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Gender transition

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"Gender change" redirects here. For sex change, see Sex change.
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Gender transition is the process of affirming and expressing one's internal sense of gender, rather than the gender assigned to them at birth. It is the recommended course of treatment for individuals struggling with gender dysphoria, providing improved mental health outcomes in the majority of people.[1]

A social transition may include coming out as transgender,[a] using a new name and pronouns, and changing one's public gender expression.[2] This is usually the first step in a gender transition. People socially transition at almost any age,[3][4] as a social transition does not involve medical procedures. It can, however, be a prerequisite to accessing transgender healthcare in many places.[5][6]

In transgender youth, puberty blockers are sometimes offered at the onset of puberty to allow the exploration of their gender identity without the distress[7][8] of irreversible pubertal changes. Upon reaching the age of consent, they become eligible to pursue a medical transition if it is still desired.

A medical transition may include hormone replacement therapy (HRT), transgender voice therapy, and gender affirming surgeries. The ability to start a medical transition is typically offered after a diagnosis of gender dysphoria,[9] a form of medicalization. In recent years, there has been a push for an informed consent model of transgender healthcare which allows adults to access HRT without a formal diagnosis.[10]

Transitioning is a process that can take anywhere from several months to several years. As a personal journey, there will never be a one-size-fits-all approach to transition.

Terminology

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This page uses topic-specific vocabulary that may be unfamiliar to the layperson. Below are some definitions to make this page more accessible:

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  • Assigned gender at birth (AGAB) is a term that refers to the sex or gender assigned to people when they are born. As people are assigned a gender at birth in regards to their physical characteristics, an assigned gender does not account for one's internal gender identity.
  • Gender expression refers to the external presentation of one's gender identity. Typically, a person's gender expression is thought of in terms of masculinity (a tomboy, a butch lesbian, a drag king) or femininity (an effeminate male, a 'femboy', a drag queen), but an individual's gender expression may incorporate both feminine and masculine traits, or neither. One may express their gender through clothing, behavior, hair styling, voice, etc.[11][12] It is not necessarily related to one's gender identity.
  • Gender identity refers to the personal sense of one's own gender. It may correlate with the gender assigned at birth, or differ from it. In most individuals, gender identity is congruent with their assigned gender. Those who do not identify with their birth gender may identify as transgender.
  • Non-binary is a term that refers to a gender identity described as neither entirely male nor female (not one of the two binary sexes). Non-binary people may suffer from gender dysphoria, and may consider themselves transgender. Non-binary people may have any sexual orientation or gender expression.
  • Transitioning refers to the process of affirming and expressing one's internal sense of gender, as opposed to the gender assigned to them at birth. There are two major facets of gender transitioning: a social transition, and a medical transition; almost all transgender people will socially transition, and most will undergo some degree of medical transition[citation needed]. See the opening paragraphs for further information on social and medical transitioning.
  • Detransitioning (sometimes also known as re-transitioning) is the cessation of transgender identity and/or a transition to a different gender, often to one's natal gender.[15]
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It is important to note that most transgender individuals will receive few, if any surgeries throughout their lifetimes and some may never receive HRT. Barriers to accessing medical transitioning can include: a lack of financing, a lack of desire, or a lack of accessibility. There is no one way to transition, and while a medical transition or surgery can absolutely be medically necessary for some individuals' personal wellbeing, no two transitions are the same.

  • Puberty blockers / hormone blockers are terms that refer to medications used to block natal sex hormones. For transgender youth, hormone blockers may be offered at the onset of puberty to allow the exploration of their gender identity without the distress[7][8] of irreversible pubertal changes. Puberty blockers are considered reversible[16] and their use is deemed safe and effective[17] as treatment for gender dysphoria in gender-diverse children[18] and precocious puberty in cisgender children;[19] their use may be discontinued at any time if natal puberty-blocking is no longer desired.[16] For transgender adults, hormone blockers may be offered in a course with cross-sex hormone replacement therapy in order to treat gender dysphoria.
  • Hormone replacement therapy (HRT) is a medical treatment that replaces the primary sex hormones in one's body, in order to develop the secondary sex characteristics of the opposite sex. Individuals seeking masculinizing HRT are prescribed the male sex hormone testosterone, while individuals seeking feminizing HRT are prescribed the female sex hormone estrogen.
  • Voice therapy (or 'voice training') refers to a non-surgical gender-affirming treatment for the masculinization or feminization of one's voice. Transfeminine people will not experience any impact on voice pitch from feminizing hormone therapy (unless their natal puberty was sufficiently blocked), so voice training is very often underwent in order to learn how to speak in a higher and more feminine register. Transmasculine people, on the other hand, will experience a marked lowering in pitch from masculinizing HRT (testosterone) to an often cisgender male level, so vocal masculinization training is uncommon outside of those who have not underwent masculinizing HRT. Irrespectively, vocal masculinization training can help one learn to speak in a lower and more masculine register.
  • Voice surgery refers to a surgical treatment that allows for the masculinization or feminization of one's vocal pitch. Transfeminine people can undergo voice surgery to surgically increase their pitch range. Transmasculine people very uncommonly undergo voice surgery, as masculinizing HRT (testosterone) often lowers voices to a cisgender male pitch. Irrespectively, vocal masculinization surgery can be underwent to surgically decrease their pitch range.
  • Facial surgery refers to any gender-affirming surgery underwent on the face. There exists facial masculinization and facial feminization.
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  • Going 'full-time' refers to the act of living everyday life as one's identified gender.[20] People who go full-time may or may not pass, and may or may not keep their transgender identity a secret.
  • Passing refers to the perception and recognition of trans people as their desired gender identity by outsiders who may not know they are transgender. For many trans people, passing is a very important aspect of their transition often seen as an 'end goal'. Passing can greatly alleviate gender dysphoria. Failure to pass can cause serious repercussions for trans people's psychological well-being and safety, including but not limited to: poor mental health, discrimination, increased barriers to medical care[citation needed], harassment, fetishization, ostracization, increased risk of homelessness, and targeted violence due to increased visibility of one's transgender status.[21]
  • Going 'stealth' refers to the act of living as one's identified gender without revealing oneself to be transgender.[22] In some countries, being stealth may be a safety necessity, due to health, safety, and wellbeing risks of being openly transgender.

Various aspects

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Transitioning is a complicated process that involves any or all of the gendered aspects of a person's life, which include aesthetics, social roles, legal status, and biological aspects of the body. People may choose elements based on their own gender identity, body image, personality, finances, and sometimes the attitudes of others. A degree of experimentation is used to know what changes best fit them. Transitioning also varies greatly between cultures and subcultures according to differences in the societies' views of gender.[23]

Social aspects

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"Social transitioning" redirects here. For social changes on a societal level, see Social change.

The social process of transitioning begins with 'coming out', where others are told that one does not identify with their birth sex. The newly out trans person may adopt a new name, ask to be referred to with a new set of pronouns, and change their presentation to better reflect their identity.[24][25] Socially transitioning does not involve medical intervention or gender affirming surgery, but it may be a prerequisite to access transgender healthcare in some regions.[5][6]

People may socially transition at any age, with documented cases of children as young as 5,[26][27][28] or adults as old as 75.[29] While the majority of those who socially transition will pursue a medical transition[citation needed], not everyone can access gender affirming care, and not all may wish to pursue it.

Psychological aspects

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A person's ideas about gender in general may change as part of their transition, which may affect their religious, philosophical and/or political beliefs. In addition, personal relationships can take on different dynamics after coming out. For instance, what was originally a lesbian couple may become a heterosexual one as a partner comes out as a trans man - or parents of a boy may become parents of a girl after their child comes out as a trans woman.

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Main articles: Transgender rights and Legal recognition of non-binary gender

Transgender people in many parts of the world can legally change their name to something consistent with their gender identity.[25] Some regions also allow one's legal sex marker changed on documents such as driver licenses, birth certificates, and passports. The exact requirements vary from jurisdiction to jurisdiction; some require sex reassignment surgery, while many do not. In addition, some states that require sex reassignment surgery will only accept 'bottom surgery', or a genital reconstruction surgery, as a valid form of sex reassignment surgery, while other states allow other forms of gender confirmation surgery to qualify individuals for changing information on their birth certificates.[30] In some U.S. states, it is also possible for transgender individuals to legally change their gender on their drivers license without having had any form of qualifying gender confirmation surgery.[30] Also, some U.S. states are beginning to add the option of legally changing one's gender marker to X on legal documents, an option used by some non-binary people.[31]

Physical aspects

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Main article: Gender-affirming care

Physical aspects of gender transition can go along with social aspects; as well as wearing gender affirming clothing, transgender people often hide features from their natal puberty, with many transgender men binding their breasts and transgender women shaving. Other physical aspects of transitioning require medical intervention, such as transgender hormone therapy or surgeries.

Grieving gender identity

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Over the course of a gender transition, people who are close to the transitioning individual may experience a sense of loss, and work through a grieving process.[32] This type of loss is an ambiguous loss, characterized by feelings of grief where the item of loss is obscure. Family members may grieve for the gendered expectations that their loved one will no longer follow, whereas the transgender person themself may feel rejected by their relatives' need to grieve.[33] Feelings that arise are described as a way of seeing the person who is transitioning as the same, but different, or both present and absent.[32]

See also

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References

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  1. ^ Baker, Kellan E; Wilson, Lisa M; Sharma, Ritu; Dukhanin, Vadim; McArthur, Kristen; Robinson, Karen A (April 2021). "Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review". Journal of the Endocrine Society. 5 (4) (published 2 February 2021): bvab011. doi:10.1210/jendso/bvab011. PMC 7894249. PMID 33644622.
  2. ^ Brown, M. L. & Rounsley, C. A. (1996) True Selves: Understanding Transsexualism – For Families, Friends, Coworkers, and Helping Professionals Jossey-Bass: San Francisco ISBN 0-7879-6702-5
  3. ^ Kennedy, Natacha; Hellen, Mark (2010). "Transgender Children: more than a theoretical challenge" (PDF). Graduate Journal of Social Science.
  4. ^ Fabbre, Vanessa D. (2015). Gender Transitions in Later Life: The Significance of Time in Queer Aging. doi:10.4324/9781315731803-5/gender-transitions-later-life-significance-time-queer-aging-vanessa-fabbre (inactive 2024-07-22). ISBN 9781315731803.{{cite book}}: CS1 maint: DOI inactive as of July 2024 (link)
  5. ^ a b Evans, Shelley; Crawley, Jamie; Kane, Debbie; Edmunds, Kathryn (December 2021). "The process of transitioning for the transgender individual and the nursing imperative: A narrative review". Journal of Advanced Nursing. 77 (12): 4646–4660. doi:10.1111/jan.14943. ISSN 0309-2402. PMID 34252206.
  6. ^ a b Rachlin, Katherine. "Medical Transition without Social Transition: Expanding Options for Privately Gendered Bodies". read.dukeupress.edu. Retrieved 2024-07-21.
  7. ^ a b Turban, Jack L.; King, Dana; Carswell, Jeremi M.; Keuroghlian, Alex S. (1 February 2020). "Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation". Pediatrics. 145 (2). doi:10.1542/peds.2019-1725. PMC 7073269. PMID 31974216. Retrieved 2024-07-21.
  8. ^ a b Lambrese, Jason (2010-08-01). "Suppression of Puberty in Transgender Children". AMA Journal of Ethics. 12 (8): 645–649. doi:10.1001/virtualmentor.2010.12.8.jdsc1-1008. ISSN 2376-6980. PMID 23186849.
  9. ^ Johnson, Austin H. (2019). "Rejecting, reframing, and reintroducing: trans people's strategic engagement with the medicalisation of gender dysphoria". Sociology of Health & Illness. 41 (3): 517–532. doi:10.1111/1467-9566.12829. ISSN 0141-9889. PMID 30484870.
  10. ^ Schulz, Sarah L. (2017-12-13). "The Informed Consent Model of Transgender Care: An Alternative to the Diagnosis of Gender Dysphoria". Journal of Humanistic Psychology. 58 (1). SAGE Publications: 72–92. doi:10.1177/0022167817745217. ISSN 0022-1678.
  11. ^ Edelman, Elijah Adiv (6 November 2019), Bosia, Michael J.; McEvoy, Sandra M.; Rahman, Momin (eds.), "Gender Identity and Transgender Rights in Global Perspective", The Oxford Handbook of Global LGBT and Sexual Diversity Politics, Oxford University Press, pp. 61–74, doi:10.1093/oxfordhb/9780190673741.013.24, ISBN 978-0-19-067374-1, retrieved 17 March 2023
  12. ^ Carabez, Rebecca; Pellegrini, Marion; Mankovitz, Andrea; Eliason, Mickey; Scott, Megan (12 August 2015). "Does your organization use gender inclusive forms? Nurses' confusion about trans* terminology". Journal of Clinical Nursing. 24 (21–22): 3306–3317. doi:10.1111/jocn.12942. ISSN 0962-1067. PMID 26263919.
  13. ^ Human Rights Campaign. "Sexual Orientation and Gender Identity Definitions". Archived from the original on November 25, 2015. Retrieved June 13, 2021.
  14. ^ Morrow DF, Messinger L, eds. (2006). Sexual Orientation and Gender Expression in Social Work Practice: working with gay, lesbian, bisexual, and transgender people. New York: Columbia University Press. p. 8. ISBN 978-0-231-50186-6. Gender identity refers to an individual's personal sense of identity as masculine or feminine, or some combination thereof.
  15. ^ "Transitioning Back To One's Assigned Sex At Birth". The TransAdvocate. 7 August 2013. Archived from the original on 2017-09-20. Retrieved 1 September 2017.
  16. ^ a b Rölver, Angela; Föcker, Manuel; Romer, Georg (2022). "Desisting from gender dysphoria after 1,5 years of puberty suppression: A case report". Department of Child and Adolescent Psychiatry. University Hospital Münster. 1 (2). doi:10.1016/j.psycr.2022.100049.
  17. ^ Rew, Lynn; Young, Cara C.; Monge, Maria; Bogucka, Roxanne (February 2021). "Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature". Child and Adolescent Mental Health. 26 (1): 3–14. doi:10.1111/camh.12437. ISSN 1475-357X. PMID 33320999.
  18. ^ Giordano, Simona; Holm, Søren (2020-04-02). "Is puberty delaying treatment 'experimental treatment'?". International Journal of Transgender Health. 21 (2): 113–121. doi:10.1080/26895269.2020.1747768. ISSN 2689-5269. PMC 7430465. PMID 33015663.
  19. ^ Eugster, Erica A (May 2019). "Treatment of Central Precocious Puberty". Journal of the Endocrine Society. 3 (5): 965–972. doi:10.1210/js.2019-00036. PMC 6486823. PMID 31041427.
  20. ^ "TransWhat? • Social transition". transwhat.org. Archived from the original on 2017-11-08. Retrieved 2017-10-29.
  21. ^ "Transgender-Specific Issues: Passing | Responding to Transgender Victims of Sexual Assault". www.ovc.gov. Archived from the original on 2019-10-07. Retrieved 2019-10-07.
  22. ^ Urquhart, Evan (June 29, 2018). "For Many Trans Men in the South, Going "Stealth" Makes the Most Sense". Slate Magazine. Archived from the original on February 25, 2022. Retrieved February 25, 2022.
  23. ^ Elliot, Patricia (1 October 2008). "Book Review: Sally Hines, Transforming Gender: Transgender Practices of Identity, Intimacy and Care. Bristol: The Policy Press,2007.227 pp.ISBN 978-1-86134-9170 £24.99 (pbk).ISBN 978-1-86134-9163 £60.00 (hbk)". Sexualities. 11 (5): 646–648. doi:10.1177/13634607080110050603. S2CID 145654831.
  24. ^ Olson, Kristina R.; Durwood, Lily; Horton, Rachel; Gallagher, Natalie M.; Devor, Aaron (13 July 2022). "Gender Identity 5 Years After Social Transition". Pediatrics. 150 (2). doi:10.1542/peds.2021-056082. PMC 9936352. PMID 35505568. Retrieved 2024-07-21.
  25. ^ a b Jerry J. Bigner, Joseph L. Wetchler, Handbook of LGBT-affirmative Couple and Family Therapy (2012, ISBN 0415883598), page 207: "gender transition can be achieved through the use of clothing, hairstyle, preferred name and pronouns,..."
  26. ^ Kennedy, Natacha; Hellen, Mark (2010). "Transgender Children: more than a theoretical challenge" (PDF). Graduate Journal of Social Science.
  27. ^ Olson, Kristina R.; Gülgöz, Selin (June 2018). "Early Findings From the TransYouth Project: Gender Development in Transgender Children". Child Development Perspectives. 12 (2): 93–97. doi:10.1111/cdep.12268. ISSN 1750-8592.
  28. ^ Olson, Kristina R.; Key, Aidan C.; Eaton, Nicholas R. (April 2015). "Gender Cognition in Transgender Children". Psychological Science. 26 (4): 467–474. doi:10.1177/0956797614568156. ISSN 0956-7976. PMID 25749700.
  29. ^ Fabbre, Vanessa D. (2015). Gender Transitions in Later Life: The Significance of Time in Queer Aging. doi:10.4324/9781315731803-5/gender-transitions-later-life-significance-time-queer-aging-vanessa-fabbre (inactive 2024-07-22). ISBN 9781315731803.{{cite book}}: CS1 maint: DOI inactive as of July 2024 (link)
  30. ^ a b "Movement Advancement Project | Snapshot: LGBT Equality by State". www.lgbtmap.org. Archived from the original on 2019-04-22. Retrieved 2019-10-07.
  31. ^ "Gender Neutral Choice in Legal Documents - Love is a Rainbow Article". Love is a Rainbow. 2018-04-14. Retrieved 2019-10-07.[permanent dead link]
  32. ^ a b Norwood, Kristen (March 2013). "Grieving Gender: Trans-identities, Transition, and Ambiguous Loss". Communication Monographs. 80 (1): 24–45. doi:10.1080/03637751.2012.739705. ISSN 0363-7751. S2CID 35092546.
  33. ^ McGuire, Jenifer K.; Catalpa, Jory M.; Lacey, Vanessa; Kuvalanka, Katherine A. (September 2016). "Ambiguous Loss as a Framework for Interpreting Gender Transitions in Families: Ambiguous Loss in Gender Transition". Journal of Family Theory & Review. 8 (3): 373–385. doi:10.1111/jftr.12159. Retrieved 30 December 2022.
  1. ^ While the label Transgender is used here, people of diverse gender identities may socially or medically transition.

Further reading

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