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Want to better understand what it means to be transgender or gender diverse? Here's an overview of the basics, along with definitions of common terms used to describe gender identity.
The terms "transgender" and "gender diverse" cover a range of gender identities and gender expressions. These terms move past the idea that all people can be classified as only one of two genders — female or male. That idea is called the gender binary.
Gender identity is the internal sense of being male, female, neither or some combination of both. Gender expression typically involves how gender identity is shown to the outside world through the way a person looks or acts. Gender expression may include clothing, mannerisms, communication style and interests, among other things.
People who are transgender or gender diverse include:
- Those who have a gender identity that differs from the sex assigned to them at birth.
- Those whose gender expression doesn't follow society's norms for the sex assigned to them at birth.
- Those who identify and express their gender outside of the gender binary.
Gender identity and sexual orientation
Most people have a sense of physical, emotional and romantic attraction to others. Sexual orientation describes the group of people to whom this attraction is directed. For example, a person may be attracted to men, women, both or neither. Being transgender or gender diverse isn't linked to a specific sexual orientation. And sexual orientation can't be assumed based on gender identity or gender expression.
Understanding gender dysphoria
Gender dysphoria is a feeling of distress that can happen when a person's gender identity differs from their sex assigned at birth or from their sex-related physical characteristics. Some transgender and gender-diverse people experience gender dysphoria at some point in their lives. Other transgender and gender-diverse people feel at ease with their bodies and gender identities, and they don't have gender dysphoria.
A diagnosis for gender dysphoria is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual published by the American Psychiatric Association. This diagnosis was created to help people with gender dysphoria get access to the health care and treatment they need. It focuses on distress as the problem, not a person's gender identity.
Knowing helpful terms
Other terms that might come up in a discussion about being transgender or gender diverse include:
- Agender. A person who doesn't identify with any gender label or who doesn't use gender as part of their identity.
- Cisgender. An individual whose gender identity and gender expression align with the sex assigned at birth.
- Cross-dressing. Dressing as the other gender. Cross-dressing isn't necessarily a sign of a person's gender identity or sexual orientation. Cross-dressing also isn't a sign of gender dysphoria.
- Gender-fluid. Displaying flexibility in gender identity and expression. Gender-fluid people typically aren't limited by gender norms and expectations. They may identify and express themselves as masculine, feminine, some combination of both or neither.
- Gender role. The norms and expectations a society associates with a person's sex assigned at birth.
- Gender minority stress. Stress related to stigma, prejudice and discrimination toward individuals with diverse gender identity and expression.
- Nonbinary. A person whose gender identity is a combination of or goes beyond the gender binary of female and male.
- Sex. A person's physical characteristics that traditionally are labeled as male or female.
- Transgender man and transgender woman. Terms used to describe a transgender individual's gender identity or expression within the gender binary. For example, the term "transgender woman" may be used for someone whose sex at birth was assigned male and who identifies as a woman. Not all transgender and gender-diverse people use these terms to describe themselves.
For more information about transgender and gender-diverse topics, consider exploring resources offered through organizations such as the World Professional Association for Transgender Health and the Fenway Institute.
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- Feldman J, et al. Primary care of transgender individuals. https://www.uptodate.com/contents/search. Accessed Jan. 3, 2023.
- AskMayoExpert. Health care for transgender and gender diverse people. Mayo Clinic; 2022.
- Erickson-Schroth L, ed. Sex and gender development. In: Trans Bodies, Trans Selves: A Resource by and for Transgender Communities. 2nd ed. Kindle edition. Oxford University Press; 2022. Accessed Jan. 4, 2023.
- Gender dysphoria. American Psychiatric Association. https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria. Accessed Jan. 5. 2023.
- Keuroghlian AS, et al., eds. Gender identity: Terminology, demographics and epidemiology. In: Transgender and Gender Diverse Health Care: The Fenway Guide. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Accessed Jan. 5, 2023.
- Nippoldt TB (expert opinion). Mayo Clinic. Jan. 6, 2023.
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Get the facts on gender-affirming care.
Everyone deserves to be treated with dignity and respect. But across the country, politicians desperate to gain power and their allies in the media are attacking LGBTQ+ people and making it impossible, particularly for transgender and non-binary youth, to be their authentic selves.
State legislatures, governors and administrative agencies across the country are taking steps to eliminate access to gender-affirming care — medically necessary, safe health care backed by decades of research and supported by every major medical association representing over 1.3 million U.S. doctors. Some are even going as far as to accuse parents who support their transgender children of child abuse. Those backing these bills are also seeking to ban this care for adults.
A concerted disinformation campaign is not only behind discriminatory laws but is fueling threats and violence against providers of gender-affirming care , preventing them from supporting the communities they are meant to serve.
As attacks on the LGBTQ+ community continue to gain steam, it is important to get the facts about gender-affirming care.
What exactly is gender-affirming care?
Gender-affirming care, sometimes referred to as transition-related care, is life-saving healthcare for transgender people of all ages. It is not a single category of services but instead is a range of services, including mental health care, medical care, and social services. At all ages, clear, well-established, evidence-based standards of care exist for who can access what form of gender affirming care, and when they are eligible to receive it.
Gender -affirming care is medically necessary for the well-being of many transgender and non-binary people who experience symptoms of gender dysphoria, or distress that results from having one’s gender identity not match their sex assigned at birth. Gender-affirming care helps transgender and non-binary people live openly and authentically as their true selves. Just like any other form of healthcare, it also helps transgender and non-binary people live safe and healthy lives.
Gender affirming care is always delivered in age-appropriate, evidence-based ways, and decisions to provide care are made in consultation with doctors and parents. Collectively representing more than 1.3 million doctors across the United States, every major medical and mental health organization — including the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association — recognizes that it is medically necessary to support people in affirming their gender identity.
What does it mean for someone to transition?
Gender transition is the process through which a transgender or non-binary person takes steps to live authentically in their true gender identity. It is a personal process that looks different for every transgender and non-binary person, and individual paths do not always follow the same order. Some people take medication, and some do not; some adults have surgeries, and others do not. For some people, it can include steps as simple as changing clothes, names and hairstyles to fit their gender identity. Regardless of the age at which a person transitions, how they do so is their choice to be made with their family and doctors.
What does it mean for children to transition? Aren’t they too young to do so?
Transgender and non-binary people who begin transitioning during childhood or adolescence work closely with parents and health care providers — including mental health providers — to determine which changes to make at a given time that are age-appropriate and in the best interest of the child. At all stages, parents, young people and medical professionals make decisions together, and no permanent medical interventions happen until a transgender person is old enough to give truly informed consent.
Prior to puberty, transition is entirely social, and may involve changing names, pronouns, clothing, and hairstyles. During and after puberty, some medical treatments may be available, but only after significant consideration and consultation between the youth, their families and their health care providers.
What is “social transitioning”?
Social transitioning is when someone takes non-medical and fully reversible steps to begin living and presenting publicly as their gender . This can include changes such as:
Using a new name and pronouns
Adopting a new hairstyle
Wearing different clothing
Disclosing gender identity to others in their lives
For those who begin transitioning prior to puberty, transition is entirely social. But for many transgender and non-binary people, social transition is the first step in their gender transition journey, regardless of the age they begin transitioning. This is because it offers the opportunity to easily and quickly take small steps to begin living authentically, before involving medical interventions.
What are puberty blockers? Why are they used? Are they safe?
"Puberty blockers” (or simply “blockers”) are a type of medication which can temporarily pause puberty and are fully reversible.
For transgender and non-binary youth who are aware of their gender at a young age, going through puberty can cause intense distress and dysphoria , as it leads their body to develop into a gender that is not theirs —including in ways that are irreversible, or only reversible with surgery. For example, teenage transgender boys who do not have access to blockers will have to go through a puberty that includes growing breasts and later in life will require surgery.
In these instances, puberty blockers may be prescribed by doctors early in puberty, in consultation with the child, their parents and therapists, in order to temporarily stop the body from going through the unwanted physical and developmental changes of puberty. They are used to give youth time to continue exploring their gender identity before potentially moving on to more permanent transition-related care when they are older.
Puberty blockers are safe . They were approved by the FDA to treat precocious puberty in cisgender youth in 1993, citing minimal side effects and high efficacy; 30 years later, puberty blockers remain the gold standard treatment for precocious puberty in cisgender youth. All youth who are taking puberty blockers — cisgender or transgender — are monitored by their care team for any side effects or complications.
Puberty blockers are fully reversible . If a person stops taking puberty blockers, normal puberty will resume , with minimal long-term effects, if any. While there may be some loss of bone mineral density, this can be easily addressed with calcium and vitamin D supplements . Previous research has also shown that cisgender youth who take puberty blockers for precocious puberty have normal fertility and reproductive function .
Puberty blockers can also be life-saving: Previous studies have found that transgender and non-binary youth who are able to receive puberty blockers report positive psychosocial impacts , including increased well-being and decreased depression. Other recent studies have found that receipt of puberty blockers can dramatically reduce risk of suicidality — in some cases by over 70% — among transgender youth, compared to those who were unable to access desired treatment.
What are cross-sex hormones or gender-affirming hormones? Why are they used? Are they safe?
Gender-affirming hormones are a type of prescription medicine transgender and non-binary people can take to cause their body to begin physically developing into the gender they identify as. These medications allow transgender and non-binary people to live more fully as their identified gender, significantly reducing negative psychological outcomes such as gender dysphoria, depression, anxiety and suicidality.
Gender-affirming hormone medications are synthetic versions of testosterone or estrogen, the same hormones that naturally develop at various levels in both cisgender men and cisgender women. These same medications are used safely every day by millions of cisgender men and women worldwide.
Gender affirming hormones are typically not prescribed until a person is at least 18 years old. Though adolescents may receive gender-affirming hormones starting in their late teens, this is only done with physician approval, parental consent and informed consent from the adolescent in question, and is typically reserved for those adolescents who have been on puberty blockers and/or socially transitioned for some time.
Gender affirming hormones are safe in both youth and adults with provider supervision and appropriate management. Depending how long a person has been taking gender-affirming hormones, the effects may be fully or partially reversible as wel l. The informed consent process involves discussions about side effects and benefits–as with any informed consent process for medication or treatments–including discussions about fertility.
Gender-affirming hormones are life-saving for transgender youth and adults . A recent study from the Trevor Project shows that transgender youth with access to gender-affirming hormones have lower rates of depression and are at a lower risk for suicide. A study by Stanford University School of Medicine found that positive mental health outcomes were higher for transgender people who accessed gender-affirming hormones as teenagers versus those who accessed it as adults. A third study, published in the New England Journal of Medicine , found that, two years after initiating gender-affirming hormones, transgender youth reported higher levels of life satisfaction and positive affect, and lower levels of gender dysphoria, depression and anxiety.
What is gender-affirming surgery? Can minors have “the” surgery?
There is no single gender-affirming surgery — nor does a person have to have any surgery, or a specific surgery, to be transgender. Gender-affirming surgery includes a wide range of procedures such as plastic surgery to change features in the face to be more typically masculine or feminine, “top surgery” to make changes to the chest or torso or “bottom surgery” to make changes to genitals.
Transgender and non-binary people typically do not have gender-affirming surgeries before the age of 18. In some rare exceptions, 16 or 17 year-olds have received gender-affirming surgeries in order to reduce the impacts of significant gender dysphoria, including anxiety, depression, and suicidality. However, this is limited to those for whom the surgery is deemed clinically necessary after discussions with both their parents and doctors, and who have been consistent and persistent in their gender identity for years, have been taking gender-affirming hormones for some time, who have undergone informed consent discussions and have approvals from both their parents and doctors, and who otherwise meet standards of care criteria (such as those laid out by WPATH ).
In all cases, regardless of the age of the patient, gender-affirming surgeries are only performed after multiple discussions with both mental health providers and physicians (including endocrinologists and/or surgeons) to determine if surgery is the appropriate course of action.
None of these surgical procedures are unique to transgender people. They are the same procedures that have safely and effectively been given to cisgender and intersex people for decades, for a host of cosmetic and medical reasons. Prior research shows that post-surgical complication rates are similarly low among transgender and cisgender people receiving the same type of surgery — if not lower among transgender people .
What is the impact of parental support — or lack of support — on transgender young people?
The single most important thing anyone can do to support the transgender and non-binary people in their lives, regardless of their age, is to support and affirm them and their journey. A simple first step is committing to use their chosen name and pronouns — and, if you make a mistake, to simply apologize, correct yourself and move on.
For transgender youth, this can be particularly important.
When parents, caregivers and teachers support a transgender youth’s journey in transitioning, they are helping them to live authentically and grow into the person they are meant to be — just like all other children and adolescents their ages do. Adolescence is typically the time when all youth begin to develop autonomy and independence and learn about themselves and their identity , as they prepare for adulthood. When parents and families support their children through actions such as respecting their opinions, showing interest in their activities and interests and providing a loving, affirming, and trusting home , it can go a long way towards ensuring they will successfully develop into happy and healthy adolescents and adults.
And parental support can save lives. Previous research has found that transgender youth who are able to socially transition and simply have their gender identity, name and pronouns affirmed report higher levels of resilience and positive well-being and lower levels of depression , anxiety, gender dysphoria , and suicidality , relative to transgender youth who are not affirmed.
What do doctors have to say about gender-affirming care? Do they think it’s necessary?
Every single major medical organization , including the American Academy of Pediatrics, the American Medical Association and the American Psychiatric Association , supports the provision of age-appropriate, gender-affirming care for transgender and non-binary people. These organizations represent millions of doctors, researchers and mental health professionals in the United States. Gender-affirming care has always existed and isn’t a new phenomenon — it’s just that in recent years, extremist politicians have made it into an issue for their own self-gain.
What is the process to begin receiving gender-affirming care from health providers?
Clear, well-established, evidence-based standards of care exist for who can get gender-affirming care and when — and these standards have existed for decades. In 2022, for example, the World Professional Association of Transgender Health (WPATH) released their 8th Standards of Care for treating transgender patients. Both the Endocrine Society and the American Academy of Pediatrics have issued guidelines as well.
The process to access gender-affirming care can differ from state to state, and hospital to hospital, due to differences in state laws around who can access gender-affirming care, and when. But, in general, transgender patients (along with their families, if they are minors under the age of 18), will start by visiting a health care provider or clinic that specializes in gender-affirming care. Some may be referred to this clinic after first disclosing their gender dysphoria to a primary care provider or therapist, and others may start with a gender clinic.
For patients seeking out gender-affirming medical care, they often receive counseling for extended periods of time. If medications or surgery are part of their gender journey, they are only prescribed after further assessments to ensure they meet prescribing criteria. This can include but is not limited to documentation and referral letters, parental consent and ongoing mental health support. At all stages, gender-affirming care is only delivered after patients and their families have been counseled, and informed consent has been given.
Are people transitioning because it’s trendy? It feels like everyone is transgender all of sudden?
Being transgender is not new . Transgender people have always existed and will continue to exist regardless of harmful laws that pass.
One thing that has changed is that people are more willing to be out about their gender identity (and sexual orientation) and live openly as LGBTQ+ in all facets of their lives. This is happening because transgender people feel safer about coming out. Public support for LGBTQ+ rights , and acceptance of LGBTQ+ people, are the highest they’ve ever been .
Another thing that has changed is people’s awareness of transgender people and gender identity. As transgender people become more visible, and willing to live openly as their authentic selves, people are simply seeing more depictions of transgender people — and encountering more transgender people in their lives.
It is also true that people are openly identifying as LGBTQ+ at younger ages . But this is because, in addition to rising national support for pro-equality policies overall, on average, younger age groups hold more pro-equality, LGBTQ+ affirming attitudes and beliefs than older generations. This shift creates a cycle where:
Higher acceptance leads more people to come out
More people coming out increases visibility of LGBTQ+ people
Increased visibility leads to increased acceptance
Increased acceptance leads more people to feel safe coming out
Are kids transitioning because of social media, or because their friends are also transitioning?
This is a right-wing theory known as “rapid onset gender dysphoria” or “social contagion” — and it has been thoroughly debunked. The American Psychological Association, the American Psychiatric Association and over 120 other medical associations issued a position statement calling for eliminating the use of this term as a diagnosis, based on a “lack of rigorous empirical support for its existence ” and "its likelihood of contributing to harm and mental health burden.” The statement also specifically calls out laws which use this debunked theory to justify anti-trans legislation.
What if someone transitions and then they change their mind about it? Don’t a lot of people de-transition?
Previous studies have found that de-transitioning is quite rare —with some studies finding levels of de-transition and regret as low as 1% or 2% . Transgender youth who meet criteria for gender dysphoria and who undergo social or medical transition are actually the least likely to de-transition — and those vast majority of transgender youth remain consistent and persistent in their gender identity over time: One recent study, published in the academic journal Pediatrics, followed over 300 transgender youth after first initiating social transition, and found that over 92% remained consistent and persistent in their gender identity 5 years later.
However, evidence-based standards of care exist to ensure that no one, regardless of their age, undergoes any permanent, irreversible changes without informed consent and careful consultation with medical and mental health care providers.
But what about legislators who say they’re protecting kids with laws about gender-affirming care?
When legislation attempts to regulate who can access gender-affirming care, they are inserting political battles into private and personal conversations between parents and their children, and patients and their doctors. These laws are not about safety — as the safety, efficacy and life-saving nature of gender-affirming care for transgender and non-binary youth and adults is clear. Instead, in ignoring a wealth of scientific evidence and overwhelming support from the medical community, these legislators are attempting to enshrine discrimination into law. Rather than protecting kids, these laws are preventing parents and young people from making informed medical decisions, and doctors and health care providers from providing best-practice care to their patients.
Last updated: 7/25/23
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The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. Adults
Findings from pew research center focus groups, table of contents, introduction.
Transgender and nonbinary people have gained visibility in the U.S. in recent years as celebrities from Laverne Cox to Caitlyn Jenner to Elliot Page have spoken openly about their gender transitions. On March 30, 2022, the White House issued a proclamation recognizing Transgender Day of Visibility , the first time a U.S. president has done so.
More recently, singer and actor Janelle Monáe came out as nonbinary , while the U.S. State Department and Social Security Administration announced that Americans will be allowed to select “X” rather than “male” or “female” for their sex marker on their passport and Social Security applications.
At the same time, several states have enacted or are considering legislation that would limit the rights of transgender and nonbinary people . These include bills requiring people to use public bathrooms that correspond with the sex they were assigned at birth, prohibiting trans athletes from competing on teams that match their gender identity, and restricting the availability of health care to trans youth seeking to medically transition.
A new Pew Research Center survey finds that 1.6% of U.S. adults are transgender or nonbinary – that is, their gender is different from the sex they were assigned at birth. This includes people who describe themselves as a man, a woman or nonbinary, or who use terms such as gender fluid or agender to describe their gender. While relatively few U.S. adults are transgender, a growing share say they know someone who is (44% today vs. 37% in 2017 ). One-in-five say they know someone who doesn’t identify as a man or woman.
In order to better understand the experiences of transgender and nonbinary adults at a time when gender identity is at the center of many national debates, Pew Research Center conducted a series of focus groups with trans men, trans women and nonbinary adults on issues ranging from their gender journey, to how they navigate issues of gender in their day-to-day life, to what they see as the most pressing policy issues facing people who are trans or nonbinary. This is part of a larger study that includes a survey of the general public on their attitudes about gender identity and issues related to people who are transgender or nonbinary.
The terms transgender and trans are used interchangeably throughout this essay to refer to people whose gender is different from the sex they were assigned at birth. This includes, but is not limited to, transgender men (that is, men who were assigned female at birth) and transgender women (women who were assigned male at birth).
Nonbinary adults are defined here as those who are neither a man nor a woman or who aren’t strictly one or the other. While some nonbinary focus group participants sometimes use different terms to describe themselves, such as “gender queer,” “gender fluid” or “genderless,” all said the term “nonbinary” describes their gender in the screening questionnaire. Some, but not all, nonbinary participants also consider themselves to be transgender.
References to gender transitions relate to the process through which trans and nonbinary people express their gender as different from social expectations associated with the sex they were assigned at birth. This may include social, legal and medical transitions. The social aspect of a gender transition may include going by a new name or using different pronouns, or expressing their gender through their dress, mannerisms, gender roles or other ways. The legal aspect may include legally changing their name or changing their sex or gender designation on legal documents or identification. Medical care may include treatments such as hormone therapy, laser hair removal and/or surgery.
References to femme indicate feminine gender expression. This is often in contrast to “masc,” meaning masculine gender expression.
Cisgender is used to describe people whose gender matches the sex they were assigned at birth and who do not identify as transgender or nonbinary.
Misgendering is defined as referring to or addressing a person in ways that do not align with their gender identity, including using incorrect pronouns, titles (such as “sir” or “ma’am”), and other terms (such as “son” or “daughter”) that do not match their gender.
References to dysphoria may include feelings of distress due to the mismatch of one’s gender and sex assigned at birth, as well as a diagnosis of gender dysphoria , which is sometimes a prerequisite for access to health care and medical transitions.
The acronym LGBTQ+ refers to lesbian, gay, bisexual, transgender, queer (or, in some cases, questioning), and other sexual orientations or gender identities that are not straight or cisgender, such as intersex, asexual or pansexual.
Pew Research Center conducted this research to better understand the experiences and views of transgender and nonbinary U.S. adults. Because transgender and nonbinary people make up only about 1.6% of the adult U.S. population, this is a difficult population to reach with a probability-based, nationally representative survey. As an alternative, we conducted a series of focus groups with trans and nonbinary adults covering a variety of topics related to the trans and nonbinary experience. This allows us to go more in-depth on some of these topics than a survey would typically allow, and to share these experiences in the participants’ own words.
For this project, we conducted six online focus groups, with a total of 27 participants (four to five participants in each group), from March 8-10, 2022. Participants were recruited by targeted email outreach among a panel of adults who had previously said on a survey that they were transgender or nonbinary, as well as via connections through professional networks and LGBTQ+ organizations, followed by a screening call. Candidates were eligible if they met the technology requirements to participate in an online focus group and if they either said they consider themselves to be transgender or if they said their gender was nonbinary or another identity other than man or woman (regardless of whether or not they also said they were transgender). For more details, see the Methodology .
Participants who qualified were placed in groups as follows: one group of nonbinary adults only (with a nonbinary moderator); one group of trans women only (with a trans woman moderator); one group of trans men only (with a trans man moderator); and three groups with a mix of trans and nonbinary adults (with either a nonbinary moderator or a trans man moderator). All of the moderators had extensive experience facilitating groups, including with transgender and nonbinary participants.
The participants were a mix of ages, races/ethnicities, and were from all corners of the country. For a detailed breakdown of the participants’ demographic characteristics, see the Methodology .
The findings are not statistically representative and cannot be extrapolated to wider populations.
Some quotes have been lightly edited for clarity or to remove identifying details. In this essay, participants are identified as trans men, trans women, or nonbinary adults based on their answers to the screening questionnaire. These words don’t necessarily encompass all of the ways in which participants described their gender. Participants’ ages are grouped into the following categories: late teens; early/mid/late 20s, 30s and 40s; and 50s and 60s (those ages 50 to 69 were grouped into bigger “buckets” to better preserve their anonymity).
These focus groups were not designed to be representative of the entire population of trans and nonbinary U.S. adults, but the participants’ stories provide a glimpse into some of the experiences of people who are transgender and/or nonbinary. The groups included a total of 27 transgender and nonbinary adults from around the U.S. and ranging in age from late teens to mid-60s. Most currently live in an urban area, but about half said they grew up in a suburb. The groups included a mix of White, Black, Hispanic, Asian and multiracial American participants. See Methodology for more details.
Identity and the gender journey
Most focus group participants said they knew from an early age – many as young as preschool or elementary school – that there was something different about them, even if they didn’t have the words to describe what it was. Some described feeling like they didn’t fit in with other children of their sex but didn’t know exactly why. Others said they felt like they were in the wrong body.
“I remember preschool, [where] the boys were playing on one side and the girls were playing on the other, and I just had a moment where I realized what side I was supposed to be on and what side people thought I was supposed to be on. … Yeah, I always knew that I was male, since my earliest memories.” – Trans man, late 30s
“As a small child, like around kindergarten [or] first grade … I just was [fascinated] by how some people were small girls, and some people were small boys, and it was on my mind constantly. And I started to feel very uncomfortable, just existing as a young girl.” – Trans man, early 30s
“I was 9 and I was at day camp and I was changing with all the other 9-year-old girls … and I remember looking at everybody’s body around me and at my own body, and even though I was visually seeing the exact shapeless nine-year-old form, I literally thought to myself, ‘oh, maybe I was supposed to be a boy,’ even though I know I wasn’t seeing anything different. … And I remember being so unbothered by the thought, like not a panic, not like, ‘oh man, I’m so different, like everybody here I’m so different and this is terrible,’ I was like, ‘oh, maybe I was supposed to be a boy,’ and for some reason that exact quote really stuck in my memory.” – Nonbinary person, late 30s
“Since I was little, I felt as though I was a man who, when they were passing out bodies, someone made a goof and I got a female body instead of the male body that I should have had. But I was forced by society, especially at that time growing up, to just make my peace with having a female body.” – Nonbinary person, 50s
“I’ve known ever since I was little. I’m not really sure the age, but I just always knew when I put on boy clothes, I just felt so uncomfortable.” – Trans woman, late 30s
“It was probably as early as I can remember that I wasn’t like my brother or my father [and] not exactly like my girl cousins but I was something else, but I didn’t know what it was.” – Nonbinary person, 60s
Many participants were well into adulthood before they found the words to describe their gender. For those focus group participants, the path to self-discovery varied. Some described meeting someone who was transgender and relating to their experience; others described learning about people who are trans or nonbinary in college classes or by doing their own research.
“I read a Time magazine article … called ‘Homosexuality in America’ … in 1969. … Of course, we didn’t have language like we do now or people were not willing to use it … [but] it was kind of the first word that I had ever heard that resonated with me at all. So, I went to school and I took the magazine, we were doing show-and-tell, and I stood up in front of the class and said, ‘I am a homosexual.’ So that began my journey to figure this stuff out.” – Nonbinary person, 60s
“It wasn’t until maybe I was 20 or so when my friend started his transition where I was like, ‘Wow, that sounds very similar to the emotions and challenges I am going through with my own identity.’ … My whole life from a very young age I was confused, but I didn’t really put a name on it until I was about 20.” – Nonbinary person, late 20s
“I knew about drag queens, but I didn’t know what trans was until I got to college and was exposed to new things, and that was when I had a word for myself for the first time.” – Trans man, early 40s
“I thought that by figuring out that I was interested in women, identifying as lesbian, I thought [my anxiety and sadness] would dissipate in time, and that was me cracking the code. But then, when I got older, I left home for the first time. I started to meet other trans people in the world. That’s when I started to become equipped with the vocabulary. The understanding that this is a concept, and this makes sense. And that’s when I started to understand that I wasn’t cisgender.” – Trans man, early 30s
“When I took a human sexuality class in undergrad and I started learning about gender and different sexualities and things like that, I was like, ‘oh my god. I feel seen.’ So, that’s where I learned about it for the first time and started understanding how I identify.” – Nonbinary person, mid-20s
Focus group participants used a wide range of words to describe how they see their gender. For many nonbinary participants, the term “nonbinary” is more of an umbrella term, but when it comes to how they describe themselves, they tend to use words like “gender queer” or “gender fluid.” The word “queer” came up many times across different groups, often to describe anyone who is not straight or cisgender. Some trans men and women preferred just the terms “man” or “woman,” while some identified strongly with the term “transgender.” The graphic below shows just some of the words the participants used to describe their gender.
The way nonbinary people conceptualize their gender varies. Some said they feel like they’re both a man and a woman – and how much they feel like they are one or the other may change depending on the day or the circumstance. Others said they don’t feel like they are either a man or a woman, or that they don’t have a gender at all. Some, but not all, also identified with the term transgender.
“I had days where I would go out and just play with the boys and be one of the boys, and then there would be times that I would play with the girls and be one of the girls. And then I just never really knew what I was. I just knew that I would go back and forth.” – Nonbinary person, mid-20s
“Growing up with more of a masculine side or a feminine side, I just never was a fan of the labelling in terms of, ‘oh, this is a bit too masculine, you don’t wear jewelry, you don’t wear makeup, oh you’re not feminine enough.’ … I used to alternate just based on who I felt I was. So, on a certain day if I felt like wearing a dress, or a skirt versus on a different day, I felt like wearing what was considered men’s pants. … So, for me it’s always been both.” – Nonbinary person, mid-30s
“I feel like my gender is so amorphous and hard to hold and describe even. It’s been important to find words for it, to find the outlines of it, to see the shape of it, but it’s not something that I think about as who I am, because I’m more than just that.” – Nonbinary person, early 30s
“What words would I use to describe me? Genderless, if gender wasn’t a thing. … I guess if pronouns didn’t exist and you just called me [by my name]. That’s what my gender is. … And I do use nonbinary also, just because it feels easier, I guess.” – Nonbinary person, late 20s
Some participants said their gender is one of the most important parts of their identity, while others described it as one of many important parts or a small piece of how they see themselves. For some, the focus on gender can get tiring. Those who said gender isn’t a central – or at least not the most central – part of their identity mentioned race, ethnicity, religion and socioeconomic class as important aspects that shape their identity and experiences.
“It is tough because [gender] does affect every factor of your life. If you are doing medical transitioning then you have appointments, you have to pay for the appointments, you have to be working in a job that supports you to pay for those appointments. So, it is definitely integral, and it has a lot of branches. And it deals with how you act, how you relate to friends, you know, I am sure some of us can relate to having to come out multiple times in our lives. That is why sexuality and gender are very integral and I would definitely say I am proud of it. And I think being able to say that I am proud of it, and my gender, I guess is a very important part of my identity.” – Nonbinary person, late 20s
“Sometimes I get tired of thinking about my gender because I am actively [undergoing my medical transition]. So, it is a lot of things on my mind right now, constantly, and it sometimes gets very tiring. I just want to not have to think about it some days. So, I would say it’s, it’s probably in my top three [most important parts of my identity] – parent, Black, queer nonbinary.” – Nonbinary person, mid-40s
“I live in a town with a large queer and trans population and I don’t have to think about my gender most of the time other than having to come out as trans. But I’m poor and that colors everything. It’s not a chosen part of my identity but that part of my identity is a lot more influential than my gender.” – Trans man, early 40s
“My gender is very important to my identity because I feel that they go hand in hand. Now my identity is also broken down into other factors [like] character, personality and other stuff that make up the recipe for my identity. But my gender plays a big part of it. … It is important because it’s how I live my life every day. When I wake up in the morning, I do things as a woman.” – Trans woman, mid-40s
“I feel more strongly connected to my other identities outside of my gender, and I feel like parts of it’s just a more universal thing, like there’s a lot more people in my socioeconomic class and we have much more shared experiences.” – Trans man, late 30s
Some participants spoke about how their gender interacted with other aspects of their identity, such as their race, culture and religion. For some, being transgender or nonbinary can be at odds with other parts of their identity or background.
“Culturally I’m Dominican and Puerto Rican, a little bit of the macho machismo culture, in my family, and even now, if I’m going to be a man, I’ve got to be a certain type of man. So, I cannot just be who I’m meant to be or who I want myself to be, the human being that I am.” – Trans man, mid-30s
“[Judaism] is a very binary religion. There is a lot of things like for men to do and a lot of things for women to do. … So, it is hard for me now as a gender queer person, right, to connect on some levels with [my] religion … I have just now been exposed to a bunch of trans Jewish spaces online which is amazing.” – Nonbinary person, mid-40s
“Just being Indian American, I identify and love aspects of my culture and ethnicity, and I find them amazing and I identify with that, but it’s kind of separated. So, I identify with the culture, then I identify here in terms of gender and being who I am, but I kind of feel the necessity to separate the two, unfortunately.” – Nonbinary person, mid-30s
“I think it’s really me being a Black woman or a Black man that can sometimes be difficult. And also, my ethnic background too. It’s really rough for me with my family back home and things of that nature.” – Nonbinary person, mid-20s
Navigating gender day-to-day
For some, deciding how open to be about their gender identity can be a constant calculation. Some participants reported that they choose whether or not to disclose that they are trans or nonbinary in a given situation based on how safe or comfortable they feel and whether it’s necessary for other people to know. This also varies depending on whether the participant can easily pass as a cisgender man or woman (that is, they can blend in so that others assume them to be cisgender and don’t recognize that they are trans or nonbinary).
“It just depends on whether I feel like I have the energy to bring it up, or if it feels worth it to me like with doctors and stuff like that. I always bring it up with my therapists, my primary [care doctor], I feel like she would get it. I guess it does vary on the situation and my capacity level.” – Nonbinary person, late 20s
“I decide based on the person and based on the context, like if I feel comfortable enough to share that piece of myself with them, because I do have the privilege of being able to move through the world and be identified as cis[gender] if I want to. But then it is important to me – if you’re important to me, then you will know who I am and how I identify. Otherwise, if I don’t feel comfortable or safe then I might not.” – Nonbinary person, early 30s
“The expression of my gender doesn’t vary. Who I let in to know that I was formerly female – or formerly perceived as female – is kind of on a need to know basis.” – Trans man, 60s
“It’s important to me that people not see me as cis[gender], so I have to come out a lot when I’m around new people, and sometimes that’s challenging. … It’s not information that comes out in a normal conversation. You have to force it and that’s difficult sometimes.” – Trans man, early 40s
Work is one realm where many participants said they choose not to share that they are trans or nonbinary. In some cases, this is because they want to be recognized for their work rather than the fact that they are trans or nonbinary; in others, especially for nonbinary participants, they fear it will be perceived as unprofessional.
“It’s gotten a lot better recently, but I feel like when you’re nonbinary and you use they/them pronouns, it’s just seen as really unprofessional and has been for a lot of my life.” – Nonbinary person, early 30s
“Whether it’s LinkedIn or profiles [that] have been updated, I’ve noticed people’s resumes have their pronouns now. I don’t go that far because I just feel like it’s a professional environment, it’s nobody’s business.” – Nonbinary person, mid-30s
“I don’t necessarily volunteer the information just to make it public; I want to be recognized for my character, my skill set, in my work in other ways.” – Trans man, early 30s
Some focus group participants said they don’t mind answering questions about what it’s like to be trans or nonbinary but were wary of being seen as the token trans or nonbinary person in their workplace or among acquaintances. Whether or not they are comfortable answering these types of questions sometimes depends on who’s asking, why they want to know, and how personal the questions get.
“I’ve talked to [my cousin about being trans] a lot because she has a daughter, and her daughter wants to transition. So, she always will come to me asking questions.” – Trans woman, early 40s
“It is tough being considered the only resource for these topics, right? In my job, I would hate to call myself the token nonbinary, but I was the first nonbinary person that they hired and they were like, ‘Oh, my gosh, let me ask you all the questions as you are obviously the authority on the subject.’ And it is like, ‘No, that is a part of me, but there are so many other great resources.’” – Nonbinary person, late 20s
“I don’t want to be the token. I’m not going to be no spokesperson. If you have questions, I’m the first person you can ask. Absolutely. I don’t mind discussing. Ask me some of the hardest questions, because if you ask somebody else you might get you know your clock cleaned. So, ask me now … so you can be educated properly. Otherwise, I don’t believe it’s anybody’s business.” – Trans woman, early 40s
Most nonbinary participants said they use “they/them” as their pronouns, but some prefer alternatives. These alternatives include a combination of gendered and gender-neutral pronouns (like she/they) or simply preferring that others use one’s names rather than pronouns.
“If I could, I would just say my name is my pronoun, which I do in some spaces, but it just is not like a larger view. It feels like I’d rather have less labor on me in that regard, so I just say they/them.” – Nonbinary person, late 20s
“For me personally, I don’t get mad if someone calls me ‘he’ because I see what they’re looking at. They look and they see a guy. So, I don’t get upset. I know a few people who do … and they correct you. Me, I’m a little more fluid. So, that’s how it works for me.” – Nonbinary person, mid-30s
“I use they/she pronouns and I put ‘they’ first because that is what I think is most comfortable and it’s what I want to draw people’s attention to, because I’m 5 feet tall and 100 pounds so it’s not like I scream masculine at first sight, so I like putting ‘they’ first because otherwise people always default to ‘she.’ But I have ‘she’ in there, and I don’t know if I’d have ‘she’ in there if I had not had kids.” – Nonbinary person, late 30s
“Why is it so hard for people to think of me as nonbinary? I choose not to use only they/them pronouns because I do sometimes identify with ‘she.’ But I’m like, ‘Do I need to use they/them pronouns to be respected as nonbinary?’ Sometimes I feel like I should do that. But I don’t want to feel like I should do anything. I just want to be myself and have that be accepted and respected.” – Nonbinary person, early 30s
“I have a lot of patience for people, but [once someone in public used] they/them pronouns and I thanked them and they were like, ‘Yeah, I just figure I’d do it when I don’t know [someone’s] pronouns.’ And I’m like, ‘I love it, thank you.’” – Nonbinary person, early 30s
Transgender and nonbinary participants find affirmation of their gender identity and support in various places. Many cited their friends, chosen families (and, less commonly, their relatives), therapists or other health care providers, religion, or LGBTQ+ spaces as sources of support.
“I’m just not close with my family [of origin], but I have a huge chosen family that I love and that fully respects my identity.” – Nonbinary person, early 30s
“Before the pandemic I used to go out to bars a lot; there’s a queer bar in my town and it was a really nice place just being friends with everybody who went and everybody who worked there, it felt really nice you know, and just hearing everybody use the right pronouns for me it just felt really good.” – Nonbinary person, early 30s
“I don’t necessarily go to a lot of dedicated support groups, but I found that there’s kind of a good amount of support in areas or groups or fandoms for things that have a large LGBT population within them. Like certain shows or video games, where it’s just kind of a joke that all the gay people flock to this.” – Trans woman, late teens
“Being able to practice my religion in a location with a congregation that is just completely chill about it, or so far has been completely chill about it, has been really amazing.” – Nonbinary person, late 30s
Many participants shared specific moments they said were small in the grand scheme of things but made them feel accepted and affirmed. Examples included going on dates, gestures of acceptance by a friend or social group, or simply participating in everyday activities.
“I went on a date with a really good-looking, handsome guy. And he didn’t know that I was trans. But I told him, and we kept talking and hanging out. … That’s not the first time that I felt affirmed or felt like somebody is treating me as I present myself. But … he made me feel wanted and beautiful.” – Trans woman, late 30s
“I play [on a men’s rec league] hockey [team]. … I joined the league like right when I first transitioned and I showed up and I was … nervous with locker rooms and stuff, and they just accepted me as male right away.” – Trans man, late 30s
“I ended up going into a barbershop. … The barber was very welcoming, and talked to me as if I was just a casual customer and there was something that clicked within that moment where, figuring out my gender identity, I just wanted to exist in the world to do these natural things like other boys and men would do. So, there was just something exciting about that. It wasn’t a super macho masculine moment, … he just made me feel like I blended in.” – Trans man, early 30s
Participants also talked about negative experiences, such as being misgendered, either intentionally or unintentionally. For example, some shared instances where they were treated or addressed as a gender other than the gender that they identify as, such as people referring to them as “he” when they go by “she,” or where they were deadnamed, meaning they were called by the name they had before they transitioned.
“I get misgendered on the phone a lot and that’s really annoying. And then, even after I correct them, they keep doing it, sometimes on purpose and sometimes I think they’re just reading a script or something.” – Trans man, late 30s
“The times that I have been out, presenting femme, there is this very subconscious misgendering that people do and it can be very frustrating. [Once, at a restaurant,] I was dressed in makeup and nails and shoes and everything and still everyone was like, ‘Sir, what would you like?’ … Those little things – those microaggressions – they can really eat away at people.” – Nonbinary person, mid-40s
“People not calling me by the right name. My family is a big problem, they just won’t call me by my name, you know? Except for my nephew, who is of the Millennial generation, so at least he gets it.” – Nonbinary person, 60s
“I’m constantly misgendered when I go out places. I accept this – because of the way I look, people are going to perceive me as a woman and it doesn’t cause me huge dysphoria or anything, it’s just nice that the company that I keep does use the right pronouns.” – Nonbinary person, early 30s
Some participants also shared stories of discrimination, bias, humiliation, and even violence. These experiences ranged from employment discrimination to being outed (that is, someone else disclosing the fact that they are transgender or nonbinary without their permission) without their permission to physical attacks.
“I was on a date with this girl and I had to use the bathroom … and the janitor … wouldn’t let me use the men’s room, and he kept refusing to let me use the men’s room, so essentially, I ended up having to use the same bathroom as my date.” – Trans man, late 30s
“I’ve been denied employment due to my gender identity. I walked into a supermarket looking for jobs. … And they flat out didn’t let me apply. They didn’t even let me apply.” – Trans man, mid-30s
“[In high school,] this group of guys said, ‘[name] is gay.’ I ignored them but they literally threw me and tore my shirt from my back and pushed me to the ground and tried to strip me naked. And I had to fight for myself and use my bag to hit him in the face.” – Trans woman, late 20s
“I took a college course [after] I had my name changed legally and the instructor called me out in front of the class and called me a liar and outed me.” – Trans man, late 30s
Seeking medical care for gender transitions
Many, but not all, participants said they have received medical care , such as surgery or hormone therapy, as part of their gender transition. For those who haven’t undergone a medical transition, the reasons ranged from financial barriers to being nervous about medical procedures in general to simply not feeling that it was the right thing for them.
“For me to really to live my truth and live my identity, I had to have the surgery, which is why I went through it. It doesn’t mean [that others] have to, or that it will make you more or less of a woman because you have it. But for me to be comfortable, … that was a big part of it. And so, that’s why I felt I had to get it.” – Trans woman, early 40s
“I’m older and it’s an operation. … I’m just kind of scared, I guess. I’ve never had an operation. I mean, like any kind of operation. I’ve never been to the hospital or anything like that. So, it [is] just kind of scary. But I mean, I want to. I think about all the time. I guess have got to get the courage up to do it.” – Trans woman, early 40s
“I’ve decided that the dysphoria of a second puberty … would just be too much for me and I’m gender fluid enough where I’m happy, I guess.” – Nonbinary person, early 30s
“I’m too old to change anything, I mean I am what I am. [laughs]” – Nonbinary person, 60s
Many focus group participants who have sought medical treatment for their gender transition faced barriers, although some had positive experiences. For those who said there were barriers, the cost and the struggle to find sympathetic doctors were often cited as challenges.
“I was flat out turned down by the primary care physician who had to give the go-ahead to give me a referral to an endocrinologist; I was just shut down. That was it, end of story.” – Nonbinary person, 50s
“I have not had surgery, because I can’t access surgery. So unless I get breast cancer and have a double mastectomy, surgery is just not going to happen … because my health insurance wouldn’t cover something like that. … It would be an out-of-pocket plastic surgery expense and I can’t afford that at this time.” – Nonbinary person, 50s
“Why do I need the permission of a therapist to say, ‘This person’s identity is valid,’ before I can get the health care that I need to be me, that is vital for myself and for my way of life?” – Nonbinary person, mid-40s
“[My doctor] is basically the first person that actually embraced me and made me accept [who I am].” – Trans woman, late 20s
Many people who transitioned in previous decades described how access has gotten much easier in recent years. Some described relying on underground networks to learn which doctors would help them obtain medical care or where to obtain hormones illegally.
“It was hard financially because I started so long ago, just didn’t have access like that. Sometimes you have to try to go to Mexico or learn about someone in Mexico that was a pharmacist, I can remember that. That was a big thing, going through the border to Mexico, that was wild. So, it was just hard financially because they would charge so much for testosterone. And there was the whole bodybuilding community. If you were transitioning, you went to bodybuilders, and they would charge you five times what they got it [for], so it was kind of tough.” – Trans man, early 40s
“It was a lot harder to get a surgeon when I started transitioning; insurance was out of the question, there wasn’t really a national discussion around trans people and their particular medical needs. So, it was challenging having to pay everything out of pocket at a young age.” – Trans man, early 30s
“I guess it was hard for me to access hormones initially just because you had to jump through so many hoops, get letters, and then you had to find a provider that was willing to write it. And now it’s like people are getting it from their primary care doctor, which is great, but a very different experience than I had.” – Trans man, early 40s
Connections with the broader LGBTQ+ community
The discussions also touched on whether the participants feel a connection with a broader lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community or with other people who are LGBTQ+. Views varied, with some saying they feel an immediate connection with other people who are LGBTQ+, even with those who aren’t trans or nonbinary, and others saying they don’t necessarily feel this way.
“It’s kind of a recurring joke where you can meet another LGBT person and it is like there is an immediate understanding, and you are basically talking and giving each other emotional support, like you have been friends for 10-plus years.” – Trans woman, late teens
“I don’t think it’s automatic friendship between queer people, there’s like a kinship, but I don’t think there’s automatic friendship or anything. I think it’s just normal, like, how normal people make friends, just based on common interests.” – Nonbinary person, early 30s
“I do think of myself as part of the LGBT [community] … I use the resources that are put in place for these communities, whether that’s different health care programs, support groups, they have the community centers. … So, I do consider myself to be part of this community, and I’m able to hopefully take when needed, as well as give back.” – Trans man, mid-30s
“I feel like that’s such an important part of being a part of the [LGBTQ+] alphabet soup community, that process of constantly learning and listening to each other and … growing and developing language together … I love that aspect of creating who we are together, learning and unlearning together, and I feel like that’s a part of at least the queer community spaces that I want to be in. That’s something that’s core to me.” – Nonbinary person, early 30s
“I identify as queer. I feel like I’m a part of the LGBT community. That’s more of a part of my identity than being trans. … Before I came out as trans, I identified as a lesbian. That was also a big part of my identity. So, that may be too why I feel like I’m more part of the LGB community.” – Trans man, early 40s
While many trans and nonbinary participants said they felt accepted by others in the LGBTQ+ community, some participants described their gender identity as a barrier to full acceptance. There was a sense among some participants that cisgender people who are lesbian, gay or bisexual don’t always accept people who are transgender or nonbinary.
“I would really like to be included in the [LGBTQ+] community. But I have seen some people try to separate the T from LGB … I’ve run into a few situations throughout my time navigating the [LGBTQ+] community where I’ve been perceived – and I just want to say that there’s nothing wrong with this – I’ve been perceived as like a more feminine or gay man in a social setting, even though I’m heterosexual. … But the minute that that person found out that I wasn’t a gay man … and that I was actually a transgender person, they became cold and just distancing themselves. And I’ve been in a lot of those types of circumstances where there’s that divide between the rest of the community.” – Trans man, early 30s
“There are some lesbians who see trans men as being traitors to womanhood. Those are not people that I really identify with or want to be close to.” – Trans man, early 40s
“It’s only in the past maybe dozen or so years, that an identity like gender fluid or gender queer was acceptable even within the LGBTQ+ community. … I tried to go to certain LGBTQ+ events as a trans man and, you know, I was not allowed in because I looked too female. The gay men would not allow me to participate.” – Nonbinary person, 50s
“Technically based on the letters [in the acronym LGBTQ+] I am part of that community, but I’ve felt discrimination, it’s very heavily exclusive to people who are either gay or lesbian and I think that’s true … for queer or bisexual or asexual, intersex … anybody who’s not like exclusively hardcore gay or lesbian. It’s very exclusive, like excluding to those people. … I feel like the BTQ is a separate group of people…. So, I identify with the second half of the letters as a separate subset.” – Trans man, late 30s
Policy and social change
When asked to name the most important policy or political issues facing transgender and nonbinary people in the United States today, many participants named basic needs such as housing, employment, and health care. Others cited recent legislation or policies related to people who are transgender that have made national news.
“Housing is a huge issue. Health care might be good in New York, it might be good in California, but … it’s not a national equality for trans folks. Health care is not equal across the states. Housing is not equal across the states. So, I think that the issues right now that we’re all facing is health care and housing. That’s the top, the most important things.” – Trans woman, early 40s
“Definitely education. I think that’s very important … Whether you identify as trans or not as a young child, it’s good to understand and know the different things under the umbrella, the queer umbrella. And it is also just a respect thing. And also, the violence that happens against trans and nonbinary people. I feel like educating them very young, that kind of helps – well, it is going to help because once you understand what’s going on and you see somebody that doesn’t identify the same as you, you’ll have that respect, or you’ll have that understanding and you’re less likely to be very violent towards them.” – Nonbinary person, mid-20s
“Employment is a big one. And I know that some areas, more metropolitan progressive-leaning areas, are really on top of this, but they’re trans people everywhere that are still being discriminated against. I think it’s a personal thing for me that goes back to my military service, but still, it’s just unfortunate. It’s an unfortunate reality.” – Trans man, early 30s
“I think just the strong intersectionality of trans people with mental health issues, or even physical health issues. … So in that way, accessing good health care or having good mental health.” – Trans man, late 30s
“I honestly think that the situation in Texas is the most pressing political and policy situation because it is a direct attack on the trans community. … And it is so insidious because it doesn’t just target bathrooms. This is saying that if you provide medical care to trans youth it is tantamount to child abuse. And it is so enraging because it is a known proven fact that access to gender affirming medical care saves lives. It saves the lives of trans youth. And trans youth have the highest suicide rate in the country.” – Nonbinary person, mid-40s
Participants had different takes on what gets in the way of progress on issues facing transgender and nonbinary people. Some pointed to the lack of knowledge surrounding the history of these issues or not knowing someone who is transgender or nonbinary. Others mentioned misconceptions people might have about transgender and nonbinary people that influence their political and policy perspectives.
“People who don’t know trans people, honestly … that’s the only barrier I can understand because people fear what they don’t know and then react to it a lot of the time.” – Nonbinary person, early 30s
“Sometimes even if they know someone, they still don’t consider them to be a human being, they are an ‘other,’ they are an ‘it,’ they are a ‘not like me,’ ‘not like my family,’ person and so they are put into a place socially where they can be treated badly.” – Nonbinary person, 50s
“Just the ignorance and misinformation and this quick fake social media fodder, where it encourages people who should not be part of the conversation to spread things that are not true.” – Trans man, late 30s
“Also, the political issues that face nonbinary people, it’s that people think nonbinary is some made-up thing to feel cool. It’s not to feel cool. And if someone does do it to feel cool, maybe they’re just doing that because they don’t feel comfortable within themselves.” – Nonbinary person, mid-30s
“There’s so much fear around it, and misunderstanding, and people thinking that if you’re talking to kids about gender and sexuality, that it’s sexual. And it’s like, we really need to break down that our bodies are not inherently sexual. We need to be able to talk with students and children about their bodies so that they can then feel empowered to understand themselves, advocate for themselves.” – Nonbinary person, early 30s
When asked what makes them hopeful for the future for trans and nonbinary people, some participants pointed to the way things in society have already changed and progress that has been made. For example, some mentioned greater representation and visibility of transgender and nonbinary people in entertainment and other industries, while others focused on changing societal views as things that give them hope for the future.
“I am hopeful about the future because I see so many of us coming out and being visible and representing and showing folks that we are not to stereotype.” – Trans woman, early 40s
“Also, even though celebrity is annoying, it’s still cool when people like Willow [Smith] or Billie Eilish or all these popstars that the kids really love are like, ‘I’m nonbinary, I’m queer,’ like a lot more progressive. … Even just more visibility in TV shows and movies, the more and more that happens the more it’s like, ‘Oh yeah, we are really here, you can’t not see us.’” – Nonbinary person, late 20s
“We shouldn’t have to look to the entertainment industry for role models, we shouldn’t have to, we should be able to look to our leaders, our political leaders, but I think, that’s what gives me hope. Soon, it’s going to become a nonissue, maybe in my lifetime.” – Trans man, 60s
“I have gotten a little bit into stand-up comedy in the last few weeks, and it is like the jokes that people made ten years ago are resurfacing online and people are enraged about it. They are saying like, ‘Oh, this is totally inappropriate.’ But that comes with the recognition that things have changed, and language has changed, and people are becoming more intolerant of allowing these things to occur. So that is why I am hopeful, is being able to see that progression and hopeful continued improvement on that front.” – Nonbinary person, late 20s
“I think because of the shift of what’s happening, how everything has become so normal, and people are being more open, and within the umbrella of queerness so many different things are happening, I think as we get more comfortable and we progress as a society, it’s just going to be better. So, people don’t have to hide who they are. So, that gives me hope.” – Nonbinary person, mid-20s
For many, young people are a source of hope. Several participants talked about younger generations being more accepting of those who are transgender or nonbinary and also being more accepted by their families if they themselves are trans or nonbinary.
“And then the other portion that gives me hope are the kids, because I work now with so many kids who are coming out as trans earlier and their families are embracing them and everything. … So I really am trusting in the young generation.” – Nonbinary person, 60s
“I mean kids don’t judge you the same way as adults do about gender, and they’re so expansive and have so much creativity. … So it’s just the kids, Gen Z, and it just makes me feel really, really hopeful.” – Nonbinary person, early 30s
“The youth, the youth. They understand almost intrinsically so much more about these things than I feel like my generation did. They give me so much hope for the future.” – Nonbinary person, early 30s
“I think future generations, just seeing this growing amount of support that they have, that it’s just going to keep improving … there’s an increase in visibility but there’s also an increase in support … like resources for parents where they can see that they don’t have to punish their kids. Their kids can grow up feeling like, ‘This is okay to be this way.’ And I feel like that’s not something that can be stopped.” – Trans man, late 30s
Lead photo: (Angela Weiss/AFP via Getty Images)
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The truth about trans
A Q&A to help build understanding around trans people and the issues they face.
If you read a newspaper, go on the internet, or turn on the TV, you may well have seen some shocking headlines about trans people lately.
It’s fine if you don’t feel like you know very much about trans people – lots of people don’t. But it’s important to know that some myths and misconceptions are repeated consistently in the media, and this makes it harder to discover the truth when it comes to some of these issues.
We’ve developed this Q&A to answer some of the common questions about trans people, and to tackle some of those myths and misconceptions you might have seen.
If you find this information useful, why not sign up to our newsletter ? We’ll keep you up to date on all of our work, and let you know what you can do to help make life better for all LGBTQ+ people.
How many trans people are there in Britain at the moment?
- How does a person know they are trans?
What’s the situation like for trans people in the UK at the moment?
What process do you have to go through to be recognised as trans in daily life, what is a gender recognition certificate and how do you get one, what’s wrong with this process, do you need to have gender reassignment surgery to be trans, does teachers and doctors talking about trans issues more make children and young people think they are trans when they aren’t, should under 18s be able to transition.
- Is trans healthcare a form of conversion therapy for gay people?
Is it true that lots of people change their mind about their transition?
Are you calling for gender to be removed from documents, what does non-binary mean, and what’s the right way to talk about it, what does ‘cis’ mean, what do deadnaming and misgendering mean, it all feels complicated and i’m frightened of saying the wrong thing, can you be trans and gay, so, could a lesbian have a trans woman as a partner, or a gay man be with a trans man, which public toilets can trans people use, should trans women continue to be allowed in women’s refuges, should trans women continue to be able to sit on women-only panels or be on women-only shortlists.
- Should trans people continue to be allowed to play sport?
How do other equality movements relate to trans equality?
How can i support a trans young person, what can i do to be an ally to trans people.
The 2021 Census was a historic moment for the LGBTQ+ community in England and Wales. For the first time, the Census included two new voluntary questions on sexual orientation and trans status.
0.5% of the population (262,000 people in England and Wales) reported having a gender identity that is different from the one they were assigned at birth.
Within this, the number of trans women and trans men is almost exactly the same – each accounting for 0.1% of the population (48,000 people in England and Wales), with a slightly smaller proportion identifying as non-binary at 0.06% (30,000 people in England and Wales). 18,000 people wrote in a different gender identity.
How does a person know they are trans?
Many people know they’re trans from a young age. Some trans people might not have the language or understanding of what it means to be trans until later in life. Other trans people do not know until they are teenagers or adults. There is no right or wrong way to be trans, but what is clear is that it’s not something that’s a fad or a 'lifestyle choice' and that all trans people deserve to be treated with dignity and respect. We can all recognise that our gender forms an important part of our identity, and when you aren’t recognised as being the gender you know you are, it can be extremely damaging.
If you are questioning or exploring your gender you can speak confidentially to MindLine Trans+ , LGBT Switchboard or search for support in your area via TransUnite .
Trans people in the UK are facing rising levels of abuse and inequality. In 2018, our research found that two in five trans people have had a hate crime committed against them in the last year, and one in eight trans people had been physically attacked by colleagues or customers at work. Research from Galop found that in 2020, four in five trans people had experienced a hate crime in the previous 12 months. This shows a worrying increase in transphobic violence and abuse.
Transphobic hate crime has been rising faster than against any other group, with the latest Home Office figures showing a 186% rise in transphobic hate crime reports in in England and Wales between 2018 - 2023, and the Home Office’s own report acknowledged that ‘Transgender issues have been heavily discussed by politicians, the media and on social media over the last year, which may have led to an increase in these offences.’
This concerning increase in anti-trans hate crime comes at a time when trans people are facing extremely high waiting times for essential healthcare - with detrimental effects on their mental wellbeing. Nearly all respondents to TransActual's 2022 research (86.9%, 814) stated that waiting to access hormones had negatively impacted their mental health, while 83.8% (897) said the same of waiting for surgery. Our research also shows a fuller picture of the challenges trans people experience with healthcare and wellbeing.
That’s why this is something we all need to care about, take seriously and work to tackle in whatever way we can – whether that’s at work, at school or in our communities.
That said, these stats only tell one part of the story. Being trans in no way means you’re going to have a bad life – trans people around the UK have rich, rewarding lives, careers, families and relationships, just like any other group of people. Being trans is not what causes trans people poor mental health - it is the discrimination, abuse and violence they often face.
In most cases, you don’t need to go through any legal or formal process. Transition can be any steps you take to express you’re a change in your gender, such as changing your name, pronouns or the way you dress. The Equality Act 2010 protects anyone proposing to undergo, is undergoing, or has undergone a process of ‘reassigning their sex’ from discrimination based on ‘gender reassignment’. You do not have to have taken any medical steps in your transition in order to be protected by this legislation. You can use the bathroom that fits your gender, expect your employers to recognise your gender, and access gender-specific public services.
Since at least as far back as 2009, to update your gender on a passport and driving licence, most people just need a note from a doctor. That’s what’s so frustrating about some of the current media debate – many of the trans rights discussions happening now are about things already established and protected by law.
One thing that causes a lot of difficulty and humiliation for some trans people is getting the gender on their birth certificate changed. This process is something that’s governed by the Gender Recognition Act 2004. The UK Government held a public consultation into reforming the Act for England and Wales in 2018 and published their response in 2020. The majority of feedback supported full reform, including a de-medicalised approach, non-binary recognition, and a simplified, cost-free process for obtaining a Gender Recognition Certificate. In spite of this, the Government decided only to reduce the fee for applying for a Gender Recognition Certificate, and to move the application process online. You can read Stonewall’s response here .
In Scotland, the Scottish Parliament passed the Gender Recognition Reform (Scotland) Bill with a majority of support drawn from MSPs from all political parties that would have de-medicalised legal gender recognition for trans people in Scotland and extended eligibility to 16 and 17 year olds. The UK Government vetoed the legislation in an unprecedented constitutional remove. The Scottish Government has challenged this decision, but until this constitutional issue is resolved, trans people in Scotland cannot benefit from the proposed changes.
Non-binary people aren’t currently recognised in legislation. Among other things, this means they must choose between ‘male’ and ‘female’ on official documents like passports and driving licences. However, a positive 2020 Employment Tribunal ruling stated that non-binary and genderfluid people could be protected from discrimination under the 2010 Equality Act. This judgment will be key in supporting future judicial decisions.
A Gender Recognition Certificate (GRC) is a document that allows some trans men and trans women to have the right gender on their birth certificate. This can make life easier when it comes to things like getting married, paying your taxes, or having your death recorded respectfully.
The process of getting a GRC is controlled by the Gender Recognition Act (GRA) 2004. It’s very outdated, and is a stressful, dehumanising and traumatic process for most trans people to go through.
Currently, in order to get a GRC, trans people have to get a medical diagnosis of ‘gender dysphoria’. Often this will be from a Gender Identity Clinic, where waiting times are long – those being seen for the first time today, would have been waiting for an average of four years. Those being referred today are likely to be waiting considerably longer.
Trans people also have to show they have lived in their ‘acquired gender’ for a minimum of two years, gathering evidence such as letters addressed to them and photos of themselves at events, to try to convince a panel of people who they will never meet that they are trans. In England and Wales, if they’re married, the individual also needs the consent of their spouse before they can proceed. This can leave trans people trapped in abusive or controlling situations.
A lot: it’s secretive, discriminatory, and it's medicalised when the World Health Organisation de-classified ‘gender identity disorders’ as a mental illness in 2019. It can also take several years to go through and involves a lot of bureaucracy and medical assessments – which are costly for those who can go private and have waiting lists of several years for those who go through the NHS system. It also only allows for people to switch from one binary gender to the other – male to female or vice versa – which means it doesn’t work at all for non-binary people who don’t identify as either.
The whole process is so traumatic and demeaning that many trans people simply can’t face it. There’s no need for it to be this way. Lots of other countries, including Ireland, have already reformed this process successfully and safely. Surveyed countries that have implemented a model based on legal declaration (often referred to as ‘Self ID’ or ‘self-determination’) - where trans people can change their gender by making a statutory declaration without the need for medical assessments – report no known case of fraud or criminal intent.
Countries with self-determination models often also have high standards protecting women’s rights and gender equality. The absence of abuse shows that self-determination is not a threat to women’s quotas and rather supports gender equality measures.
Being able to get a Gender Recognition Certificate matters: it means you can have a birth certificate with the right gender on it. While a trans person can access services and have official ID that reflects their gender without a GRC, having a GRC is important for major life events such as marriage – so that your marriage certificate can reflect your gender.
The findings from the UK Government’s consultation on the Gender Recognition Act can be found here and Stonewall’s statement on the disappointing lack of action from the Government on the results can be found here .
You do not need to have had any surgery or medical intervention to be, or to be recognised as, trans. This has been established in law for a long time. A lot of media coverage is focused on trans people’s body parts and surgical procedures, which is invasive and dehumanising.
For some trans people, having surgery to relieve dysphoria is an important part of their transition. Getting access to surgery has become increasingly difficult in recent years, with NHS waiting lists growing longer and Covid-19 and pressures on the NHS compounding the existing delays. More investment is desperately needed so that trans people can get the procedures they need. Our TRANSforming Futures: Healthcare report details the experiences of trans people across the UK, and their experiences with accessing healthcare.
For other trans people, surgery isn’t something they want or need in order to feel happy with their body. It’s the same with hormones, like testosterone and oestrogen treatments. It’s important to remember that being trans isn’t about having a particular appearance or particular body parts. It’s something that’s absolutely core to a trans person’s identity and is not dependent on their outward appearance.
Transition means different things for each person: there is no one single ‘gender reassignment operation’ and no end goal to transition, beyond what the individual wants.
No. Over 30 years ago, Section 28 was introduced to prevent schools from ‘promoting homosexuality’ because there were fears that children would ‘turn gay’ if they learned about lesbian, gay and bi people. While this might seem ridiculous to many of us now, we’re currently seeing very similar conversations happening around teaching kids about trans people in school.
The fact that teachers, doctors, families, and caregivers are talking about gender more is a good thing. It means that children and young people have a better grounding to understand themselves, and to celebrate difference in others.
All children and young people deserve the right to be happy and to be themselves. When young people access support, they’re looking for exactly that: support. They want someone to talk things through with, someone who can understand their thoughts and feelings, and help them to have similar conversations with others around them. Those who do explore their identity and realise they are trans deserve love, support, and age-appropriate care.
Every trans person’s transition is individual. For some, it will involve purely social steps, such as changing their name or pronouns. For others, transitioning may also include medical steps – meaning hormone blockers or hormone therapy. Under 18s cannot access surgery within the UK.
Research ( 1 , 2 , 3 ) shows that allowing trans young people to explore their gender identity, and using their chosen pronouns, greatly benefits their mental wellbeing.
When it comes to medical transition, some children and young people may not want or require any medical support. Some may choose to wait before making decisions about future medical care. For some young people who are certain about who they are, and who may become increasingly distressed by changes in their body as they get older, medical treatment can be the right course of action with support from specialist medical professionals.
In the UK, after assessment, this can involve being prescribed puberty blockers. This non-permanent treatment gives young people time and space to work out what is right for them, without the distress of the heightened dysphoria that puberty can bring on. It can also help those who know for sure that they do not want to experience the puberty that will occur for them without intervention. From 16 onwards, after further assessment, this can include cross-sex hormones (such as oestrogen or testosterone). In the UK, only adults (over 18s) can access gender-affirming surgery.
It’s important to note that, contrary to narratives that young people are being ‘fast-tracked’ into medical transition, waiting lists for these services are now an average of almost four years long – leaving young people and their families without any support.
It is important that the wellbeing, rights, and wishes of the young person are at the centre of any decisions made. What is right for one young person may be different to what is right for another.
Is trans healthcare a form of conversion therapy for gay people?
In short: no. Conversion therapy are practices where the only goal is to stop someone being who they are. Good therapy supports patients to explore their identity and supports them regardless of the answers they find.
This question also assumes that a person can only be trans or lesbian, gay, bi, etc. But sexual orientation (who you are attracted to) is unrelated to gender identity (who you are). The UK Government's National LGBT Survey shows that only 9.4% of trans people identify as straight, while 73.1% of trans respondents said that they are gay/lesbian, bi, pan, or queer. A further 5.4% were ace.
Some trans people are subjected to conversion practices that attempt to stop them being trans. This is as harmful and damaging as conversion therapy that tries to change someone’s sexual orientation. Our research found that that in the UK, one in five trans people (20%) have been pressured to access services to suppress their gender identity when accessing healthcare services.
Conversion therapy, in all its forms, should be banned – you can learn more about our campaign to ban LGBTQ+ conversion therapy here .
Let’s start with the reality: the vast majority of trans people who transition do so without any regrets. But while detransitioning is very rare ( less than 1% ), it does happen.
People detransition for many reasons, and detransition does not, in and of itself, mean regret. It can mean that a person, having explored their gender, has found that this isn’t the right thing for them. It can also mean a person has decided this moment isn’t the right time for them to transition, and they might plan to do so when they have more support.
The most common reason for detransition is that an individual cannot cope with the family and community support they lost and the transphobia they experienced when they transitioned. Those who detransition or experience regret deserve ongoing support and care, as do people who transition and live as that gender for the rest of their lives.
It's important to remember that the fact that some people detransition does not make the experiences and existence of trans people any less valid or real. Nor does it mean that transition-based healthcare should be made even harder to access than it already is.
You can read more about this on our dispelling myths around detransition page .
We want systems that are inclusive and do not discriminate against people because of who they are. Most importantly of all, we want equality.
Where gender is listed on documents, we believe it is only fair for all people to have the gender that reflects their lived reality on their documents – including non-binary people and intersex people.
We believe that processes and documents can be made to include and protect everyone quite easily. We need to look at systems sensibly and think critically about what information is needed and what information isn’t. For some trans people, having a gender listed on a document will make them feel safer, and for others the opposite can be true. Safety and inclusion must be at the centre of any future decisions.
All that is required is a common-sense approach that is inclusive and supportive.
‘Non-binary’ is an umbrella term for people who:
- don’t solely identify as either male or female
- identify as both male and female
- identify with another gender
- don’t identify with any gender
Because the binary terms of ‘male’ and ‘female’ don’t fit, using pronouns such as ‘he’ or ‘she’ might not always be right, so when you talk to someone who’s non-binary try to find a good moment and ask them how they would prefer to be addressed. The person might use ‘they’, ‘he’ or ‘she’ pronouns, something different, or no pronouns at all.
It may take a bit of getting used to, but using the pronouns a non-binary person has asked for will make that person feel acknowledged and welcomed. It’s not long since some people struggled to accept that some women wanted to be called Ms instead of Miss, but we got used to the common courtesy of simply asking people how they wanted to be addressed. This is no different.
There are websites that can help you get used to using pronouns that are new to you, such as Practice with Pronouns .
‘Cis’ is short for ‘cisgender’, which means somebody whose gender identity matches the sex they were assigned at birth. Basically, it means ‘not trans’. The word has a Latin root which means ‘on the same side as’.
Using the word ‘cis’ is important – without it, people might use phrases like ‘trans people and normal people’, which is stigmatising.
‘Cis’ and ‘trans’ are neutral descriptive terms that put everyone on an equal footing and name one part of our experiences of gender.
‘Deadnaming’ is the term for when somebody refers to a trans person using the name they had before they transitioned. ‘Misgendering’ is the term used when someone refers to a trans person using terms linked to the gender they were assigned at birth, instead of their real gender (for example by using terms like ‘man’, ‘woman’ or using pronouns incorrectly).
When done deliberately, deadnaming and misgendering are both deeply hurtful to trans people. If you hear people doing this, stand up as an ally and challenge the person saying it, if it’s safe for you to do so.
Understanding gender identity and trans issues can be confusing at first, but nobody is expecting you to know everything right away. If you want to find out more about the experiences of some trans people, you can hear them in their own words in these videos .
If you say the wrong thing by accident (which is something that happens to everyone), just apologise, recognise you’ve got it wrong, and move on. We’re all human and people slip up sometimes. As long as you have good intentions, most trans people will appreciate you acknowledging your blunder and help you get it right. It’s important that we have real, honest, respectful conversations.
Sexual orientation (who you are attracted to) is completely unrelated to gender identity (who you are). You can be trans and gay, trans and straight, trans and bi, ace, or anything else – just like a cis person can be.
Of course – if they fancy each other! Adults are free to have relationships with other consenting adults, whatever their sexual orientation or gender identity. Trans people have the same range of sexual orientations as cis people, and there are many trans lesbians and gay trans men.
Trans people can and have been using the toilets that match their gender for decades without issue. The media-generated ‘debate’ about public toilets is having a negative effect on the whole LGBTQ+ community. Anyone whose appearance doesn’t fit with stereotypical ideas around what men or women look like are increasingly being challenged simply for using the loo.
Having facilities that everyone can use – like gender-neutral single stall toilets and changing rooms with private space – makes life easier for lots of people. Many businesses and institutions have been taking this approach for a long time now as it benefits families, people with disabilities and many LGBTQ+ people.
When toilets are gendered, in general trans men have the legal right to use the men’s toilets, and trans women have the legal right to use women’s toilets.
Restricting trans peoples’ access to public toilets would severely limit their ability to live their lives freely. After all, most people need to use a toilet at some point during the day.
Refuges exist to support vulnerable women leaving unsafe situations. Our 2018 research found that 41% of trans people have experienced a hate crime in the past year, and more than one in four trans people in a relationship have faced domestic abuse from a partner. It’s heart-breaking to imagine being the victim of violence and then being turned away from help when you desperately need it.
Many refuges already support trans women escaping abuse. In fact, most domestic violence services in Scotland have been doing this for nearly 10 years. You can read a statement from Scottish women’s organisations about this here . We have to trust that the people running these services know what they’re doing. They’re the experts at supporting women in these services and running risk assessments on a number of issues every day.
There’s a chronic lack of funding and support for refuges, which means victims of domestic violence and abuse who desperately need help are being turned away in ever increasing numbers. That’s something we all need to work together to tackle. We also need more shelters for men, and LGBTQ-specific shelters.
Yes. Trans women are women, and because of that it makes sense that they should have the same opportunities as any other woman. Women-only panels and shortlists exist to try and redress the gender inequality that all women – trans women included – face every day.
Panels and shortlists are stronger when they recognise and represent women from a wide range of backgrounds. This includes trans women, who have very little visible representation in positions of power and who can bring different experiences and perspectives to the table.
Should trans people continue to be allowed to play sport?
Trans people are already playing sport. Most governing bodies in sports have rules to support trans inclusion which have been in place for many years.
But recently, there has been lots of discussion about opportunities for trans people in sport, with particular attention on how trans women can participate in elite sport. It’s important that these conversations have inclusion at their heart, so that everyone can experience the different benefits of sport.
The impact of transition on athletes at different levels in different sports is not well understood. Generalised average data about strength, body mass and testosterone doesn’t account for the wide range of people of all genders who take part in different sports, at different levels. It also ignores the influence of skill and training on fairness and safety.
When people focus on testosterone levels as equating to sporting success, it not only negatively affects trans people in sport, but it also affects anyone who does not fit with stereotypical, western ideas about what a woman’s body should be like. This sexism often intersects with other prejudices such as racism, homophobia and discrimination against intersex people. We saw this in action at the 2020 Olympics, when Namibian track and field stars Christine Mboma and Beatrice Masilingi were banned from competing because of their natural testosterone levels .
Sport has the power to change lives. From recreational to elite, sport at all levels helps people come together, work as a team, push themselves and achieve amazing things – and no one should be left behind or excluded.
Read more on trans inclusion in sport here .
Trans people are not one-dimensional beings: like everyone else we have intersectional identities. This means the fight for trans equality cannot be fully achieved without achieving equality for everyone.
At its core, the trans rights movement is based on the same ideals as other liberation movements, including the women’s rights, racial equality and disability rights movements. For example:
- the right to bodily autonomy
- the right to self-determination rather than physical attributes determining the options open to you
- freedom from limits and stereotypes placed on us by society
- freedom from interpersonal and state violence
When supporting a trans young person, the most impactful things you can do are:
Refer to them in whatever way they prefer and be willing to changing the pronouns and names you use for them – they may try out several different names and pronouns to find the one that is right for them.
Let them know that:
- they will have your support no matter what identity they settle on
- it’s OK for them to change their mind as many times as they need to
- it’s also OK for them identify the way they currently do for the rest of their lives
Check in with them about what they want, and who they are comfortable with you using the new pronouns and name around. If there are people that the young person does not feel comfortable being out to, it is important to respect their confidentiality.
Create space for the young person to share situations that they are finding difficult and try to problem solve together.
For more information on how to support trans young people in education settings, visit our trans inclusion guide for schools and colleges .
You can also check out Gendered Intelligence who work with young trans people aged 8+.
More and more people are recognising the importance of stepping up and being a vocal ally to trans people. Prominent individuals in politics and in the media are already doing it, as are leading organisations and businesses.
But there are also lots of small steps you can take to be a trans ally. Whether it’s online or in real life, simply listening to – and supporting – trans people can make a huge difference.
For more information on what else you can do, go to our current campaigns page . You can also sign up for our newsletter to stay up to date, as well as getting stuck into our five-year partnership project TRANSforming Futures . Explore our programmes with workplaces and schools to take your trans inclusion work to the next level.
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Get the Facts: The Truth About Transition-Related Care for Transgender Youth
As extremist lawmakers in state after state try to attack our transgender community’s basic health care, the misinformation is rampant. Serious misconceptions about transgender people are fueling legislation from Florida to Missouri to Mississippi – and they all aim to stop young people and their parents from accessing essential mental and physical health care. Some even go farther, with some bills attempting to ban transition-related care until the age of 21 or even beyond. These bans attack our most basic values of privacy and control over our own bodies, and they’re based on misleading or even outright false ideas. Here are the real facts everyone should know.
Being trans is beautiful.
The reality is that trans people of all ages are leading joyous, full, normal lives. Transition-related care helps make those lives possible. All too often, media narratives portray transgender people as if our lives are just pain and suffering, but nothing could be further from the truth. Age-appropriate medical care helps so many people to live their best lives. Trans people deserve to live joyfully and authentically – and so many of us are doing just that!
Trans kids know who they are.
The overwhelming majority of transgender and nonbinary youth who receive transition-related health care continue to identify as transgender or nonbinary after reaching adulthood.
Those who argue that being transgender is a “phase” often rely on deeply flawed studies that conflate gender dysphoria with gender non-conforming behavior. That means that these flawed studies lumped children who don't conform to gendered expectations in with transgender children, regardless of how they describe themselves or whether they experience gender dysphoria at all.
Studies which solely examine patients experiencing gender dysphoria show extremely low rates of desistance. This recent study found that 98% of youths prescribed puberty blockers went on to be prescribed hormone replacement therapy after turning 18. This means that the overwhelming majority of young people who take medications that delay the onset of puberty are indeed transgender - and continue to be so as adults. Those medications helped them get through puberty without unwanted physical changes that would have otherwise caused them distress.
Transition-related care is safe.
Expert health care providers have been studying and providing transition-related health care for more than four decades. Decades of clinical research and experience show that transgender people who have access to the care they need see a positive impact on their mental and physical health.
Young people seeking transition-related medical care first receive significant counseling and a psychological assessment. The World Professional Association for Transgender Health (WPATH), which sets global best practices for transition care , recommends “extensive exploration of psychological, family, and social issues” prior to any physical interventions for young people. Puberty-blocking medications and hormone therapy for trans youth and adults have been prescribed and studied by experts for over 40 years. When needed, cisgender (meaning non-transgender) children also safely receive these medications for other health conditions. In addition, puberty-blocking medications simply delay puberty. If the medications are stopped, puberty will continue.
Like all medical interventions, surgical care is highly individual, and only undertaken after significant consultations with experts. It’s important to know that very young children do not receive surgeries or medications . For young children, gender transition is a social transition, which often involves a haircut, a new name, and new clothes that match their gender identity. For adolescents, any medical transition care such as hormone therapy or puberty blockers are only prescribed based on an individual young person’s needs.
Any surgical care for teenagers under 18 is rare and individualized. It is carefully examined under the supervision of medical professionals using standardized, evidence-based guidelines. Like everyone, those teenagers deserve the best possible medical care for their well-being. Importantly, young people deserve privacy as they make their own decisions with the support of parents, mental health professionals, and doctors.
Transition-related care is lifesaving care.
A large body of research demonstrates that trans youth who receive transition-related health care to treat their dysphoria show decreased anxiety, depression, suicidal behavior, and psychological distress, and increased quality of life.
Acceptance and support for LGBTQ youth quite literally saves lives . According to the Trevor Project’s 2022 Report , young people who felt highly supported by their family reported attempting suicide at less than half the rate of those who did not receive support.
Trans children who are allowed to socially transition before puberty have normal rates of depression and anxiety, “in striking contrast” with trans children who could not socially transition. There is an extremely strong scientific and medical consensus that transgender people exist and that transition-related care is clinically appropriate and medically necessary. Transition-related health care is acknowledged as medically necessary by the American Medical Association , the American Academy of Pediatrics , and many more.
"Regret" about transition is extremely rare.
Feigned concerns about “regret” around medical transition completely fail to see the reality of trans people’s lives. The vast majority of trans people cannot even access the transition-related care they need! The truth is that trans people deserve competent and compassionate health care as they seek to live their best lives – and that very, very few ever regret receiving this care. One Dutch study of nearly 7,000 transgender people found that the rate of regret was less than 1% among those who received treatment as adults – and there were no cases of regret among those who received care before the age of 18.
It’s helpful to put this fearmongering about “regret” into context. Up to 30% of knee replacement patients regret getting surgery – but no one’s trying to ban those!
Research tells us that the overwhelming majority of people who transition medically are satisfied with their decision to do so. Of the very few people who have detransitioned, over 82% did so because of external pressures such as rejection from family, and discrimination in education or employment. Most people also only detransitioned temporarily – likely due to those same pressures from others - before resuming their lives as trans people.
Gender identity is personal.
As trans theorist and biologist Julia Serano writes , “Transitioning is a matter of personal exploration, of finding what works for you on the individual level.” Everyone deserves the freedom to explore and express their identity – and that includes, if they decide they need it, receiving compassionate transition-related care. These are deeply personal and individual decisions, and it’s simply wrong for politicians to attack our health care and violate our basic privacy.
Click here for a printable PDF of this fact sheet.
[ A note on terminology: While "gender-affirming care" is a commonly used term with a broad definition, we use the term "transition-related care" in this article to specifically refer to the type of health care involved in medical transition for transgender people, such as hormone treatment and transition-related surgeries .]
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clock This article was published more than 8 years ago
Here’s how sex reassignment surgery works
In this excellent post , my colleague Steven Petrow advised that if you're wondering whether someone you know is transitioning from one gender to the other, it's best to "check your curiosity and hold your tongue." But we all have questions about a subject that is increasingly mainstream. Aside from the recent coverage of Bruce Jenner 's apparent transition , Laverne Cox last year became the first trans person on the cover of Time magazine, and Amazon debuted “Transparent,” a show about a father who is transitioning.
[UPDATE: Bruce Jenner: ‘Call me Caitlyn’ ]
Here are answers to some of the questions surrounding this issue.
How many people are transgender?
The Williams Institute, a think tank at the UCLA School of Law dedicated to research on sexual orientation law and public policy, estimates that 700,000 Americans are transgender . But a good piece last year on fivethirtyeight.com noted that there are no national surveys. And if there were, there is no agreement on what "trangender" means.
How many people have sex reassignment surgery?
It's very difficult to know. The Encyclopedia of Surgery says that "the number of gender reassignment procedures conducted in the United States each year is estimated at between 100 and 500. The number worldwide is estimated to be two to five times larger." At least one other researcher says there are many more. Marci Bowers, a transgender obstetrician and gynecologist in Burlingame, Calif., who performs the surgeries, said in an interview that she does about 200 per year herself, about three quarters of them male to female.
Fred Ettner, a physician in Evanston, Ill., who works with people going through transition, estimated that only about 25 percent to 30 percent of transgender people have any kind of surgery.
How does one begin the process of changing one's sex?
Under the standards of care adopted by the World Professional Association for Transgender Health (WPATH), the first step usually is meeting with a mental health professional for a diagnosis and psychotherapy. A diagnosis of gender identity disorder or gender dysphoria and a letter of recommendation from the therapist allows a person to begin hormone therapy with a doctor. That is usually followed by a period of living publicly as a member of the opposite sex and, finally, surgery to alter the genitalia and other body parts.
What do hormones do?
Androgens are given to women to help them develop secondary male sex characteristics such as a beard and body hair. Estrogen and anti-androgens are given to men to help change their musculature, skin and fat distribution, all of which will make them appear more feminine. Body hair also diminishes.
But Ettner said the hormones' most important contribution is to reduce the dysphoria transgender people have been struggling with all their lives. After a month or two, their bodies and brains begin aligning.
"It's very obvious to the individuals," Ettner said, adding, "Their brain finally is getting this hormone. They feel differently. They behave differently.
"The first effect is the brain effect," he said.
What is the Real-Life Experience (also known as the Real-Life Test)
Surgeons who follow the WPATH standards of care (which some patients and experts consider too strict) usually require candidates for surgery to live for as long as a year in their preferred gender role. They must work or go to school; do volunteer work; change their first names and prove to the surgeon that people other than their therapists know they are successfully living this way.
What happens during surgery?
Male to female genital surgery is easier, less expensive and generally more successful than female to male surgery. That's one reason why fewer women choose to have surgery on their genitals, Bowers said. (Another is cost.)
In male to female surgery , the testicles and most of the penis are removed and the urethra is cut shorter. Some of the skin is used to fashion a largely functional vagina. A "neoclitoris" that allows sensation can be created from parts of the penis. Men retain their prostates.
In female to male surgery, the breasts, uterus and ovaries are removed (in two separate procedures). A "neophallus" can be constructed using tissue from the forearm or other parts of the body that allows sexual sensation, an expensive procedure. Extending the urethra to allow standing urination has proved to be perhaps the most difficult part of the process, Bowers said.
What other kinds of surgery are performed?
Women wishing to live as men often have mastectomies. Men transitioning to women can have plastic surgery to "feminize" their appearance, including work on their eyes, noses, brows, chins and hairlines. They also can have their Adam's apple shaved down so it is less prominent.
Sounds expensive. Is it covered by insurance?
Bowers and Ettner said a woman who chooses the full range of surgical procedures available would spend $75,000 or more to transition to a male. Switching from male to female might cost in the $40,000 to $50,000 range. Some people have the work done in Thailand, which is well known for the surgery and where the cost is much lower.
Insurance is just beginning to cover some of the costs. Last year, Medicare lifted a 33-year ban on coverage for gender reassignment surgery , and the surgery was performed on 74-year-old Army veteran .
Do many people regret having the surgery?
Anecdotal accounts of regret abound, but overall it appears to be rare. Bowers said that only two of the 1,300 people she has operated on have wanted to go back to their old bodies.
But that doesn't mean that surgery is a miracle cure for the difficulties of gender dysphoria. People who make the transition often lose spouses, families, friends and jobs. They may find themselves completely alone if they relocate to start new lives. Johns Hopkins University, which in the 1960s was one of the first medical institutions to perform sex reassignment surgery, halted the practice when officials concluded that it was not helping the transgendered overall.
A 2o11 study of 324 Swedish transsexuals by the Karolinska Institute showed that "after sex reassignment, [they] have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."
The forgotten history of Bruce Jenner
Transgender etiquette 101
Transgender at 7: Tyler gets a legal name change