Gender transitioning

Gender transitioning is a process through which a person alters their gender presentation or sex characteristics, so they align with their internally perceived gender identity. For many people, gender transitioning functions as a form of treatment for gender dysphoria, a condition that causes distress or discomfort among those whose gender identity differs from their assigned sex at birth. Such individuals are referred to as transgender. A transgender person who wants to affirm or confirm their gender identity may choose to undergo gender transitioning to accomplish that goal, though not all transgender people choose to do so.

The process of gender transitioning is a multi-faceted matter that may include a variety of individual social, medical, and legal transitions. These transitions cover a wide range of potential personal changes that can include everything from selecting a new name to choosing to use different preferred pronouns, wearing clothing that reflects one’s gender identity, using hormones to alter one’s appearance to conform with desired gender norms, or undergoing gender-affirming surgical procedures. The exact parameters of and steps in the gender transitioning process vary from person to person. Each transgender individual who wishes to transition chooses how much of a transition they want to undertake and what they need to do to affirm their gender identity. While some may choose to transition to the greatest extent possible, others may prefer a more limited approach. As a result, gender transitioning is a deeply personal process defined by the specific desires of each person seeking to transition.

Background

The concept of gender transitioning is primarily associated with individuals who identify as transgender. The word transgender is an umbrella term commonly used to describe a wide range of individuals whose gender identity, gender expression, or gender-related behavior does not conform to the norms typically linked with the sex they were assigned at birth. The key factor in determining whether a person is transgender is their gender identity. Gender identity is an individual’s internal sense of being male, female, or something else. A person may identify as transgender when their gender identity conflicts in some way with their assigned biological sex.

Many transgender people who ultimately choose to undergo gender transitioning do so because they are experiencing gender dysphoria. This is a form of psychological distress that arises from conflict between a person’s gender identity and the sex they were assigned at birth. An official diagnosis for gender dysphoria can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the American Psychiatric Association’s (APA) guide to psychiatric diagnoses. The DSM-5 describes gender dysphoria as a marked difference between gender identity and assigned sex that persists for no less than six months. This difference must be demonstrated by at least two of the following conditions:

• A difference between gender identity and genitals or secondary sex characteristics, such as breast size, voice, and facial hair. In young adolescents, a difference between gender identity and anticipated secondary sex characteristics.
• A strong desire to be rid of their genitals or secondary sex characteristics or a desire to prevent the development of secondary sex characteristics.
• A strong desire to be or be treated as another gender.
• A strong belief of having the typical feelings and reactions of another gender.

Gender dysphoria can occur at any time in a person’s life. While many people begin to experience gender dysphoria during childhood or adolescence, others may not be affected until later in life. Some individuals may also experience gender dysphoria only intermittently.

The distress caused by gender dysphoria can significantly impact an individual’s life. People who experience gender dysphoria often struggle at school or work because of the pressure they are under to behave and/or dress as is typically expected for the gender they were assigned at birth. This pressure frequently arises out of fear of harassment. Such difficulties can become a functional impairment that could lead a person to drop out of school or become unemployed. People with gender dysphoria may also experience depression, anxiety, eating disorders, self-harm, substance abuse, or other similar problems. The distress of gender dysphoria may also be worsened by the increased likelihood of discrimination that is often faced by those who do not conform to traditional gender norms.

For many people with gender dysphoria, the first step in treatment is engaging in an open-ended exploration of their personal feelings and experiences related to their gender identity and expression. Beyond that, such individuals often choose to address their gender dysphoria by making some sort of gender transition. It is important to note, however, that no one definitive treatment exists for gender dysphoria. Rather, treatment should be specifically tailored to each individual needs and desires.

Overview

Gender transition is the process through which an individual makes any type of change to become the gender they feel like rather than the one they were assigned at birth. Individuals can transition in many ways. For some transgender individuals, transitioning may mean changing their name or using different pronouns. For others, it may mean undergoing medical treatments to alter their appearance. Transitioning can also mean wearing different clothes or coming out to family or friends. The process of gender transitioning can also vary in terms of the amount of time it takes for a transition to be complete. While some individuals may progress through their transition quickly, others may do so over a longer time.

Gender transitioning has social, legal, and medical aspect. Typically, the most basic of the three, social transitioning, involves a person changing their appearance and/or behavior as a way of affirming their gender identity. In short, social transitioning is primarily about gender expression. The process of social transitioning may involve coming out as transgender, asking to be referred to by a different name, establishing preferred pronouns that reflect gender identity, wearing clothing or hairstyles that reflect gender identity, using a different tone of voice, or altering one’s body through non-surgical means.

Legal transitioning involves making official changes to one’s identity. People who wish to legally transition may choose to change the name or sex designation that appears on official documents like birth certificates, driver’s licences, or passports. Taking such steps is necessary for individuals who wish to make their transition legally official. For minors who seek to transition, the legal aspect of the process requires permission from a parent or legal guardian.

Medical transitioning is the physical aspect of the gender transitioning process. Many medical interventions can help a transgender person affirm their gender identity. While some are relatively simple and non-invasive, others are more complex and result in more dramatic physical changes. Hormones often play an important role in medical transitioning. Prepubescent individuals who believe they might be transgender may be prescribed hormone blockers to delay the onset of puberty until they are old enough to decide whether to proceed with transitioning. Transgender individuals who choose to transition may undergo hormone therapy to develop the features they wish to have. Masculinizing hormones encourage the growth of body and facial hair, promote muscle growth, deepen the voice, redistribute fat from the breasts and hips, and end the menstrual cycle. Feminizing hormones lessen body and facial hair growth, decrease muscle mass, encourage breast growth, and redistribute fat to the breasts and hips. In instances where more significant physical changes are desired, more invasive interventions may be required. Such interventions are often referred to as gender-affirming surgeries. Chest reconstruction may be performed to either remove breast tissue or achieve augmentation through the insertion of breast implants. A tracheal shave could also be performed to reduce the size of the Adam’s apple in individuals who wish to look more feminine. These individuals may choose to have facial feminization surgery as well to further feminize their appearance. The most radical gender-affirming surgeries may involve the removal of undesired reproductive organs, such as ovaries or testes, and/or the reconstruction of existing genitals into those that conform with an individual’s gender identity.

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