Gender transition

Last updated November 28, 2024

Gender transition is the process of affirming and expressing one's internal sense of gender, rather than the gender assigned to them at birth. It is the recommended course of treatment for individuals struggling with gender dysphoria, providing improved mental health outcomes in the majority of people.^[1]

A social transition may include coming out as transgender,^[a] using a new name and pronouns, and changing one's public gender expression.^[2] This is usually the first step in a gender transition. People socially transition at almost any age,^[3]^[4] as a social transition does not involve medical procedures. It can, however, be a prerequisite to accessing transgender healthcare in many places.^[5]^[6]

In transgender youth, puberty blockers are sometimes offered at the onset of puberty to allow the exploration of their gender identity without the distress^[7]^[8] of irreversible pubertal changes. Upon reaching the age of consent, they become eligible to pursue a medical transition if it is still desired.

A medical transition may include hormone replacement therapy (HRT), transgender voice therapy, and gender affirming surgeries. The ability to start a medical transition is typically offered after a diagnosis of gender dysphoria,^[9] a form of medicalization. In recent years, there has been a push for an informed consent model of transgender healthcare which allows adults to access HRT without a formal diagnosis.^[10]

Transitioning is a process that can take anywhere from several months to several years. As a personal journey, there will never be a one-size-fits-all approach to transition.

Terminology

This page uses topic-specific vocabulary that may be unfamiliar to the layperson. Below are some definitions to make this page more accessible:

Identity-related terms

Assigned gender at birth (AGAB) is a term that refers to the sex or gender assigned to people when they are born. As people are assigned a gender at birth in regards to their physical characteristics, an assigned gender does not account for one's internal gender identity.
Gender expression refers to the external presentation of one's gender identity. Typically, a person's gender expression is thought of in terms of masculinity (a tomboy, a butch lesbian, a drag king) or femininity (an effeminate male, a 'femboy', a drag queen), but an individual's gender expression may incorporate both feminine and masculine traits, or neither. One may express their gender through clothing, behavior, hair styling, voice, etc.^[11]^[12] It is not necessarily related to one's gender identity.
Gender identity refers to the personal sense of one's own gender. It may correlate with the gender assigned at birth, or differ from it. In most individuals, gender identity is congruent with their assigned gender. Those who do not identify with their birth gender may identify as transgender.

Gender dysphoria refers to the distress a person experiences from a mismatch between their internal gender identity and their gender assigned at birth.^[13]^[14] People who suffer from gender dysphoria may transition in order to alleviate this distress.
Cisgender is an adjective that refers to individuals who identify the gender assigned to them at birth. Cisgender people may have any sexual orientation or gender expression.
Transgender is an adjective that refers to individuals who identify with a gender that differs from the one assigned to them at birth. Transgender people may have any sexual orientation or gender expression.

Non-binary is a term that refers to a gender identity described as neither entirely male nor female (not one of the two binary sexes). Non-binary people may suffer from gender dysphoria, and may consider themselves transgender. Non-binary people may have any sexual orientation or gender expression.
Transitioning refers to the process of affirming and expressing one's internal sense of gender, as opposed to the gender assigned to them at birth. There are two major facets of gender transitioning: a social transition, and a medical transition; almost all transgender people will socially transition, and most will undergo some degree of medical transition^{[ citation needed ]}. See the opening paragraphs for further information on social and medical transitioning.
Detransitioning (sometimes also known as re-transitioning) is the cessation of transgender identity and/or a transition to a different gender, often to one's natal gender.^[15]

Medical-related terms

It is important to note that most transgender individuals will receive few, if any surgeries throughout their lifetimes and some may never receive HRT. Barriers to accessing medical transitioning can include: a lack of financing, a lack of desire, or a lack of accessibility. There is no one way to transition, and while a medical transition or surgery can absolutely be medically necessary for some individuals' personal wellbeing, no two transitions are the same.

Puberty blockers / hormone blockers are terms that refer to medications used to block natal sex hormones. For transgender youth, hormone blockers may be offered at the onset of puberty to allow the exploration of their gender identity without the distress^[7]^[8] of irreversible pubertal changes. Puberty blockers are considered reversible^[16] and their use is deemed safe and effective^[17] as treatment for gender dysphoria in gender-diverse children^[18] and precocious puberty in cisgender children;^[19] their use may be discontinued at any time if natal puberty-blocking is no longer desired.^[16] For transgender adults, hormone blockers may be offered in a course with cross-sex hormone replacement therapy in order to treat gender dysphoria.
Hormone replacement therapy (HRT) is a medical treatment that replaces the primary sex hormones in one's body, in order to develop the secondary sex characteristics of the opposite sex. Individuals seeking masculinizing HRT are prescribed the male sex hormone testosterone, while individuals seeking feminizing HRT are prescribed the female sex hormone estrogen.

Voice therapy (or 'voice training') refers to a non-surgical gender-affirming treatment for the masculinization or feminization of one's voice. Transfeminine people will not experience any impact on voice pitch from feminizing hormone therapy (unless their natal puberty was sufficiently blocked), so voice training is very often underwent in order to learn how to speak in a higher and more feminine register. Transmasculine people, on the other hand, will experience a marked lowering in pitch from masculinizing HRT (testosterone) to an often cisgender male level, so vocal masculinization training is uncommon outside of those who have not underwent masculinizing HRT. Irrespectively, vocal masculinization training can help one learn to speak in a lower and more masculine register.
Voice surgery refers to a surgical treatment that allows for the masculinization or feminization of one's vocal pitch. Transfeminine people can undergo voice surgery to surgically increase their pitch range. Transmasculine people very uncommonly undergo voice surgery, as masculinizing HRT (testosterone) often lowers voices to a cisgender male pitch. Irrespectively, vocal masculinization surgery can be underwent to surgically decrease their pitch range.
Facial surgery refers to any gender-affirming surgery underwent on the face. There exists facial masculinization and facial feminization.

'Top surgery' refers to any gender affirming surgeries performed on the breasts. In transmasculine individuals, this may be a double mastectomy (removal of breast tissue), and/or a 'male chest reconstruction'. In transfeminine individuals, this may be a breast augmentation.
' Bottom surgery ' refers to any gender affirming surgeries performed on the genitalia. In transmasculine individuals, this may be a hysterectomy (removal of the uterus), and/or a oophorectomy (removal of the ovaries). A penis can be constructed through metoidioplasty or phalloplasty, and a scrotum through scrotoplasty. In transfeminine individuals, this may be a penectomy (removal of the penis), orchiectomy (removal of the testicles), vaginoplasty (construction of a vagina), and/or a vulvoplasty (construction of a vulva).

Going 'full-time' refers to the act of living everyday life as one's identified gender.^[20] People who go full-time may or may not pass, and may or may not keep their transgender identity a secret.
Passing refers to the perception and recognition of trans people as their desired gender identity by outsiders who may not know they are transgender. For many trans people, passing is a very important aspect of their transition often seen as an 'end goal'. Passing can greatly alleviate gender dysphoria. Failure to pass can cause serious repercussions for trans people's psychological well-being and safety, including but not limited to: poor mental health, discrimination, increased barriers to medical care^{[ citation needed ]}, harassment, fetishization, ostracization, increased risk of homelessness, and targeted violence due to increased visibility of one's transgender status.^[21]

Going 'stealth' refers to the act of living as one's identified gender without revealing oneself to be transgender.^[22] In some countries, being stealth may be a safety necessity, due to health, safety, and wellbeing risks of being openly transgender.

Various aspects

Transitioning is a complicated process that involves any or all of the gendered aspects of a person's life, which include aesthetics, social roles, legal status, and biological aspects of the body. People may choose elements based on their own gender identity, body image, personality, finances, and sometimes the attitudes of others. A degree of experimentation is used to know what changes best fit them. Transitioning also varies greatly between cultures and subcultures according to differences in the societies' views of gender.^[23]

Social aspects

The social process of transitioning begins with 'coming out', where others are told that one does not identify with their birth sex. The newly out trans person may adopt a new name, ask to be referred to with a new set of pronouns, and change their presentation to better reflect their identity.^[24]^[25] Socially transitioning does not involve medical intervention or gender affirming surgery, but it may be a prerequisite to access transgender healthcare in some regions.^[5]^[6]

People may socially transition at any age, with documented cases of children as young as 5,^[3]^[26]^[27] or adults as old as 75.^[4] While many of those who socially transition will pursue a medical transition, not everyone can access gender affirming care, and not all may wish to pursue it.

Psychological aspects

A person's ideas about gender in general may change as part of their transition, which may affect their religious, philosophical and/or political beliefs. In addition, personal relationships can take on different dynamics after coming out. For instance, what was originally a lesbian couple may become a heterosexual one as a partner comes out as a trans man - or parents of a boy may become parents of a girl after their child comes out as a trans woman.

Legal aspects

Transgender people in many parts of the world can legally change their name to something consistent with their gender identity.^[25] Some regions also allow one's legal sex marker changed on documents such as driver licenses, birth certificates, and passports. The exact requirements vary from jurisdiction to jurisdiction; some require sex reassignment surgery, while many do not. In addition, some states that require sex reassignment surgery will only accept 'bottom surgery', or a genital reconstruction surgery, as a valid form of sex reassignment surgery, while other states allow other forms of gender confirmation surgery to qualify individuals for changing information on their birth certificates.^[28] In some U.S. states, it is also possible for transgender individuals to legally change their gender on their drivers license without having had any form of qualifying gender confirmation surgery.^[28] Also, some U.S. states are beginning to add the option of legally changing one's gender marker to X on legal documents, an option used by some non-binary people.^[29]

Physical aspects

Physical aspects of gender transition can go along with social aspects; as well as wearing gender affirming clothing, transgender people often hide features from their natal puberty, with many transgender men binding their breasts and transgender women shaving. Other physical aspects of transitioning require medical intervention, such as transgender hormone therapy or surgeries.

Grieving gender identity

Over the course of a gender transition, people who are close to the transitioning individual may experience a sense of loss, and work through a grieving process.^[30] This type of loss is an ambiguous loss, characterized by feelings of grief where the item of loss is obscure. Family members may grieve for the gendered expectations that their loved one will no longer follow, whereas the transgender person themself may feel rejected by their relatives' need to grieve.^[31] Feelings that arise are described as a way of seeing the person who is transitioning as the same, but different, or both present and absent.^[30]

Related Research Articles

Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder. The International Classification of Diseases uses the term gender incongruence instead of gender dysphoria, defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment.

Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender. The phrase is most often associated with transgender health care and intersex medical interventions, though many such treatments are also pursued by cisgender and non-intersex persons. It is also known as sex reassignment surgery (SRS), gender confirmation surgery (GCS), and several other names.

The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.

The following outline is provided as an overview of and topical guide to transgender topics.

A trans man is a man who was assigned female at birth. Trans men have a male gender identity, and many trans men undergo medical and social transition to alter their appearance in a way that aligns with their gender identity or alleviates gender dysphoria.

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.

Gender incongruence is the state of having a gender identity that does not correspond to one's sex assigned at birth. This is experienced by people who identify as transgender or transsexual, and often results in gender dysphoria. The causes of gender incongruence have been studied for decades.

Sexuality in transgender individuals encompasses all the issues of sexuality of other groups, including establishing a sexual identity, learning to deal with one's sexual needs, and finding a partner, but may be complicated by issues of gender dysphoria, side effects of surgery, physiological and emotional effects of hormone replacement therapy, psychological aspects of expressing sexuality after medical transition, or social aspects of expressing their gender.

In the context of gender, passing is when a person is perceived as a gender by which they identify or as which they are attempting to be seen. Historically, this was common among women who served in occupations where women were prohibited, such as in combat roles in the military. For transgender people, it is when the person is perceived as cisgender instead of the sex they were assigned at birth. For example, a transgender woman is passing if she is perceived as a cisgender woman.

Masculinizing hormone therapy, also known as transmasculine hormone therapy or female-to-male hormone therapy, is a form of hormone therapy and gender affirming therapy which is used to change the secondary sexual characteristics of transgender people from feminine or androgynous to masculine. It is a common type of transgender hormone therapy, and is predominantly used to treat transgender men and other transmasculine individuals who were assigned female at birth. Some intersex people also receive this form of therapy, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

<span class="mw-page-title-main">Transsexual</span> People experiencing a gender identity inconsistent with their assigned sex

A transsexual person is someone who experiences a gender identity that is inconsistent with their assigned sex, and desires to permanently transition to the sex or gender with which they identify, usually seeking medical assistance to help them align their body with their identified sex or gender.

Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, they face different challenges compared to adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.

Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay puberty in children with precocious puberty. They are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity and have been shown to reduce depression and suicidality in transgender and nonbinary youth.The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.

Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

The real-life experience (RLE), sometimes called the real-life test (RLT), is a period of time or process in which transgender individuals live full-time in their identified gender role in order to be eligible to receive gender-affirming treatment. The purpose of the RLE has been to confirm that a given transgender person could function successfully as a member of said gender in society, as well as to confirm that they are sure they want to live as said gender for the rest of their life. A documented RLE was previously a requirement of many physicians before prescribing gender-affirming hormone therapy, and a requirement of most surgeons before performing gender-affirming surgery.

Transgender pregnancy is the gestation of one or more embryos or fetuses by transgender people. As of 2024, the possibility is restricted to those born with female reproductive systems. However, transition-related treatments may impact fertility. Transgender men and nonbinary people who are or wish to become pregnant face social, medical, legal, and psychological concerns. As uterus transplantations are currently experimental, and none have successfully been performed on trans women, they cannot become pregnant.

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world. Gender affirming health care can include psychological, medical, physical, and social behavioral care. The purpose of gender affirming care is to help a transgender individual conform to their desired gender identity.

Transgender rights in Australia have legal protection under federal and state/territory laws, but the requirements for gender recognition vary depending on the jurisdiction. For example, birth certificates, recognised details certificates, and driver licences are regulated by the states and territories, while Medicare and passports are matters for the Commonwealth.

Detransition is the cessation or reversal of a transgender identification or of gender transition, temporarily or permanently, through social, legal, and/or medical means. The term is distinct from the concept of 'regret', and the decision may be based on a shift in gender identity, or other reasons, such as health concerns, social or economic pressure, discrimination, stigma, political beliefs, or religious beliefs.

Transmedicalism is the idea that being transgender is primarily a medical issue related to the incongruence between an individual's assigned sex at birth and their gender identity, characterized by gender dysphoria. There are divides and debates within the transmedicalist community on the exact definition of who is or is not transgender. Many transmedicalists believe individuals who identify as transgender without experiencing gender dysphoria or desiring to undergo a medical transition through methods such as hormone replacement therapy or sex reassignment surgery are not genuinely transgender. They may also exclude those who identify themselves as non-binary from the trans label.

References

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↑ While the label Transgender is used here, people of diverse gender identities may socially or medically transition.

Gender transition

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