Gender transition


Gender transition is the process of affirming and expressing internal sense of gender, rather than the sex assigned at birth. It is a recommended course of treatment for persons experiencing gender dysphoria, providing improved mental health outcomes in the majority of people.
A social transition may include coming out as transgender, using a new name and pronouns, and changing one's public gender expression. This is usually the first step in a gender transition. People socially transition at almost any age, as a social transition does not involve medical procedures. It can, however, be a prerequisite to accessing transgender healthcare in many places.
In transgender youth, puberty blockers are sometimes offered at the onset of puberty to allow the exploration of their gender identity without the distress 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, transgender voice therapy, and gender-affirming surgery. The ability to start a medical transition is typically offered after a diagnosis of gender dysphoria, 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.
Transitioning is a process that can take anywhere from several months to several years.

Terminology

This page uses topic-specific vocabulary. Below are some definitions to make this page more accessible:

Identity-related terms

  • Assigned gender at birth is a term that refers to the sex or gender assigned to people when they are born. Assigned a gender at birth is based on physical characteristics, and does not account for internal gender identity.
  • Gender expression refers to the external presentation of gender identity. Typically, a person's gender expression is thought of in terms of masculinity or femininity, 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. It is not necessarily related to one's gender identity.
  • Gender identity is the personal sense of their 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 is the distress a person experiences from a mismatch between their internal gender identity and their gender assigned at birth. People who suffer from gender dysphoria may transition in order to alleviate this distress.
  • Cisgender is an adjective that refers to people 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 people 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 gender identity described as neither entirely male nor female. 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 many will undergo some degree of medical transition.
  • Detransitioning is the cessation of transgender identity and/or a transition to a different gender, often to the natal gender.

    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 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 of irreversible pubertal changes. Puberty blockers are considered reversible and their use is deemed safe and effective as treatment for gender dysphoria in gender-diverse children and precocious puberty in cisgender children; their use may be discontinued at any time if natal puberty-blocking is no longer desired. 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 is a medical treatment that replaces the primary sex hormones in the body, in order to develop the secondary sex characteristics of the opposite sex. Masculinizing HRT uses a male sex hormone testosterone, while feminizing HRT uses a female sex hormone estrogen.
  • Voice therapy is non-surgical gender-affirming treatment for the masculinization or feminization of the voice. Transfeminine people will not experience any impact on voice pitch from feminizing hormone therapy, so voice training is very often undergone 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 to an often cisgender male level, so vocal masculinization training is uncommon outside of those who have not undergone 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 often lowers voices to a cisgender male pitch. Irrespectively, vocal masculinization surgery can be underwent to surgically decrease their pitch range.
  • Facial surgery is gender-affirming surgery underwent on the face, usually facial masculinization or facial feminization.
  • Top surgery is gender affirming surgeries of the breasts. In transmasculine and/or nonbinary individuals, this may be a double mastectomy, and/or a ''chest reconstruction'. In transfeminine and/or nonbinary individuals, this may be a breast augmentation.
  • Bottom surgery is gender affirming surgery performed on the genitalia. In transmasculine and/or nonbinary individuals, this may be a hysterectomy, and/or a oophorectomy. A penis can be constructed through metoidioplasty or phalloplasty, and a scrotum through scrotoplasty. In transfeminine and/or nonbinary individuals, this may be a penectomy, orchiectomy, vaginoplasty, and/or a vulvoplasty.

    Social-related terms

  • Going 'full-time' refers to the act of living everyday life as one's identified gender. 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, harassment, fetishization, ostracization, increased risk of homelessness, and targeted violence due to increased visibility of one's transgender status.
  • Going 'stealth' refers to the act of living as one's identified gender without revealing oneself to be transgender. 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.

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. Socially transitioning does not involve medical intervention or gender affirming surgery, but it may be a prerequisite to access transgender healthcare in some regions.
People may socially transition at any age, with documented cases of children as young as 5, or adults as old as 75. 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.