Gender transitioning describes the process of affirming and expressing one's internal sense of gender rather than the gender assigned to them at birth. It is a process through which transgender and gender-nonconforming people align their presentation or sex characteristics with their gender identity.
Gender transitioning, known more commonly today as gender affirmation, not only involves aesthetic appearances but may also involve changes in social roles, legal recognitions, or physical aspects of the body. Gender transitioning is often described as a binary (male or female) but can also be non-binary, meaning a person is neither strictly male nor female.
This article describes what gender transitioning involves as well as the social, legal, and physical aspects of gender affirmation.
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What Does It Mean to Transition?
Gender transitioning is the process by which you express your gender externally (gender expression) so that it aligns with how view your gender internally (gender identity). The process has no particular timeline and isn't always linear.
Many transgender and gender-nonconforming people prefer the term "gender affirmation" to "gender transitioning"—in part because transitioning is often taken to mean the process of transforming one medically. In fact, a person doesn't need to undergo medical treatment to affirm their identity, and some transgender people avoid hormones or gender-affirming surgery.
Gender transitioning is a holistic process, addressing all aspects of who a person is inwardly and outwardly. It can be broadly categorized into three types:
- Social transitioning: Relating to how you present yourself to the world
- Legal transitioning: Relating to the recognition of your gender through legal means
- Medical transitioning: Relating to treatments that align your body with your gender identity
Certain aspects of gender transitioning may be more important to some people than others (such as changing your name and gender on your birth certificate). It is also possible to reevaluate and revise your gender identity as part of a lifelong continuum rather than as a step-by-step, one-way process.
Exploring Your Gender Identity
Gender transitioning is a process that often starts in response to genderdysphoria. Gender dysphoria describes the persistent sense of unease that occurs when the gender you were assigned at birth does not match how you experience or express your gender internally. Some people have experienced symptoms of gender dysphoria as early as 3 or 4 years of age.
Gender dysphoria can be largely informed by the culture you live in, particularly in cultures where there are strict codes as to what is masculine/male and feminine/female.
The unease can be expressed in children in different ways, including:
- A strong preference for clothes typically worn by the other gender
- A strong aversion to clothes typically worn by their own gender
- A strong preference for cross-gender roles in fantasy play
- A strong preference for the toys, games, or activities typically used by the other gender
- A strong preference for playmates of the other gender
- A strong dislike of one’s sexual anatomy
For many, gender dysphoria fully emerges during puberty when awareness about how their body defines them creates internal distress. Feelings of unease may be amplified when a child is described as "tomboy" or "sissy," or is criticized and attacked for "acting like a girl" or "acting like a boy."
With physical changes during puberty, long-standing feelings that "I don't fit in" may evolve into feelings that "I don't fit into my own body." It is then that children or teens may undergo a process referred to as internal transitioning. This is when you start to change how you see yourself.
Gender transitioning/affirmation is the next step. There is no set course as to how a person aligns their internal sense of gender with their outward expression of gender identity. Gender transitioning is not about "changing" or "recreating" oneself. It's about expressing one's authentic self and asserting who you are socially, legally, and/or medically.
Social Transitioning
Social transitioning involves how a person publicly expresses their gender to the world at large.
Social transition can take many forms:
- Changing your pronouns
- Using your chosen name
- Coming out to friends, family, and colleagues
- Wearing new clothes
- Cutting or styling your hair differently
- Changing your manner (such as how you sit)
- Changing how you speak or use your voice
- Packing (wearing a penile prosthesis to create a penile bulge)
- Tucking (tucking your penis to conceal a penile budge)
- Binding (strapping your chest to hide your breasts)
- Wearing breast and hip prosthetics to accentuate "feminine" curves
Social affirmation may also include playing certain sports, pursuing different lines of work, or partaking in activities that some might typically see as "male" or "female."
Legal Transitioning
Legal transitioning is about legal recognition. It involves changing legal documents to reflect your chosen name, gender, and pronouns.
This includes governmental and non-government documents such as:
- School IDs
- Bank records
- Medical and dental record
- Driver's license
- Voter's registration card
- Birth certificates
- Social Security ID
- Passports
The provisions allowing for these changes can vary by state.
Some states will only allow changes if "bottom surgery" (genital reconstruction) is performed, while others will allow you to do so without any form of gender-affirming surgery. Other states have begun to offer an "X" gender option for people who are non-binary.
Medical Transitioning
Medicaltransitioning most commonly involves hormone therapy to develop some of the desired secondary male or female sex characteristics. It can also involve surgery to change certain physical aspects that hormone therapy alone can't change.
Hormone Therapy
Hormone therapy helps people look physically more like the gender they identify as.They are sometimes used on their own and may also be used before gender-affirming surgery to improve outcomes.
Gender-affirming hormone therapy takes two forms:
- Transgender men can take testosterone to help deepen their voice, increase muscle mass, promote body and facial hair, and enlarge their clitoris.
- Transgender women can take estrogen as well as a testosterone blocker to redistribute body fat, increase breast size, reduce male-pattern baldness, and reduce testicle size.
Gender-Affirming Surgery
Gender affirmation surgery is used to align a person's physical appearance to their gender identity. Many hospitals offer gender-affirming surgery through a department of transgender medicine.
Gender-affirming medical procedures include:
- Breast augmentation: Increasing breast size with implants
- Chest masculinization: Removing and contouring of breast tissues
- Facial surgery: Including facial feminization surgery
- Tracheal shaving: Used to reduce the Adam's apple
- Phalloplasty: Construction of a penis
- Scrotoplasty: Construction of a scrotum
- Vaginoplasty: Construction of the vaginal canal
- Vulvoplasty: Construction of the outer female genitals
- Orchiectomy: Removal of the testicles
What to Know About Gender-Affirming Surgery
Barriers to Gender Transitioning
Transgender people are protected from public and private insurance discrimination under federal and state laws, including Medicare and Medicaid.
Even so, Medicaid programs in nine states offer no coverage of gender-affirming medical treatments, and only two (Illinois and Maine) offer the comprehensive standard of care recommended by the World Professional Association for Transgender Health (WPATH).
Medicare also has no consistent policy regarding the approval of gender-affirming surgery. It instead relies on precedents in individual states to direct whether a treatment is approved or not. As such, states in which Medicaid coverage is denied may also be more likely to deny Medicare coverage.
In terms of private insurance, most providers have removed restrictions on gender-affirming care. Although larger insurers (like Aetna and Cigna) usually cover a more comprehensive array of services, in full or in part, many smaller insurers do not (or may only cover things like hormone therapy).
Even if treatments are covered, private insurers will often require psychological evaluations and health screenings that non-transgender people would never be asked to undergo (such as for breast reconstruction).
Another barrier is stigma and discrimination. Studies have shown that no less than 53% of transgender people report being harassed or bullied in public. Others report family or partner disapproval as the main reason why they abandon gender affirmation.
These factors can discourage transgender people from seeking gender-affirming care or embarking on treatments they would otherwise desire.
Where to Find Support
Gender transitioning can be complex and overwhelming, but there are organizations that can help with everything from insurance coverage to simply having someone to share your feelings with.
Here are some of the leading support organizations:
- Transgender Institute offers individual and group therapy for transgender youths and adults to better cope with stigma, discrimination, family issues, substance abuse problems, and transphobia.
- World Professional Association for Transgender Health offers a list of mental health providers by state who are experienced and trained in gender-affirming care.
- Pride Counseling is a paid mobile app that connects users to licensed therapists specializing in LGBTQI+ counseling.
- National Center for Transgender Equality offers a step-by-step guide to help transgender people obtain insurance coverage for gender-affirming care.
- The Trevor Project offers a 24/7 hotline for transgender youths in crisis or in need of a safe space to talk.
- Gay & Lesbian Alliance Against Defamation (GLAAD) offers a comprehensive list of resources for transgender adults and youth.
- Transgender Legal Defense and Eductions Fund offers resources to assist with legal affirmation, insurance access, financial assistance, and legal action for transgender people who are unjustly denied gender-affirming care.
Health Disparities in Transgender People of Color
How to Be an Ally
If you know someone who is transgender or is considering transitioning, learning how to be supportive is the best way to be an ally. Educate yourself about gender and gender transitioning. Everyone's transition is different, and there is no right or wrong way to do it.
Take the first step by asking the person's pronouns and affirmed name. It’s an act of respect, and everyone deserves to be addressed in the way they choose.
Summary
Gender transitioning, more commonly known today as gender affirmation, is the process taken by transgender people to align their internal gender identity with their external gender expression.
Gender transitioning may involve social affirmation (such as dressing differently or coming out to friends and family), legal affirmation (changing your name and gender on legal documents), or medical affirmation (using hormones and/or surgery to change certain physical aspects of your body). Transgender people can pursue some or all of these.
Barriers to gender transitioning include cost, lack of insurance, stigma, discrimination, and lack of family or partner support.
