogen, the primary steroid hormone facilitating secondary sex characteristics of females. Estriol is the weakest of the three types as merely a by-product of estradiol usage, only significantly abundant in pregnant woman.

Jasmine informed me she was undergoing Estradiol treatments, which now made sense as this hormone would greater facilitate her transition to her true self. Her initial side effects experienced were anxiety, bloating, melasma (skin darkening) and swelling in various regions.

Other side effects of Estradiol treatments include toothaches, stomach cramps, muscle cramps, missed menstrual periods, hypertension, excessive thirst and headaches. Jasmine did not report any of the latter listed effects.

Jasmine also informed me early in her transition she was using anti-androgen drugs to block the effects of testosterone. Her side effects from anti-androgens were hot flashes, skin rashes, anemia-like symptoms of lethargy and fatigue and diarrhea.

An Effortless Session

As I undraped Jasmine’s back, placing my hands upon her familiar canvas, I began a sequence of effleurage and friction strokes in all four quadrants of the back. I use this warm up sequence to assess the integrity of physical tissues. I caught myself initially comparing her muscle tone to what was felt prior to last year. At that moment, I consciously made the choice to stop comparing and simply feel what was presenting in front of me.

This conscious shift of thought allowed the session to flow effortlessly. Weaving together a tapestry of myofascial and sports massage techniques in among classic (Swedish) massage upon Jasmine, I felt what I often describe to my students as tissue talk—sensations of muscle fibers moving under my fingertips; temperature changes (heat in some areas, cool in others); twitch responses; and fascial adhesions and knotted regions needing more attention.

By session end, I walked out of the room feeling happy to have served Jasmine and to have refrained from comparing her body this year versus last year. There was no need for this comparison. All I needed to do was focus on each moment of touch.

After washing my hands, I waited for her to get dressed and greeted her once more when she opened the door, allowing me to return. We sat for a few minutes to discuss how she felt and to schedule next appointment.

Our massage was like any other, with a focus on relieving physical tissue tension within her body. My initial mind chatter dissipated quickly, allowing me to focus simply on her body in need of care.

Jasmine encouraged me to explore transsexuality as a topic of education and reminded me the importance of holding neutral, nonjudgmental space in my practice. I am grateful for the opportunity to work with her.

*Names changes to protect client confidentiality.

About the Author:

Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education ( in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular contributor to MASSAGE Magazine, and his articles include “To Succeed in Today’s Massage Market, You Can’t Make These 3 Mistakes” and “These 5 Keys Will Unlock the Door to Massage Session Re-Bookings.”