Gender Transition For Dummies E-Book

Adrien Lawyer

• Herausgeber: John Wiley & Sons
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 392

Veröffentlichungsjahr: 2025

Beschreibung

Gender transition is different for everyone—get the support you need for your unique journey

Gender Transition For Dummies is an essential resource for transgender and non-binary readers who are considering the various elements of what is often called gender transition. It starts at the beginning, answering questions like, “What is transgender and what is non-binary?” and, “How Do I Know If I'm Transgender?” Learn to navigate social transition, prepare for gender-affirming surgery, tell loved ones about your transition plans, find a supportive community, and take care of your mental health.

Undertaking any of these steps is a big decision, and it isn't always easy. With this Dummies guide, you'll know that you aren't alone, and you'll get tips from experts on advocating for yourself.

• Manage gender dysphoria, find supportive care providers, and protect your mental health
• Know what to expect with hormone therapy and gender-affirming surgery
• Learn how to change your legal documents and ask people to use the name and pronouns that feel right for you

Gender Transition For Dummies is here to support and guide the transgender and gender-diverse community—and their loved ones—and help them to thrive.

Leseprobe

Gender Transition For Dummies®

To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Gender Transition For Dummies Cheat Sheet” in the Search box.

Table of Contents

Cover

Title Page

Copyright

Introduction

About This Book

Foolish Assumptions

Icons Used in This Book

Beyond the Book

Where to Go from Here

Part 1: Getting Familiar with Gender Transition

Chapter 1: Exploring Gender Transition Elements and Common Questions

Discovering the Meaning of Transgender and Non-binary

Exploring the Changes Involved in Gender Transition

Understanding the Life Implications of Transitioning

Answering a Few Common Questions

Finding Help and Support for Navigating Gender Transition

Chapter 2: Looking More Closely at Gender Transition

Examining Social Transition

Delving into Medical Transition: Looking at Your Options

Chapter 3: Planning for and Adapting with Gender Transition

Establishing a Supportive Community

Dealing With People Who Aren’t Supportive

Making the Necessary Name and Legal Changes

Understanding Your Evolving Sexuality

Recognizing the Long-Term Commitments of Transition

Part 2: Managing Social Transition

Chapter 4: Changing Your Style and Appearance

Managing Clothing and Grooming Changes

Modifying Your Body Profile: Considering the Possibilities

Chapter 5: Changing Legal Documents

Updating Your Name

Getting Set for Travel with a New Passport

Modifying Military Records

Altering Immigration Documents

Chapter 6: Planning for the Future

Doing Your Advance Planning

Safeguarding Your Important Documents

Part 3: Navigating Medical Transition

Chapter 7: Considering Primary Healthcare

Taking Charge of Your Preventive Healthcare

Choosing Healthcare Providers

Understanding Gender Dysphoria Evaluations

Examining Stress-Related Illness

Addressing Simple Aesthetics and Hygiene Basics

Chapter 8: Opting for Hormone Therapy

Knowing What Happens Before You Start Hormone Therapy

Starting Masculinizing Hormones

Using Feminizing Hormones

Achieving Gender-Expansive Hormone Goals

Providing Treatment for Trans and Non-Binary Children

Chapter 9: Deciding to Undergo Surgery

Masculinizing Surgeries

Pondering Feminizing Surgeries

Chapter 10: Changing Your Tune with Voice and Speech Therapy

Talking about Voice Training

Finding Your Gendered Voice

Looking at Vocal Surgeries

Chapter 11: Planning a Family

Considering Your Options if Planning a Family

Understanding How Transition Care Can Impact Your Fertility

Choosing a Method of Contraception That’s Right for You

Part 4: Finding Support for Your Journey

Chapter 12: Reaching Out for Transition Support

Using Resources Offered by Community Organizations

Finding a Supportive Healthcare Provider

Expanding Your Personal Connections

Chapter 13: Obtaining Mental Health Support

Seeking Out Mental Health Care

Experimenting with Other Behavioral Health Resources

Turning to Suicide Prevention Resources

Part 5: The Part of Tens

Chapter 14: Ten (or So) Famous Transgender and Non-Binary People

Leslie Feinberg

Compton’s Cafeteria “Rioters”

We’wha

Brian Michael Smith

Sarah McBride

Alok Vaid-Menon

Janelle Monáe

Kim Coco Iwamoto

Amelio Robles Ávila

Lucy Hicks Anderson

The Wachowskis

Chapter 15: Ten Essential Topics to Discuss with Your Healthcare Provider

Communicating Your Pronouns

Discussing Preventive Care

Providing Your Health History

Consulting about Hair Issues

Getting Thorough Information about Transition Care

Navigating the Insurance Maze

Easing into Sexual Health Conversations

Exploring Mental and Emotional Health Resources

Inquiring about Your Provider’s Level of Trans Education

Saying No

Chapter 16: Ten (or So) Trans-Friendly Organizations

Advocates for Trans Equality

Transgender Resource Center of New Mexico

Sylvia Rivera Law Project

Transathlete.com

Transgender Gender-Variant & Intersex Justice Project

Transgender Law Center

Camp Lost Boys

Trans Justice Funding Project

TransLatin@ Coalition

Notable Medical Organizations

Honorable Mention

Chapter 17: Ten Ways to Support Transgender and Non-Binary People

Educating Yourself

Respecting Names and Pronouns

Helping with Bathroom Access

Making Sure You Don’t Out Someone

Offering Your Pronouns

Teaching Kids about LGBTQ People

Using Gender-Neutral Language

Working Through Challenging Feelings with Others

Speaking Up through Advocacy

Showing Visible Support

Index

About the Authors

Advertisement Page

Connect with Dummies

End User License Agreement

List of Illustrations

Chapter 1

FIGURE 1-1: An example of a self-adhesive name tag with pronouns.

FIGURE 1-2: A table from the 2022 U.S. Transgender Survey addressing satisfacti...

Chapter 2

FIGURE 2-1: Percentage of people satisfied with gender transition.

FIGURE 2-2: Percentage of people satisfied with hormone use for gender transiti...

FIGURE 2-3: Percentage of people satisfied with gender-affirming surgery.

Chapter 3

FIGURE 3-1: A Safe Space image lets you know you have a place of support and ac...

Chapter 4

FIGURE 4-1: This is the way the first pieces of tape can be positioned when you...

FIGURE 4-2: A photo of hip-padding shapewear.

FIGURE 4-3: A photo of oval (left) and triangular (right) silicone breast prost...

Chapter 5

FIGURE 5-1: The Movement Advancement Project’s 2024 state ID map.

Chapter 7

FIGURE 7-1: Health impacts of trauma.

Chapter 8

FIGURE 8-1: Some changes and timelines associated with masculinizing hormones. ...

FIGURE 8-2: A table of the changes and timelines associated with feminizing hor...

Chapter 9

FIGURE 9-1: Results from a study about different transgender surgeries.

FIGURE 9-2: Table of genital surgery recovery times.

FIGURE 9-3: An illustration of the parts of a vulva.

FIGURE 9-4: Common barriers to gender-affirming surgeries.

FIGURE 9-5: Reasons for disinterest in gender-affirming surgeries.

Chapter 10

FIGURE 10-1: An illustration of the vocal cords.

Guide

Cover

Table of Contents

Title Page

Copyright

Begin Reading

Index

About the Authors

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Gender Transition For Dummies®

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Library of Congress Control Number: 2025931328

ISBN: 978-1-394-29318-6 (pbk); ISBN: 978-1-394-29319-3 (epub); ISBN: 978-1-394-29320-9 (ebk)

Introduction

Congratulations on finding this book! Even now, we know that it can be incredibly difficult to get ahold of the resources you need to understand, evaluate, and begin your gender transition journey. Most of our writing team is trans, so we can relate to the excitement and anxiety you may be feeling right now. We’re so glad you’re here, and we know you’ll find some great information in these pages.

Everyone on our team works with and for transgender and non-binary people in the state of New Mexico. Three of us are with the Transgender Resource Center of New Mexico, and one of us is an MD who has treated many trans and non-binary young people and adults. In our combined years of providing services, advocacy, education, and care, we have encountered the same questions over and over.

How do I know if I am trans?

What happens if I take gender-affirming hormones?

What kinds of surgeries are available for trans people?

How can I find a supportive healthcare provider?

How will I handle all of my relationships?

The answers to these questions and more are provided throughout this book, from our own experience and from years of researching answers for our communities.

As you move further into your journey, you’ll be faced with complex decisions and situations. Things will be difficult at times, and some folks may experience serious depression and anxiety. Know that you are not alone, and use this resource to find that hand you may need to reach out for when it feels dark.

Transgender and non-binary people have existed throughout human history, even though that’s not common knowledge yet. Trans and non-binary people have made huge contributions in many areas of human thought and achievement.

You are part of an unbroken thread of humanity, and you have special gifts to offer the world. Read on for more info and signposts for the road ahead of you.

About This Book

This book was written to compile all the currently known information about gender transition. We wanted to bring together information about medical options, social and legal transition, behavioral health, and personal relationships into one easy-to-access guide.

For the first of many times we note that each person reading this is unique, and your gender transition journey is your own. This book doesn’t prescribe a protocol for transition; it’s meant to provide you with the information you need to make your own deeply personal decisions about how to proceed and at what pace.

The whole transition process will be easier if you have a good team — healthcare providers you can trust, other trans folks you can talk to, and friends or family who care about and support you. Not everyone is lucky enough to have this support team already in place, so look to this book for some tips and advice about where to begin the search.

Foolish Assumptions

When you’re writing a book, it’s impossible not to imagine the folks you’re talking to on the other side. Imagining you means making some assumptions about you, and here are ours:

You are transgender or non-binary, or you are a close loved one of someone who is.

You are interested in taking steps associated with gender transition, or at least want to know what your options are.

You are looking for scientific and data-based information about the transition process.

You want to make your own decisions about your transition but would appreciate some information to guide your choices.

You read and often turn to books like this for guidance.

If this list sounds like it describes you, you’ve come to the right place. Welcome to Gender Transition For Dummies!

Icons Used in This Book

The margins of this book are filled with little cartoons. In the For Dummies universe, these are known as icons, and they signal certain (we hope) exciting things going on in the accompanying text.

This icon points to practical advice and actionable steps. If you’re looking for a clear how-to, this is your go-to marker for helpful suggestions to guide your transition journey.

Whenever you see this icon, know that it highlights something essential — whether it’s an important fact or a nugget of wisdom worth keeping in mind. Consider revisiting these worthwhile notes as you move forward.

Gender transition can be a challenging process with risks and pitfalls, whether they’re medical, social, or legal. This icon signals areas where extra caution is advised, so that you can navigate these challenges thoughtfully and safely.

Curious about the science behind gender-affirming hormones or the legal details of name changes? This icon introduces in-depth explanations and technical information.

Beyond the Book

In addition to the pages you’re reading right now, this book comes with a free, access-anywhere online Cheat Sheet that summarizes some of our key advice at a glance. To access this Cheat Sheet, go to http://www.dummies.com/, and type Gender Transition cheat sheet in the search box.

Where to Go from Here

One option is to read this book from cover to cover to become something of an expert on gender transition. However, you’re probably more likely to bounce around from chapter to chapter as you have questions, possibly even returning to this book over months, or even years, as new questions arise and as you reach new inflection points in your personal journey.

If you only want to read about surgeries at this point, you can jump straight to Chapter 9. If you are still really apprehensive and just want to find out more about personal relationships and how they may change during your transition, you can stick with Part 1 for the time being.

It doesn’t matter how you use this book. It’s here to be both the tour and the guide through the sometimes daunting landscape of gender transition, and we hope it’s a great road map for you as you embark on your journey.

Part 1

Getting Familiar with Gender Transition

IN THIS PART …

Understand the elements of gender transition and find answers to common questions.

Explore the nuances and deeper aspects of transitioning.

Plan for and adapt to the gender transition journey.

Chapter 1

Exploring Gender Transition Elements and Common Questions

IN THIS CHAPTER

Uncovering terms and definitions

Grasping the elements and implications of gender transition

Addressing common questions

Finding support on your path

If you’re considering transitioning, you’ve no doubt thought about the many ways that taking this step can change your life. For a lot of people the goal of walking down this path is what some folks today call gender euphoria (feelings of satisfaction, confidence, comfort, or even joy that come from being aligned with your gender).

At the same time, challenges and complications may arise for you along the way. You may be someone who came to this book because you are considering this path but really aren't sure yet. That is also absolutely okay.

In the end, nobody but you can know whether this is right for you. Hopefully, though, this book can fill in the gaps in knowledge that you might have, and help provide you with crucial information and perspective to help you with this, sometimes intimidating, decision process.

In this chapter, you find some of the most basic information about what’s often called gender transition (an array of social, legal, and medical options that some transgender and non-binary people undertake to be more authentically themselves).

You also find definitions of the words transgender and non-binary, as well as other terms associated with gender and transitioning. (Much more detailed information about social and medical transition is sprinkled throughout the rest of the book, so this chapter is truly an overview.) Finally, we answer some common questions that arise about this topic, including an initial look at finding support and help.

You may be excited, scared, or confused right now. This book aims to give you more information and provide some pathways to connection and assistance along your journey. Remember that you aren’t in this alone, and your transgender or non-binary identity, and your way of relating to it, is valid and valued.

Discovering the Meaning of Transgender and Non-binary

Transgender and non-binary: What do these words mean? Although terminology evolves, the word transgender currently refers to anyone whose gender doesn’t match up completely with the sex they were designated at birth. Non-binary specifically refers to folks who don’t feel like either a man or a woman.

As U.S. culture finally recognizes that a child’s consistent awareness of their gender typically develops between 2 and 5 years old, it’s critical that this awareness doesn’t become a hard and fast expectation of ALL transgender and non-binary people. Being transgender or non-binary isn’t fully understood by a lot of cisgender people (folks whose gender and sex match up 100 percent — in other words, people who aren’t transgender), which means that this simple minority characteristic is still stigmatized. Discrimination and violence are strongly correlated with being trans or non-binary, and a lot of people aren’t aware of the existence of trans and non-binary people until adulthood, even today! In those circumstances, it’s no wonder that many folks don’t come to the realization that they’re transgender or non-binary, even internally, until later in life. People come out, to themselves and others, in their 20s, 40s, and even their 60s.

Some folks talk about not being able to ask the question “Am I trans?” or “Is there something different about my gender?” until they were much, much older than 5. Another specific time when people tend to start talking about possibly being trans or non-binary, or seeking help from others about gender issues, is at the onset of natal puberty (the changes and emergence of secondary sex traits associated with the designated sex at birth).

When the body starts to change in ways that can feel very “wrong” for many trans and non-binary people, those changes can set off an emotional and psychological tailspin. Not everyone experiences this gender dysphoria (a thorough definition is found in the section “Answering a Few Common Questions” later in this chapter), and each person’s experience is their own. But for a lot of folks, natal puberty is a huge challenge that can worsen all types of behavioral health symptoms, including suicidal thoughts.

Even trans/non-binary people can struggle when different folks in their lives come out, for a lot of reasons. If you find yourself having a hard time with someone's disclosure about their gender, try to take them at face value. Even if you think they may have something more complex going on, be warm and accepting, and ask open-ended questions about their identity and experience. They thought you were safe enough to confide in, so prove them right!

The bottom line is that right now there’s no validating test for someone’s gender or for being transgender or non-binary. This means that it can’t currently be proved, but it also can’t be disproved. Certainly, some folks have questioned their gender and then determined that they weren’t trans in the end. But in the initial conversations, it's important not to invalidate a person who needs support (this is great advice for cis folks in your life, too.).

Don’t be hesitant to use any of the words in this section as identity labels — or not! While there are standard definitions for transgender and non-binary, the words people use to describe and define themselves are more like the peel-and-stick name tags folks use at formal events (see Figure 1-1 for an example). You get to write your own label or descriptor on your name tag. Whether a term is generally considered out of date, or may not be used by a majority of folks whose gender is similar to yours, it’s up to you how you want to be talked to and talked about. These sticker name tags can be pulled off and exchanged for a new one, if you realize that the one you're wearing isn't working for you anymore.

FIGURE 1-1: An example of a self-adhesive name tag with pronouns.

Transgender

The word transgender is currently used to mean a person whose designated sex and gender are not the same. It's important to notice that this definition is not binary in nature — meaning that you don't have to feel the opposite of your designated sex to fall under the trans umbrella, just not the same.

When you read about non-binary in the following section, you'll see that non-binary falls under the trans umbrella using these definitions, too. But as we say above, that doesn't mean that a non-binary person has to put on a trans “name tag.”

The other critical aspect to stress is that the definition of transgender is not medical in nature. We talk about gender dysphoria more throughout the book, but experiencing gender dysphoria is NOT part of the meaning of transgender. Trans is a shortened version of transgender and is appropriate for anyone to use.

Being transgender or non-binary does not mean that you dress any certain way or adhere to gender norms and stereotypes. It also doesn't indicate anything about your orientation. Trans people fall into every existing category of people, so trans folks can be gay, straight, bisexual, pansexual, asexual, or any other orientation.

Non-binary

Non-binary people have a gender that falls outside the man/woman binary. It’s a common misperception that this means that someone who’s non-binary is a blend of man and woman. In fact, non-binary describes a wealth of different genders and experiences. Some non-binary people do feel like a mix of man and woman, while others experience no gender at all (sometimes called agender).

There are non-binary people who experience their gender as neutral. The term genderfluid describes people whose gender shifts and changes over time. This is such a small sampling of ways to be non-binary. If you do not feel like a man, and you also do not feel like a woman, you fall under this non-binary umbrella.

The Four Aspects

For people raised in mainstream U.S. culture, these concepts can feel new and even a little confusing. In order to fully understand these ideas, you must have a grasp of four basic traits. Those traits are sex (broken down into biological sex and designated sex), gender (sometimes referred to as gender identity but not in our trainings or in this book), gender expression, and orientation. We describe these traits more thoroughly in the following sections.

Sex

Sex is a broad term that refers to physiology (how the human body works). It's important to distinguish between biological sex and designated sex, so read on for more information and to find out why.

Biological sex

Biological sex is a complex system formed by five component parts:

Sex chromosomes

are packets of DNA containing the genes that determine someone’s sex. XX (female) and XY (male) are the most common examples, but they aren’t the only ones humans have.

Sex hormones

are steroid hormones produced by the gonads that cause the development of other secondary sex characteristics. Estrogen and testosterone are the most common examples.

External genitals

(or external genitalia) is the term we use throughout this book to refer to external sex organs. Most commonly, we’re talking about the penis/testicles or vulva.

Gonads

is another name for the internal reproductive organs. In humans these are typically testes or ovaries.

Gametes

refers to sex cells (often sperm and ova, or eggs).

Designated sex

Designated sex refers to the sex that was put down on your original birth record. More than 99 percent of the time in the U.S., this designation is made strictly on the basis of external genitals.

The reason you can’t interchange the terms biological sex and designated sex is that intersex people exist. Intersex currently refers to the estimated 1.7 percent of humans who are born with variations in their biological sex system. In other words, their bodies don’t fit the typical definition of male or female. These variations are often very subtle, and there is nothing “wrong” with the bodies of intersex people (just like there is nothing “wrong” with left-handed or red-haired people).

There are never two kinds of people in the world! For more information about intersex people, check out InterACT Advocates for Intersex Youth (online at https://interactadvocates.org).

Gender

Gender is the term we (and most folks engaged in trans education and advocacy) use to mean the deep, fundamental, internal knowledge that each person has about whether they’re a man, a woman, or a non-binary person. This cannot be observed from the outside, which means it can be hidden. If you’ve been through times in your life when you hid your gender, many people can relate. Hopefully you’re now in a place where you can take any steps you want and need to take to live authentically, in alignment with your gender.

You definitely may have heard gender referred to as “gender identity!” That term is still most often what you will read in protective nondiscrimination laws and policies, and it was the term that even trans folks and trans educators used for many years. As we learn more, the language continues to evolve. When one of our team started teaching about trans people and issues in 2008, trans folks still used the term “preferred gender pronouns.” We had gotten so familiar and intimate with that term that we even abbreviated it to “PGPs.” After a while though, folks started to realize that we didn't call them “PGPs” when we talked about cisgender folks. And the pronouns of trans folks and cis folks are the same! So now we just say pronouns. Your gender is not the way you “identify.” It is (for most folks) a deep, integral, crucial piece of who you are and how you see yourself. For that reason, within the trans and non-binary communities, we typically just use the word gender these days, rather than the outdated and mildly condescending gender identity."

Gender expression

Gender expression is the external aspect of gender, composed of elements such as clothing, hairstyle, jewelry, makeup, speech, gait, gestures, certain preferences, and even many names. This facet of gender is also the most culturally based.

Gender norms and stereotypes vary from one cultural group to another, and they shift over time within a single cultural group. In the U.S., some obvious examples of gender norms shifting over time include women having access to the same professions men work in, as well as men choosing to be stay-at-home dads. Kilts and skirts are terrific examples of how the same item can be classified as masculine or feminine depending on the cultural group you’re raised in. After all, a piece of fabric that wraps around your waist can’t be masculine or feminine on its own. These expectations and definitions that many people are taught from the first moments of their lives can change throughout your lifetime.

Orientation

Orientation refers to a person’s romantic, physical, emotional, and/or sexual attraction — or lack of attraction — to other people. Some of the relative terms used to describe orientation are straight (opposite-gender attraction), gay (same-gender attraction), bisexual (attraction to two or more genders), pansexual (individualized attraction to any gender), and asexual (lack of sexual attraction to others). Asexual, sometimes called “ace,” refers to a wide range of experiences around sex. Being asexual certainly doesn't mean that you don't like people. It may not even mean that you don't engage in sex. Some asexual folks enjoy having sex, but others may not feel that way. These attitudes can be referred to as sex positive, sex neutral, or sex negative asexual. Asexual also does not specify a person's experience, or interest in, romantic attraction. One person could be panromantic and asexual, for example. And guess what? Straight, gay, bi, pansexual and asexual aren't the only options. There is so much more to learn when it comes to orientation and attraction.

Each of the four attributes described in the preceding sections is separate and distinct from the others. Trans and non-binary people are defined by having a sex and gender that don’t match. Likewise, someone’s gender expression may not be linked with their internal gender. There’s actually no way to “look” non-binary. And think of people like RuPaul, a cisgender man who elaborately dresses like a woman, but not to show that he feels like a woman internally. The acronym LGBT (which stands for lesbian, gay, bisexual, and transgender) may make it sound like orientation and gender are linked, but even those pieces are separate. Just like a cisgender person, a trans person can be gay, straight, bi, or any other orientation.

A HISTORICAL PERSPECTIVE OF TRANSGENDER AND NON-BINARY PEOPLE

One of the most important things to remember is that transgender and non-binary people are not new. Cultures throughout human history have recognized more than two defined gender categories — some acknowledge as many as seven! Many languages contain words and categories for transgender and non-binary people, such as the Polynesian fa’afafine. Transgender and non-binary individuals have existed throughout history, way before the advent of modern medical transition. The Public Universal Friend and Albert Cashier (you can search Wikipedia for more info about both) are just two examples. Joe Stevens, a very talented trans musician, actually co-wrote a musical about Albert. It's called The Civility of Albert Cashier, and you can learn more about it and Joe at the website https://www.albertcashiermusical.com/.

This history is often associated with ancient and/or Indigenous cultures, and some of those societies definitely did recognize multiple gender categories. But even in the modern era, you can find examples of gender variance worldwide. Hijras in India and Muxe in Mexico are good examples. Even in the United States, the first group that could be seen as a transgender advocacy group came about in New York City in 1895! It was called the Cercle Hermaphroditos.

Even though the concept feels new in a lot of places, including the U.S., understanding that transgender and non-binary people have always existed helps ground them in human history and establishes that trans people represent a normal human variation, or minority characteristic. Because a small percentage of humans are born trans or non-binary, being trans/non-binary is actually similar to being left-handed or having red hair — both great examples of minority traits.

Lefties and redheads also have a well-documented history of being misunderstood, looked down on, and persecuted, but both groups are fairly well integrated into U.S. culture at this point. In fact, it’s not difficult to find left-handed notebooks, can openers, guitars, rifles, and even golf clubs! In 1971, an article in the Florence (AL) Times — Tri-Cities Daily entitled “New Day Dawns for Southpaws” included the quote “Left-handers — not to be confused with leftists — are becoming increasingly accepted and enabled to take their right (or left) place in the world.” This provides hope that transgender and non-binary people will someday be treated with the same casual acceptance that society displays toward left-handed people today.

Exploring the Changes Involved in Gender Transition

The gender transition steps and options we outline in this book may be some of the best things you ever do for yourself; still, many people have a significant fear of change and the unknown. A little information can go a long way in easing that anxiety, and this book has a lot of information.

It’s important to realize going into this journey that each step you take can be something that changes your body, your confidence, your relationships, your work or school life, and your family. Of course, this can be true about any decisions you make for yourself throughout your life. The choice to have children, be in committed romantic relationships, take or leave a job, or move to a new place can also have big ramifications. We want you to know that this may not be completely smooth sailing, but that's true about life in general!

Taking hormones or having surgery will result in major changes to your body and the way you experience it. We detail the masculinizing and feminizing effects of hormones in Chapter 8, but in general, hormones will cause huge shifts in your feelings and in various aspects of your body. If you opt for what is considered a full masculinizing or feminizing dose of hormones, you’ll actually restart puberty. For some transgender and non-binary people who begin this process later in life, this can mean going through full puberty twice. They will experience many of the changes and challenges related to puberty, including

Physical

Developmental

Cognitive

Psychological

When you’re aware of this, and get the support you need, it’s a lot easier to get through it. You may even be the person who sometimes reassures your loved ones that puberty is a process, and that it eventually comes to an end.

Socially and professionally, things can unfold in a lot of different ways. For some people who transition very little changes in the reality of their day-to-day lives. Some trans or non-binary people stay in the relationships they’re in when they begin the process, and work for employers who are supportive and affirming. For some people, their children, young or older, are their biggest cheerleaders. So, try not to assume that everything will only be negative once you begin showing up as the person you’re meant to be.

However, it’s misleading to suggest that people don’t ever run into challenges, large and small, as a result of charting their course through these waters. Some people have family members, partners, or children who don’t accept them as they start to tell the truth about who they are. Some folks lose their jobs, and others have a hard time finding new employment after embarking on transition-related changes. We address many of these challenges, as well as the ways some people have managed them, in Chapters 3 and 12.

Despite the potential issues, the data indicates that people who take steps to transition are quite satisfied. Figure 1-2 shows the data from the 2022 U.S. Transgender Survey on how many trans and non-binary people report high levels of satisfaction with the steps they took to transition.

FIGURE 1-2: A table from the 2022 U.S. Transgender Survey addressing satisfaction levels with gender transition.

Understanding the Life Implications of Transitioning

Because each trans and non-binary person is on an individual path, we can’t provide a standard recipe or certain order for how to proceed with your transition. That also means we can’t fully predict what the implications of the steps you take will be. The one thing you can be sure of, though, is that things will definitely be different in many ways once you start making changes like the ones we explore in this book.

Many areas of your life can be impacted when you decide to be your authentic self and move toward your genuine presentation of who you are and/or the creation of a body that’s the right home for you. Although many people don’t experience these things, and others don’t report them as negatives, some of the fundamental issues people share about transition that can be challenging include

Body changes that are less desirable, such as decreased strength for people taking estrogen, and pattern baldness or even increased difficulty freely crying for some people on testosterone

Unwanted social attention in public

Fear of seeking out medical care

Difficulty at work or obtaining employment

Dating challenges

Discrimination

Fears about blending in or “passing”

Difficulty navigating existing romantic and family relationships

Unfamiliar gender stereotypes (for example, a trans man who hasn’t been perceived as a man in the past may face aggressive behavior from other men, such as being challenged to a fight)

On the other hand, transgender and non-binary people have cited the following things as the upside of transitioning:

Confidence, happiness, and peace of mind

Freedom to make other big decisions that will improve their lives

Easing of some behavioral health symptoms

Less or no substance misuse

An end to suicidal thoughts

More involvement in their medical care and well-being

Dreams and hopes for the future

The real-world consequences of transitioning can sound intimidating, but don’t let doubt or anxiety hold you back from checking out the options you believe are right for you. As Figure 1-2 demonstrates, the majority of trans and non-binary people who take these steps report lifelong satisfaction with them. Plus, very few transition-related changes are truly irreversible. It’s okay to explore!

Answering a Few Common Questions

You may be wondering about some transition-related issues, or you may have friends or family who are curious about these topics. The following sections provide answers to a handful of questions some folks may have.

Does everyone have gender dysphoria?

The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), currently defines gender dysphoria as

A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by at least two or more of the following:

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)

A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Another book can be written (and probably has been!) about the complex and troubling history of the DSM-5. One brief example is that the DSM classified being gay as a “mental disorder” from its first edition in 1952 up to the seventh printing of the second edition in 1974.

While gender dysphoria helps many trans and non-binary people organize and understand their experiences and serves as the needed justification for coverage of gender-affirming treatment by insurance carriers, who almost all pay for this treatment now, the APA’s current definition of the term must be taken with a grain of salt given the DSM’s past.

Does every trans person experience gender dysphoria? The answer is no! But folks can’t be blamed for thinking that gender dysphoria is essential to being transgender or non-binary. Most media coverage and representation has focused on trans people who both experience gender dysphoria and undergo medical treatment for it.

The definition of being transgender is that your internal gender — that internal knowing about being a man, a woman, or a non-binary person — doesn’t completely match the sex you were designated at birth (in other words, the sex that was recorded on your first birth certificate). It’s absolutely possible to know that about yourself and not simultaneously harbor angry or hateful feelings toward your body. As always, remember that each transgender and non-binary person is an individual, and your experience is your own.

What about cisgender people? Since the current definition of gender dysphoria specifically references the incongruence, or disconnect, between designated sex and gender, cisgender folks, by definition, cannot experience gender dysphoria. They certainly can, and sometimes do, feel deep and debilitating insecurities about their gender, their body, and their gender presentation.

Cisgender women who undergo mastectomies for breast cancer, or who have naturally thinning hair or bald patches, can face unsolicited feedback from strangers about their femininity and appeal. Cisgender men who have wide hips or aren’t able to grow a thick, full beard may face the same criticism, or may just suffer internally with feelings of inadequacy about their masculinity. In fact, if you think about it, many, if not most, cosmetic surgeries can be considered gender-affirming surgeries. They often represent a person’s efforts to obtain the stereotypical ideal of how a man or woman is supposed to appear.

The prefix “cis” is a Latin prefix meaning “lined up on the same side.” Trans is the natural opposite in Latin, meaning “crossing over.” When you look at these prefixes, much like “pre” and “post,” you can see that they belong together in a set. A cis person has a gender and sex that line up, or match, while trans and non-binary folks have crossing over of some kind between those two things. Cisgender is not in any way a hateful or derogatory term, no matter what you hear. It is really most like the word right-handed, in other words, a neutral word for the dominant, majority group.

How do I know if I’m transgender?

If you’re asking yourself this question, you should know that you’re not alone. Many people before you have taken this same interior journey. There’s nothing wrong with you, and no matter what the answer turns out to be, this questioning process is a great opportunity to understand more deeply who you are.

In short, if you fit the definition of transgender — your gender is different from the sex you were designated at birth — then you are trans. This is definitely not meant to be a glib answer, because being transgender contains a world of nuance and variations.

For example, many people can feel like a man or a woman and still be uncomfortable with or resent the gender norms and stereotypes they face in that gender. Enjoying the clothes, activities, or stereotypical interests of one gender or another doesn’t make you that gender. Every tomboy isn’t a transgender boy, and many drag queens are cisgender gay men who don’t feel deeply that they’re women internally. Some male pop stars have incorporated so-called women’s clothing into their stage or street looks, dating back to the 1960s. Conversely, you can be a transgender man and enjoy performing as a drag queen.

Deep internal knowledge of being a man, woman, or non-binary person doesn’t obligate you to adhere to the norms and expectations your culture associates with that group. To put it another way, gender expression isn’t gender.

Many transgender and non-binary adults will tell you that sometime between the ages of 2 and 5, they knew their gender, and that their knowledge was unexpected and sometimes unwanted by their parents and others. Although some people find that astonishing, it’s the common experience of kids across the board. The American Academy of Pediatrics (AAP) has affirmed that awareness of gender is a typical part of a child’s development. The AAP’s parenting website, HealthyChildren.org, repeatedly reinforces that gender identity typically develops in the following stages:

Around age 2:

Children become conscious of the physical differences between boys and girls.

Before their 3rd birthday:

Most children can easily label themselves as either a boy or a girl.

By age 4:

Most children have a stable sense of their gender identity.

During this same time of life, children learn gender role behavior — that is, how to do “things that boys do” or “things that girls do.” However, cross-gender preferences and play are a normal part of gender development and exploration regardless of a child’s future gender identity (see “The Power of Play: How Fun and Games Help Children Thrive” on HealthyChildren.org).