- Transgender, nonbinary, or gender-nonconforming people may undergo a process called transitioning to live in alignment with their gender identity.
- Transitioning can include a variety of social, legal, physical, and/or medical changes.
- Gender-affirming care may include hormone therapy or different kinds of gender affirmation surgery.
- Research shows that trans people who transition tend to report lower rates of gender dysphoria, anxiety, depression, and suicidal ideation.
- Not all gender-nonconforming people or transgender people transition.
- There are many barriers to transitioning, including social stigma, discrimination, and insurance challenges.
Transitioning looks different for each gender-diverse person. There are many social, legal, physical, and medical steps a person can take to live in alignment with their gender. Learning about the transition process can help you to prepare for transition or for supporting a loved one through their own process.
“Gender transition” refers to the steps a person takes to live in their gender identity. These changes might include changing one’s name or appearance, seeking gender-affirming medical care, or making legal changes. Transitioning is linked to improved mental health and overall well-being.
Some people prefer to refer to this process as “pursuing congruence” or “pursuing congruence measures.” This is because a person’s gender isn’t changing; instead, they are undergoing changes to how their appearance, body, behavior, social standing, or legal status aligns with their gender.
What Is Gender Identity?
Your gender identity is your personal sense of having a gender that is masculine, feminine, neither, or both. Your gender identity doesn’t always align with the sex you were assigned at birth.
Do All Trans People Transition?
Some transgender, nonbinary, or gender-nonconforming people transition. Some don’t transition at all. There is no right or wrong way to be transgender, nonbinary, or gender nonconforming.
Some people don’t want to undergo the transition process. Others may not have access to the gender-affirming care, financial resources, or social support needed to transition.
Mental and Physical Health Considerations for Transitioning
Like many new phases in life, transitioning can bring about both anxiety and relief. Some people compare transitioning to going through puberty for a second time.
People undergoing transition may notice changes in:
- Physical appearance
- Mental and emotional health
- Sexual, emotional, or romantic attraction
- Medical needs
Gender Dysphoria and Gender Euphoria
Someone whose gender identity doesn’t align with their assigned sex may experience gender dysphoria. This severe discomfort and distress associated with gender incongruence is linked to the structural and social discrimination transgender people experience.
Someone undergoing transition may begin to experience gender euphoria. Researchers describe gender euphoria as “a joyful feeling of rightness” in relation to the body, mind, and social life.
The transition process may be marked with periods of both gender dysphoria and gender euphoria. Fortunately, gender-affirming care can reduce gender dysphoria. As a person feels more comfortable with and confident in expressing their gender, they are less likely to experience gender dysphoria.
Improved Mental Health and Well-Being
Transgender, nonbinary, and other gender-diverse people are at greater risk for experiencing mental health conditions. People who experience gender dysphoria are also likely to report:
- Disordered eating
- Post-traumatic stress disorder (PTSD)
- Substance use disorder
Research has consistently linked transition to improved mental health and well-being for transgender and gender-diverse youth and adults.
For example, research clearly demonstrates the benefits of:
- Social transition. Research shows that socially transitioned transgender children have lower rates of depression and anxiety.
- Hair removal. Hair removal is not just cosmetic for transfeminine adults. Researchers have found that hair removal is associated with decreased distress and increased well-being.
- Gender-affirming hormone therapy. Hormone therapy is linked to improved psychological functioning and quality of life, improved body satisfaction, reduced gender dysphoria, and reduced suicidal ideation. For example, one study demonstrated that gender-affirming hormone therapy improved emotional well-being and social functioning within six months of treatment.
- Gender-affirming surgery. Results from the U.S. Transgender Survey suggest that gender-affirming surgeries have a number of positive health benefits. People who have undergone gender-affirming surgeries report lower rates of psychological distress and suicidal ideation.
- Multi-disciplinary gender-affirming care. Recent research links accessing puberty blockers or gender-affirming hormone therapy within a multi-disciplinary gender-affirming care setting to lower odds of depression and suicidality in transgender and nonbinary youth.
Potential Health Risks
As with all medications and medical procedures, gender-affirming medical care can carry risks. The severity of risk depends on the care received and a person’s individual risk factors. However, severe risks and complications from gender-affirming care are rare.
Gender-affirming hormone therapy may cause:
- Changes to cholesterol or blood pressure
- Hair growth
- Hair loss
- Weight change
Gender-affirming surgery may cause:
- Side effects from anesthesia
- Changes to sexual sensation
- Difficulty emptying the bladder
Social Implications and Challenges of Transitioning
The transition process can bring up additional stress and anxiety. For example, someone may experience distress over how their family, friends, or other social circles accept their transition. They may also experience distress related to discrimination, healthcare access, and their legal rights.
Research shows that access to social support is a key concern for many people undergoing transition. Having robust social support can help people as they navigate the complex process of transition. This includes support from family, friends, romantic partners, or colleagues.
Examples of social supports that can be helpful throughout the transition process include:
- Acceptance from loved ones
- Loved ones who work to understand the transition process
- Connections with other people who are undergoing or who have undergone transition
- A supportive work environment
- A supportive school environment
Research suggests that the mental health benefits of transitioning may be dampened by severe social challenges. For example, limited social support is linked to negative mental and behavioral health outcomes, such as depression, suicidal thoughts, and substance use in people undergoing transition.
Researchers have found that transgender youth who undergo early social transition often experience improved mental health outcomes. However, youth who experience harassment within unaccepting school environments have worse mental health outcomes over the long term. Feeling safe and supported throughout the transition process is critical to improving long-term mental health.
People undergoing transition may experience changes to their sexual, romantic, or emotional attraction to others. In fact, it’s not uncommon for people who transition to report changes to their sexual orientation during or after transition. This may be due to physical and hormonal changes or because someone feels more at home in their body during transition.
Many people who undergo transition report being attracted to more than one gender. Similar to the transition process, exploring your sexual orientation can be simultaneously liberating and overwhelming. This makes social support and affirmation an essential resource for transgender and gender-diverse people.
The Transition Process
The transition process can involve any steps that bring you closer to living in congruence with your gender. This may include affirming your gender internally, socially, legally, or physically.
Some people have access to all types of transitioning, but this isn’t the case for everyone. Even if someone has access to social support and gender-affirming care, they may not wish to undergo all types of transition.
There is no right or wrong way to transition; the transition process looks different for each person.
Social transitioning may include living in alignment with your gender with your close social circle or with everyone.
The social transition process may include:
- Disclosing your gender identity to friends and family
- Using pronouns aligned with your gender
- Using a name that aligns with your gender
- Dressing or grooming in ways that feel right for you
- Using mannerisms or speaking in a way that feels right to you
Legal transition involves any steps a person takes to update their gender in official records or government documents.
Legal transition may include making changes to your:
- State identification or driver’s license
- Social security number or records
- Employment records
- Education records
- Medical records
- Health insurance
- Immigration or naturalization documents
The laws and regulations related to gender markers are different in each state. This process can be time intensive and costly, depending on your location and the records you need to update.
Physical transition can involve a variety of steps to align your body with your gender identity. This can be accomplished through medical or non-medical means.
Examples of physical transition without medical intervention include:
- Chest binding. Binding involves using binders or sports bras to flatten the chest and make breasts less noticeable.
- Padding. Padding involves using materials to make the chest, hips, or buttocks look fuller.
- Packing. Packing refers to the use of a packer, prosthetic penis, or socks to create a bulge in the groin area.
- Tucking. Tucking refers to hiding the genitals so they aren’t visible when wearing tight clothing.
Some people use these methods on special occasions, and others use them regularly. This is typically low cost and can be done at home.
Physical transition through medical intervention is also known as medical transition. This process is typically more time intensive and has longer-lasting effects on the body and appearance.
Most people think of hormone therapy and surgical procedures when they think of gender-affirming healthcare. However, there are other types of gender-affirming healthcare available, including:
- Fertility preservation. This includes any sperm or egg retrieval and storage procedures prior to hormonal or surgical intervention.
- Hair removal. Laser hair removal procedures help to reduce the growth and appearance of facial hair and body hair.
- Puberty blockers. In some cases, adolescents may be given puberty blockers to prevent puberty.
- Speech therapy. Speech therapy can help you to align your voice and tone with your gender.
- Therapy or counseling. Therapy may not have an affect on your physical appearance, but it’s an essential component of gender-affirming care. Ideally, you would have the opportunity to work with a therapist who has experience supporting clients through the transition process.
Gender-affirming hormone therapy involves the use of medication and hormones to trigger physical changes that better align your body with your gender. You will likely notice changes to your muscle mass and body composition, sweat and odor patterns, and your voice. This can also have a significant effect on your sex drive and your mood.
There are two main categories of gender-affirming hormone therapy:
- Masculinizing hormone therapy. This therapy involves taking testosterone to make the body more masculine. This often causes changes to your hairline, facial and body hair growth, clitoral growth, and cessation of the menstrual cycle.
- Feminizing hormone therapy. This therapy involves taking estrogen and medication to block the action of testosterone in the body. This often leads to breast development, reduced testicular size, and a reduction in sperm and semen production.
Gender-affirming surgery covers a variety of surgical procedures that help to align your body with your gender. Some people refer to this as “sex reassignment surgery.” The cost and risks vary by procedure.
Examples of gender-affirming surgery include:
- Facial reconstructive surgery. This includes any surgical procedure to make your facial features more feminine or masculine. Examples include reshaping the nose, brow bone, forehead, jaw, chin, or Adam’s apple.
- “Top” surgery. This includes any surgical procedure to augment the chest. Examples include removal of breast tissue, contouring of the chest, or breast implantation.
- “Bottom” surgery. This includes any surgery to reconstruct the genitals. Examples include removal of the testicles, creation of a scrotum, formation of a penis, and formation of a vaginal canal and vulva.
- Hysterectomy. Some people may also undergo a partial or a complete hysterectomy. This involves the removal of the uterus and the ovaries.
Barriers to Transitioning
Transitioning looks different for each person. There are many barriers and challenges to completing transition. However, experts agree that the benefits of transitioning outweigh the risks for the vast majority of trans people.
Research consistently shows that LGBTQ+ people are at risk for harassment and discrimination. This is especially true for transgender and gender-diverse people. This can be a significant barrier to a safe transition process.
Many states do not have legal protections for transgender and gender-diverse people. This makes it even more challenging to address the harassment and discrimination transgender people experience:
- At work
- At school
- In public
- While seeking healthcare
- Within family and friend groups
Access to Care
Research consistently shows that early access to gender-affirming care is life-saving, while late or limited access to gender-affirming care is linked to poorer mental health outcomes. Unfortunately, transgender and gender-diverse people face tremendous barriers in accessing gender-affirming care.
Access may be hindered by:
- Inadequate health insurance coverage
- High cost of care
- Provider shortages
- Transportation barriers
The National Center for Transgender Equality provides comprehensive information and resources on the rights of transgender people in accessing care.
Accessing gender-affirming care can be especially challenging for transgender youth. Fortunately, medical intervention isn’t needed prior to the onset of puberty. Medical intervention, like puberty blockers or hormone therapy, are typically recommended in adolescence.
Transgender and gender-diverse youth have better long-term mental health outcomes when they are supported during social transition.
Resources for the Transgender Community
The transition process is complex and unique to each person. Having a supportive social network and a quality care team can make all the difference. There are many organizations and institutions that work to support the transgender community.
For example, the National Center for Transgender Equality produces self-help guides for navigating healthcare coverage and legal challenges. They also offer guidance to others who want to be good allies to the transgender community.
The Trevor Project provides extensive information, resources, and peer support to LGBTQ+ youth.
For immediate peer support, you can also contact the Trans Lifeline’s hotline at 877-565-8860.
Moving Forward with Awareness
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Shelby is a public health professional with research and field experience in sexual and reproductive health. She holds a Master of Public Health (MPH) and is a Certified Health Education Specialist (CHES).