Transgender Transition

Transgender Transition




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Transgender Transition

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Getting Gender Confirmation Surgery Covered by Insurance Can Be Hard


6 Science-Backed Reasons Trans Youth Need Gender-Affirming Care


Gender Expression: How You Present Yourself to the World


What Does It Mean to Be Transgender?


Understanding the Differences Between Sex and Gender


Learn How Tying Gender Dysphoria to Autism Might Be Discriminatory


Medicare Covers Gender Confirmation Surgery on a Case-by-Case Basis


Earlier Access to Gender-affirming Hormones Linked to Better Mental Health


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S. Nicole Lane is a freelance health journalist focusing on sexual health and LGBTQ wellness. She is also the editorial associate for the Chicago Reader.
Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Transgender people are people who feel that their gender identity is different from the gender associated with their assigned sex at birth (ASAB). When a transgender person chooses to undergo a process to align with their desired gender, this is called gender transitioning.


There are many ways to do this. An individual may go through social transition by changing their name and pronouns or medical transition by changing their body through hormone therapy or surgery. People who wish to transition may undertake one, all, or none of these steps.

Sex is assigned at birth based on what genitals you were born with, while gender refers to how someone feels inside and how they express that. Some ways people might communicate their gender are through behavior, appearance, and pronoun usage. Pronouns and expression do not necessarily have to "align" with each other or with gender, however.

People who feel like their gender assigned at birth does not line up with the gender they identify with may experience gender dysphoria . They may be uncomfortable because society genders them incorrectly because of their body type and appearance.


Gender dysphoria is when someone feels like their body is wrong. This feeling can be amplified because images of different genders are usually cissexist (the assumption that only cisgender identities and expressions are normal) and are not typically inclusive of transgender bodies.


This lack of representation can make it hard for transgender individuals to see themselves as beautiful or handsome (and therefore deserving of love) and/or for the world to gender them correctly (seeing someone as a man, woman, or an androgynous being).

Misgendering means referring to someone with words, such as pronouns or names that do not correctly reflect the gender with which they identify.

Gender dysphoria may begin to become more recognized and acknowledged during puberty. Some children may experience it even earlier (when they are 4 years old or younger). 1


Gender dysphoria is typically diagnosed by a mental health professional. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides guidelines for the diagnosis of gender dysphoria, with separate criteria for children or adolescents and adults. It defines gender dysphoria as at least six months of a marked incongruence between one's expressed/experienced gender and one's assigned gender. 2


Under the DSM-5 criteria, gender dysphoria diagnosis in adults and adolescents starts by assessing if they have at least two of the following:


The assessment of gender dysphoria in children begins with confirming that they have a strong desire to be of the other gender or that they are insisting that they are the other gender and at least five of the following:


For people of all ages, in order to meet the diagnostic criteria of gender dysphoria, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.


Transgender people may transition socially, which may include coming out to friends and family as transgender and changing their name to one that expresses their true gender and makes them feel comfortable. They may also ask people to use pronouns that match their desired gender.


They may want to change how they publicly express their gender, which is known as gender expression . This could mean changing their appearance, mannerisms, hairstyle, and the way they dress to express the gender they identify with.


Health care for transgender individuals starts with the same basics as cisgender individuals: annual physical exams, STI testing, and reproductive health care.


Those who are considering medical transitioning may need hormone therapy or surgery, which will require additional medical appointments and screenings.


Hormone therapy helps people look physically more like the gender they identify as. 


Sex reassignment surgery is a procedure by which a transgender person's physical appearance and functional abilities are changed to those of the gender they identify as. The procedure is now known as gender affirmation surgery because a person's gender identity prompts the desire for these medical procedures.

Gender affirmation refers to an interpersonal, interactive process whereby a person receives social recognition and support for their gender identity and expression. 6

Many hospitals offer gender-affirming surgery through a department or center for transgender medicine.


Gender-affirming medical procedures include: 


Transgender individuals are protected from public and private insurance discrimination under federal and state laws, including Medicare and Medicaid. 7 Many insurance plans have removed restrictions that exclude transgender people. But some insurance plans do not pay for the cost of gender transition-related health care, especially for surgeries. 


If a transgender person's medical treatment for gender transitioning is denied coverage or if their insurance plan has an exclusion for those services, they may need to explain to their insurance company why it is illegal discrimination to exclude medically necessary transition-related care. The National Center for Transgender Equality offers a step-by-step guide to help transgender individuals who wish to pursue transition care obtain coverage for these services from their insurance providers.


Many transgender people seek therapy, especially in adulthood, to discuss issues such as gender dysphoria and experiences with transphobia , which refers to prejudice against transgender people. Therapy and counseling can be a safe, supportive space for those with gender dysphoria to explore and work through their feelings.


The Transgender Institute offers individual and group therapy for transgender youths and adults. It also provides a comprehensive list of transgender-friendly healthcare providers. Transgender individuals can also find a therapist who specializes in transgender therapy near them through the member directory of the World Professional Association for Transgender Health , which lists mental health professionals by state.


For those who don't want to do in-person therapy, they can try Pride Counseling , which is a mobile app that connects users to licensed therapists who specialize in LGBTQ counseling. There is a weekly fee for unlimited chat, phone, and/or video therapy. The app is subject to strict local and federal laws, including HIPAA, that protect users' privacy.


A lack of education, understanding, and compassion in society puts transgender people at risk of harassment and discrimination. Fifty-three percent of transgender people reported being harassed or disrespected in public. 8 They are also more likely to experience harassment at work, bullying at school, homelessness, eviction, issues with health care, incarceration, and violence.


In a 2015 survey, 10% of transgender youth revealed that they had been sexually assaulted and 47% were assaulted in their lifetime. 9


The Trevor Project offers a 24/7 hotline for transgender youths in crisis or in need of a safe space to talk. The Gay & Lesbian Alliance Against Defamation (GLAAD) , a national organization that advocates for LGBTQ acceptance, has a comprehensive list of resources for transgender people on its website.


For transgender individuals who are undergoing or are interested in gender transitioning, the process can be complex and overwhelming, but you are not alone. There are many organizations that can help with your needs—whether it's insurance coverage for transition care or having someone to talk to about your feelings. Everyone's transition is different, and there is no right or wrong way to do it.


For those who know someone who is transgender and/or considering transitioning, learning how to be supportive is the best way to be an ally. Educate yourself about gender and gender transitioning. Don’t hesitate to ask what a person’s correct pronouns and chosen name are. It’s an act of respect and everyone deserves to be addressed in the way they choose.

If you are seeking support for issues with coming out, relationships, bullying, self-harm, and more, contact the LGBT National Hotline at 1-888-843-4564 for one-to-one peer support. For more mental health resources, see our National Helpline Database .
Gülgöz S, Glazier JJ, Enright EA, et al. Similarity in transgender and cisgender children’s gender development. PNAS . 2019;116(49):24480-24485. doi: 10.1073/pnas.1909367116
American Psychiatric Association. What Is Gender Dysphoria?
Irwig MS, Childs K, Hancock AB. Effects of testosterone on the transgender male voice. Andrology . 2017;5(1):107-112. doi: 10.1111/andr.12278
Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol . 2017;5(4):291-300. doi: 10.1016/S2213-8587(16)30319-9
National Center for Transgender Equality. Know Your Rights in Health Care.

By S. Nicole Lane

S. Nicole Lane is a freelance health journalist focusing on sexual health and LGBTQ wellness. She is also the editorial associate for the Chicago Reader.

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Think through who you will tell and what you will say. If you haven’t already, make a plan to come out as transgender . Start by telling people who you trust. They can help serve as a support system. Choose a good time and place where you will be able to have a private, uninterrupted talk. [1]
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You might tell your sister, "I have something important I’d like to talk to you about. Can you come over Friday evening?" Then you can say whatever makes you comfortable. "I’m transgender and I identify as a male," might be a good place to start.


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Talk to people who are supportive. You don't have to tell anyone that you don't want to. If you only want to tell 1 friend or family member, that's fine. This is your news to share. If you have someone who is supportive of you, consider asking them to be with you while you come out to others. They can be a great source of moral support!

Before you come out, make sure that doing so won’t endanger your health, safety, or living situation. If you think there might be a problem, have a safety plan in place. That means having a bag with some essentials packed and ready to go. Plan ahead to stay at a friend or family member's house, if necessary.
Make sure that you are completely comfortable with your own identity before discussing it with others.


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Research being trans so that you are prepared to answer questions. Unfortunately, many people don’t understand what it means to be trans. It’s likely that they will have plenty of questions for you. Take some time to gather lots of facts about being trans and transitioning. You can share this information with those who have questions. [2]
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You can search online for helpful information. You could also reach out to a local LGBT center and ask them for good resources.

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Give people time to process your news. Hopefully, you are met with immediate support and love. But some people might need time to adjust to knowing that you are trans. That’s okay; it probably took you a little while to come to terms, too. [3]
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You can say something like, "Thanks for listening. I know this is a lot to process. Maybe we can get together in a couple of days after you’ve had time to think?"

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Look into laws in your area before coming out at work. There is no federal law that protects people from being fired because of their gender identity or expression. Many states and cities, however, do have protections in place. If you think your gender identity might cause problems for you at work, check the laws where you live.

If there are not explicit protections in place, you might want to contact a lawyer for some advice.
If you are still in school, you might want to talk to an adult before you decide to come out. A favorite teacher or the school counselor can help you decide how open you want to be at school. Hopefully, everyone will be supportive. But if you are bullied, these people will be ready to support you. [4]
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