transgender topics for essay

85 Transgender Essay Topic Ideas & Examples

🏆 best transgender topic ideas & essay examples, ⭐ simple & easy transgender essay titles, 📌 most interesting transgender topics to write about, 👍 good research topics about transgender.

• Transgender Issues in “The Crying Game” and “M. Butterfly” The acceptance of the phenomenon of transgender status in contrast to widely spread stereotypes on it is one of the central themes and moral messages of the 1992 movie The Crying Game and the 1993 […]
• Xaniths as a Transgender in Omani Culture The Xaniths are the third gender within the Omani social system. The Xaniths represents the transsexuals and homosexuals within the Omani society.
• The Issue of Transgender in Sporting Activities Transgender women’s increased body strength and mass make it unfair for them to compete with cisgender women in the same sporting categories. The IOC sets the recommended testosterone level for transgender women to participate in […]
• Transgender People in the USA The statistics are impressive and, no matter how unpleasant it is to some of us, we have to face the reality that quite a large number of people in our society can be classified as […]
• Equality of Transgender and LGBTQ+ Populations The principles of the struggle for the transgender and LGBTQ+ populations should include respect for the choice and self-identification of a person.
• Aspects of Equality for Transgender Athletes The authors of the article claim that transgender athletes deserve equal representation and the right to participate in competitions in the divisions of the gender they identify themselves by referring to social structures and justice.
• Transgender Student-Athlete Participation Policy The updated regulations place the decision to let transgender sportsmen take part in the competition in the hands of the national governing body or, in the absence of such, of a sport’s international federation.
• Health Disparities in the Transgender Community The purpose of the research study is to improve health disparities in the transgender community by eliminating financial barriers, discrimination, lack of cultural competence of providers, and socioeconomic and health system barriers that will increase […]
• Transgender Bathroom Policies in Schools The topic of why transgender pupils cannot simply utilize private rooms designated for such gender identification, given that individuals who identify as boys and girls have their washrooms, is at the heart of the discussion […]
• The Transgender Teens Policy Issues Problem recognition involves recognizing that policies serving to protect the interests of transgender teens need proper enforcement or even proper formulation to ensure effectiveness in protecting and ensuring the best interests of the children.
• Transgender Women in Sports: Is the Threat Real? In this regard, it can be argued that the advantages of transgender women are a barrier to women’s sports. However, the topic of transgender people has received the most discussion in the last few years […]
• The Advantages of Transgender Women Are a Barrier to Women’s Sports The main counterargument of proponents of transpeople participation in women’s sports is that there is no proven link between biology and endurance.
• The Article “The Transgender Threat to Women’s Sports” by Abigail Shrier Abigail Shrier’s article The Transgender Threat to Women’s Sports provides a series of arguments and evidence that support the idea of excluding transgender people from women’s sports.
• Transgender Women Take Part in Sports Competitions The issues that support this statement are unequal muscular mass of men and women unchanged by transgender therapy; and unequal height and length of the body needed in game sports and jumping.
• Transgender Participation in Sports Among the successes in resolving the subject of transgenderism in society, medicine, psychology and sports, scientists include the exclusion of transgender issues from the sections of psychiatric diseases, and their inclusion in the section of […]
• Aspects of Identity: Transgender Status, Gender Identity In many countries in Europe and the rest of the world, the whites always obtain more benefits at the expense of the people of color and other races.
• Transgender Women Should Be Allowed to Compete in Olympic Sports It is all due to the higher level of testosterone in their bodies and that some of them can pretend to be transgender to compete against women.
• Lesbian, Gay, Bisexual, Transgender, and Queer Families’ Issues In tendency for this, it is essential to analyze issues faced by such families in the community and thus provide recommendations on approaches to adopt during counseling sessions of LGBTQ families.
• Considering Social Acceptability of Transgender and Transracial Identities This essay will examine two articles providing different views on transgender and transracial identities and argue that considerations used to support the transgender community are not transferable to the issue of transracial.
• Anti-Transgender and Anti-LGBQ Violence Crisis in the US The vicious circle of minority stress that leads to marginalization and the marginalization that contributes to the stigma has to be broken.
• LGBT (Lesbian, Gay, Bisexual, and Transgender) in Canada, Japan and China With a perfect understanding of the LGBTQ issue in Canada, my team and I started to compare LGBTQ in Canada, China, and Japan.
• Why LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer) Is Becoming Popular In the context of the continuity of experience, morality, and moral values, it is appropriate to emphasize one of the most apparent global trends, namely the gradual recognition of the inalienable rights of the LGBTQ+ […]
• Harassment of Young Adults Who Are Gay, Lesbian, Bisexual, Transgender, Questioning According to the professional code of ethics, it is the duty of a social worker to help people in need and with problems.
• Lesbian, Gay, Bisexual, and Transgender Ideation, Correlations With ‘Suicidality’ In addition, experience of verbal ill-treatment and physical assault intensified feeling suicidal for both heterosexual and gay or bisexual men, not just for homosexual men alone as contained in many research findings, and that social […]
• Ethical Issues of the Transgender Rights One of the most significant burdens transgender people experience is the recognition of their identity. Therefore, to increase the chances for transgender adults’ health care, it is important to pay thorough attention to any signs […]
• Growing Up Transgender: Malisa’s Story on NBC News It is essential to develop a better understanding of the concept of gender in relation to children and their development to ensure the protection of the interests of all people and, thus, improve their lives.
• Equal Employment Opportunity Commission for Transgenders The representatives of the EEOC are able to investigate each case of discrimination in different organizations using the law and the intentions of people to leave in an equal society.
• Transgender Bathroom Rights and Legal Reforms One of the themes that deserve discussion is the possibility of creating transgender baths and the rights that can be given to this category of the population.
• Health Care for Transgender Individuals However, the medicalization of transsexualism made it more difficult to receive the treatment as individuals have to prove that they have such problems, and it is not just a temperate state of their mind that […]
• Racism in Lesbians, Gays, Bisexuals, Transgenders Instead of supporting one another as members of a minority group, these people arrange internal arguments within the society of LGBT that leads to the increased feeling of depression and psychological pressure on behalf of […]
• Cancer Screening in Lesbians, Gays, Transgenders Moreover, one of the diseases that are the burden of American society as a whole and the LGBT population, in particular, is cancer.
• Transgender Issues in Modern Society The legalization of gay marriage in many countries did not lead to the eradication of homophobia, protection of women’s rights did not eliminate sexism and gender inequality present in many aspects of life, and the […]
• Lesbian, Gay, Bisexual, Transgender at Life Stages In general, all people are claimed to be equal in the USA, however, there is a high possibility to lose a job or fail to be applied to it if one is a representative of […]
• Transgender Bathroom Rights and Needed Policy In both articles, the subject of the study is the right of transgenders to access bathrooms according to the preferences of these people.
• Women in Sports: Policy for Transgender Players Drawing from this elucidation, the proposed policy statement on transgender participation in mixed leagues will not require transgender athletes to prove their gender identity through the testimony of professional experts and psychologists; on the contrary, […]
• Transgender Inclusivity in Higher Education The individuals and organizations opposing trans inclusion in higher education stress that one of the main purposes of all-female colleges is to ensure the safety of the female students.
• Transgender Students on Colleges: Needs and Challenges In order to accommodate all the involved groups of people, there is no attributed definition of transgender due to the diversity of the subject.
• Lesbian, Gay, Bisexual and Transgender Sexuality in the Hispanic Culture Men are the breadwinners of the family, a duty that requires men to play the father figure role in the family.
• Leslie Feinberg: Transgenders in “Stone Butch Blues” On one hand, traditionally, the transgenders have never assumed the authority held by men in the society and on the other hand, there is the issue that arises in a situation comprising of families composed […]
• Transgender People and the Rights Act of 1964
• Bathroom Discrimination Against the Transgender Community
• Unjust and Inhumane Transgender Discrimination
• Understanding Transgender People and the Discrimination They Face Today
• Lesbian, Gay, Bisexual and Transgender Rights
• Treatment and Support for Transgender Children
• Transgender Individuals and Sex Reassignment Therapy
• Violence Against Lesbians, Gays, Bisexuals and Transgender
• Women, Gay, Bisexual and Transgender Rights
• Transgender Sexuality and The Transgender Rights Movement
• Philosophy: Transgender and Radical Freedom
• Transgender People Face Harassment and Discrimination
• Transgender Sexuality and the Transgender Rights Movement
• Oppression and Lesbian, Gay, Bisexual, and Transgender Persons
• Understanding the Transgender Phenomenon
• Stigma and Discrimination That Transgender Individuals Experience
• Hate Crimes Against Lesbian, Gay, Bisexual, and Transgender
• Discrimination Against Transgender Individuals Within Society
• Building Relationships With Transgender Individuals
• Domestic Violence and Lesbian, Gay, Bisexual and Transgender Relationships
• Beyond Depression and Suicide: The Mental Health of Transgender College Students
• Transgender Rights and Representation in Sports
• Gender Dysphoria and the Persecution of Transgender People
• Lesbian, Gay, Bisexual and Transgender Inclusion
• Critical Race Studies Program Panel Detention Conditions Facing Queer and Transgender Immigrants
• U.S. Politics and Society: Lesbian, Gay, Bisexual, and Transgender Political Identity
• The Health and Well Being of Transgender High School Students
• The Pros and Cons of Transgender and Gender Nonconforming
• Comparing Intersex and Transgender Females
• Capitalism and Its Impact on the Transgender Movement
• Transgender Surgery and the Separation Between Mind and Body
• Gender Differences Between Effeminate Boys and Transgender
• How Schools Can Support Transgender Students and Improve School Climate
• The Transgender Community For Hate Based Crimes of Violence
• Public Bathroom Controversies Due to Transgender Issue in America
• The First Transgender Woman to Speak at a Major Party Convention in America
• The Causes and Solutions to the Mental Health Issues of Transgender Youth
• Sexual Orientation, Sexual, And Transgender Orientation
• Researching and Working for Transgender Youth: Contexts, Problems and Solutions
• Transgender Orientation and The Transgender Community
• Why Transgender People Should Use the Public Restroom that Matches Their Gender Identity
• Sexism Essay Ideas
• Homophobia Topics
• Same Sex Marriage Questions
• Parenting Research Topics
• Subculture Research Topics
• Masculinity Topics
• Stereotype Topics
• Tolerance Essay Ideas
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102 Transgender Essay Topics & Research Paper Titles

Are you looking for the best transgender essay topics? On this page, you’ll find a perfect title for your essay or research paper about gender identity, LGBT rights, and other transgender-related issues. Read on to get inspired by research topics on transgender prepared by StudyCorgi!

🏆 Best Transgender Research Paper Topics

🎓 interesting transgender essay topics, 👍 good transgender research topics & essay examples, 🌶️ hot research topics about transgender, 📝 transgender argumentative essay topics, ✒️ more transgender topics for essay.

• Transgender Women in Sports
• Critical Thinking and Transgender Ethics
• Transgender People in the Olympic Games
• Transgender People: Prejudice and Discrimination
• Transgender Support Group Meeting and Its Importance
• Gender Non-Conforming or Transgender Children Care
• Transgender Women Athletes in Professional Sports
• The Issue of Transgender Discrimination Despite numerous attempts to eliminate biased attitude, transgender people still face different challenges that deteriorate results of treatment.
• Challenges of Transgender Patients Transgender patients have to face a certain amount of resistance and discrimination in society regularly, this group of people has to deal with certain challenges in the health care arena.
• The Fight for $15 Movement vs. the Transgender Law Center For an examination of non-profit organizations, it will be convenient to use case studies. The Fight for $15 movement and the Transgender Law Center will be used as comparisons.
• Health Disparities of Transgender Population The problem is centered around the healthcare inequality experienced by members of the transgender community, where the barriers include financial factors and discrimination.
• Clinically and Culturally Competent Care for Transgender and Non-Binary People The analyzed review can be considered an essential step toward a better understanding of how to work with such groups.
• Transgender People in Prisons: Rights Violations There are many instances of how transgender rights are violated in jails: from misgendering from the staff and other prisoners to isolation and refusal to provide healthcare.
• Transgender Health Disparities and Solutions People who identify as transgender, intersex, gender non-conforming, or gender diverse have exacerbated health disparities compared to other people.
• Mental Healthcare Services for Transgender Individuals This research paper suggests a range of options to treat mental health and related illnesses among the non-binary populations.
• Transgender Prisoners and How They Are Treated According to international studies, transgender persons are a particularly defenseless population in the correctional structure, with their most necessities often being withheld.
• Media Coverage of Transgender Policy in Military This paper aims to provide an annotated bibliography for the ten articles related to the topic of media coverage of transgender policy in the military.
• Transgender Movement: Overview and Importance Ultimately, policies, guidelines, or steps ensure that the social change that the transgender movement is yearning for can be realized.
• Transgender Offenders in the Criminal Justice System The transgender population who are incarcerated often faces various unique challenges which expose them to vulnerabilities both physical and mental.
• Transgender Health Care in the USA: Then and Now The change of physical appearance or function through clothing, medical, surgical, or other means often becomes part of the personal gender experience of a transgender person.
• Why We Shouldn’t Compare Transracial and Transgender Identities To compare transracial identity with transgender identity is to reduce both to a set of immutable rules, be it rules of biology or society – and this is a very wrong approach.
• Conflict Between Transgender Theory, Ethics, and Scientific Community This essay aims to give answers to questions of ethics within the transgender topic and research fraud based on scholarly articles and presentations by Dr. Q Van Meter.
• The Problem of Lesbian, Gay, Bisexual and Transgender Youth Suicidality Recently, there was a sharp increase in cases of suicides committed by lesbian, gay, bisexual, transgender, and queer youth.
• Lesbian, Gay, Bisexual, Transgender Activism This paper aims at exploring the background of LGBTQ activism, the oppression that its members experience, the measures they take, and the opposition that hinders their progress.
• Transgender Care: Challenges, Implications In a healthcare setting not putting effort into ensuring diverse patient groups are treated with professional finesse with no regard for their differences is a timely issue.
• Trump Administration and Transgender Discrimination The paper reviews one of the recent issues that caught the public eye and media attention is the Trump administration’s treatment of transgender people’s healthcare rights.
• Transgender People’s Challenges Within Healthcare This paper aims to discuss the challenges in healthcare that the transgender community faces and how the challenges affect their overall health outcome.
• Transgender Care by Healthcare Professionals Transgender patients require healthcare professionals who are conversant with their experiences and who can treat them with utmost respect and dignity.
• Transgender People and Healthcare Barriers This essay aims to explain the barriers that prevent transgender people from receiving quality care and suggest improvements that can be implemented in current medical institutions.
• Transgender Bias in News Coverage In the context of increasing LGBTQ activism and recognition, transgenderism faces the greatest controversy and public backlash.
• Transgender Children’s Issues in Society The topic of transgender children in society proves to be divisive and is widely discussed by parents, teachers, clinicians, and politicians.
• Transgender Community and Heterosexism in Language The term “transgender” became commonly used only by the end of the 20th century. Not all transgenders commenced using this and preferred to pass as a different gender.
• Healthcare System: Transgender Patients Discrimination According to the statistics, almost 1 million Americans identifies themselves as transgender, making it a numerous population subgroup that is likely to expand in the future.
• Transgender Patients Problem and the Consequences of Discrimination Transgender patients come across different forms of harassment and do not have the same access to services as other people do.
• Transgender and Gender Non-Conforming Children This paper discusses the issues a psychiatric mental health nurse practitioner should be aware of when interacting with transgender and gender non-conforming children and adolescents.
• Transgender Patients and Health Care Challenges One of the challenges encountered by transgender patients refers to the lack of adequate access to healthcare services.
• Transgender Care and Health Care Professionals Despite the adoption of policies aimed at limiting discrimination, transgender people still face daily challenges in the aspects of employment, education, and healthcare access.
• Transgender Healthcare Barriers in the United States This paper examines central barriers to high-quality health care and includes practices employed to address the issue and some recommendations.
• Transgender Patients: Challenges & Discrimination in Healthcare It is worth noting that the concept of transgenderism implies a state of internal imbalance between the real and desired gender of an individual.
• Healthcare Challenges of Transgender Patients Transgender individuals have health problems common for the whole population and frequently face challenges in healthcare settings related to inadequate healthcare.
• Transgender Patients and Challenges in Health Care The community remains predominantly marginalized, with policies and laws denying them recognition of their gender, making accessing health care very challenging.
• Lesbian, Gay, Bisexual, Transgender Patients’ Therapy The current quality of managing the needs of the representatives of the LGBT community needs a significant improvement.
• Transgender Patients and Nursing Health Management There is a growing recognition today among health care providers and researchers that patients’ transgenderism may become a factor in their care.
• Lesbian, Gay, Bisexual, Transgender in Hospital The paper discusses the cultural competency concept since it appears to be of critical importance for the profound understanding of the problems of the LGBT community.
• Challenges to Transgender Patients Despite the recent attention to the issues of transgender people, the level of discrimination against them is still incredibly high.
• Transgender Issues in Cis- and Trans-Made Movies This paper discusses the implications of transgender and transsexual experience from the outside and from within, particularly how they are represented and how the public sees it.
• Discrimination Faced by Transgender Patients Contemporary hospitals are not designed for transgender people, therefore, they can have many troubles there ranging from the unfriendly environment of a hospital and doctors.
• Transgender-Associated Stigma in Healthcare Transgender individuals are people who assume a gender definition of identity that differs from gender assigned to them at birth.
• Viviane Namaste and Julia Serano’ Views on Transgenders First of all, it is important to note that both authors consider the theme of representation of transsexuals and transvestites.
• Transgender and Problems with Healthcare Services Transgender individuals find it difficult to approach physicians because it is difficult for them to reach needed treatment.
• Transgender People in Healthcare Facilities Gender nonconforming and transgender people face discrimination in almost every sphere of human activity. It has a negative impact on the access of these groups to primary care.
• Transgenders Discrimination from Healthcare Providers The transgender community reports that at the moment, it faces numerous barriers to care because of health workers` inability to consider their specific needs.
• Transgender, Its History and Development Transgender is not a new concept and people have discussed the issues associated with it since the 19th century.
• Problems of Transgender Patients in Health Care A number of transgender patients admit cases of discrimination from the health care workers. From 30% to 60% of the representatives of this group face biased attitude.
• Transgender Discrimination in Health Care This paper investigates the discrimination that transgender persons are subjected to in the health care setting in more detail.
• Transgender Community’s Treatment in Healthcare This paper discusses the transgender community and the discrimination that affects them every day, especially in healthcare, and how we can help stop it.
• Principles of Healthcare for Transgender Patients
• Characteristics of Interpersonal Relationships and the Transgender Community
• Improving Correctional Healthcare Providers’ Ability to Care For Transgender Patient
• Analyzing Transgender Communities Rights
• General Information About Gay, Lesbian, and Transgender Rights Movement
• Transgender Equality and the Progression of the Employment Non-Discriminate
• Beyond Depression and Suicide: The Mental Health of Transgender College Students
• Violence Against Lesbians, Gays, Bisexuals, and Transgender
• Transgender Men and Women Have Been Around for Centuries
• Quality Healthcare for Transgender People
• Role of African American Gay, Bisexual and Transgender Men in Contemporary Society
• Public Bathroom Controversies Due to Transgender Issue in America
• Hate Crimes Against Lesbian, Gay, Bisexual and Transgender
• Empowering and Educating About the Transgender Sodality Through Social Media and Laws
• Transgender Youth Homelessness: Understanding Programmatic Barriers Through the Lens of Cisgenderism
• Policies and Best Practices for Transgender Hiring Organizations in India
• Transgender Rage: The Compton’s Cafeteria Riot of 1966
• The Pros and Cons of Transgender and Gender Nonconforming
• Proper Communication With the Transgender Community
• Gender Dysphoria and the Persecution of Transgender People
• Lesbian, Gay, Bisexual, and Transgender U.S. Legal Questions
• Informal Mentoring for Lesbian, Gay, Bisexual, and Transgender Students
• Transgender Rights Under Bigotry and Ignorance
• Differences Between Gender Feminism and Transgender Activism
• Transgender Rights and Surviving Hate Crimes in the Case of Cece McDonald
• Should transgender adolescents have access to gender-affirming treatments?
• Is transgender representation in media crucial for promoting transgender rights?
• Transgender athletes in competitive sports: equality or unfair advantage?
• Is religious freedom incompatible with protecting transgender rights?
• Transgender parenting rights: why do they deserve equal protection and recognition?
• Transgender people in prisons: how should they be placed and protected?
• Should puberty blockers be banned?
• Should transgender people be disqualified from military service?
• Is it ethical for homeless shelters to discriminate against transgender individuals?
• Should non-binary gender be legally recognized?
• The importance of inclusive terminology for protecting transgender rights.
• Mental health challenges faced by transgender youth.
• The role of transgender activists in driving social change.
• How can religious beliefs help and hinder transgender rights promotion?
• Challenges faced by transgender parents.
• Ways to support transgender youth in schools.
• The relationship between transgender identity and body positivity.
• Comparing transgender rights in different countries.
• Transgender identity and aging: unique challenges.
• The impact of corporate policies on transgender workplace inclusion.

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StudyCorgi. (2021, December 21). 102 Transgender Essay Topics & Research Paper Titles. https://studycorgi.com/ideas/transgender-essay-topics/

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These essay examples and topics on Transgender were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 9, 2024 .

Transgender - Free Essay Samples And Topic Ideas

Transgender individuals have a gender identity that differs from the sex they were assigned at birth. Essays on transgender topics could explore the experiences of transgender individuals, the challenges they face, and the societal attitudes towards transgender people. Discussions might also delve into the legal protections, healthcare access, and representation of transgender individuals in media and popular culture. Moreover, examining the ongoing efforts of advocacy groups, the impact of gender-affirming care, and the importance of fostering inclusivity and understanding can provide a comprehensive exploration of the transgender experience and the journey towards achieving equality and acceptance. A vast selection of complimentary essay illustrations pertaining to Transgender you can find in Papersowl database. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Transgender Bathroom Bill: Support it or against It?

The Transgender Bathroom Bill is one of the hot topics that has been going around the news and media, especially in Texas and North Carolina. This topic has been around since 2016 and it has only grown more and more ever since then. The Transgender Bathroom Bill stems from transgender rights. The bill was created to define the rights and access to public toilets for transgender people. The current arguments circling around this bill is that transgender individuals should be […]

Use of Public Restrooms by Transgender People

For years, transgender people in the LGBTQ community has been fighting for their civil rights. The rights to marry who they love, the rights to protect their country by joining the army, and now the rights to use the restroom of their choice. More and more transgenders are demanding the right to use the public restroom that identifies their sex. “Over 30 percent of trans people report not eating or drinking so they can avoid going to public restrooms,” Laverne […]

Gender Problems in our Society

Over the years gender has been a problem in our society that we cannot avoid. We live in a society based on two and only two sex categories (male and female) leading to sex itself being a socially constructed category. Gender refers to the socially constructed characteristic of men and women, such as roles, norms and relationships of and between them. Many questions come into play on what does sex mean in terms of your gender role as a man […]

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What it Means to be Transgender

Being transgender is a very controversial topic. Some people say being transgender bad and that your commiting a sin, some people say it's alright and to do what you feel what's right as long as you're being true to yourself, and other people just don't care. I believe being transgender is not good or bad. But the question being asked, is transgender good or bad? This not the real question, the real question that people are asking is transgender a […]

Transgenders in the Church

As the issue of gender identity and how to handle it has become more prevalent over the recent years, churches in the United States have been forced to make decisions about their ideologies regarding these individuals. As was the case with homosexuals before them, transgender and non-binary persons have long faced discrimination from religious groups, in large part due to the church struggling with how the concept of transgender persons fits in with the traditional idea of the creation of […]

Discrimination of the LGBTQ Community

Since the beginning of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, it has been one of the most discriminated against groups in the world as they are denied the basic rights that most people get to enjoy. Today, it is still legal to discriminate someone based on their sexual orientation or gender identity in thirty states. The following pages will inform readers on discrimination of the LGBTQ community by the general public, in schools, and in the workplace. […]

Suicidality in Transgender Teens

Gender identity is defined as one’s sense of being a male, female, or other gender. It is the individual’s own connection to their gender which defines who they are. Many people feel as if the sex they were born with does not match with the gender they identify with. In many cases, people may identify as transgender. Transgender individuals believe, “the sex assigned at birth is discordant with their gender identity” (Sitkin & Murota, 2017, p. 725). An example of […]

Disenfranchised Transgender People of Color Current Events

Ever present and always relevant, transgender issues deserve a lot of traction and there is this excelling push for reformation. Nonetheless, passionate hearts, old and young continue to fight for their own. Whether you are an ally or personally affected, the drive for change still remains. I, myself, a member of the LGBTQIA also referred as Lesbian, Gay, Bi-sexual, Transgender, Queer, Intersex and Asexual community, proud representative of the “B” and as a woman of color I am fully aware […]

All Religion View LGBTQ Life Styles Negatively

The Relationship between religion and LGBTQ community is different from time and place, and different religions. Countless religions in the world view LGBTQ negatively. This Negativity can range from explicitly forbidding to discouraging same sex sexual practices, and sexual reassignment, but liberals and progressive voices actively push social acceptance of the LGBTQ Identities. Most of the LGBTQ have been raised in many different organized religions many cherish their community’s faith but many are being forced to leave those communities’ behind […]

Transgender Youth Coming out

Transgender youth all around the world face the common social and emotional challenges of “coming out”. This can be a struggle for many of these individuals who are in young adulthood, still developing. Trying to balance dealing with the process of coming out and the stigma that comes along with it while attempting to explore, make commitments and deal with the social norm’s society creates are all challenges that may hinder a young adult’s development. Young adulthood is a very […]

Transgender: Reality and Representation

“I planted a tounge for the divided sexual personalities.I felt the urge to write when I could retaliate with the coinage of sapumsakar against the denial of identity thrust by the word napumsakam.” One survival strategy of the main stream ideology for up keeping the status quo is to neglect certain social realities that may have the potential to subvert it. Transgender and transgender issues are real, but the conservative societies pretend it to be negligible. Transgender people live among ourselves. […]

Anti LGBT Discrimination

Anti LGBT Discrimination The lesbian, gay, bisexual, and transgender (LGBT) population has long fought for their right to equal treatment with some progress made. As society's values change and adjust to become more accepting of this marginalized community, the more our policies and lawmakers include them. Anti-LGBT policy is at risk. Under the Trump administration, the federal civil rights law, Title IX, that bans sex discrimination, would enact that sex only include female, or male orientation and is strictly determined […]

The Case of Transgenderism

Since the very introduction of Gender Identity Disorder (GID) to the DSM (Diagnostic and Statistical Manual of Mental Disorders), many controversies have been made apparent. LGBTQA activists have years since said it was a poorly veiled, discriminatory attempt to restore the category of homosexuality, or promote “preventative treatment.” Because of this controversy, GID is now listed as gender dysphoria, and sexual development disorders have been introduced. Is this condition unjustly listed as a dysfunctional disorder, or is there legitimate science […]

Harry Benjamin: a Pioneer in Transgender Care

Early Life and Education Harry Benjamin was born in Berlin, Germany on January 12, 1885 to a German mother and Jewish father. He was the oldest of three siblings. His father converted to Lutheranism shortly before Dr. Benjamin’s birth. Dr. Benjamin enjoyed opera from a young age, and was enamored with singer Geraldine Farrar, who sang at the Royal Opera. In his frequenting of opera houses, he became acquainted with a house physician, and began to learn his trade from […]

Lesbian, Gay, Bisexual, Transgender, and Queer

Purpose of the Research The paper will explore and examine issues relating to LGBTQ and come up with newfound knowledge by providing relevant information on the topic. The research is necessary as it will provide different stands of the society about the issue. Although more inquiry has been made on the subject, the piece attempts to give the reader a broader perspective on the issue; the judgment decision lies with the reader on the stand they are going to take […]

The Effects of the Ostracization of Transgender Youth

There is a roughly estimated one million individuals in the United States who identify as transgender. Often these individuals begin to feel some form of disparity between their gender identity and their biological sex at a very early age, frequently before puberty, and sometimes at as early as only a few years old. Unfortunately, within our society, there is a very large amount of stigma associated with transgenderism and people frequently react poorly to it, even when it is being […]

More Common in the LGBTQ Community

If a person identifies themselves as transgender, this means that their gender identity and/or expression does not match the sex that they were when they were born (Arcelus et al., 2018). There are many studies that have tested to see if transgender individuals tend to get more depressed than other individuals. Being transgender growing up can cause one to get bullied more and they also tend to have more peer rejection. Even the individual's family sometimes rejects them (Arcelus et […]

A Nurse’s Guide in Caring for Transgender and Gender-Variant Youth

Abstract With the increasing number of transgender youth and families seeking medical care, they often turn initially to their primary care provider, pediatrician, or nurse practitioner for guidance. Creating and maintaining a positive identity is a developmental step for all adolescents; however, trans youth have the additional challenge and pressure of integrating a non-conforming gender identity with their cultural and ethnic backgrounds, personal characteristics, and family circumstances. This places pediatric healthcare providers in a unique position to guide and support […]

Transgender Individuals in the Military

There is an ongoing debate / argument as to whether or not to allow transgender individuals to severed in the military. In order to properly formulate one’s opinion there is to know understand a definition of who is considered a transgender. A transgender can be described as an individual who have a gender identity or in most case a gender expression that is differ from their assigned sex at birth. However some transgender individual can be identify as transsexual if […]

The Rights of Lesbian, Gay, Bisexual and Transgender

On July 2nd, 1964, President Lyndon B. Johnson signed the Civil Rights Act following the assassination of President John F. Kennedy who originally had initiated the enactment of this act. The proclamation of this act, was the largest change to the Constitution since the reconstruction of the document. The Civil Rights Act of 1964 states that it is unconstitutional to discriminate against race, national origin, gender, and religion in both public places as well as in the workforce. This act […]

What is it Like to Grow up Transgender or Gay or Lesbian

Gender-neutral education gives the child the opportunity to try himself in different social roles and choose the one that will be related to his character and personal wishes (or not at all - there is such an option too). Studies show that calm is the most important thing in transgender or gay or lesbian child rearing. If this behavior is perceived as meaningless, then it means nothing to the child. But if the parents begin to tell the child that […]

Gender Identity and LGBTQ Rights

In this piece I’m going to explain how the LGBTQ community are being treated because of their Sex/Gender/Gender identity/sexuality an article that shows this was the privileges article a how people that comes out as straight or gay can help the gay community’s when they come out. I’m going to do this by explaining the way Carbados thinks that there’s a new way that heterosexual people tailored as “coming out” as heterosexual and this could affect the homosexual community in […]

The Oppression of Lesbian Gay Bisexual Transgender and Questioning

The LGBTQ is a standard abbreviation for Lesbians, Gays, Bisexual, Transgender and Questioning individuals. In a recent study according to (Gates, n.d.), there are approximately 9 million people who identify themselves as members of the LGBTQ Culture in America today. According to (Greve, 2016) This indicates the LGBTQ Culture is larger than the population of 40 American States. According to the past 14 years of hate crime data, Mark potok of the Southern Poverty Law Center recently told the PBS […]

Transgender Youth Issues

One who might be of a minority race facing issues like poverty may very much find the risks and struggles of coming out to be more severe due to circumstances they are already dealing with. On the other hand, one who may be of a privileged group, and very high class may find it much easier to deal with coming out and may have much more social support. As a social worker using intersectionality theory, keeping these things in mind […]

Lesbian Gay Bisexual Transgender and Queer (LGBTQ) Community

Even though our nation’s views about the Lesbian Gay Bisexual Transgender and Queer (LGBTQ) community have definitely changed over the years, there are still huge issues with discrimination and harassment against this community. In human history, gay men and lesbians have been viciously persecuted. Discrimination against LGBTQ continues to affect not only the individuals but our entire society, and more broadly the world. During earlier times, and still today, homosexual rights were not validated because they go against the beliefs […]

Institutional Violence and Discrimination of Transgender

Transgender individuals continue to experience institutional violence and discrimination. Although the nation has made tremendous strides in improving the welfare of transgender people, a lot still needs to be done to ensure that their rights can be respected. Besides enacting appropriate laws to protect the rights of transgender individuals, it would be imperative to ensure that the society is actively involved in finding a lasting solution to the problem. Institutional violence and discrimination cannot be tackled without the participation of […]

Culture Heritage – LGBT+ Community

One thing, many people pride themselves on is their culture heritage. Culture can be described as the attitudes, beliefs, and behaviors of indigenous or social groups that have been passed down through generations. U.S. Census Bureau has recorded that 11 % of people in America were not native born, which has created America to become a multicultural society (Black, 2017). All culture are different when it comes to their beliefs and values. One culture that is rapidly building its members […]

Navigating the Complex Terrain: Transgender Athletes in Competitive Sports

The global athletic community has always been a crucible for talent, determination, and human potential. However, it has also often served as a battleground for cultural, societal, and political issues. One of the most contemporary and heated debates in this arena revolves around the participation of transgender individuals in competitive sports. This discourse raises intricate questions about fairness, biology, and the very essence of what constitutes a level playing field. Historically, sports competitions have been segregated primarily based on gender, […]

Essay on Transgender Persons

The Human Rights Campaign defines transgender as “an umbrella term that describes people whose gender identity and/or gender expression differs from the sex they were assigned at birth” (HRC, 2018). Susan Stryker further explains stating that transgender refers “to people who move away from the gender they were assigned at birth, people who cross over (trans-) the boundaries constructed by their culture to define and contain that gender” (Stryker, 2017, p. 1); the meanings of trans, according to Stryker are […]

Gender Dysphoria & Identity: Teens

Have you ever wondered what harsh cruelties that some teens have to face, because of their gender identity? Gender fluidity is the belief that you feel male one day but feel like a female another day regardless of what sex you were born. Teens that discover they are gender fluid can experience bullying from peers and family. There are many cases of injustices against gender fluid teens experience. The older generations are usually unaccepting of the younger generations gender identity. […]

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Understanding transgender people, gender identity and gender expression

According to the APA Style guide, the term “transsexual” is largely outdated, but some people identify with it; this term should be used only for an individual who specifically claims it. While the term “transsexual” appears multiple times throughout this document, APA’s Committee on Sexual Orientation and Gender Diversity is undertaking a systematic review of its use along with other terms. In the meantime, please refer to the Guidelines for Psychological Practice with Transgender and Gender Nonconforming People (PDF, 472KB)  for more up-to-date language regarding transgender and gender nonconforming people.

Transgender is an umbrella term for persons whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth. Gender identity refers to a person’s internal sense of being male, female or something else; gender expression refers to the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice or body characteristics. “Trans” is sometimes used as shorthand for “transgender.” While transgender is generally a good term to use, not everyone whose appearance or behavior is gender-nonconforming will identify as a transgender person. The ways that transgender people are talked about in popular culture, academia and science are constantly changing, particularly as individuals’ awareness, knowledge and openness about transgender people and their experiences grow.

What is the difference between sex and gender?

Sex is assigned at birth, refers to one’s biological status as either male or female, and is associated primarily with physical attributes such as chromosomes, hormone prevalence, and external and internal anatomy. Gender refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for boys and men or girls and women. These influence the ways that people act, interact, and feel about themselves. While aspects of biological sex are similar across different cultures, aspects of gender may differ.

Various conditions that lead to atypical development of physical sex characteristics are collectively referred to as intersex conditions.

Have transgender people always existed?

Transgender persons have been documented in many indigenous, Western, and Eastern cultures and societies from antiquity until the present day. However, the meaning of gender nonconformity may vary from culture to culture.

What are some categories or types of transgender people?

Many identities fall under the transgender umbrella. The term transsexual refers to people whose gender identity is different from their assigned sex. Often, transsexual people alter or wish to alter their bodies through hormones, surgery, and other means to make their bodies as congruent as possible with their gender identities. This process of transition through medical intervention is often referred to as sex or gender reassignment, but more recently is also referred to as gender affirmation. People who were assigned female, but identify and live as male and alter or wish to alter their bodies through medical intervention to more closely resemble their gender identity are known as transsexual men or transmen (also known as female-to-male or FTM). Conversely, people who were assigned male, but identify and live as female and alter or wish to alter their bodies through medical intervention to more closely resemble their gender identity are known as transsexual women or transwomen (also known as male-to-female or MTF). Some individuals who transition from one gender to another prefer to be referred to as a man or a woman, rather than as transgender.

People who cross-dress wear clothing that is traditionally or stereotypically worn by another gender in their culture. They vary in how completely they cross-dress, from one article of clothing to fully cross-dressing. Those who cross-dress are usually comfortable with their assigned sex and do not wish to change it. Cross-dressing is a form of gender expression and is not necessarily tied to erotic activity. Cross-dressing is not indicative of sexual orientation. (See Answers to Your Questions: For a Better Understanding of Sexual Orientation and Homosexuality  for more information on sexual orientation.) The degree of societal acceptance for cross-dressing varies for males and females. In some cultures, one gender may be given more latitude than another for wearing clothing associated with a different gender.

The term drag queens generally refers to men who dress as women for the purpose of entertaining others at bars, clubs, or other events. The term drag kings refers to women who dress as men for the purpose of entertaining others at bars, clubs, or other events.

Genderqueer is a term that some people use who identify their gender as falling outside the binary constructs of “male” and “female.” They may define their gender as falling somewhere on a continuum between male and female, or they may define it as wholly different from these terms. They may also request that pronouns be used to refer to them that are neither masculine nor feminine, such as “zie” instead of “he” or “she,” or “hir” instead of “his” or “her.” Some genderqueer people do not identify as transgender.

Other categories of transgender people include androgynous , multigendered , gender nonconforming , third gender , and two-spirit people . Exact definitions of these terms vary from person to person and may change over time, but often include a sense of blending or alternating genders. Some people who use these terms to describe themselves see traditional, binary concepts of gender as restrictive.

Why are some people transgender?

There is no single explanation for why some people are transgender. The diversity of transgender expression and experiences argues against any simple or unitary explanation. Many experts believe that biological factors such as genetic influences and prenatal hormone levels, early experiences, and experiences later in adolescence or adulthood may all contribute to the development of transgender identities.

How prevalent are transgender people?

It is difficult to accurately estimate the number of transgender people, mostly because there are no population studies that accurately and completely account for the range of gender identity and gender expression.

What is the relationship between gender identity and sexual orientation?

Gender identity and sexual orientation are not the same. Sexual orientation refers to an individual’s enduring physical, romantic, and/or emotional attraction to another person, whereas gender identity refers to one’s internal sense of being male, female, or something else. Transgender people may be straight, lesbian, gay, bisexual, or asexual, just as nontransgender people can be. Some recent research has shown that a change or a new exploration period in partner attraction may occur during the process of transition. However, transgender people usually remain as attached to loved ones after transition as they were before transition. Transgender people usually label their sexual orientation using their gender as a reference. For example, a transgender woman, or a person who is assigned male at birth and transitions to female, who is attracted to other women would be identified as a lesbian or gay woman. Likewise, a transgender man, or a person who is assigned female at birth and transitions to male, who is attracted to other men would be identified as a gay man.

How does someone know that they are transgender?

Transgender people experience their transgender identity in a variety of ways and may become aware of their transgender identity at any age. Some can trace their transgender identities and feelings back to their earliest memories. They may have vague feelings of “not fitting in” with people of their assigned sex or specific wishes to be something other than their assigned sex. Others become aware of their transgender identities or begin to explore and experience gender-nonconforming attitudes and behaviors during adolescence or much later in life. Some embrace their transgender feelings, while others struggle with feelings of shame or confusion. Those who transition later in life may have struggled to fit in adequately as their assigned sex only to later face dissatisfaction with their lives. Some transgender people, transsexuals in particular, experience intense dissatisfaction with their sex assigned at birth, physical sex characteristics, or the gender role associated with that sex. These individuals often seek gender-affirming treatments.

What should parents do if their child appears to be transgender or gender nonconforming?

Parents may be concerned about a child who appears to be gender-nonconforming for a variety of reasons. Some children express a great deal of distress about their assigned sex at birth or the gender roles they are expected to follow. Some children experience difficult social interactions with peers and adults because of their gender expression. Parents may become concerned when what they believed to be a “phase” does not pass. Parents of gender-nonconforming children may need to work with schools and other institutions to address their children’s particular needs and ensure their children’s safety. It is helpful to consult with mental health and medical professionals familiar with gender issues in children to decide how to best address these concerns. It is not helpful to force the child to act in a more gender-conforming way. Peer support from other parents of gender-nonconforming children may also be helpful.

How do transgender individuals make a gender transition?

Transitioning from one gender to another is a complex process and may involve transition to a gender that is neither traditionally male nor female. People who transition often start by expressing their preferred gender in situations where they feel safe. They typically work up to living full time as members of their preferred gender by making many changes a little at a time. While there is no “right” way to transition genders, there are some common social changes transgender people experience that may involve one or more of the following: adopting the appearance of the desired sex through changes in clothing and grooming, adopting a new name, changing sex designation on identity documents (if possible), using hormone therapy treatment, and/or undergoing medical procedures that modify their body to conform with their gender identity.

Every transgender person’s process or transition differs. Because of this, many factors may determine how the individual wishes to live and express their gender identity. Finding a qualified mental health professional who is experienced in providing affirmative care for transgender people is an important first step. A qualified professional can provide guidance and referrals to other helping professionals. Connecting with other transgender people through peer support groups and transgender community organizations is also helpful.

The World Professional Association for Transgender Health (WPATH), a professional organization devoted to the treatment of transgender people, publishes The Standards of Care for Gender Identity Disorders , which offers recommendations for the provision of gender affirmation procedures and services.

Is being transgender a mental disorder?

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety , depression or related disorders at higher rates than nontransgender persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who experience intense, persistent gender incongruence can be given the diagnosis of "gender dysphoria." Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated. Others argue that it is essential to retain the diagnosis to ensure access to care. The International Classification of Diseases (ICD) is under revision and there may be changes to its current classification of intense persistent gender incongruence as "gender identity disorder."

What kinds of discrimination do transgender people face?

Anti-discrimination laws in most U.S. cities and states do not protect transgender people from discrimination based on gender identity or gender expression. Consequently, transgender people in most cities and states face discrimination in nearly every aspect of their lives. The National Center for Transgender Equality and the National Gay and Lesbian Task Force released a report in 2011 entitled Injustice at Every Turn , which confirmed the pervasive and severe discrimination faced by transgender people. Out of a sample of nearly 6,500 transgender people, the report found that transgender people experience high levels of discrimination in employment, housing, health care, education, legal systems, and even in their families. 

Transgender people may also have additional identities that may affect the types of discrimination they experience. Groups with such additional identities include transgender people of racial, ethnic, or religious minority backgrounds; transgender people of lower socioeconomic statuses ; transgender people with disabilities ; transgender youth; transgender elderly; and others. Experiencing discrimination may cause significant amounts of psychological stress, often leaving transgender individuals to wonder whether they were discriminated against because of their gender identity or gender expression, another sociocultural identity, or some combination of all of these.

According to the study, while discrimination is pervasive for the majority of transgender people, the intersection of anti-transgender bias and persistent, structural racism is especially severe. People of color in general fare worse than White transgender people, with African American transgender individuals faring far worse than all other transgender populations examined.

Many transgender people are the targets of hate crimes . They are also the victims of subtle discrimination—which includes everything from glances or glares of disapproval or discomfort to invasive questions about their body parts.

How can I be supportive of transgender family members, friends, or significant others?

Educate yourself about transgender issues by reading books, attending conferences, and consulting with transgender experts. Be aware of your attitudes concerning people with gender-nonconforming appearance or behavior.

Know that transgender people have membership in various sociocultural identity groups (e.g., race, social class, religion, age, disability, etc.) and there is not one universal way to look or be transgender.

Use names and pronouns that are appropriate to the person’s gender presentation and identity; if in doubt, ask.

Don’t make assumptions about transgender people’s sexual orientation, desire for hormonal or medical treatment, or other aspects of their identity or transition plans. If you have a reason to know (e.g., you are a physician conducting a necessary physical exam or you are a person who is interested in dating someone that you’ve learned is transgender), ask.

Don’t confuse gender nonconformity with being transgender. Not all people who appear androgynous or gender nonconforming identify as transgender or desire gender affirmation treatment.

Keep the lines of communication open with the transgender person in your life.

Get support in processing your own reactions. It can take some time to adjust to seeing someone you know well transitioning. Having someone close to you transition will be an adjustment and can be challenging, especially for partners, parents, and children.

Seek support in dealing with your feelings. You are not alone. Mental health professionals and support groups for family, friends, and significant others of transgender people can be useful resources.

Advocate for transgender rights, including social and economic justice and appropriate psychological care.Familiarize yourself with the local and state or provincial laws that protect transgender people from discrimination.

Where can I find more information about transgender health, advocacy and human rights?

• American Psychological Association Office on Sexual Orientation and Gender Diversity Programs and Projects 750 First Street, NE Washington, DC 20002 Email
• Children's National Medical Center Gender and Sexuality Advocacy and Education 111 Michigan Avenue, NW Washington, DC 20010 (202) 476-4172
• Family Acceptance Project San Francisco State University 3004 16th Street, #301 San Francisco, CA 94103 Email
• FTMInternational (FTM means Female-to-Male) 601 Van Ness Ave., Suite E327 San Francisco, CA 94102 (877) 267-1440 Email
• Gender Spectrum (510) 788-4412 Email
• National Center for Transgender Equality 1325 Massachusetts Ave., Suite 700 Washington, DC 20005 (202) 903-0112 (202) 393-2241 (fax) Email
• Parents, Families, and Friends of Lesbians and Gays (PFLAG) Transgender Network (TNET) PFLAG National Office 1828 L Street, NW, Suite 660 Washington, DC 20036 (202) 467-8180 Email
• Sylvia Rivera Law Project 147 W. 24th Street, 5th Floor New York, NY 10011 (212) 337-8550 (212) 337-1972 (Fax) Email
• Transgender Law Center 870 Market Street Room 400 San Francisco, CA 94102 (415) 865-0176 Email
• TransYouth Family Allies P.O. Box1471 Holland, MI 49422-1471 (888) 462-8932
• World Professional Association for Transgender Health Email

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.

American Psychological Association. (2008). Answers to questions: For a better understanding of sexual orientation and homosexuality . Washington, D.C.: Author.

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., ... Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender nonconforming people (7th version). International Journal of Transgenderism, 13 , 165-232. doi:10.1080/15532739.2011.700873

National Center for Transgender Equality and the National Gay and Lesbian Task Force. (2011). Injustice at every turn .

World Health Organization. (1990). ICD-10: International classification of diseases and related health problems (10th ed).

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Related resources

• Sexual orientation and gender diversity
• Transgender Identity Issues in Psychology
• Guidelines for Psychological Practice with Transgender and Gender Nonconforming People (PDF, 472KB)
• APA LGBTQ Resources and Publications

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LGBTQIA Studies : Research and topic suggestions

Arts & culture.

• queer performance art
• LGBTQIA+ writers
• bullying in schools; opposition to anti-bullying efforts by those who want to maintain traditional gender roles and stereotypes
• gender nonconforming children in schools
• how people who identify as non-binary navigate a world that sees gender in binary terms
• how nonbinary and transgender identities are similar and different
• legal rights of transgender people
• transgender visibility and "passing"
• how sexual orientation (who you're attracted to) differs from gender identity (who you are)
• LGBTQIA+ marches and political movements
• LGBTQIA+ pioneers and activists
• transgender history-- e.g., search transgender history in San Francisco
• lesbian and gay history-- at what point did sexual behavior come to be seen as an identity?
• history of bisexuality-- at what point was it recognized as an identity?
• the influence of cultural norms and attitudes of a specific century or decade, and how/why people hid their feelings of same-sex attraction
• was there a time period and location in which the social climate was more accepting of same-sex attraction and desire?
• biography of a specific person in history whose trans identity or same-sex attraction was known or documented
• Important Legislation for LGBTQIA+ people

International

• contrast how LGBTQIA+ people experience life in other countries outside of the United States
• compare and contrast laws and culture within the Asian continent
• which countries are the most and least accepting of LGBTQIA+ people
• LGBTQIA+ couples of differing nationalities-- can they live in the same country?
• LGBTQIA+ rights worldwide (focusing on the "LGBTQIA+ climate" in a specific country or region)
• how are transgender people transforming the medical establishment?
• sexual orientation-- what does biological research tell us about it?
• LGBTQIA+ mental health; research shows LGBTQIA+ people have higher overall rates of depression, anxiety, and substance abuse disorders
• the diagnosis of "gender dysphoria" and how it has been reframed and is no longer a pathology
• parenting as a trans, nonbinary or gender fluid person
• lesbian and gay parenting and adoption
• new reproductive technologies for LGBTQIA+ people
• the history of how LGBTQIA+ people have or have not been integrated into the priesthood of a particular faith
• what new elements have LGBTQIA+ people brought to a particular faith
• LGBTQIA+ themes in the Bible;
• use of the Bible to justify mistreatment of LGBTQIA people
• What it's like to be gay and Muslim
• Gay and Lesbian - Does God Love you?
• 10 Reasons God Loves Gay Christians

Sexual Orientation

• bisexuality and issues that are unique to bisexual people
• asexuality-- what is means, how it is often misunderstood;
• new efforts at asexual visibility coming out stories/ coming out process;
• challenges to the concept of "coming out"

Society & Politics

• recent backlash against LGBTQIA+ people
• gender identity and America's (or another nation's) changing cultural norms
• opposition to gay rights
• discrimination and treatment in the workplace (search also phrases such as "openly gay teachers")
• violence and bullying of LGBTQIA+ people
• marriage of LGBTQIA+ people to heterosexuals in order to "pass" (especially in traditional cultures)
• queer film festivals as a step toward visibility
• same-sex marriage -- who supports it, who opposes it, and which countries have legalized it
• Rainbow capitalism

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Scholarly and nonscholarly articles on LGBTQ topics can be found in the following sources (accessible to current Northeastern affiliates)

For cultural studies, current events, political aspects, and all interdisciplinary topics:

For psychological aspects:, for sociological aspects:, for health aspects:, additional databases.

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Article Definition

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What does the scholarly research say about the effect of gender transition on transgender well-being?

We conducted a systematic literature review of all peer-reviewed articles published in English between 1991 and June 2017 that assess the effect of gender transition on transgender well-being. We identified 55 studies that consist of primary research on this topic, of which 51 (93%) found that gender transition improves the overall well-being of transgender people, while 4 (7%) report mixed or null findings. We found no studies concluding that gender transition causes overall harm. As an added resource, we separately include 17 additional studies that consist of literature reviews and practitioner guidelines.

Bottom Line

This search found a robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals. The literature also indicates that greater availability of medical and social support for gender transition contributes to better quality of life for those who identify as transgender.

Below are the 8 findings of our review, and links to the 72 studies on which they are based. Click here to view our methodology . Click here for a printer-friendly one-pager of this research analysis .

Suggested Citation : What We Know Project, Cornell University, “What Does the Scholarly Research Say about the Effect of Gender Transition on Transgender Well-Being?” (online literature review), 2018.

Research Findings

1. The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.

2. Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use.

3. The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved.

4. Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.

5. Factors that are predictive of success in the treatment of gender dysphoria include adequate preparation and mental health support prior to treatment, proper follow-up care from knowledgeable providers, consistent family and social support, and high-quality surgical outcomes (when surgery is involved).

6. Transgender individuals, particularly those who cannot access treatment for gender dysphoria or who encounter unsupportive social environments, are more likely than the general population to experience health challenges such as depression, anxiety, suicidality and minority stress. While gender transition can mitigate these challenges, the health and well-being of transgender people can be harmed by stigmatizing and discriminatory treatment.

7. An inherent limitation in the field of transgender health research is that it is difficult to conduct prospective studies or randomized control trials of treatments for gender dysphoria because of the individualized nature of treatment, the varying and unequal circumstances of population members, the small size of the known transgender population, and the ethical issues involved in withholding an effective treatment from those who need it.

8. Transgender outcomes research is still evolving and has been limited by the historical stigma against conducting research in this field. More research is needed to adequately characterize and address the needs of the transgender population.

Below are 51 studies that found that gender transition improves the well-being of transgender people. Click here to jump to 4 studies that contain mixed or null findings on the effect of gender transition on transgender well-being. Click here to jump to 17 studies that consist of literature reviews or guidelines that help advance knowledge about the effect of gender transition on transgender well-being.

Ainsworth and spiegel, 2010.

Ainsworth, T., & Spiegel, J. (2010). Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Quality of Life Research , 19 (7), 1019-1024.

Objectives: To determine the self-reported quality of life of male-to-female (MTF) transgendered individuals and how this quality of life is influenced by facial feminization and gender reassignment surgery. Methods: Facial Feminization Surgery outcomes evaluation survey and the SF-36v2 quality of life survey were administered to male-to-female transgender individuals via the Internet and on paper. A total of 247 MTF participants were enrolled in the study. Results: Mental health-related quality of life was statistically diminished (P < 0.05) in transgendered women without surgical intervention compared to the general female population and transwomen who had gender reassignment surgery (GRS), facial feminization surgery (FFS), or both. There was no statistically significant difference in the mental health-related quality of life among transgendered women who had GRS, FFS, or both. Participants who had FFS scored statistically higher (P < 0.01) than those who did not in the FFS outcomes evaluation. Conclusions: Transwomen have diminished mental health-related quality of life compared with the general female population. However, surgical treatments (e.g. FFS, GRS, or both) are associated with improved mental health-related quality of life.

Bailey, Ellis, & McNeil, 2014

Bailey, L., Ellis, S. J., & McNeil, J. (2014). Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt. The Mental Health Review , 19 (4), 209-220.

Purpose: The purpose of this paper is to present findings from the Trans Mental Health Study (McNeil et al., 2012) – the largest survey of the UK trans population to date and the first to explore trans mental health and well-being within a UK context. Findings around suicidal ideation and suicide attempt are presented and the impact of gender dysphoria, minority stress and medical delay, in particular, are highlighted. Design/methodology/approach: This represents a narrative analysis of qualitative sections of a survey that utilised both open and closed questions. The study drew on a non-random sample (n 1⁄4 889), obtained via a range of UK-based support organisations and services. Findings: The study revealed high rates of suicidal ideation (84 per cent lifetime prevalence) and attempted suicide (48 per cent lifetime prevalence) within this sample. A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors. Subsequently, gender dysphoria, confusion/denial about gender, fears around transitioning, gender reassignment treatment delays and refusals, and social stigma increased suicide risk within this sample. Research limitations/implications: Due to the limitations of undertaking research with this population, the research is not demographically representative. Practical implications: The study found that trans people are most at risk prior to social and/or medical transition and that, in many cases, trans people who require access to hormones and surgery can be left unsupported for dangerously long periods of time. The paper highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritise timely intervention and support. Originality/value: The first exploration of suicidal ideation and suicide attempt within the UK trans population revealing key findings pertaining to social and medical transition, crucial for policy makers, commissioners and practitioners working across gender identity services, mental health services and suicide prevention.

Bar et al., 2016

Bar, M. A., Jarus, T., Wada, M., Rechtman, L., & Noy, E. (2016). Male-to-female transitions: Implications for occupational performance, health, and life satisfaction. The Canadian Journal of Occupational Therapy , 83 (2), 72-82.

Background. People who undergo a gender transition process experience changes in different everyday occupations. These changes may impact their health and life satisfaction. Purpose. This study examined the difference in the occupational performance history scales (occupational identity, competence, and settings) between male-to-female transgender women and cisgender women and the relation of these scales to health and life satisfaction. Method. Twenty-two transgender women and 22 matched cisgender women completed a demographic questionnaire and three reliable measures in this cross-sectional study. Data were analyzed using a two-way analysis of variance and multiple linear regressions. Findings. The results indicate lower performance scores for the transgender women. In addition, occupational settings and group membership (transgender and cisgender groups) were found to be predictors of life satisfaction. Implications. The present study supports the role of occupational therapy in promoting occupational identity and competence of transgender women and giving special attention to their social and physical environment.

Bodlund and Kullgren, 1996

Bodlund, O., & Kullgren, G. (1996). Transsexualism–general outcome and prognostic factors: A five-year follow-up study of nineteen transsexuals in the process of changing sex. Archives of Sexual Behavior , 25 (3), 303-316.

Nineteen transsexuals, approved for sex reassignement, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n = 13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socio-economic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.

Bouman et al., 2016

Bouman, W. P., Claes, L., Marshall, E., Pinner, G. T., Longworth, J., et al. (2016). Sociodemographic variables, clinical features, and the role of preassessment cross-sex hormones in older trans people. The Journal of Sexual Medicine , 13 (4), 711-719.

Introduction: As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available. Aims: The aim of this study was to investigate the sociodemographic and clinical characteristics of older trans people attending a national service and to investigate the influence of cross-sex hormones (CHT) on psychopathology. Methods: Individuals over the age of 50 years old referred to a national gender identity clinic during a 30-month period were invited to complete a battery of questionnaires to measure psychopathology and clinical characteristics. Individuals on cross-sex hormones prior to the assessment were compared with those not on treatment for different variables measuring psychopathology. Main Outcome Measures: Sociodemographic and clinical variables and measures of depression and anxiety (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), social support (Multidimensional Scale of Perceived Social Support), interpersonal functioning (Inventory of Interpersonal Problems), and nonsuicidal self-injury (Self-Injury Questionnaire). Results: The sex ratio of trans females aged 50 years and older compared to trans males was 23.7:1. Trans males were removed for the analysis due to their small number (n = 3). Participants included 71 trans females over the age of 50, of whom the vast majority were white, employed or retired, and divorced and had children. Trans females on CHT who came out as trans and transitioned at an earlier age were significantly less anxious, reported higher levels of self-esteem, and presented with fewer socialization problems. When controlling for socialization problems, differences in levels of anxiety but not self-esteem remained. Conclusion: The use of cross-sex hormones prior to seeking treatment is widespread among older trans females and appears to be associated with psychological benefits. Existing barriers to access CHT for older trans people may need to be re-examined.

Boza and Nicholson, 2014

Boza, C., & Nicholson Perry, K. (2014). Gender-related victimization, perceived social support, and predictors of depression among transgender Australians. International Journal Of Transgenderism , 15 (1), 35-52.

This study examined mental health outcomes, gender-related victimization, perceived social support, and predictors of depression among 243 transgender Australians (n= 83 assigned female at birth, n= 160 assigned male at birth). Overall, 69% reported at least 1 instance of victimization, 59% endorsed depressive symptoms, and 44% reported a previous suicide attempt. Social support emerged as the most significant predictor of depressive symptoms (p>.05), whereby persons endorsing higher levels of overall perceived social support tended to endorse lower levels of depressive symptoms. Second to social support, persons who endorsed having had some form of gender affirmative surgery were significantly more likely to present with lower symptoms of depression. Contrary to expectations, victimization did not reach significance as an independent risk factor of depression (p=.053). The pervasiveness of victimization, depression, and attempted suicide represents a major health concern and highlights the need to facilitate culturally sensitive health care provision.

Budge et al., 2013

Budge, S. L., Katz-Wise, S. L., Tebbe, E. N., Howard, K. A. S., Schneider, C. L., et al. (2013). Transgender emotional and coping processes: Facilitative and avoidant coping throughout gender transitioning. The Counseling Psychologist , 41 (4), 601-647.

Eighteen transgender-identified individuals participated in semi-structured interviews regarding emotional and coping processes throughout their gender transition. The authors used grounded theory to conceptualize and analyze the data. There were three distinct phases through which the participants described emotional and coping experiences: (a) pretransition, (b) during the transition, and (c) posttransition. Five separate themes emerged, including descriptions of coping mechanisms, emotional hardship, lack of support, positive social support, and affirmative emotional experiences. The authors developed a model to describe the role of coping mechanisms and support experienced throughout the transition process. As participants continued through their transitions, emotional hardships lessened and they used facilitative coping mechanisms that in turn led to affirmative emotional experiences. The results of this study are indicative of the importance of guiding transgender individuals through facilitative coping experiences and providing social support throughout the transition process. Implications for counselors and for future research are discussed.

Cardoso da Silva et al., 2016

Cardoso da Silva, D., Schwarz, K., Fontanari, A.M.V., Costa, A.B., Massuda, R., et al. (2016). WHOQOL-100 Before and after sex reassignment surgery in Brazilian male-to-female transsexual individuals. Journal of Sexual Medicine , 13 (6), 988-993.

Introduction: The 100-item World Health Organization Quality of Life Assessment (WHOQOL-100) evaluates quality of life as a subjective and multidimensional construct. Currently, particularly in Brazil, there are controversies concerning quality of life after sex reassignment surgery (SRS). Aim: To assess the impact of surgical interventions on quality of life of 47 Brazilian male-to-female transsexual individuals using the WHOQOL-100. Methods: This was a prospective cohort study using the WHOQOL-100 and sociodemographic questions for individuals diagnosed with gender identity disorder according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The protocol was used when a transsexual person entered the ambulatory clinic and at least 12 months after SRS. Main Outcome Measures: Initially, improvement or worsening of quality of life was assessed using 6 domains and 24 facets. Subsequently, quality of life was assessed for individuals who underwent new surgical interventions and those who did not undergo these procedures 1 year after SRS. Results: The participants showed significant improvement after SRS in domains II (psychological) and IV (social relationships) of the WHOQOL-100. In contrast, domains I (physical health) and III (level of independence) were significantly worse after SRS. Individuals who underwent additional surgery had a decrease in quality of life reflected in domains II and IV. During statistical analysis, all results were controlled for variations in demographic characteristics, without significant results. Conclusion: The WHOQOL-100 is an important instrument to evaluate the quality of life of male-to-female transsexuals during different stages of treatment. SRS promotes the improvement of psychological aspects and social relationships. However, even 1 year after SRS, male-to-female transsexuals continue to report problems in physical health and difficulty in recovering their independence.

(Due to a citation error, this study was initially listed twice.)

Castellano et al., 2015

Castellano, E., Crespi, C., Dell’Aquila, R., Rosato, C., Catalano, V., et al. (2015). Quality of life and hormones after sex reassignment surgery.  Journal of Endocrinological Investigation , 38 (12), 1373-1381.

Background: Transpeople often look for sex reassignment surgery (SRS) to improve their quality of life (QoL). The hormonal therapy has many positive effects before and after SRS. There are no studies about correlation between hormonal status and QoL after SRS. Aim: To gather information on QoL, quality of sexual life and body image in transpeople at least 2 years after SRS, to compare these results with a control group and to evaluate the relations between the chosen items and hormonal status. Subjects and methods: Data from 60 transsexuals and from 60 healthy matched controls were collected. Testosterone, estradiol, LH and World Health Organization Quality of Life (WHOQOL-100) self-reported questionnaire were evaluated. Student’s t test was applied to compare transsexuals and controls. Multiple regression model was applied to evaluate WHOQOL’s chosen items and LH. Results: The QoL and the quality of body image scores in transpeople were not statistically different from the matched control groups’ ones. In the sexual life subscale, transwomen’s scores were similar to biological women’s ones, whereas transmen’s scores were statistically lower than biological men’s ones (P = 0.003). The quality of sexual life scored statistically lower in transmen than in transwomen (P = 0.048). A significant inverse relationship between LH and body image and between LH and quality of sexual life was found. Conclusions: This study highlights general satisfaction after SRS. In particular, transpeople’s QoL turns out to be similar to Italian matched controls. LH resulted inversely correlated to body image and sexual life scores.

Colizzi, Costa, & Todarello, 2014

Colizzi, M., Costa, R. & Todarello, O. (2014). Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: Results from a longitudinal study.  Psychoneuroendocrinology , 39 , 65-73.

The aim of the present study was to evaluate the presence of psychiatric diseases/symptoms in transsexual patients and to compare psychiatric distress related to the hormonal intervention in a one year follow-up assessment. We investigated 118 patients before starting the hormonal therapy and after about 12 months. We used the SCID-I to determine major mental disorders and functional impairment. We used the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS) for evaluating self-reported anxiety and depression. We used the Symptom Checklist 90-R (SCL-90-R) for assessing self-reported global psychological symptoms. Seventeen patients (14%) had a DSM-IV-TR axis I psychiatric comorbidity. At enrollment the mean SAS score was above the normal range. The mean SDS and SCL-90-R scores were on the normal range except for SCL-90-R anxiety subscale. When treated, patients reported lower SAS, SDS and SCL-90-R scores, with statistically significant differences. Psychiatric distress and functional impairment were present in a significantly higher percentage of patients before starting the hormonal treatment than after 12 months (50% vs. 17% for anxiety; 42% vs. 23% for depression; 24% vs. 11% for psychological symptoms; 23% vs. 10% for functional impairment). The results revealed that the majority of transsexual patients have no psychiatric comorbidity, suggesting that transsexualism is not necessarily associated with severe comorbid psychiatric findings. The condition, however, seemed to be associated with subthreshold anxiety/depression, psychological symptoms and functional impairment. Moreover, treated patients reported less psychiatric distress. Therefore, hormonal treatment seemed to have a positive effect on transsexual patients’ mental health.

Colizzi et al., 2013

Colizzi. M., Costa, R., Pace, V., & Todarello, O. (2013). Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. The Journal of Sexual Medicine , 10 (12), 3049–3058.

Introduction: Gender identity disorder may be a stressful situation. Hormonal treatment seemed to improve the general health as it reduces psychological and social distress. The attachment style seemed to regulate distress in insecure individuals as they are more exposed to hypothalamic–pituitary–adrenal system dysregulation and subjective stress. Aim: The objectives of the study were to evaluate the presence of psychobiological distress and insecure attachment in transsexuals and to study their stress levels with reference to the hormonal treatment and the attachment pattern. Methods: We investigated 70 transsexual patients. We measured the cortisol levels and the perceived stress before starting the hormonal therapy and after about 12 months. We studied the representation of attachment in transsexuals by a backward investigation in the relations between them and their caregivers. Main Outcome Measures: We used blood samples for assessing cortisol awakening response (CAR); we used the Perceived Stress Scale for evaluating self‐reported perceived stress and the Adult Attachment Interview to determine attachment styles. Results: At enrollment, transsexuals reported elevated CAR; their values were out of normal. They expressed higher perceived stress and more attachment insecurity, with respect to normative sample data. When treated with hormone therapy, transsexuals reported significantly lower CAR (P < 0.001), falling within the normal range for cortisol levels. Treated transsexuals showed also lower perceived stress (P < 0.001), with levels similar to normative samples. The insecure attachment styles were associated with higher CAR and perceived stress in untreated transsexuals (P < 0.01). Treated transsexuals did not expressed significant differences in CAR and perceived stress by attachment. Conclusion: Our results suggested that untreated patients suffer from a higher degree of stress and that attachment insecurity negatively impacts the stress management. Initiating the hormonal treatment seemed to have a positive effect in reducing stress levels, whatever the attachment style may be.

Colton-Meier et al., 2011

Colton-Meier, S. L., Fitzgerald, K. M., Pardo, S. T., & Babcock, J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of Gay & Lesbian Mental Health , 15 (3), 281-299.

Hormonal interventions are an often-sought option for transgender individuals seeking to medically transition to an authentic gender. Current literature stresses that the effects and associated risks of hormone regimens should be monitored and well understood by health care providers (Feldman & Bockting, 2003). However, the positive psychological effects following hormone replacement therapy as a gender affirming treatment have not been adequately researched. This study examined the relationship of hormone replacement therapy, specifically testosterone, with various mental health outcomes in an Internet sample of more than 400 self-identified female-to-male transsexuals. Results of the study indicate that female-to-male transsexuals who receive testosterone have lower levels of depression, anxiety, and stress, and higher levels of social support and health related quality of life. Testosterone use was not related to problems with drugs, alcohol, or suicidality. Overall findings provide clear evidence that HRT is associated with improved mental health outcomes in female-to-male transsexuals.

Costantino et al., 2013

Costantino, A., Cerpolini, S., Alvisi, S., Morselli, P. G., Venturoli, S., & Meriggiola, M. C. (2013). A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery. Journal of Sex & Marital Therapy , 39 (4), 321-335.

Testosterone administration in female-to-male transsexual subjects aims to develop and maintain the characteristics of the desired sex. Very little data exists on its effects on sexuality of female-to-male transsexuals. The aim of this study was to evaluate sexual function and mood of female-to-male transsexuals from their first visit, throughout testosterone administration and after sex reassignment surgery. Participants were 50 female-to-male transsexual subjects who completed questionnaires assessing sexual parameters and mood. The authors measured reproductive hormones and hematological parameters. The results suggest a positive effect of testosterone treatment on sexual function and mood in female-to-male transsexual subjects.

Davis and Meier, 2014

Davis, S. A. & Meier, S. C. (2014). Effects of testosterone treatment and chest reconstruction surgery on mental health and sexuality in female-to-male transgender people. International Journal of Sexual Health , 26 (2), 113-128.

Objectives: This study examined the effects of testosterone treatment with or without chest reconstruction surgery (CRS) on mental health in female-to-male transgender people (FTMs). Methods: More than 200 FTMs completed a written survey including quantitative scales to measure symptoms of anxiety and depression, feelings of anger, and body dissatisfaction, as well as qualitative questions assessing shifts in sexuality after the initiation of testosterone. Fifty-seven percent of participants were taking testosterone and 40% had undergone CRS. Results: Cross-sectional analysis using a between-subjects multivariate analysis of variance showed that participants who were receiving testosterone endorsed fewer symptoms of anxiety and depression as well as less anger than the untreated group. Participants who had CRS in addition to testosterone reported less body dissatisfaction than both the testosterone-only or the untreated groups. Furthermore, participants who were injecting testosterone on a weekly basis showed significantly less anger compared with those injecting every other week. In qualitative reports, more than 50% of participants described increased sexual attraction to nontransgender men after taking testosterone. Conclusions: Results indicate that testosterone treatment in FTMs is associated with a positive effect on mental health on measures of depression, anxiety, and anger, while CRS appears to be more important for the alleviation of body dissatisfaction. The findings have particular relevance for counselors and health care providers serving FTM and gender-variant people considering medical gender transition.

De Cuypere et al., 2006

De Cuypere, G., Elaut, E., Heylens, G., Maele, G. V., Selvaggi, G., et al. (2006). Long-term follow-up: Psychosocial outcome of Belgian transsexuals after sex reassignment surgery. Sexologies , 15 (2), 126-133.

Background: To establish the benefit of sex reassignment surgery (SRS) for persons with a gender identity disorder, follow-up studies comprising large numbers of operated transsexuals are still needed. Aims: The authors wanted to assess how the transsexuals who had been treated by the Ghent multidisciplinary gender team since 1985, were functioning psychologically, socially and professionally after a longer period. They also explored some prognostic factors with a view to refining the procedure. Method: From 107 Dutch-speaking transsexuals who had undergone SRS between 1986 and 2001, 62 (35 male-to-females and 27 female-to-males) completed various questionnaires and were personally interviewed by researchers, who had not been involved in the subjects’ initial assessment or treatment. Results: On the GAF (DSM-IV) scale the female-to-male transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2). While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. Conclusion: While sex reassignment treatment is an effective therapy for transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects.

Dhejne et al., 2014

Dhejne, C., Öberg, K., Arver, S., & Landén, M. (2014). An analysis of all applications for sex reassignment surgery in sweden, 1960-2010: Prevalence, incidence, and regrets. Archives of Sexual Behavior , 43 (8), 1535-1545.

Incidence and prevalence of applications in Sweden for legal and surgical sex reassignment were examined over a 50-year period (1960-2010), including the legal and surgical reversal applications. A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89 % (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS). A total of 25 individuals (7 natal females and 18 natal males), equaling 3.3 %, were denied a new legal gender and SRS. The remaining withdrew their application, were on a waiting list for surgery, or were granted partial treatment. The incidence of applications was calculated and stratified over four periods between 1972 and 2010. The incidence increased significantly from 0.16 to 0.42/100,000/year (FM) and from 0.23 to 0.73/100,000/year (MF). The most pronounced increase occurred after 2000. The proportion of FM individuals 30 years or older at the time of application remained stable around 30 %. In contrast, the proportion of MF individuals 30 years or older increased from 37 % in the first decade to 60 % in the latter three decades. The point prevalence at December 2010 for individuals who applied for a new legal gender was for FM 1:13,120 and for MF 1:7,750. The FM:MF sex ratio fluctuated but was 1:1.66 for the whole study period. There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2 % regret rate for both sexes. There was a significant decline of regrets over the time period.

Eldh, Berg, & Gustafsson, 1997

Eldh, J., Berg, A., Gustafsson, M. (1997). Long-term follow up after sex reassignment surgery. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery , 27 (1), 39-45.

A long-term follow up of 136 patients operated on for sex reassignment was done to evaluate the surgical outcome. Social and psychological adjustments were also investigated by a questionnaire in 90 of these 136 patients. Optimal results of the operation are essential for a successful outcome. Personal and social instability before operation, unsuitable body build, and age over 30 years at operation correlated with unsatisfactory results. Adequate family and social support is important for postoperative functioning. Sex reassignment had no influence on the person’s ability to work.

Fisher et al., 2014

Fisher, A. D., Castellini, G., Bandini, E., Casale, H., Fanni, E., et al. (2014). Cross‐sex hormonal treatment and body uneasiness in individuals with gender dysphoria. The Journal of Sexual Medicine , 11 (3), 709–719.

Introduction: Cross‐sex hormonal treatment (CHT) used for gender dysphoria (GD) could by itself affect well‐being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone. Aims: This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones (no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms. Methods: A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered. Main Outcome Measures: Subjects were asked to complete the Body Uneasiness Test (BUT) to explore different areas of body‐related psychopathology and the Symptom Checklist‐90 Revised (SCL‐90‐R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records. Results: Among the male‐to‐female (MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no‐CHT group. No significant differences were observed between CHT and no‐CHT groups in the female‐to‐male (FtM) sample. Also, no significant differences in SCL score were observed with regard to gender (MtF vs. FtM), hormone treatment (CHT vs. no‐CHT), or the interaction of these two variables. Moreover, a two‐step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI. Conclusions: The differences observed between MtF and FtM individuals suggest that body‐related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for MtF clients. A discussion is provided on the importance of controlling both length and daily dose of treatment for the most effective impact on body uneasiness.

Glynn et al., 2016

Glynn, T. R., Gamarel, K. E., Kahler, C. W., Iwamoto, M., Operario, D., & Nemoto, T. (2016). The role of gender affirmation in psychological well-being among transgender women. Psychology Of Sexual Orientation And Gender Diversity , 3 (3), 336-344.

High prevalence of psychological distress, including greater depression, lower self-esteem, and suicidal ideation, has been documented across numerous samples of transgender women and has been attributed to high rates of discrimination and violence. According to the gender affirmation framework (Sevelius, 2013), access to sources of gender-affirmative support can offset such negative psychological effects of social oppression. However, critical questions remain unanswered in regards to how and which aspects of gender affirmation are related to psychological well-being. The aims of this study were to investigate the associations among 3 discrete areas of gender affirmation (psychological, medical, and social) and participants’ reports of psychological well-being. A community sample of 573 transgender women with a history of sex work completed a 1-time self-report survey that assessed demographic characteristics, gender affirmation, and mental health outcomes. In multivariate models, we found that social, psychological, and medical gender affirmation were significant predictors of lower depression and higher self-esteem whereas no domains of affirmation were significantly associated with suicidal ideation. Findings support the need for accessible and affordable transitioning resources for transgender women to promote better quality of life among an already vulnerable population. However, transgender individuals should not be portrayed simplistically as objects of vulnerability, and research identifying mechanisms to promote wellness and thriving is necessary for future intervention development. As the gender affirmation framework posits, the personal experience of feeling affirmed as a transgender person results from individuals’ subjective perceptions of need along multiple dimensions of gender affirmation. Thus, personalized assessment of gender affirmation may be a useful component of counseling and service provision for transgender women.

Gomez-Gil et al., 2012

Gomez-Gil, E., Zubiaurre-Elorz, L., Esteva, I., Guillamon, A., Godas, T., Cruz Almaraz, M., Halperin, I., Salamero, M. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology , 37 (5), 662-670.

Introduction: The aim of the present study was to evaluate the presence of symptoms of current social distress, anxiety and depression in transsexuals. Methods: We investigated a group of 187 transsexual patients attending a gender identity unit; 120 had undergone hormonal sex-reassignment (SR) treatment and 67 had not. We used the Social Anxiety and Distress Scale (SADS) for assessing social anxiety and the Hospital Anxiety and Depression Scale (HADS) for evaluating current depression and anxiety. Results: The mean SADS and HADS scores were in the normal range except for the HAD-Anxiety subscale (HAD-A) on the non-treated transsexual group. SADS, HAD-A, and HAD-Depression (HAD-D) mean scores were significantly higher among patients who had not begun cross-sex hormonal treatment compared with patients in hormonal treatment (F = 4.362, p = .038; F = 14.589, p = .001; F = 9.523, p = .002 respectively). Similarly, current symptoms of anxiety and depression were present in a significantly higher percentage of untreated patients than in treated patients (61% vs. 33% and 31% vs. 8% respectively). Conclusions: The results suggest that most transsexual patients attending a gender identity unit reported subclinical levels of social distress, anxiety, and depression. Moreover, patients under cross-sex hormonal treatment displayed a lower prevalence of these symptoms than patients who had not initiated hormonal therapy. Although the findings do not conclusively demonstrate a direct positive effect of hormone treatment in transsexuals, initiating this treatment may be associated with better mental health of these patients.

Gomez-Gil et al., 2014

Gómez-Gil, E., Zubiaurre-Elorza, L., de Antonio, E. D., Guillamon, A., & Salamero, M. (2014). Determinants of quality of life in Spanish transsexuals attending a gender unit before genital sex reassignment surgery. Quality of Life Research , 23 (2), 669-676.

Purpose: To evaluate the self-reported perceived quality of life (QoL) in transsexuals attending a Spanish gender identity unit before genital sex reassignment surgery, and to identify possible determinants that likely contribute to their QoL. Methods: A sample of 119 male-to-female (MF) and 74 female-to-male (FM) transsexuals were included in the study. The WHOQOL-BREF scale was used to evaluate self-reported QoL. Possible determinants included age, sex, education, employment, partnership status, undergoing cross-sex hormonal therapy, receiving at least one non-genital sex reassignment surgery, and family support (assessed with the family APGAR questionnaire). Results: Mean scores of all QoL domains ranged from 55.44 to 63.51. Linear regression analyses revealed that undergoing cross-sex hormonal treatment, having family support, and having an occupation were associated with a better QoL for all transsexuals. FM transsexuals have higher social domain QoL scores than MF transsexuals. The model accounts for 20.6 % of the variance in the physical, 32.5 % in the psychological, 21.9 % in the social, and 20.1 % in the environment domains, and 22.9 % in the global QoL factor. Conclusions: Cross-sex hormonal treatment, family support, and working or studying are linked to a better self-reported QoL in transsexuals. Healthcare providers should consider these factors when planning interventions to promote the health-related QoL of transsexuals.

Gorin-Lazard et al., 2012

Gorin‐Lazard, A., Baumstarck, K., Boyer, L., Maquigneau, A., Gebleux, S., Penochet, J., Pringuey, D., Albarel, F., Morange, I., Loundou, A., Berbis, J., Auquier, P., Lançon, C. and Bonierbale, M. (2012). Is hormonal therapy associated with better quality of life in transsexuals? A cross‐sectional study. The Journal of Sexual Medicine , 9 (2), 531–541.

Introduction: Although the impact of sex reassignment surgery on the self‐reported outcomes of transsexuals has been largely described, the data available regarding the impact of hormone therapy on the daily lives of these individuals are scarce. Aims: The objectives of this study were to assess the relationship between hormonal therapy and the self‐reported quality of life (QoL) in transsexuals while taking into account the key confounding factors and to compare the QoL levels between transsexuals who have, vs. those who have not, undergone cross‐sex hormone therapy as well as between transsexuals and the general population (French age‐ and sex‐matched controls). Methods: This study incorporated a cross‐sectional design that was conducted in three psychiatric departments of public university teaching hospitals in France. The inclusion criteria were as follows: 18 years or older, diagnosis of gender identity disorder (302.85) according to the Diagnostic and Statistical Manual, fourth edition text revision (DSM‐IV TR), inclusion in a standardized sex reassignment procedure following the agreement of a multidisciplinary team, and pre‐sex reassignment surgery. Main Outcome Measure. QoL was assessed using the Short Form 36 (SF‐36). Results: The mean age of the total sample was 34.7 years, and the sex ratio was 1:1. Forty‐four (72.1%) of the participants received hormonal therapy. Hormonal therapy and depression were independent predictive factors of the SF‐36 mental composite score. Hormonal therapy was significantly associated with a higher QoL, while depression was significantly associated with a lower QoL. Transsexuals’ QoL, independently of hormonal status, did not differ from the French age‐ and sex‐matched controls except for two subscales of the SF‐36 questionnaire: role physical (lower scores in transsexuals) and general health (lower scores in controls). Conclusion: The present study suggests a positive effect of hormone therapy on transsexuals’ QoL after accounting for confounding factors. These results will be useful for healthcare providers of transgender persons but should be confirmed with larger samples using a prospective study design.

Gorin-Lazard et al., 2013

Gorin-Lazard, A., Baumstarck, K., Boyer, L., Maquigneau, A., Penochet, J. C., et al. (2013). Hormonal therapy is associated with better self-esteem, mood, and quality of life in transsexuals. Journal of Nervous and Mental Disease , 201 (11), 996–1000.

Few studies have assessed the role of cross-sex hormones on psychological outcomes during the period of hormonal therapy preceding sex reassignment surgery in transsexuals. The objective of this study was to assess the relationship between hormonal therapy, self-esteem, depression, quality of life (QoL), and global functioning. This study incorporated a cross-sectional design. The inclusion criteria were diagnosis of gender identity disorder (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) and inclusion in a standardized sex reassignment procedure. The outcome measures were self-esteem (Social Self-Esteem Inventory), mood (Beck Depression Inventory), QoL (Subjective Quality of Life Analysis), and global functioning (Global Assessment of Functioning). Sixty-seven consecutive individuals agreed to participate. Seventy-three percent received hormonal therapy. Hormonal therapy was an independent factor in greater self-esteem, less severe depression symptoms, and greater “psychological-like” dimensions of QoL. These findings should provide pertinent information for health care providers who consider this period as a crucial part of the global sex reassignment procedure.

Hess et al., 2014

Hess, J., Neto, R. R., Panic, L., Rübben, H., & Senf, W. (2014). Satisfaction with male-to-female gender reassignment surgery: Results of a retrospective analysis. Deutsches Ärzteblatt International , 111 (47), 795–801.

Background: The frequency of gender identity disorder is hard to determine; the number of gender reassignment operations and of court proceedings in accordance with the German Law on Transsexuality almost certainly do not fully reflect the underlying reality. There have been only a few studies on patient satisfaction with male-to-female gender reassignment surgery. Methods: 254 consecutive patients who had undergone male-to-female gender reassignment surgery at Essen University Hospital’s Department of Urology retrospectively filled out a questionnaire about their subjective postoperative satisfaction. Results: 119 (46.9%) of the patients filled out and returned the questionnaires, at a mean of 5.05 years after surgery (standard deviation 1.61 years, range 1–7 years). 90.2% said their expectations for life as a woman were fulfilled postoperatively. 85.4% saw themselves as women. 61.2% were satisfied, and 26.2% very satisfied, with their outward appearance as a woman; 37.6% were satisfied, and 34.4% very satisfied, with the functional outcome. 65.7% said they were satisfied with their life as it is now. Conclusion: The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned.

Heylens et al., 2014

Heylens, G., Verroken, C., De Cock, S., T’Sjoen, G., & De Cuypere, G. (2014). Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder. The Journal of Sexual Medicine , 11 (1), 119–126.

Introduction: At the start of gender reassignment therapy, persons with a gender identity disorder (GID) may deal with various forms of psychopathology. Until now, a limited number of publications focus on the effect of the different phases of treatment on this comorbidity and other psychosocial factors. Aims: The aim of this study was to investigate how gender reassignment therapy affects psychopathology and other psychosocial factors. Methods: This is a prospective study that assessed 57 individuals with GID by using the Symptom Checklist‐90 (SCL‐90) at three different points of time: at presentation, after the start of hormonal treatment, and after sex reassignment surgery (SRS). Questionnaires on psychosocial variables were used to evaluate the evolution between the presentation and the postoperative period. The data were statistically analyzed by using SPSS 19.0, with significance levels set at P < 0.05. Main Outcome Measures: The psychopathological parameters include overall psychoneurotic distress, anxiety, agoraphobia, depression, somatization, paranoid ideation/psychoticism, interpersonal sensitivity, hostility, and sleeping problems. The psychosocial parameters consist of relationship, living situation, employment, sexual contacts, social contacts, substance abuse, and suicide attempt. Results: A difference in SCL‐90 overall psychoneurotic distress was observed at the different points of assessments (P = 0.003), with the most prominent decrease occurring after the initiation of hormone therapy (P < 0.001). Significant decreases were found in the subscales such as anxiety, depression, interpersonal sensitivity, and hostility. Furthermore, the SCL‐90 scores resembled those of a general population after hormone therapy was initiated. Analysis of the psychosocial variables showed no significant differences between pre‐ and postoperative assessments. Conclusions: A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy.

Imbimbo et al., 2009

Imbimbo, C., Verze, P., Palmieri, A., Longo, N., Fusco, F., Arcaniolo, D., & Mirone, V. (2009). A report from a single institute’s 14-year experience in treatment of male-to-female transsexuals. The Journal of Sexual Medicine , 6 (10), 2736–2745.

Introduction: Gender identity disorder or transsexualism is a complex clinical condition, and prevailing social context strongly impacts the form of its manifestations. Sex reassignment surgery (SRS) is the crucial step of a long and complex therapeutic process starting with preliminary psychiatric evaluation and culminating in definitive gender identity conversion. Aim: The aim of our study is to arrive at a clinical and psychosocial profile of male-to-female transsexuals in Italy through analysis of their personal and clinical experience and evaluation of their postsurgical satisfaction levels SRS. Methods: From January 1992 to September 2006, 163 male patients who had undergone gender-transforming surgery at our institution were requested to complete a patient satisfaction questionnaire. Main Outcome Measures: The questionnaire consisted of 38 questions covering nine main topics: general data, employment status, family status, personal relationships, social and cultural aspects, presurgical preparation, surgical procedure, and postsurgical sex life and overall satisfaction. Results: Average age was 31 years old. Seventy-two percent had a high educational level, and 63% were steadily employed. Half of the patients had contemplated suicide at some time in their lives before surgery and 4% had actually attempted suicide. Family and colleague emotional support levels were satisfactory. All patients had been adequately informed of surgical procedure beforehand. Eighty-nine percent engaged in postsurgical sexual activities. Seventy-five percent had a more satisfactory sex life after SRS, with main complications being pain during intercourse and lack of lubrication. Seventy-eight percent were satisfied with their neovagina’s esthetic appearance, whereas only 56% were satisfied with depth. Almost all of the patients were satisfied with their new sexual status and expressed no regrets. Conclusions: Our patients’ high level of satisfaction was due to a combination of a well-conducted preoperative preparation program, competent surgical skills, and consistent postoperative follow-up.

Johansson et al., 2010

Johansson, A., Sundbom, E., Höjerback, T., & Bodlund, O. (2010). A five-year follow-up study of Swedish adults with gender identity disorder. Archives of Sexual Behavior , 39 (6), 1429-1437.

This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At follow-up, 32 patients had completed sex reassignment surgery, five were still in process, and five—following their own decision—had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5–15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years), and non-homosexually oriented (56 vs. 15%). In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.

Keo-Meier et al., 2015

Keo-Meier, C. L., Herman, L. I., Reisner, S. L., Pardo, S. T., Sharp, C., & Babcock, J. C. (2015). Testosterone treatment and MMPI-2 improvement in transgender men: A prospective controlled study. Journal of Consulting and Clinical Psychology, 83 , 143-156.

Objective: Most transgender men desire to receive testosterone treatment in order to masculinize their bodies. In this study, we aimed to investigate the short-term effects of testosterone treatment on psychological functioning in transgender men. This is the 1st controlled prospective follow-up study to examine such effects. Method: We examined a sample of transgender men (n = 48) and nontransgender male (n = 53) and female (n = 62) matched controls (mean age = 26.6 years; 74% White). We asked participants to complete the Minnesota Multiphasic Personality Inventory (2nd ed., or MMPI–2; Butcher, Graham, Tellegen, Dahlstrom, & Kaemmer, 2001) to assess psychological functioning at baseline and at the acute posttreatment follow-up (3 months after testosterone initiation). Regression models tested (a) Gender × Time interaction effects comparing divergent mean response profiles across measurements by gender identity; (b) changes in psychological functioning scores for acute postintervention measurements, adjusting for baseline measures, comparing transgender men with their matched nontransgender male and female controls and adjusting for baseline scores; and (c) changes in meeting clinical psychopathological thresholds. Results: Statistically significant changes in MMPI–2 scale scores were found at 3-month follow-up after initiating testosterone treatment relative to baseline for transgender men compared with female controls (female template): reductions in Hypochondria (p < .05), Depression (p < .05), Hysteria (p < .05), and Paranoia (p < .01); and increases in Masculinity–Femininity scores (p < .01). Gender × Time interaction effects were found for Hysteria (p < .05) and Paranoia (p < .01) relative to female controls (female template) and for Hypochondria (p < .05), Depression (p < .01), Hysteria (p < .01), Psychopathic Deviate (p < .05), Paranoia (p < .01), Psychasthenia (p < .01), and Schizophrenia (p < .01) compared with male controls (male template). In addition, the proportion of transgender men presenting with co-occurring psychopathology significantly decreased from baseline compared with 3-month follow-up relative to controls (p < .05). Conclusions: Findings suggest that testosterone treatment resulted in increased levels of psychological functioning on multiple domains in transgender men relative to nontransgender controls. These findings differed in comparisons of transgender men with female controls using the female template and with male controls using the male template. No iatrogenic effects of testosterone were found. These findings suggest a direct positive effect of 3 months of testosterone treatment on psychological functioning in transgender men.

Kraemer et al., 2008

Kraemer, B., Delsignore, A., Schnyder, U., & Hepp, U. (2008). Body image and transsexualism. Psychopathology , 41 (2), 96-100.

Background: To achieve a detailed view of the body image of transsexual patients, an assessment of perception, attitudes and experiences about one’s own body is necessary. To date, research on the body image of transsexual patients has mostly covered body dissatisfaction with respect to body perception. Sampling and Methods: We investigated 23 preoperative (16 male-to-female and 7 female-to-male transsexual patients) and 22 postoperative (14 male-to-female and 8 female-to-male) transsexual patients using a validated psychological measure for body image variables. Results: We found that preoperative transsexual patients were insecure and felt unattractive because of concerns about their body image. However, postoperative transsexual patients scored high on attractiveness and self-confidence. Furthermore, postoperative transsexual patients showed low scores for insecurity and concerns about their body. Conclusions: Our results indicate an improvement of body image concerns for transsexual patients following standards of care for gender identity disorder. Follow-up studies are recommended to confirm the assumed positive outcome of standards of care on body image.

Landen et al., 1998

Landén, M., Wålinder, J., Hambert, G., & Lundström, B. (1998). Factors predictive of regret in sex reassignment. Acta Psychiatrica Scandinavica , 97 (4), 284-289.

The objective of this study was to evaluate the features and calculate the frequency of sex-reassigned subjects who had applied for reversal to their biological sex, and to compare these with non-regretful subjects. An inception cohort was retrospectively identified consisting of all subjects with gender identity disorder who were approved for sex reassignment in Sweden during the period 1972-1992. The period of time that elapsed between the application and this evaluation ranged from 4 to 24 years. The total cohort consisted of 218 subjects. The results showed that 3.8% of the patients who were sex reassigned during 1972-1992 regretted the measures taken. The cohort was subdivided according to the presence or absence of regret of sex reassignment, and the two groups were compared. The results of logistic regression analysis indicated that two factors predicted regret of sex reassignment, namely lack of support from the patient’s family, and the patient belonging to the non-core group of transsexuals. In conclusion, the results show that the outcome of sex reassignment has improved over the years. However, the identified risk factors indicate the need for substantial efforts to support the families and close friends of candidates for sex reassignment.

Lawrence, 2003

Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior , 32 (4), 299-315.

This study examined factors associated with satisfaction or regret following sex reassignment surgery (SRS) in 232 male-to-female transsexuals operated on between 1994 and 2000 by one surgeon using a consistent technique. Participants, all of whom were at least 1-year postoperative, completed a written questionnaire concerning their experiences and attitudes. Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. Most indicators of transsexual typology, such as age at surgery, previous marriage or parenthood, and sexual orientation, were not significantly associated with subjective outcomes. Compliance with minimum eligibility requirements for SRS specified by the Harry Benjamin International Gender Dysphoria Association was not associated with more favorable subjective outcomes. The physical results of SRS may be more important than preoperative factors such as transsexual typology or compliance with established treatment regimens in predicting postoperative satisfaction or regret.

Lawrence, 2006

Lawrence, A. A. (2006). Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Archives of Sexual Behavior , 35 (6), 717-727.

This study examined preoperative preparations, complications, and physical and functional outcomes of male-to-female sex reassignment surgery (SRS), based on reports by 232 patients, all of whom underwent penile-inversion vaginoplasty and sensate clitoroplasty, performed by one surgeon using a consistent technique. Nearly all patients discontinued hormone therapy before SRS and most reported that doing so created no difficulties. Preoperative electrolysis to remove genital hair, undergone by most patients, was not associated with less serious vaginal hair problems. No patients reported rectal-vaginal fistula or deep-vein thrombosis and reports of other significant surgical complications were uncommon. One third of patients, however, reported urinary stream problems. No single complication was significantly associated with regretting SRS. Satisfaction with most physical and functional outcomes of SRS was high; participants were least satisfied with vaginal lubrication, vaginal touch sensation, and vaginal erotic sensation. Frequency of achieving orgasm after SRS was not significantly associated with most general measures of satisfaction. Later years of surgery, reflecting greater surgeon experience, were not associated with lower prevalence rates for most complications or with better ratings for most physical and functional outcomes of SRS.

Lobato et al., 2006

Lobato M. I., Koff, W. J., Manenti, C., da Fonseca Seger, D., Salvador, J., et al. (2006). Follow-up of sex reassignment surgery in transsexuals: a Brazilian cohort.  Archives of Sexual Behavior, 35(6) , 711–715.

This study examined the impact of sex reassignment surgery on the satisfaction with sexual experience, partnerships, and relationship with family members in a cohort of Brazilian transsexual patients. A group of 19 patients who received sex reassignment between 2000 and 2004 (18 male- to-female, 1 female-to-male) after a two-year evaluation by a multidisciplinary team, and who agreed to participate in the study, completed a written questionnaire. Mean age at entry into the program was 31.21 ± 8.57 years and mean schooling was 9.2 ± 1.4 years. None of the patients reported regret for having undergone the surgery. Sexual experience was considered to have improved by 83.3% of the patients, and became more frequent for 64.7% of the patients. For 83.3% of the patients, sex was considered to be pleasurable with the neovagina/neopenis. In addition, 64.7% reported that initiating and maintaining a relationship had become easier. The number of patients with a partner increased from 52.6% to 73.7%. Family relationships improved in 26.3% of the cases, whereas 73.7% of the patients did not report a difference. None of the patients reported worse relationships

Manieri et al., 2014

Manieri, C., Castellano, E., Crespi, C., Di Bisceglie, C., Dell’Aquila, C., et al. (2014). Medical treatment of subjects with gender identity disorder: The experience in an Italian public health center. International Journal Of Transgenderism , 15 (2), 53-65.

Hormonal treatment is the main element during the transition program for transpeople. The aim of this paper is to describe the care and treatment of subjects, highlighting both the endocrine-metabolic effects of the hormonal therapy and the quality of life during the first year of cross-sex therapy in an Italian gender team. We studied 83 subjects (56 male-to-female [MtF], 27 female-to-male [FtM]) with hematological and hormonal evaluations every 3 months during the first year of hormonal therapy. MtF persons were treated with 17βestradiol and antiandrogens (cyproterone acetate, spironolactone, dutasteride); FtM persons were treated with transdermal or intramuscular testosterone. The WHO Quality of Life questionnaire was administered at the beginning and 1 year later. Hormonal changes paralleled phenotype modifications with wide variability. Most of both MtF and FtM subjects reported a statistically significant improvement in body image (p < 0.05). In particular, MtF subjects reported a statistically significant improvement in the quality of their sexual life and in the general quality of life (p < 0.05) 1 year after treatment initiation. Cross-sex therapy seems to be free of major risks in healthy subjects under clinical supervision during the first year. Selected subjects show an optimal adaptation to hormone-induced neuropsychological modifications and satisfaction regarding general and sexual life.

Megeri and Khoosal, 2007

Megeri, D., & Khoosal, D. (2007). Anxiety and depression in males experiencing gender dysphoria. Sexual & Relationship Therapy , 22 (1), 77-81.

Objective: The aim of the study was to compare anxiety and depression scores for the first 40 male to female people experiencing gender dysphoria attending the Leicester Gender Identity Clinic using the same sample as control pre and post gender realignment surgery. Hypothesis: There is an improvement in the scores of anxiety and depression following gender realignment surgery among people with gender dysphoria (male to female – transwomen). Results: There was no significant change in anxiety and depression scores in people with gender dysphoria (male to female) pre- and post-operatively.

Nelson, Whallett, & Mcgregor, 2009

Nelson, L., Whallett, E., & McGregor, J. (2009). Transgender patient satisfaction following reduction mammaplasty. Journal of Plastic, Reconstructive & Aesthetic Surgery , 62 (3), 331-334.

Aim: To evaluate the outcome of reduction mammaplasty in female-to-male transgender patients. Method: A 5-year retrospective review was conducted on all female-to-male transgender patients who underwent reduction mammaplasty. A postal questionnaire was devised to assess patient satisfaction, surgical outcome and psychological morbidity. Results: Seventeen patients were identified. The senior author performed bilateral reduction mammaplasties and free nipple grafts in 16 patients and one patient had a Benelli technique reduction. Complications included two haematomas, one wound infection, one wound dehiscence and three patients had hypertrophic scars. Secondary surgery was performed in seven patients and included scar revision, nipple reduction/realignment, dog-ear correction and nipple tattooing. The mean follow-up period after surgery was 10 months (range 2–23 months). Twelve postal questionnaires were completed (response rate 70%). All respondents expressed satisfaction with their result and no regret. Seven patients had nipple sensation and nine patients were satisfied with nipple position. All patients thought their scars were reasonable and felt that surgery had improved their self-confidence and social interactions. Conclusion: Reduction mammaplasty for female-to-male gender reassignment is associated with high patient satisfaction and a positive impact on the lives of these patients.

Newfield et al., 2006

Newfield, E., Hart, S., Dibble, S., & Kohler, L. (2006). Female-to-male transgender quality of life. Quality of Life Research , 15 (9), 1447-1457.

Objectives: We evaluated health-related quality of life in female-to-male (FTM) transgender individuals, using the Short-Form 36-Question Health Survey version 2 (SF-36v2). Methods: Using email, Internet bulletin boards, and postcards, we recruited individuals to an Internet site ( http://www.transurvey.org ), which contained a demographic survey and the SF36v2. We enrolled 446 FTM transgender and FTM transsexual participants, of which 384 were from the US. Results: Analysis of quality of life health concepts demonstrated statistically significant (p<0.0\) diminished quality of life among the FTM transgender participants as compared to the US male and female population, particularly in regard to mental health. FTM transgender participants who received testosterone (67%) reported statistically significant higher quality of life scores (/?<0.01) than those who had not received hormone therapy. Conclusions: FTM transgender participants reported significantly reduced mental health-related quality of life and

Padula, Heru, & Campbell, 2016

Padula, W. V., Heru, S. & Campbell, J. D. (2016). Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: A cost-effectiveness analysis. Journal of General Internal Medicine , 31 ( 4), 394-401.

Background: Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. Objective: To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. Design: Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3 % (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). Patients: U.S. transgender population starting before transitional therapy. Interventions: No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. Main Measures: Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. Key Results: Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000–22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints —HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85 % of simulations. Conclusions: Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.

Parola et al., 2010

Parola, N., Bonierbale, M., Lemaire, A., Aghababian, V., Michel, A., & Lançon, C. (2010). Study of quality of life for transsexuals after hormonal and surgical reassignment. Sexologies , 19 (1), 24-28.

Aim: The main objective of this work is to provide a more detailed assessment of the impact of surgical reassignment on the most important aspects of daily life for these patients. Our secondary objective was to establish the influence of various factors likely to have an impact on the quality of life (QoL), such as biological gender and the subject’s personality. Methods: A personality study was conducted using Eysenck Personality Inventory (EPI) so as to analyze two aspects of the personality (extraversion and neuroticism). Thirty-eight subjects who had undergone hormonal surgical reassignment were included in the study. Results: The results show that gender reassignment surgery improves the QoL for transsexuals in several different important areas: most are satisfied of their sexual reassignment (28/30), their social (21/30) and sexual QoL (25/30) are improved. However, there are differences between male-to-female (MtF) and female-to-male (FtM) transsexuals in terms of QoL: FtM have a better social, professional, friendly lifestyles than MtF. Finally, the results of this study did not evidence any influence by certain aspects of the personality, such as extraversion and neuroticism, on the QoL for reassigned subjects.

Pfäfflin, 1993

Pfäfflin, F. (1993). Regrets after sex reassignment surgery. Journal of Psychology & Human Sexuality , 5 (4), 69-85.

Using data draw from the follow-up literature covering the last 30 years, and the author’s clinical data on 295 men and women after SRS, an estimation of the number of patients who regretted the operations is made. Among female-to-male transsexuals after SRS, i.e., in men, no regrets were reported in the author’s sample, and in the literature they amount to less than 1%. Among male-to- female transsexuals after SRS, i.e., in women, regrets are reported in 1-1.5%. Poor differential diagnosis, failure to carry out the real-life- test, and poor surgical results seem to be the main reasons behind the regrets reported in the literature. According to three cases observed by the author in addition to personality traits the lack of proper care in treating the patients played a major role.

Pimenoff and Pfäfflin, 2011

Pimenoff, V., & Pfäfflin, F. (2011). Transsexualism: Treatment outcome of compliant and noncompliant patients. International Journal Of Transgenderism , 13 (1), 37-44.

The objective of the study was a follow-up of the treatment outcome of Finnish transsexuals who sought sex reassignment during the period 1970–2002 and a comparison of the results and duration of treatment of compliant and noncompliant patients. Fifteen male-to-female transsexuals and 17 female-to-male transsexuals who had undergone hormone and surgical treatment and legal sex reassignment in Finland completed a questionnaire on psychosocial data and on their experience with the different phases of clinical assessment and treatment. The changes in their vocational functioning and social and psychic adjustment were used as outcome indicators. The results and duration of the treatment of compliant and noncompliant patients were compared. The patients benefited significantly from treatment. The noncompliant patients achieved equally good results as the compliant ones, and did so in a shorter time. A good treatment outcome could be achieved even when the patient had told the assessing psychiatrist a falsified story of his life and sought hormone therapy, genital surgery, or legal sex reassignment on his own initiative without a recommendation from the psychiatrist. Based on these findings, it is recommended that the doctor-patient relationship be reconsidered and founded on frank cooperation.

Rakic et al., 1996

Rakic, Z., Starcevic, V., Maric, J., & Kelin, K. (1996). The outcome of sex reassignment surgery in Belgrade: 32 patients of both sexes. Archives of Sexual Behavior , 25 (5), 515-525.

Several aspects of the quality of life after sex reassignment surgery in 32 transsexuals of both sexes (22 men, 10 women) were examined. The Belgrade Team for Gender Identity Disorders designed a standardized questionnaire for this purpose. The follow-up period after operation was from 6 months to 4 years, and four aspects of the quality of life were examined: attitude towards the patients’ own body, relationships with other people, sexual activity, and occupational functioning. In most transsexuals, the quality of life was improved after surgery inasmuch as these four aspects are concerned. Only a few transsexuals were not satisfied with their life after surgery.

Rehman et al., 1999

Rehman, J., Lazer, S., Benet, A. E., Schaefer, L. C., & Melman, A. (1999). The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients. Archives of Sexual Behavior , 28 (1), 71-89.

From 1980 to July 1997 sixty-one male-to-female gender transformation surgeries were performed at our university center by one author (A.M.). Data were collected from patients who had surgery up to 1994 (n = 47) to obtain a minimum follow-up of 3 years; 28 patients were contacted. A mail questionnaire was supplemented by personal interviews with 11 patients and telephone interviews with remaining patients to obtain and clarify additional information. Physical and functional results of surgery were judged to be good, with few patients requiring additional corrective surgery. General satisfaction was expressed over the quality of cosmetic (normal appearing genitalia) and functional (ability to perceive orgasm) results. Follow-up showed satisfied who believed they had normal appearing genitalia and the ability to experience orgasm. Most patients were able to return to their jobs and live a more satisfactory social and personal life. One significant outcome was the importance of proper preparation of patients for surgery and especially the need for additional postoperative psychotherapy. None of the patients regretted having had surgery. However, some were, to a degree, disappointed because of difficulties experienced post operatively in adjusting satisfactorily as women both in their relationships with men and in living their lives generally as women. Findings of this study make a strong case for making a change in the Harry Benjamin Standards of Care to include a period of postoperative psychotherapy.

Rotondi et al., 2011

Rotondi, N. K., Bauer, G. R., Scanlon, K., Kaay, M., Travers, R., & Travers, A. (2011). Prevalence of and risk and protective factors for depression in female-to-male transgender Ontarians: Trans PULSE Project. Canadian Journal Of Community Mental Health , 30 (2), 135-155.

Although depression is understudied in transgender and transsexual communities, high prevalences have been reported. This paper presents original research from the Trans PULSE Project, an Ontario-wide, community-based initiative that surveyed 433 participants using respondent-driven sampling. The purpose of this analysis was to determine the prevalence of, and risk and protective factors for, depression among female-to-male (FTM) Ontarians (n = 207). We estimate that 66.4% of FTMs have symptomatology consistent with depression. In multivariable analyses, sexual satisfaction was a strong protective factor. Conversely, experiencing transphobia and being at the stage of planning but not having begun a medical transition (hormones and/or surgery) adversely affected mental health in FTMs.

Ruppin and Pfäfflin, 2015

Ruppin, U., & Pfäfflin, F. (2015). Long-term follow-up of adults with gender identity disorder. Archives of Sexual Behavior , 44 (5), 1321-1329.

The aim of this study was to re-examine individuals with gender identity disorder after as long a period of time as possible. To meet the inclusion criterion, the legal recognition of participants’ gender change via a legal name change had to date back at least 10 years. The sample comprised 71 participants (35 MtF and 36 FtM). The follow-up period was 10–24 years with a mean of 13.8 years (SD = 2.78). Instruments included a combination of qualitative and quantitative methods: Clinical interviews were conducted with the participants, and they completed a follow-up questionnaire as well as several standardized questionnaires they had already filled in when they first made contact with the clinic. Positive and desired changes were determined by all of the instruments: Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation. Despite these positive results, the treatment of transsexualism is far from being perfect.

Smith et al., 2005

Smith, Y. L. S., Van Goozen, S. H. M., Kuiper, A. J., & Cohen-Kettenis, P. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine, 35 (1), 89-99.

Background: We prospectively studied outcomes of sex reassignment, potential differences between subgroups of transsexuals, and predictors of treatment course and outcome. Method: Altogether 325 consecutive adolescent and adult applicants for sex reassignment participated: 222 started hormone treatment, 103 did not; 188 completed and 34 dropped out of treatment. Only data of the 162 adults were used to evaluate treatment. Results between subgroups were compared to determine post-operative differences. Adults and adolescents were included to study predictors of treatment course and outcome. Results were statistically analysed with logistic regression and multiple linear regression analyses. Results: After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes. Conclusions: The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment.

van de Grift et al., 2017

van de Grift, T. C., Elaut, E., Cerwenka, S. C., Cohen-Kettenis, P. T., Cuypere, G. D., Richter-Appelt, H., & Kreukels, B. P. (2017). Effects of medical interventions on gender dysphoria and body image. Psychosomatic Medicine , 79 (7), 815-823.

Objective: The aim of this study from the European Network for the Investigation of Gender Incongruence is to investigate the status of all individuals who had applied for gender confirming interventions from 2007 to 2009, irrespective of whether they received treatment. The current article describes the study protocol, the effect of medical treatment on gender dysphoria and body image, and the predictive value of (pre)treatment factors on posttreatment outcomes. Methods: Data were collected on medical interventions, transition status, gender dysphoria (Utrecht Gender Dysphoria Scale), and body image (Body Image Scale for transsexuals). In total, 201 people participated in the study (37% of the original cohort). Results: At follow-up, 29 participants (14%) did not receive medical interventions, 36 hormones only (18%), and 136 hormones and surgery (68%). Most transwomen had undergone genital surgery, and most transmen chest surgery. Overall, the levels of gender dysphoria and body dissatisfaction were significantly lower at follow-up compared with clinical entry. Satisfaction with therapy responsive and unresponsive body characteristics both improved. High dissatisfaction at admission and lower psychological functioning at follow-up were associated with persistent body dissatisfaction. Conclusions: Hormone-based interventions and surgery were followed by improvements in body satisfaction. The level of psychological symptoms and the degree of body satisfaction at baseline were significantly associated with body satisfaction at follow-up.

van de Grift, T. C., Elaut, E., Cerwenka, S. C., Cohen-Kettenis, P. T., & Kreukels, B. P. (2017). Surgical satisfaction, quality of life, and their association after gender-affirming surgery: A follow-up study. Journal of Sex & Marital Therapy , 44 (2), 138-148.

We assessed the outcomes of gender-affirming surgery (GAS, or sex-reassignment surgery) 4 to 6 years after first clinical contact, and the associations between postoperative (dis)satisfaction and quality of life (QoL). Our multicenter, cross-sectional follow-up study involved persons diagnosed with gender dysphoria (DSM-IV-TR) who applied for medical interventions from 2007 until 2009. Of 546 eligible persons, 201 (37%) responded, of whom 136 had undergone GAS (genital, chest, facial, vocal cord and/or thyroid cartilage surgery). Main outcome measures were procedure performed, self-reported complications, and satisfaction with surgical outcomes (standardized questionnaires), QoL (Satisfaction With Life Scale, Subjective Happiness Scale, Cantril Ladder), gender dysphoria (Utrecht Gender Dysphoria Scale), and psychological symptoms (Symptom Checklist-90). Postoperative satisfaction was 94% to 100%, depending on the type of surgery performed. Eight (6%) of the participants reported dissatisfaction and/or regret, which was associated with preoperative psychological symptoms or self-reported surgical complications (OR= 6.07). Satisfied respondents’ QoL scores were similar to reference values; dissatisfied or regretful respondents’ scores were lower. Therefore, dissatisfaction after GAS may be viewed as indicator of unfavorable psychological and QoL outcomes.

Vujovic et al., 2009

Vujovic, S., Popovic, S., Sbutega-Milosevic, G., Djordjevic, M., & Gooren, L. (2009). Transsexualism in Serbia: A twenty-year follow-up study. The Journal of Sexual Medicine , 6 (4), 1018-1023.

Introduction: Gender dysphoria occurs in all societies and cultures. The prevailing social context has a strong impact on its manifestations as well as on applications by individuals with the condition for sex reassignment treatment. Aim: To describe a transsexual population seeking sex reassignment treatment in Serbia, part of former Yugoslavia. Methods: Data, collated over a period of 20 years, from subjects applying for sex reassignment to the only center in Serbia, were analyzed retrospectively. Main Outcome Measures: Age at the time of application, demographic data, family background, sex ratio, the prevalence of polycystic ovarian syndrome (PCOS) among female-to-male (FTM) transsexuals, and readiness to undergo surgical sex reassignment were tabulated. Results: Applicants for sex reassignment in Serbia are relatively young. The sex ratio is close to 1:1. They often come from single-child families. More than 10% do not wish to undergo surgical sex reassignment. The prevalence of PCOS among FTM transsexuals was higher than in the general population but considerably lower than that reported in the literature from other populations. Of those who had undergone sex reassignment, none expressed regret for their decision. Conclusions: Although transsexualism is a universal phenomenon, the relatively young age of those applying for sex reassignment and the sex ratio of 1:1 distinguish the population in Serbia from others reported in the literature.

Weigert et al., 2013

Weigert, R., Frison, E., Sessiecq, Q., Al Mutairi, K., & Casoli, V. (2013). Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals. Plastic and Reconstructive Surgery, 132 (6), 1421-1429.

Background: Satisfaction with breasts, sexual well-being, psychosocial well-being, and physical well-being are essential outcome factors following breast augmentation surgery in male-to-female transsexual patients. The aim of this study was to measure change in patient satisfaction with breasts and sexual, physical, and psychosocial well-being after breast augmentation in male-to-female transsexual patients. Methods: All consecutive male-to-female transsexual patients who underwent breast augmentation between 2008 and 2012 were asked to complete the BREAST-Q Augmentation module questionnaire before surgery, at 4 months, and later after surgery. A prospective cohort study was designed and postoperative scores were compared with baseline scores. Satisfaction with breasts and sexual, physical, and psychosocial outcomes assessment was based on the BREAST-Q. Results: Thirty-five male-to-female transsexual patients completed the questionnaires. BREAST-Q subscale median scores (satisfaction with breasts, +59 points; sexual well-being, +34 points; and psychosocial well-being, +48 points) improved significantly (p < 0.05) at 4 months postoperatively and later. No significant change was observed in physical well-being. Conclusions: In this prospective, noncomparative, cohort study, the current results suggest that the gains in breast satisfaction, psychosocial well-being, and sexual well-being after male-to-female transsexual patients undergo breast augmentation are statistically significant and clinically meaningful to the patient at 4 months after surgery and in the long term.

Weyers et al., 2009

Weyers, S., Elaut, E., De Sutter, P., Gerris, J., T’Sjoen, G., et al. (2009). Long-term assessment of the physical, mental, and sexual health among transsexual women. The Journal of Sexual Medicine , 6 (3), 752-760.

Introduction: Transsexualism is the most extreme form of gender identity disorder and most transsexuals eventually pursue sex reassignment surgery (SRS). In transsexual women, this comprises removal of the male reproductive organs, creation of a neovagina and clitoris, and often implantation of breast prostheses. Studies have shown good sexual satisfaction after transition. However, long-term follow-up data on physical, mental and sexual functioning are lacking. Aim: To gather information on physical, mental, and sexual well-being, health-promoting behavior and satisfaction with gender-related body features of transsexual women who had undergone SRS. Methods: Fifty transsexual women who had undergone SRS >or=6 months earlier were recruited. Main Outcome Measures: Self-reported physical and mental health using the Dutch version of the Short-Form-36 (SF-36) Health Survey; sexual functioning using the Dutch version of the Female Sexual Function Index (FSFI). Satisfaction with gender-related bodily features as well as with perceived female appearance; importance of sex, relationship quality, necessity and advisability of gynecological exams, as well as health concerns and feelings of regret concerning transition were scored. Results: Compared with reference populations, transsexual women scored good on physical and mental level (SF-36). Gender-related bodily features were shown to be of high value. Appreciation of their appearance as perceived by others, as well as their own satisfaction with their self-image as women obtained a good score (8 and 9, respectively). However, sexual functioning as assessed through FSFI was suboptimal when compared with biological women, especially the sublevels concerning arousal, lubrication, and pain. Superior scores concerning sexual function were obtained in those transsexual women who were in a relationship and in heterosexuals. Conclusions: Transsexual women function well on a physical, emotional, psychological and social level. With respect to sexuality, they suffer from specific difficulties, especially concerning arousal, lubrication, and pain.

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Below are 4 studies that contain mixed or null findings on the effect of gender transition on transgender well-being. Click here to jump to the 17 studies that consist of literature reviews or guidelines that help advance knowledge about the effect of gender transition on transgender well-being . Click here to jump to the 51 studies that found that gender transition improves the well-being of transgender people .

Barrett, 1998.

Barrett J. (1998). Psychological and social function before and after phalloplasty. The International Journal of Transgenderism , 2 (1), 1-8.

There are no quantitative assessments of the benefits of phalloplasty in a female transsexual population. The study addresses this question, comparing transsexuals accepted for such surgery with transsexuals after such surgery has been performed. A population of 23 transsexuals accepted for phalloplasty was compared to a population of 40 who had undergone such surgery between six and one hundred and sixty months previously. The General Health Questionnaire (GHQ), Symptom Checklist 90 (SCL-90), Bem Sex Role Inventory and Social Role Performance Schedule (SRPS) were employed. Additionally, a questionnaire assessing satisfaction with cosmetic appearance, sexual function, relationship and urinary function was used, along with a semi-structured interview quantifying alcohol, cigarette and drug usage, and current sexual practice. There were significant differences between the populations. The post operative group showed higher depression ratings on the depression subscale of the GHQ. The masculine pre-operative Bem scores were neutral post-operatively as feminine sub-scores increased. There was improved satisfaction with genital appearance post-operatively, but satisfaction with relationships fell, although to a non-significant extent. Most other changes were in the expected direction but did not achieve significance. Transsexuals accepted for phalloplasty have very good psychological health. Tendency to further improvement is the case after phalloplasty. Depression is commoner, however, and quality of relationships declines somewhat, perhaps in consequence. Surgeons might advise partners as well as patients of realistic expectations from such surgery.

Lindqvist et al., 2017

Lindqvist, E. K., Sigurjonsson, H., Möllermark, C., Rinder, J., Farnebo, F., et al. (2017). Quality of life improves early after gender reassignment surgery in transgender women. European Journal of Plastic Surgery , 40 (3), 223-226.

Background: Few studies have examined the long-term quality of life (QoL) of individuals with gender dysphoria, or how it is affected by treatment. Our aim was to examine the QoL of transgender women undergoing gender reassignment surgery (GRS). Methods: We performed a prospective cohort study on 190 patients undergoing male-to-female GRS at Karolinska University Hospital between 2003 and 2015. We used the Swedish version of the Short Form-36 Health Survey (SF-36), which measures QoL across eight domains. The questionnaire was distributed to patients pre-operatively, as well as 1, 3, and 5 years post-operatively. The results were compared between the different measure points, as well as between the study group and the general population. Results: On most dimensions of the SF-36 questionnaire, transgender women reported a lower QoL than the general population. The scores of SF-36 showed a non-significant trend to be lower 5 years post-GRS compared to pre-operatively, a decline consistent with that of the general population. Self-perceived health compared to 1 year previously rose in the first post-operative year, after which it declined. Conclusions: To our knowledge, this is the largest prospective study to follow a group of transgender patients with regards to QoL over continuous temporal measure points. Our results show that transgender women generally have a lower QoL compared to the general population. GRS leads to an improvement in general well-being as a trend but over the long-term, QoL decreases slightly in line with that of the comparison group. Level of evidence: Level III, therapeutic study.

Simonsen et al., 2016

Simonsen, R. K., Giraldi, A., Kristensen, E., & Hald, G. M. (2016). Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality. Nordic Journal Of Psychiatry , 70 (4), 241-247.

Background: There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. Aims: (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978–2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978–2010.Method: Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. Results: Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. Conclusions: No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.

Udeze, 2008

Udeze, B., Abdelmawla, N., Khoosal, D., & Terry, T. (2008). Psychological functions in male-to-female transsexual people before and after surgery. Sexual & Relationship Therapy , 23 (2), 141-145.

Patients with gender dysphoria (GD) suffer from a constant feeling of psychological discomfort related to their anatomical sex. Gender reassignment surgery (GRS) attempts to release this discomfort. The aim of this study was to compare the functioning of a cohort or patients with GD before and after GRS. We hypothesized that there would be an improvement in the scores of the self-administered SCL-90R following gender reassignment surgery among male-to-female people with gender dysphoria. We studied 40 patients with a DSM-IV diagnosis of Gender Identity Disorder (GID) who attended Leicester Gender Identity Clinic. We compared their functioning as measured by Symptom Check List-90R (SCL-90R) which was administered to 40 randomly selected male-to-female patients before and within six months after GRS using the same sample as control pre-and post-surgery. There was no significant change in the different sub-scales of the SCL-90R scores in patients with male-to-female GID pre- and within six months post-surgery. The results of the study showed that GRS had no significant effect on functioning as measured by SCL-90R within six months of surgery. Our study has the advantage of reducing inter-subject variability by using the same patients as their own control. This study may be limited by the duration of reassessment post-surgery. Further studies with larger sample size and using other psychosocial scales are needed to elucidate on the effectiveness of surgical intervention on psychosocial parameters in patients with GD.

Below are 17 studies that consist of literature reviews or guidelines that help advance knowledge about the effect of gender transition on transgender well-being. Click here to jump to the 4 studies that contain mixed or null findings on the effect of gender transition on transgender well-being. Click here Click here to jump to the 51 studies that found that gender transition improves the well-being of transgender people .

American psychological, 2015.

Guidelines for psychological practice with transgender and gender nonconforming people. (2015). American Psychologist, 70 (9), 832-864.

In 2015, the American Psychological Association adopted Guidelines for Psychological Practice with Transgender and Gender Nonconforming Clients in order to describe affirmative psychological practice with transgender and gender nonconforming (TGNC) clients. There are 16 guidelines in this document that guide TGNC-affirmative psychological practice across the lifespan, from TGNC children to older adults. The Guidelines are organized into five clusters: (a) foundational knowledge and awareness; (b) stigma, discrimination, and barriers to care; (c) lifespan development; (d) assessment, therapy, and intervention; and (e) research, education, and training. In addition, the guidelines provide attention to TGNC people across a range of gender and racial/ethnic identities. The psychological practice guidelines also attend to issues of research and how psychologists may address the many social inequities TGNC people experience.

Bockting et al., 2016

Bockting, W., Coleman, E., Deutsch, M. B., Guillamon, A., Meyer, W., et al. (2016). Adult development and quality of life of transgender and gender nonconforming people. Current Opinion in Endocrinology & Diabetes and Obesity , 23 (2), 188–197.

Purpose of review: Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research. Recent findings: Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking. Summary: Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.

Byne et al., 2012

Byne, W., Bradley, S.J., Coleman, E., et al. (2012). Report of the American Psychiatric Association task force on treatment of gender identity disorder. Archives of Sexual Behavior, 41 (4): 759–796.

Both the diagnosis and treatment of Gender Identity Disorder (GID) are controversial. Although linked, they are separate issues and the DSM does not evaluate treatments. The Board of Trustees (BOT) of the American Psychiatric Association (APA), therefore, formed a Task Force charged to perform a critical review of the literature on the treatment of GID at different ages, to assess the quality of evidence pertaining to treatment, and to prepare a report that included an opinion as to whether or not sufficient credible literature exists for development of treatment recommendations by the APA. The literature on treatment of gender dysphoria in individuals with disorders of sex development was also assessed. The completed report was accepted by the BOT on September 11, 2011. The quality of evidence pertaining to most aspects of treatment in all subgroups was determined to be low; however, areas of broad clinical consensus were identified and were deemed sufficient to support recommendations for treatment in all subgroups. With subjective improvement as the primary outcome measure, current evidence was judged sufficient to support recommendations for adults in the form of an evidence-based APA Practice Guideline with gaps in the empirical data supplemented by clinical consensus. The report recommends that the APA take steps beyond drafting treatment recommendations. These include issuing position statements to clarify the APA’s position regarding the medical necessity of treatments for GID, the ethical bounds of treatments of gender variant minors, and the rights of persons of any age who are gender variant, transgender or transsexual.

Carroll, 1999

Carroll, R. A. (1999). Outcomes of treatment for gender dysphoria. Journal of Sex Education and Therapy , 24 (3), 128–136.

This paper reviews the empirical research on the psychosocial outcomes of treatment for gender dysphoria. Recent research has highlighted the heterogeneity of transgendered experiences. There are four possible outcomes for patients who present with the dilemma of gender dysphoria: an unresolved outcome, acceptance of one’s given gender, engaging in a cross-gender role on a part-time basis, and making a full-time transition to the other gender role. Clinical work, but not empirical research, suggests that some individuals with gender dysphoria may come to accept their given gender role through psychological treatment. Many individuals find that it is psychologically sufficient to express the transgendered part of themselves through such activities as cross-dressing or gender blending. The large body of research on the outcome of gender reassignment surgery indicates that, for the majority of those who undergo this process, the outcome is positive. Predictors of a good outcome include good pre-reassignment psychological adjustment, family support, at least 1 year of living in the desired role, consistent use of hormones, psychological treatment, and good surgical outcomes. The outcome literature provides strong support for adherence to the Standards of Care of the Harry Benjamin International Gender Dysphoria Association. Implications to be drawn from this research include an appreciation of the diversity of transgendered experience, the need for more research on non-reassignment resolutions to gender dysphoria, and the importance of assisting the transgendered individual to identify the resolution that best suits him or her.

Cohen-Kettenis and Gooren, 1999

Cohen-Kettenis, P. T., & Gooren, L. J. G. (1999). Transsexualism: A review of etiology, diagnosis and treatment. Journal of Psychosomatic Research , 46 (4), 315-333.

Transsexualism is considered to be the extreme end of the spectrum of gender identity disorders characterized by, among other things, a pursuit of sex reassignment surgery (SRS). The origins of transsexualism are still largely unclear. A first indication of anatomic brain differences between transsexuals and nontranssexuals has been found. Also, certain parental (rearing) factors seem to be associated with transsexualism. Some contradictory findings regarding etiology, psychopathology and success of SRS seem to be related to the fact that certain subtypes of transsexuals follow different developmental routes. The observations that psychotherapy is not helpful in altering a crystallized cross-gender identity and that certain transsexuals do not show severe psychopathology has led clinicians to adopt sex reassignment as a treatment option. In many countries, transsexuals are now treated according to the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, a professional organization in the field of transsexualism. Research on postoperative functioning of transsexuals does not allow for unequivocal conclusions, but there is little doubt that sex reassignment substantially alleviates the suffering of transsexuals. However, SRS is no panacea. Psychotherapy may be needed to help transsexuals in adapting to the new situation or in dealing with issues that could not be addressed before treatment.

Coleman et al., 2012

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., et al. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism , 13 (4), 165-232.

The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.

Committee on Health Care for Underserved, 2011

Committee Opinion No. 512: Health Care for Transgender Individuals. (2011). Obstetrics & Gynecology , 118 (6), 1454–1458.

Transgender individuals face harassment, discrimination, and rejection within our society. Lack of awareness, knowledge, and sensitivity in health care communities eventually leads to inadequate access to, underutilization of, and disparities within the health care system for this population. Although the care for these patients is often managed by a specialty team, obstetrician–gynecologists should be prepared to assist or refer transgender individuals with routine treatment and screening as well as hormonal and surgical therapies. The American College of Obstetricians and Gynecologists opposes discrimination on the basis of gender identity and urges public and private health insurance plans to cover the treatment of gender identity disorder.

Costa and Colizzi, 2016

Costa, R., & Colizzi, M. (2016). The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: A systematic review. Neuropsychiatric Disease and Treatment , 12 , 1953-1966.

Cross-sex hormonal treatment represents a main aspect of gender dysphoria health care pathway. However, it is still debated whether this intervention translates into a better mental well-being for the individual and which mechanisms may underlie this association. Although sex reassignment surgery has been the subject of extensive investigation, few studies have specifically focused on hormonal treatment in recent years. Here, we systematically review all studies examining the effect of cross-sex hormonal treatment on mental health and well-being in gender dysphoria. Research tends to support the evidence that hormone therapy reduces symptoms of anxiety and dissociation, lowering perceived and social distress and improving quality of life and self-esteem in both male-to-female and female-to-male individuals. Instead, compared to female-to-male individuals, hormone-treated male-to-female individuals seem to benefit more in terms of a reduction in their body uneasiness and personality-related psychopathology and an amelioration of their emotional functioning. Less consistent findings support an association between hormonal treatment and other mental health-related dimensions. In particular, depression, global psychopathology, and psychosocial functioning difficulties appear to reduce only in some studies, while others do not suggest any improvement in these domains. Results from longitudinal studies support more consistently the association between hormonal treatment and improved mental health. On the contrary, a number of cross-sectional studies do not support this evidence. This review provides possible biological explanation vs psychological explanation (direct effect vs indirect effect) for the hormonal treatment-induced better mental well-being. In conclusion, this review indicates that gender dysphoria-related mental distress may benefit from hormonal treatment intervention, suggesting a transient reaction to the nonsatisfaction connected to the incongruent body image rather than a stable psychiatric comorbidity. In this perspective, timely hormonal treatment intervention represents a crucial issue in gender dysphoria individuals’ mental health-related outcome.

Dhejne et al., 2016

Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International Review Of Psychiatry , 28 (1), 44-57.

Studies investigating the prevalence of psychiatric disorders among trans individuals have identified elevated rates of psychopathology. Research has also provided conflicting psychiatric outcomes following gender-confirming medical interventions. This review identifies 38 cross-sectional and longitudinal studies describing prevalence rates of psychiatric disorders and psychiatric outcomes, pre- and post-gender-confirming medical interventions, for people with gender dysphoria. It indicates that, although the levels of psychopathology and psychiatric disorders in trans people attending services at the time of assessment are higher than in the cis population, they do improve following gender-confirming medical intervention, in many cases reaching normative values. The main Axis I psychiatric disorders were found to be depression and anxiety disorder. Other major psychiatric disorders, such as schizophrenia and bipolar disorder, were rare and were no more prevalent than in the general population. There was conflicting evidence regarding gender differences: some studies found higher psychopathology in trans women, while others found no differences between gender groups. Although many studies were methodologically weak, and included people at different stages of transition within the same cohort of patients, overall this review indicates that trans people attending transgender health-care services appear to have a higher risk of psychiatric morbidity (that improves following treatment), and thus confirms the vulnerability of this population.

Gijs and Brewaeys, 2007

Gijs, L., & Brewaeys, A. (2007). Surgical treatment of gender dysphoria in adults and adolescents: Recent developments, effectiveness, and challenges. Annual Review of Sex Research , 18 (1), 178-224.

In 1990 Green and Fleming concluded that sex reassignment surgery (SRS) is an effective treatment for transsexuality because it reduced gender dysphoria drastically. Since 1990, many new outcome studies have been published, raising the question as to whether the conclusion of Green and Fleming still holds. After describing terminological and conceptual developments related to the treatment of gender identity disorder (GID), follow-up studies, including both adults and adolescents, of the outcomes of SRS are reviewed. Special attention is paid to the effects of SRS on gender dysphoria, sexuality, and regret. Despite methodological shortcomings of many of the studies, we conclude that SRS is an effective treatment for transsexualism and the only treatment that has been evaluated empirically with large clinical case series.

Gooren, 2011

Gooren, L. J. (2011). Care of transsexual persons. New England Journal of Medicine , 364 (13), 1251–1257.

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. A healthy and successful 40-year-old man finds it increasingly difficult to live as a male. In childhood he preferred playing with girls and recalls feeling that he should have been one. Over time he has come to regard himself more and more as a female personality inhabiting a male body. After much agonizing, he has concluded that only sex reassignment can offer the peace of mind he craves. What would you advise? A healthy and successful 40-year-old man finds it increasingly difficult to live as a male. In childhood he preferred playing with girls and recalls feeling that he should have been one. Over time he has come to regard himself more and more as a female personality inhabiting a male body. After much agonizing, he has concluded that only sex reassignment can offer the peace of mind he craves. What would you advise?

Hembree et al., 2009

Hembree, W. C., Cohen-Kettenis, P., Delemarre-van de Waal, H. A., Gooren, L. J., Meyer, W., et al. (2009). Endocrine treatment of transsexual persons: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 94 (9), 3132–3154.

Objective: The aim was to formulate practice guidelines for endocrine treatment of transsexual persons. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence, which was low or very low. Consensus Process: Committees and members of The Endocrine Society, European Society of Endocrinology, European Society for Paediatric Endocrinology, Lawson Wilkins Pediatric Endocrine Society, and World Professional Association for Transgender Health commented on preliminary drafts of these guidelines. Conclusions: Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe, effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person’s genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person’s desired gender. A mental health professional (MHP) must recommend endocrine treatment and participate in ongoing care throughout the endocrine transition and decision for surgical sex reassignment. The endocrinologist must confirm the diagnostic criteria the MHP used to make these recommendations. Because a diagnosis of transsexualism in a prepubertal child cannot be made with certainty, we do not recommend endocrine treatment of prepubertal children. We recommend treating transsexual adolescents (Tanner stage 2) by suppressing puberty with GnRH analogues until age 16 years old, after which cross-sex hormones may be given. We suggest suppressing endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and monitoring for known risks in adult transsexual persons. Endocrine treatment of transsexual persons should include suppression of endogenous sex hormones, physiologic levels of gender-appropriate sex hormones, and suppression of puberty in adolescents (Tanner stage 2).

Michel et al., 2002

Michel, A., Ansseau, M., Legros, J., Pitchot, W., & Mormont, C. (2002). The transsexual: What about the future? European Psychiatry , 17 (6), 353-362.

Since the 1950s, sexual surgical reassignments have been frequently carried out. As this surgical therapeutic procedure is controversial, it seems important to explore the actual consequences of such an intervention and objectively evaluate its relevance. In this context, we have carried out a review of the literature. After looking at the methodological limitations of follow-up studies, the psychological, sexual, social, and professional futures of the individuals subject to a transsexual operation are presented. Finally, prognostic aspects are considered. In the literature, follow-up studies tend to show that surgical transformations have positive consequences for the subjects. In the majority of cases, transsexuals are very satisfied with their intervention and any difficulties experienced are often temporary and disappear within a year after the surgical transformation. Studies show that there is less than 1% of regrets, and a little more than 1% of suicides among operated subjects. The empirical research does not confirm the opinion that suicide is strongly associated with surgical transformation.

Murad et al., 2010

Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., & Montori, V. M. (2010). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology , 72 (2), 214-231.

Objective: To assess the prognosis of individuals with gender identity disorder (GID) receiving hormonal therapy as a part of sex reassignment in terms of quality of life and other self‐reported psychosocial outcomes. Methods: We searched electronic databases, bibliography of included studies and expert files. All study designs were included with no language restrictions. Reviewers working independently and in pairs selected studies using predetermined inclusion and exclusion criteria, extracted outcome and quality data. We used a random‐effects meta‐analysis to pool proportions and estimate the 95% confidence intervals (CIs). We estimated the proportion of between‐study heterogeneity not attributable to chance using the I2 statistic. Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male‐to‐female, 801 female‐to‐male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68–89%; 8 studies; I2 = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56–94%; 7 studies; I2 = 86%); 80% reported significant improvement in quality of life (95% CI = 72–88%; 16 studies; I2 = 78%); and 72% reported significant improvement in sexual function (95% CI = 60–81%; 15 studies; I2 = 78%). Conclusions: Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.

Reisner et al., 2016

Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., et al. (2016). Global health burden and needs of transgender populations: A review. The Lancet , 388 (10042), 412-436.

Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.

Schmidt and Levine, 2015

Schmidt, L., & Levine, R. (2015). Psychological Outcomes and Reproductive Issues Among Gender Dysphoric Individuals. Endocrinology and Metabolism Clinics of North America , 44 (4), 773-785.

Gender dysphoria is a condition in which a person experiences discrepancy between the natal anatomic sex and the gender he or she identifies with, resulting in internal distress and a desire to live as the preferred gender. There is increasing demand for treatment, which includes suppression of puberty, cross-sex hormone therapy, and sex reassignment surgery. This article reviews longitudinal outcome data evaluating psychological well-being and quality of life among transgender individuals who have undergone cross-sex hormone treatment or sex reassignment surgery. Proposed methodologies for diagnosis and initiation of treatment are discussed, and the effects of cross-sex hormones and sex reassignment surgery on future reproductive potential.

White Hughto and Reisner, 2016

White Hughto, J. M., & Reisner, S. L. (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health , 1 (1), 21–31.

Objectives: To review evidence from prospective cohort studies of the relationship between hormone therapy and changes in psychological functioning and quality of life in transgender individuals accessing hormone therapy over time. Data Sources: MEDLINE, PsycINFO, and PubMed were searched for relevant studies from inception to November 2014. Reference lists of included studies were hand searched. Results: Three uncontrolled prospective cohort studies, enrolling 247 transgender adults (180 male-to-female [MTF], 67 female-to-male [FTM]) initiating hormone therapy for the treatment of gender identity disorder (prior diagnostic term for gender dysphoria), were identified. The studies measured exposure to hormone therapy and subsequent changes in mental health (e.g., depression, anxiety) and quality of life outcomes at follow-up. Two studies showed a significant improvement in psychological functioning at 3–6 months and 12 months compared with baseline after initiating hormone therapy. The third study showed improvements in quality of life outcomes 12 months after initiating hormone therapy for FTM and MTF participants; however, only MTF participants showed a statistically significant increase in general quality of life after initiating hormone therapy. Conclusions: Hormone therapy interventions to improve the mental health and quality of life in transgender people with gender dysphoria have not been evaluated in controlled trials. Low quality evidence suggests that hormone therapy may lead to improvements in psychological functioning. Prospective controlled trials are needed to investigate the effects of hormone therapy on the mental health of transgender people.

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Library Resources for Transgender Topics

Types of resources, scholarly journals, specialized reference books, archives and special collections, datasets and statistics.

Scholarly journals include articles of original research, literature reviews, opinion pieces, book reviews, and more. Usually written by experts in the discipline for an academic audience, they are published periodically ( e.g. , annually, quarterly, or monthly). Scholarly journals are also called serials or periodicals. This list is not comprehensive. One may have to look for other relevant journals in related fields such as women’s studies, history, or psychology.

• International Journal of Transgenderism
• Journal of GLBT Family Studies
• Journal of LGBT Issues in Counseling
• Journal of LGBT Youth
• LGBT Law Notes
• Transgender Health
• Transgender Studies Quarterly

Selected titles include specialized reference works like encyclopedias, handbooks, or bibliographies that primarily focus on transgender topics. This list is not intended to be comprehensive.

• Encyclopedia of Gender and Society
• Handbook of Research with Lesbian, Gay, Bisexual, and Transgender Populations
• The Sage Encyclopedia of LGBTQ Studies
• Sexual orientation, gender identities, and the law: a research bibliography, 2006-2016
• Trans Bodies, Trans Selves: A Resource for the Transgender Community

Bibliographic databases, which are collections of references to published literature, may include journal articles, newspaper articles, conference proceedings, reports, government and legal publications, books, or other types of publications. This list of databases is not exhaustive, but is meant to highlight those most likely to include relevant published materials.

• CINAHL Ultimate (Nursing & Allied Health) Covers nursing and allied health journal articles, book chapters, and dissertations, as well as providing summarized evidence-based resources such as care sheets and quick lessons.
• GenderWatch Search articles from journals, etc. that focus on how gender impacts a broad spectrum of subject areas such as the women's movement, men's studies, the transgender community and the changes in gender roles.
• LGBTQ+ Source LGBTQ+ Source contains indexing, abstracts, amd select full text for LGBTQ+ specific core periodicals. Books, newsletters, case studies, dissertations, and core primary sources are also represented. LGBTQ+ Source content is largely unique from other databases, and it includes indexing from its own LGBTQ+ focused thesaurus.
• Left Index Find left-leaning literature on topics including politics, economics, the labor movement, ecology and environment, women's studies, race and ethnicity, social and cultural theory, sociology, art and aesthetics, philosophy, history, education, law, and globalization.
• MEDLINE (Ovid) Searches MEDLINE, which is the primary source of journal articles for the health sciences (fields of medicine, nursing, dentistry, veterinary medicine, public health, health care systems, and basic sciences). Ovid MEDLINE is optimized for advanced literature searches. Coverage is from the 1940s to the present.
• APA PsycInfo Find articles in thousands of psychology journals, from 1806 to current. View this tutorial to learn how to go from a general idea to a very precise set of results of journal articles and scholarly materials.
• PubMed Searches MEDLINE, which is the primary source of journal articles for the health sciences (fields of medicine, nursing, dentistry, veterinary medicine, public health, health care systems, and basic sciences). Coverage is from the 1940s to the present. View this tutorial to learn how to go from a general idea to a very precise set of results of journal articles and scholarly materials.
• WestlawNext Campus Research (Law) WestlawNext Campus Research provides access to legal materials, including cases, statutes, and regulations of the U.S. government and the various state governments. It includes law journals, the American Jurisprudence encyclopedia, the American Law Reports, and news content.
• Women's Studies International This database is a compilation of ten databases covering journal articles, books, anthology chapters, and reports for feminist writings from 1972 to the present.

Archives and special collections refer to groups of unique or rare materials, often focused around a single topic or from a single source. Items in archives and special collections cannot be borrowed and are viewed instead on site or digitally. In this guide, we include only collections/archives with dedicated focus on transgender topics, or LGBTQIA+ with transgender specific sections (unless a particular general collection/archive has an overwhelming abundance of material, warranting an exception).

• Digital Transgender Archive
• The Labadie Collection's Materials for the Study of Trans History (University of Michigan)
• Lili Elbe Digital Archive
• Louise Lawrence Transgender Archive
• Milwaukee Transgender Oral History Project
• Museum of Trans Hirstory & Art (MOTHA)
• NYC Trans Oral History Project
• The Transgender Oral History Project of Iowa (TOPI)
• Tretter Transgender Oral Histories
• University of Victoria Transgender Archives

It is not entirely possible to separate trans collections from LGBTQIA+ ones. In the following section, you will find more expansive collections that include content relevant to research on trans topics.

• Lavender Legacies Guide: Lesbian and Gay Archives Roundtable Guide to Sources in North America
• The Black Lesbian Gay Bisexual Transgender Cultural Archive
• Duke University Libraries’ LGBT Studies Primary Sources
• Lesbian and Gay Newsmedia Archive (London) Materials in the "transgender topics clippings" subject section
• LGBTQ History Digital Collaboratory
• The Pittsburgh Queer History Project
• The Queer Archive for Memory Reflection (Bangalore, India)
• The Queer Zine Archive Project

Datasets consist of individual data points or input collected ( e.g. , individuals’ reported alcohol use and gender identity). Statistics are the result of analysis done on data or datasets ( e.g. , percentage of transgender teenagers who have high alcohol usage). This list i ncludes datasets/statistics that have specific data about trans populations or transgender topics. There are many other datasets/statistics/surveys ( e.g. , hate crime or homeless populations) that are not trans-specific, but likely contain trans people; these are not listed below but would have relevance to this area. However, we do point to broad repositories and resources that include these types of datasets and statistics.

• 2021 Canadian Census of Population Beginning in 2021, the precision of "at birth" was added to the sex question on the census questionnaire, and a new question on gender was included. As a result, the historical continuity of information on sex was maintained while allowing all cisgender, transgender and non-binary individuals to report their gender.
• Behavioral Risk Factor Surveillance System (BRFSS) Some states collect sexual identity data on the BRFSS at their own expense - you must contact the state coordinator to inquire about the data.
• Minnesota Student Survey This voluntary survey asks students about their activities, opinions, behaviors and experiences, including a few questions related to transgender identity. Students respond to questions on school climate, bullying, out-of-school activities, health and nutrition, emotional and mental health, relationships, substance use and more. Questions about sexual behaviors are asked only of ninth- and 11th-grade students. All responses are anonymous.
• National Transgender Discrimination Survey 2011 precursor to the US Transgender Survey. It was the biggest study of transgender populations at the time it was conducted. Includes interviews with over 6,400 transgender and gender non-conforming people.
• Registry: Clinical Trials with Transgender Persons National Institutes of Health Clinical Trials Registry. This is a curated list of trials with transgender persons.
• Repository: Dryad There are datasets in Dryad tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category. As of Spring 2019, Dryad contains one dataset tagged with the term transgender.
• Repository: FigShare There are many datasets in FigShare tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category.
• Repository: Harvard Dataverse There are many datasets in Harvard Dataverse tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category.
• Repository: ICPSR There are many datasets in ICPSR tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category.
• Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-12-Update Data on the number of transgender inmates assaulted in US prisons.
• Social Justice Sexuality Project The Social Justice Sexuality Project is one of the largest ever national surveys of Black, Latinx, and Asian and Pacific Islander, and multiracial LGBTQIA+ people. With over 5,000 respondents, the final sample includes respondents from all 50 states; Washington, DC, and Puerto Rico.
• TransPop The TransPop study (2016-2018) is the first national probability sample of transgender individuals in the United States (it also includes a comparative cisgender sample). A primary goal of this study was to provide researchers with a representative sample of transgender people in the United States. The study examines a variety of health-relevant domains including health outcomes and health behaviors, experiences with interpersonal and institutional discrimination, identity, transition-related experiences, and basic demographic characteristics (age, race/ethnicity, religion, political party affiliation, marital status, employment, income, location, sex, gender, and education).
• U.S. Transgender Survey The 2015 U.S. Transgender Survey (USTS) is the largest survey ever devoted to the lives and experiences of transgender people, with 27,715 respondents across the United States. The USTS was conducted by the National Center for Transgender Equality in the summer of 2015, and the results provide a detailed look at the experiences of transgender people across a wide range of areas, such as education, employment, family life, health, housing, and interactions with police and prisons.
• Unerased: Counting Transgender Lives Database of transgender homicides from 2010-2018. Click on the Database heading and then anywhere on the page to access the database. Mic is a news media company publishing stories focused on millennials and policy analysis.
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TOP 100 Gender Equality Essay Topics

Table of Contents

Need ideas for argumentative essay on gender inequality? We’ve got a bunch!

… But let’s start off with a brief intro.

What is gender equality?

Equality between the sexes is a huge part of basic human rights. It means that men and women have the same opportunities to fulfil their potential in all spheres of life.

Today, we still face inequality issues as there is a persistent gap in access to opportunities for men and women.

Women have less access to decision-making and higher education. They constantly face obstacles at the workplace and have greater safety risks. Maintaining equal rights for both sexes is critical for meeting a wide range of goals in global development.

Inequality between the sexes is an interesting area to study so high school, college, and university students are often assigned to write essays on gender topics.

In this article, we are going to discuss the key peculiarities of gender equality essay. Besides, we have created a list of the best essay topic ideas.

What is the specifics of gender equality essay?

Equality and inequality between the sexes are important historical and current social issues which impact the way students and their families live. They are common topics for college papers in psychology, sociology, gender studies.

When writing an essay on equality between the sexes, you need to argue for a strong point of view and support your argument with relevant evidence gathered from multiple sources.

But first, you’d need to choose a good topic which is neither too broad nor too narrow to research.

Research is crucial for the success of your essay because you should develop a strong argument based on an in-depth study of various scholarly sources.

Equality between sexes is a complex problem. You have to consider different aspects and controversial points of view on specific issues, show your ability to think critically, develop a strong thesis statement, and build a logical argument, which can make a great impression on your audience.

If you are looking for interesting gender equality essay topics, here you will find a great list of 100 topic ideas for writing essays and research papers on gender issues in contemporary society.

Should you find that some topics are too broad, feel free to narrow them down.

Powerful gender equality essay topics

Here are the top 25 hottest topics for your argumentative opinion paper on gender issues.

Whether you are searching for original creative ideas for gender equality in sports essay or need inspiration for gender equality in education essay, we’ve got you covered.

Use imagination and creativity to demonstrate your approach.

• Analyze gender-based violence in different countries
• Compare wage gap between the sexes in different countries
• Explain the purpose of gender mainstreaming
• Implications of sex differences in the human brain
• How can we teach boys and girls that they have equal rights?
• Discuss gender-neutral management practices
• Promotion of equal opportunities for men and women in sports
• What does it mean to be transgender?
• Discuss the empowerment of women
• Why is gender-blindness a problem for women?
• Why are girls at greater risk of sexual violence and exploitation?
• Women as victims of human trafficking
• Analyze the glass ceiling in management
• Impact of ideology in determining relations between sexes
• Obstacles that prevent girls from getting quality education in African countries
• Why are so few women in STEM?
• Major challenges women face at the workplace
• How do women in sport fight for equality?
• Women, sports, and media institutions
• Contribution of women in the development of the world economy
• Role of gender diversity in innovation and scientific discovery
• What can be done to make cities safer for women and girls?
• International trends in women’s empowerment
• Role of schools in teaching children behaviours considered appropriate for their sex
• Feminism on social relations uniting women and men as groups

Gender roles essay topics

We can measure the equality of men and women by looking at how both sexes are represented in a range of different roles. You don’t have to do extensive and tiresome research to come up with gender roles essay topics, as we have already done it for you.

Have a look at this short list of top-notch topic ideas .

• Are paternity and maternity leaves equally important for babies?
• Imagine women-dominated society and describe it
• Sex roles in contemporary western societies
• Compare theories of gender development
• Adoption of sex-role stereotyped behaviours
• What steps should be taken to achieve gender-parity in parenting?
• What is gender identity?
• Emotional differences between men and women
• Issues modern feminism faces
• Sexual orientation and gender identity
• Benefits of investing in girls’ education
• Patriarchal attitudes and stereotypes in family relationships
• Toys and games of girls and boys
• Roles of men and women in politics
• Compare career opportunities for both sexes in the military
• Women in the US military
• Academic careers and sex equity
• Should men play larger roles in childcare?
• Impact of an ageing population on women’s economic welfare
• Historical determinants of contemporary differences in sex roles
• Gender-related issues in gaming
• Culture and sex-role stereotypes in advertisements
• What are feminine traits?
• Sex role theory in sociology
• Causes of sex differences and similarities in behaviour

Gender inequality research paper topics

Examples of inequality can be found in the everyday life of different women in many countries across the globe. Our gender inequality research paper topics are devoted to different issues that display discrimination of women throughout the world.

Choose any topic you like, research it, brainstorm ideas, and create a detailed gender inequality essay outline before you start working on your first draft.

Start off with making a debatable thesis, then write an engaging introduction, convincing main body, and strong conclusion for gender inequality essay .

• Aspects of sex discrimination
• Main indications of inequality between the sexes
• Causes of sex discrimination
• Inferior role of women in the relationships
• Sex differences in education
• Can education solve issues of inequality between the sexes?
• Impact of discrimination on early childhood development
• Why do women have limited professional opportunities in sports?
• Gender discrimination in sports
• Lack of women having leadership roles
• Inequality between the sexes in work-family balance
• Top factors that impact inequality at a workplace
• What can governments do to close the gender gap at work?
• Sex discrimination in human resource processes and practices
• Gender inequality in work organizations
• Factors causing inequality between men and women in developing countries
• Work-home conflict as a symptom of inequality between men and women
• Why are mothers less wealthy than women without children?
• Forms of sex discrimination in a contemporary society
• Sex discrimination in the classroom
• Justification of inequality in American history
• Origins of sex discrimination
• Motherhood and segregation in labour markets
• Sex discrimination in marriage
• Can technology reduce sex discrimination?

Most controversial gender topics

Need a good controversial topic for gender stereotypes essay? Here are some popular debatable topics concerning various gender problems people face nowadays.

They are discussed in scientific studies, newspaper articles, and social media posts. If you choose any of them, you will need to perform in-depth research to prepare an impressive piece of writing.

• How do gender misconceptions impact behaviour?
• Most common outdated sex-role stereotypes
• How does gay marriage influence straight marriage?
• Explain the role of sexuality in sex-role stereotyping
• Role of media in breaking sex-role stereotypes
• Discuss the dual approach to equality between men and women
• Are women better than men or are they equal?
• Sex-role stereotypes at a workplace
• Racial variations in gender-related attitudes
• Role of feminism in creating the alternative culture for women
• Feminism and transgender theory
• Gender stereotypes in science and education
• Are sex roles important for society?
• Future of gender norms
• How can we make a better world for women?
• Are men the weaker sex?
• Beauty pageants and women’s empowerment
• Are women better communicators?
• What are the origins of sexual orientation?
• Should prostitution be legal?
• Pros and cons of being a feminist
• Advantages and disadvantages of being a woman
• Can movies defy gender stereotypes?
• Sexuality and politics

Feel free to use these powerful topic ideas for writing a good college-level gender equality essay or as a starting point for your study.

No time to do decent research and write your top-notch paper? No big deal! Choose any topic from our list and let a pro write the essay for you!

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• v.4(1); 2019

Documenting Research with Transgender, Nonbinary, and Other Gender Diverse (Trans) Individuals and Communities: Introducing the Global Trans Research Evidence Map

Zack marshall.

1 School of Social Work, Faculty of Arts, McGill University, Montreal, Canada.

2 Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Canada.

Vivian Welch

3 Bruyère Research Institute, Ottawa, Canada.

4 School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.

Michelle Swab

5 Health Sciences Library, Faculty of Medicine, Memorial University, St. John's, Canada.

Fern Brunger

Chris kaposy, associated data.

There is limited information about how transgender, nonbinary, and other gender diverse (trans) people have been studied and represented by researchers. The objectives of this study were to: (1) increase access to trans research; (2) map and describe trans research across subject fields; and (3) identify evidence gaps and opportunities for more responsible research. Eligibility criteria were established to include empirical research of any design, which included trans participants or their personal information and that was published in English in peer-reviewed journals. A search of 15 academic databases resulted in 25,230 references; data presented include 690 trans-focused articles that met the screening criteria and were published between 2010 and 2014. The 10 topics studied most frequently were: (1) therapeutics and surgeries; (2) gender identity and expression; (3) mental health; (4) biology and physiology; (5) discrimination and marginalization; (6) physical health; (7) sexual health, HIV, and sexually transmitted infections; (8) health and mental health services; (9) social support, relationships, and families; and (10) resilience, well-being, and quality of life. This map also highlights the relatively minor attention that has been paid to a number of study topics, including ethnicity, culture, race, and racialization; housing; income; employment; and space and place. Results of this review have the potential to increase awareness of existing trans research, to characterize evidence gaps, and to inform strategic research prioritization. With this information, it is more likely that trans communities and allies will be in a position to benefit from existing research and to hold researchers accountable.

Introduction

Systematic review methodologies, including scoping reviews and evidence maps, provide an opportunity to study detailed aspects of knowledge production, including what topics are researched, who tends to be studied, what types of methods are used, and how people interact with the products of research. In this way, reviews turn the focus of attention toward the research process and researchers themselves, uncovering new information and increasing the visibility of diverse fields of study.

The aim of this review is to map and describe how transgender, nonbinary, and other gender diverse (trans) people have been studied and represented within and across research in the fields of social sciences, humanities, health, sciences, business, and education. The term “trans” refers to people who “do not conform to prevailing expectations about gender” (Terminology section, para. 1) 1 and includes transgender, transsexual, and other gender diverse people of all ages. In contrast, the term cisgender refers to people who identify with the gender they were labeled at birth. 2 While trans is a self-identification, it also relates to a psychiatric diagnosis. 3 Transsexual and transgender people diagnosed with gender identity disorder or gender dysphoria have been the subjects of medical and psychiatric research and are described in clinical and social science literature. In this review of trans research, we have opted for a broad trans conceptualization 4 that incorporates diverse gender identities and expressions across global contexts. This includes transgender and transsexual people as well as drag queens, butch femmes, Two-Spirit people, hijra, travesti, cross-dressers, and additional nonbinary and gender diverse identities and expressions.

Knowledge about the scope of research focusing on trans individuals and communities is incomplete. Because many people are unaware of the extent of research that has been carried out, this leads to miscommunication and misinterpretations. Such misunderstandings may be particularly troublesome if trans community members are not aware of existing research evidence related to the questions they have about their lives. Systematic research detailing the nature of studies that have been conducted provides new insights into the evidence that does exist and can aid in identifying opportunities for more responsible research 5 with trans individuals and communities.

Multiple challenges constrain our ability to conduct reviews in the field of trans research. The first relates to the language used to describe transgender and nonbinary people and the ways this impacts search strategies. Terminology to describe gender diverse people differs across stakeholder communities, including language used within communities, medical diagnoses, and phrases distinct to linguistic or cross-cultural groups. As this language develops over time, 6 it adds to the diversity of terms that should be incorporated into effective search strategies. A second barrier relates to indexed subject headings, both in terms of their inability to remain up to date, and the ways these headings reflect the spectrum of trans experience. 7 These complications require searches that go beyond subject headings, a process that is made more convoluted because it is difficult to search terms such as “trans” or “gender identity” by themselves due to the lack of specificity of these terms and the consequent number of extraneous results this produces. Search strategies also need to include database-specific headings and independent search terms such as vaginoplasty or mastectomy that may be germane to both cisgender and transgender experiences. Once searches are complete, screening is impacted by problems identifying whether the study includes any trans participants, or whether the research is trans focused, due to incomplete and/or unclear information in the title and abstract. For example, these difficulties arise when reviewing references that include trans participants within larger studies with lesbian, gay, bisexual, trans, Two-Spirit, and queer (LGBT2Q) communities, and surgery-related case reports. In their recent systematic review of gaps and opportunities in primary care preventative health services for trans people, Edmiston et al. 8 reported similar challenges.

Despite these circumstances, some researchers have attempted to increase awareness of the types of trans research available. One of the earliest examples was published by Denny as an annotated bibliography in 1994, 9 including a classification of books, articles, and community reports. Since then, the number of systematic reviews has slowly increased. Primarily health focused, 10 researchers have conducted trans-focused reviews related to mental health, 11 gender dysphoria, 12 learning disabilities, 13 aging, 14 cancer care, 15 and HIV. 16 More commonly, trans research is included as part of larger reviews centering men who have sex with men (MSM), LGBT2Q communities, or other marginalized populations. 17 , 18

Combining a comprehensive search strategy, text mining, and evidence map, this investigation has the potential to enhance knowledge in several fields. There are currently no evidence maps of trans research. By documenting this broad field of study, this review will enhance awareness of existing trans research, highlight evidence gaps, and inform strategic research prioritization. 19 Publishing the map online will also expand access to research for key stakeholders, including community members, policymakers, and health care providers.

Materials and Methods

Evidence maps are an emerging research method 20 to “collate, describe, and catalog” knowledge across a broad field of study. 21 This information can then be leveraged by stakeholders to inform policy and clinical decision-making. 21 This evidence map was developed using the four-step framework introduced by Hetrick et al. 22 : identify objectives, describe characteristics to be mapped and eligibility criteria, screen the literature, and chart the study within the map. The protocol for this evidence map was previously published 23 in agreement with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). 24

Aim and objectives

The aim of this study was to map and describe how trans people have been studied and represented within and across multiple fields of research. The objectives were to

• (1) increase access to research that includes trans people for community members, health care providers, and policymakers by establishing an online evidence map, including a searchable reference database;
• (2) document trans research in the fields of social sciences, health, sciences, education, humanities, and business, including information about sample demographics, study topic, and study design; and
• (3) characterize evidence gaps and opportunities for more responsible research with trans individuals and communities.

Eligibility criteria

It is suggested that researchers clarify concepts and engage key stakeholders as part of the process of developing evidence maps. 25 Accordingly, one-on-one consultations were held with members of trans and cisgender communities to discuss search scope, terminology, and possible uses of an evidence map. Based on the results of pilot searches and consultations, the eligibility criteria were established to include empirical research studies of any design with human participants, which identifiably included trans people or their personal information, and were reported in English in peer-reviewed journals.

Information sources

The identification of academic databases was informed by the larger goal of locating trans research from multiple fields. A secondary emphasis was to gather research on a global scale. For example, to appropriately identify research related to gender diverse Indigenous people, three databases focused on Indigenous and First Nations research were included.

Fifteen databases were selected to ensure diverse study design identification, 26 including Academic Search Premier, Anthropology Plus, Bibliography of Native North Americans, CINAHL, First Nations Periodical Index, Indigenous Studies Portal, LILACS, ProQuest Social Sciences Premium (contains ERIC, Social Services Abstracts & Applied Social Sciences Index and Abstracts, and Sociological Abstracts,), PsycINFO, PubMed, SciELO, Scopus, Social Work Abstracts, Web of Science, and Women's Studies International.

Search strategy

Search terms concentrated on transgender, non-binary, and other gender diverse experiences and identities. Because there are multiple terms used for (and/or by) trans people, and this language continues to evolve over time, 6 the full list of search terms was wide-ranging and comprised terms linked to gender identity (e.g., “trans woman”), diagnoses (e.g., “gender dysphoria” and “gender identity disorder”), therapeutics and surgical procedures (e.g., facial feminization), language that was used historically (e.g., transvestite), and words used in a range of cultures and countries (e.g., waria, travesti, Two-Spirit, and hijra). A sample search strategy for one academic database is provided in Supplementary Data S1 .

Data management

A health sciences librarian reviewed the draft search. Pilot searches were conducted in January 2015 in all 15 databases for each search string to ensure that the search was specific, but not overly sensitive. Full searches were then carried out between January 25 and February 22, 2015. Searches resulted in a total of 63,004 references ( Table 1 ). After eliminating duplicates, the total number of references included in the review was 25,230 ( Fig. 1 ).

PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis.

Search Results

Selection process

Screening on title and abstract.

The first author developed the initial approach to screening and 2 reviewers conducted a pilot review of a random sample of 100 references. This was followed by a follow-up review of a random sample of ∼10% of the dataset (2,393 references). Differences were reconciled through discussion and clarification, leading to a refinement of the eligibility criteria. After this, references were randomly allocated into groups of 1,000. Two reviewers screened the first two groups, reconciling differences through dialogue and discussion.

Reference screening was conducted based on the content of the title and abstract (level 1). Studies were excluded if they were not written in English, if they were not empirical research, if they did not include humans, or if they included only cisgender heterosexual people or people diagnosed with disorders of sex development (DSD; sometimes referred to as intersex people). If a reference was not excluded at level 1, the article was uploaded so that the full text could be reviewed (level 2). Any reference with no abstract was automatically screened on full text.

Whether there were any trans participants included in studies was often not clear from the abstracts. For example, in research with a diversity of LGBT2Q participants, authors might have presented the total number of participants in the abstract, or the study may have included trans participants, but they were not necessarily mentioned at this level. Early in the screening process, it became clear that many disagreements between reviewers were linked to a lack of specificity about sample characteristics in the abstract. As a result, it was necessary to automatically include references with LGBT2Q or MSM samples for screening on full text. In addition, due to the connections between HIV, sex work, and trans populations, all references that mentioned sex workers or people living with HIV as participants were automatically screened on full text. Lack of specificity was also a challenge with some clinical case studies. As a result, any study that mentioned trans-specific surgeries or therapeutics was automatically included. Finally, due to diversity within the general population, any study with a sample size over 1,000 was included. The rationale for this was to verify in the full-text article whether surveys included demographic questions inclusive of trans identities, and whether any trans participant had self-identified.

Screening on full text

For full-text screening, two team members reviewed each reference, and any difference was reconciled through discussion. The goal of level 2 screening was to identify original research that included trans participants or their personal information. In addition, at this level, we identified three different types of studies: trans focused, LGBT2Q/MSM, and mixed. Trans-focused studies included those with only trans participants as well as those with a cisgender control group. LGBT2Q/MSM studies were studies that included trans people as part of larger studies with sexual and gender diverse participants. Mixed studies were those with both cisgender and trans participants. In addition, studies with photographs were also flagged at this level of screening. The purpose of identifying this information at level 2 was to support data extraction. The evidence map presented in this study included only trans-focused studies.

Data items for mapping

Data extraction focused on developing an evidence map that emphasized the distribution and extent 27 of trans research studies. The following information was collected for mapping: year of publication, study topic, study design, trans sample demographics, data sources, geographic location of data collection, and open access availability. This article focuses on data related to study topic and study design.

Data analysis

Study topics.

To develop a list of study topics for the map, the team started with the social determinants of health 28 and frameworks that incorporate both structural health perspectives and individual health behaviors. Models by Ansari et al. 29 and Brennan Ramirez et al. 30 inspired early conceptualizations of topic areas. After piloting, additional subjects were added to the map that helped to expand the coding framework beyond a health focus. New topics that were added included the following: arts and creativity; sex work; resilience, well-being and quality of life; and resistance and activism.

In the first phase of data extraction, one reviewer went through each reference to identify key study topics. In coding for study topic, we focused on the stated purpose as identified by the study author(s). While there was no set limit to the number of study topics that could be selected, we aimed for a range of two to four study topics per reference. In the next phase, a second team member reviewed groups of references by study topic. For example, all references within the study topic of aging or physical health were verified for consistency and topic cohesion. In this phase, some of the more traditional social determinant topics were also renamed to better communicate the subject matter included in that category. For example, natural built environments were reconceptualized as space and place.

In this phase, the second reviewer also conducted word searches within the set of included studies to verify that no relevant references had been excluded. For example, in searching for articles about aging, the dataset was searched for any reference that included relevant search terms such as “age,” “aging,” “elder,” “senior,” and “old” in the title and/or abstract. This not only produced larger sets of references for checking but also helped to ensure that studies relevant to each topic were captured within the map.

Study design

Because this review included a broad range of quantitative, qualitative, and clinical study types, it was not possible to use an existing evidence-based categorization scheme. As a result, two of the coauthors developed a coding framework, including the following options: (1) systematic review of randomized controlled trials; (2) randomized controlled trial; (3) nonrandomized controlled trial; (4) case–control study; (5) cohort study; (6) systematic review of descriptive or qualitative studies; (7) cross-sectional study; (8) qualitative study with interviews or focus groups; (9) ethnography or phenomenological qualitative study; (10) historical research; (11) case report, case study, or case series; (12) autoethnography; (13) basic science; and (14) community-based research or other forms of participatory research.

Clear definitions of each study design were identified using the following sources: systematic reviews, 31 case–control, cohort, and cross-sectional studies, 32–34 case studies, 35 and case reports and case series. 36 To be categorized as a systematic review, studies needed to include a clear search strategy or method to identify studies, and to explicitly state their methods of study selection. Because there are limited systematic reviews in the field of trans studies and this evidence map aimed for broad inclusion, we did not require the third criteria from the PRISMA-P definition of a systematic review (explicitly described methods of synthesis) 31 in order for studies to be included.

One reviewer extracted information about study design and data collection methods from all trans-focused studies. A second reviewer verified the first 10% of the data extraction. After clarifying any difference in coding, additional questions about how to code particular studies were discussed with a third member of the study team. Based on this information reviewer, two checked the references within each study design, grouping for accuracy and consistency.

A total of 25,230 references were screened based on title and abstract content (level 1). Around 14,579 references were excluded for the following reasons: 8,133 based on study design, 2,926 were not in English, 1,608 because they gave no indication that trans people had been participants, 794 did not include human participants (i.e., they were based on animal models or relied on documents for analysis), 723 were articles about surgery that did not suggest trans participation, and 395 focused on intersex or DSD experience. A total of 6,915 references met the inclusion criteria based on title and abstract, and an additional 3,736 were included based on no abstract being available ( Fig. 1 ).

A total of 10,651 references were eligible for screening on full text. Due to resource constraints, the decision was made to focus the first version of the evidence map on the most recent 5-year period. As a result, 3,533 references published between 2010 and 2014 were screened on full text.

A total of 1,667 articles met the inclusion criteria. Six hundred ninety articles were trans focused, 462 included LGBT2Q and/or MSM participants, and 515 included mixed samples. A total of 1,866 studies were excluded based on the following criteria: not empirical research (787 references); no trans participants (552 references); LGB or MSM, but explicitly no trans participants (273 references); no human participants (96 references); not written in English (62 references); book reviews (52 references); not journal articles (19 references); case summary or composite only (14 references); or focused on intersex participants or people diagnosed with DSD (11 references).

The 690 trans-focused articles form the basis of the remaining data analysis for this article (see Supplementary Data S2 for a full list of the trans-focused references). Data on study topics and study design are the focus of the next section, and are summarized in Supplementary Data S3 . Combining data about topic and study design provides additional insights into how researchers have chosen to explore trans research topics, including information about areas of overemphasis and underemphasis, topics that could benefit from knowledge synthesis, and areas that need further attention.

The map included a total of 37 study topics ( Table 2 ). The top 10 study topics were as follows: (1) therapeutics and surgeries; (2) gender identity and expression; (3) mental health; (4) biology and physiology; (5) discrimination and marginalization; (6) physical health; (7) sexual health, HIV, and sexually transmitted infections (STIs); (8) health and mental health services; (9) social support, relationships, and families; and, (10) resilience, well-being, and quality of life ( Fig. 2 ).

Top 10 study topics.

Summary Table of Study Topics and Frequencies

STIs, sexually transmitted infections.

Therapeutics and surgeries

The number one topic area was therapeutics and surgeries, with 224 references. This study topic included gender-affirming processes and procedures such as cross-gender hormone treatment, feminizing or masculinizing procedures such as facial feminization surgery, silicone injection, or electrolysis/laser hair removal, and studies focusing on gender-affirming surgeries such as orchiectomy and vaginoplasty, chest reconstruction, hysterectomy, and phalloplasty. Also included in this category were studies that detailed surgical procedures and outcomes, research and case reports describing side effects of therapeutics or surgeries, and studies exploring levels of satisfaction with gender-affirming medical therapeutics or procedures.

Gender identity and expression

Gender identity and expression was the second most common study topic with 203 references. While it was not surprising that a trans research evidence map would include a large number of studies focused on gender identity, efforts were made to clearly distinguish this topic area so that it did not include all studies in the review. Areas of focus included the following: the experience of gender identity, including trans gender identity development; nonbinary and other gender diverse identities; gender dysphoria; gender identity disclosure; medical and social transition; and gender identity assessment and diagnosis.

Mental health

Mental health was the third most common study topic with 124 references. This included diagnoses and/or experiences of depression, anxiety, suicide, and other co-occurring mental health diagnoses. This category also included studies documenting the interaction between discrimination, structural oppression, and mental health, and the medicalization and pathologization of gender identity.

Biology and physiology

Including 106 studies, the category of biology and physiology includes research at the cellular level, neurological research, bone density studies, and genetic and chromosomal research. In some cases, these studies explored the impacts of medical transition on the physical body. In others, researchers were attempting to identify the etiology of trans gender identity through twin studies, handedness, and measures of cortical thickness.

Discrimination and marginalization

There were a total of 99 articles on the topic of discrimination and marginalization. This included studies about different aspects of discrimination such as harassment, bullying, microaggressions, cisgenderism, transphobia, and other forms of oppression. In addition, this topic included research on the topic of social exclusion, stigma, and marginalization. This topic was distinct from violence and trauma, a subject area that included 47 studies. Verbal abuse, physical abuse, and any other form of violence or trauma were included in the latter category.

Physical health

The area of physical health had 97 studies, including research related to diabetes, cancer, eating disorders, granulomas, meningiomas, and cardiovascular disease. Some studies explored the link between trans-related therapeutics and longer term health, where others documented complications as a result of surgeries or other medical procedures. Physical health as a study topic was distinct from side effects and impacts of therapeutics and surgeries, and there was little overlap between these two areas of the map. Short-term impacts or complications from surgeries such as chest reconstruction or vaginoplasty were coded within the area of therapeutics and surgeries, whereas longer term health impacts that needed their own intervention were classified under the area of physical health.

Sexual health, HIV, and STIs

The category of sexual health, HIV, and STIs included 97 studies about sexual behaviors, and HIV and other STIs. The HIV and STI literature included articles linked to testing, treatment and treatment adherence, transmission, and co-infection, as well as literature that connected HIV and STIs to broader syndemic factors. Sexual health literature included studies about sexual behaviors, communication and negotiation of safer sex behavior, and research related to sexual risk factors. Sexual health was differentiated from the study topic of sexuality, which included 52 references and referred more specifically to sexual attraction and sexual identity.

Health and mental health services

Health and mental health services was a relatively large area of the map, including 89 references. These studies investigated barriers and access to health and/or mental health services, experiences with mental health services, discrimination in health care, patient satisfaction, studies of interactions between patients and providers from the trans person's perspective, waitlists, cost-effectiveness, and models of care. This research also explored the impact of barriers to health services on health and mental health.

Social support, relationships, and families

Social support, relationships, and families included 70 references. This element of the map included references related to social support and communities, relationships with friends and family, as well as romantic and/or sexual relationships. Social support has been measured and investigated as a factor in relation to health incorporating mental health, physical health, and sexual health. In addition, there were a number of articles related to family support, including family responses to trans children, siblings, or parents.

Resilience, well-being, and quality of life

The review included 61 articles on the topic of resilience, well-being, and quality of life. In these strength-based articles, researchers often explored alternate, nonpathologizing conceptualizations of trans lives, including experiences of hope, resilience, and community support.

Of the 37 study topics that we categorized, the top 10 most common (listed above), each included at least 50 references. In the mid-range (i.e., between the top 10 and the bottom 10), categories included the following: sexuality; ethnicity, culture, race, and racialization; violence and trauma; early life experiences; resistance and politicization; therapeutic process; intersectionalities * ; space and place; education; law and criminalization (crime, prisons, incarceration, and policing); research methods; employment; arts and creativity; sex work; substance use; and parenting, reproduction, and assisted reproduction. The bottom 10 topics in the map all included less than 15 references. These were as follows: disability; age and aging; historical perspectives; religion and spirituality; ethics; income; sports and physical activity; housing; Indigeneity; and migration and refugee experiences ( Fig. 3 ).

Bottom 10 study topics.

Exploring the intersections between study topic and study design

Of the 690 studies in the review, the emphasis was on observational research. Less than 2% were experimental. The frequency of study design across the trans-focused dataset was: (1) cross-sectional studies (250 references); (2) case reports, case studies, and case series (182 references); (3) qualitative study with interviews or focus groups (99 references); (4) cohort studies (56 references); (5) ethnographies or phenomenological studies (37 references); (6) basic science (23 references); (7) systematic reviews of descriptive or qualitative studies (20 references); (8) community-based research or other participatory research (15 references), (9) autoethnographies (8 references); (10) case–control studies (7 references); (11) nonrandomized controlled trials (7 references); (12) historical research (4 studies); and (13) randomized controlled trials (3 references) ( Fig. 4 ).

Frequency of study designs.

The most common research was cross-sectional, emphasizing information gathered at one point in time. Within the top 10 study topics, cross-sectional research was most common in the areas of (1) mental health; (2) gender identity and expression; (3) sexual health, HIV, and STIs; (4) biology and physiology; and (5) therapeutics and surgeries. Cross-sectional research most often involved survey research and clinical measures.

Case reports, case studies, and case series were also very common within the dataset, specifically within the areas of therapeutics and surgeries, and physical health. In these situations, case reports were often used to document novel procedures, surgical complications, or physical side effects related to therapeutics. We also saw the use of case reports and case studies in relation to mental health; gender identity and expression; therapeutic processes; health and mental health services; and sexual health, HIV, and STIs. In the case of health and mental health services, and therapeutic processes, some clinicians reported on client demographics within their clinic, or on the process with specific patients.

Ninety-nine studies included qualitative interviews or focus groups. These methods were particularly relevant when exploring gender identity and expression; discrimination and social exclusion; and social support, relationships, and families. While cross-sectional studies were more frequently used in each of these areas, qualitative interviews or focus groups were the second most common study design for all of these study topics.

Conclusions

Topics that received the most attention.

Study topics that received the most attention from researchers were as follows: (1) therapeutics and surgeries; (2) gender identity and expression; (3) mental health; (4) biology and physiology; (5) discrimination and marginalization; (6) physical health; (7) sexual health, HIV, and STIs; (8) health and mental health services; (9) social support, relationships, and families; and (10) resilience, well-being, and quality of life. Comparing these results to Reisner et al.'s 10 review of health-related outcome categories, there were similarities and differences. For example, both reviews share an emphasis on the following topics: (1) mental health; (2) sexual and reproductive health; (3) stigma and discrimination; and (4) general health. In contrast, two topics that were highlighted in Reisner et al.'s 10 review—substance use, and violence and victimization—did not include a large enough number of studies to be included in the top 10 topics of the evidence map. Some of these differences were linked to Reisner et al.'s 10 emphasis on quantitative health research. Having a broader subject and methodological focus in this study meant that it was possible to incorporate greater diversity into the evidence map, including research related to therapeutics and surgeries, health and mental health services, social support, and resilience.

Topics that received the least attention

Topics that have received the least attention include several factors linked to the social determinants of health such as ethnicity and culture, housing, income, employment, and space and place. This review highlights the relatively minor attention invested to date in these study topics and underscores the need to assess whether additional research focused in these areas would be beneficial. For example, given the challenges many trans people face in obtaining employment, research centering on poverty and employment in trans communities, including barriers and facilitators to employment, may be called for. These studies could provide insight into these topics beyond their consideration as risk factors in relation to health and/or mental health.

Areas that have been systematically reviewed and opportunities for knowledge synthesis

Examining the overlap between the study topics that have received the most attention and existing systematic reviews, there was some positive overlap. For example, gender identity and expression is one of the most researched subject areas and is the topic of five systematic reviews. Similarly, mental health received good attention from researchers and was the focus of five systematic reviews. Sexual health, HIV, and STIs has been the subject of three reviews.

As discussed, therapeutics and surgeries was the most commonly investigated study topic. On the one hand, the ability to conduct reviews in this area was complicated by study designs that tended to emphasize case reports. That said, researchers have taken several approaches to synthesizing knowledge in this area, including case series and analysis of outcomes linked to specific therapeutic interventions or surgeries (e.g., long-term impact of cross-gender hormone treatment, or complications from silicone injection). In addition, although they were not included in this study because they did not meet the criteria for systematic reviews, some authors who are also surgeons review their experiences with surgical procedures, including outcomes and advances in technique.

While 20 systematic reviews of descriptive and qualitative studies have been conducted, there are opportunities for additional knowledge synthesis related to the following: specific aspects of gender identity and expression such as disclosure, or social or medical transition; discrimination and marginalization; physical health; health and mental health services; social support, relationships, and families; and resilience, well-being, and quality of life. Other topics in the map that received less attention (although they each included at least 15 studies) were as follows: sexuality; ethnicity, culture, race, and racialization; violence and trauma; early life experiences; resistance and politicization; education; law and criminalization; employment; arts and creativity; and sex work. These are all relevant and important topics for future systematic or scoping reviews.

Limitations

The primary limitations of this study relate to resources and technology. Time and financial resources necessitated limiting the map to studies published between 2010 and 2014. To complete the full map, it will be necessary to screen an additional 7,118 references on full text, and references that meet the inclusion criteria will need further data extraction. In addition, to update the map to 2017 would require the searches to be updated and these references would then need to be screened on title and abstract, and where relevant on full text.

Resource constraints have also limited the type of research included in the evidence map. This project is focused on documenting research with trans people from the perspective of human subjects research ethics. As a result, all studies in the map include at least one trans participant. One drawback is that this also means studies about trans topics that do not include trans people are not currently a part of the evidence map. For example, a study to evaluate the knowledge and awareness of health care providers in relation to trans health would not be included, unless it explicitly also included one or more trans participants. While these types of studies form part of the larger field of trans research, this work is not visible in this dataset.

Similarly, the evidence map contains empirical research published in English in peer-reviewed journals. In stating this, it is also important to acknowledge that it does not include solely theoretical, conceptual, or historical work, unless that work is based on original or secondary data analysis with trans participants. There are also no community research reports (sometimes referred to as “gray” literature) or book chapters. In focusing on one aspect of research with trans participants, our intent was not to contribute to making this other work less visible or to imply that it does not constitute an important aspect of the broader field of trans studies.

That the map is already out of date before being published points to the critical need for different ways of working. In time, promising new developments in text mining, automation, and semiautomation will allow us to complete large, living reviews and share this information with key stakeholders in a more timely manner.

Hesitations: the implications of mapping

There is great potential for this evidence map and the accompanying database to be useful to community members, researchers, clinicians, and policymakers. There are also limitations to how useful it can be to community members if information is not presented in an accessible manner. In addition, research itself can be damaging. As noted by Ansara and Hegarty, 37 some research continues to perpetuate pathologizing beliefs and to misgender participants from multiple angles.

The selection of the term “evidence map” is informative. Building on the work of Ahmed, 38 and her approach to following multiple meanings of words and concepts, it is useful to be circumspect about the concept of evidence in relation to evidence-based practice, and about research as a form of evidence. One should be mindful of the implicit goals of empirical research, and question evidence as “evidence of what?,” and “evidence for what?.” In addition to providing data, the research articles in this review are themselves a form of evidence, documenting the actions and decisions of researchers and clinicians.

In speaking of evidence maps, we refer as well to evidence gaps. What do gaps mean in the context of research about trans people? The word gap suggests that something is absent. However, we should ask whether what is missing is something that should be there. What do these gaps hinder and what purpose might they also serve, and perhaps more importantly, whom do they serve? This analysis leads to larger questions about who and what gets studied, who makes these decisions, and what motivates researcher attention.

Critical Data Studies 39 highlights the connections between “the spatial nature of data” and “the processes of data production and accumulation” (p. 1). Data visualizations such as maps are built on templates of those that have come before. In some ways, this map is no different. It mirrors a tradition of evidence mapping and borrows from longer standing frameworks related to social determinants of health and medical framing of experiences. Where this project is different is in the ways we consider the potential of digital evidence maps as living documents 40 that can be leveraged to document previous ways of working and to “challenge the legacies of colonialism—to emphasize local knowledge and local control” (p. 422). 41

In identifying future directions for research and knowledge synthesis, it is critical to engage trans communities and other stakeholders in local and global contexts to determine research priorities. Engagement is about more than participation: rather we advocate for the centering of trans people, and more specifically trans women of color. 42 There are many excellent examples of these forms of engagement, including Marvellous Grounds: Queer of Colour Spaces in Toronto 43 and the work of Reisner et al. at the Fenway Institute. 44 These types of involvement will help to ensure that the knowledge that is produced is relevant to trans communities and to stakeholders such as policy-makers, health care providers, and educators. Within this study, we have taken the approach that it is better for people to be aware of the types of research that are being conducted. These insights make it clearer as to whose knowledge and perspectives are centered in this work, and it is more likely that trans communities and our allies will be in a position to benefit from existing research and hold researchers accountable as community awareness increases.

Supplementary Material

Acknowledgments.

The authors wish to acknowledge the generous contributions of community members who provided consultation on search terms and data extraction. In addition, we are grateful for the work of a large team of research assistants who supported this project at different stages of the review process. This work would also not have been possible without the librarians, library assistants, and library technicians at Memorial University, Dalhousie University, the University of Waterloo, and others who retrieved and processed 1,192 Interlibrary Loan requests. During this study, Z.M. was supported by a doctoral fellowship funded by the Canadian Institutes of Health Research and the Research and Development Corporation (RDC) of Newfoundland and Labrador, and by the Canadian Mental Health Association-Newfoundland and Labrador (CMHA-NL). V.W. holds an Ontario Early Researcher Award.

Abbreviations Used

* The articles that were categorized within the intersectionalities study topic explicitly explored the impact of interacting or interlocking identities. For example, if the article was about trans women with disabilities, or trans people of color, the authors needed to address the ways these experiences intersected to produce specific structural dynamics, rather than exploring these as stand-alone topics.

Author Disclosure Statement

No competing financial interests exist.

Supplementary Data S1

Supplementary Data S2

Supplementary Data S3

Cite this article as: Marshall Z, Welch V, Minichiello A, Swab M, Brunger F, Kaposy C (2019) Documenting research with transgender, non-binary, and other gender diverse (trans) individuals and communities: introducing the global trans research evidence map, Transgender Health 4:1, 68–80, DOI: 10.1089/trgh.2018.0020.

Transgender identities: a series of invited essays

As discussion about gender self-identification becomes heated, the economist seeks to uphold the liberal value of open debate.

By H.J. | LONDON

This is the introduction to a two-week, ten-part series of essays on transgender identities. Click here for the essays .

FROM the transgender bathroom debate in America to the argument in Britain over who can stand for election on women-only shortlists, a row about transgender identities is generating more heat than light. On one hand are some transgender people and activists, who advocate for “gender self-identification”: the belief that the world should take at face value a person’s declaration of their own gender identity. On the other are people who assert the primacy of biological sex; who fear the erosion of protections for women, including from male violence; or who see gender as a pernicious class system that maintains male supremacy and would like it done away entirely.

The row pits one historically oppressed group against another. It strikes at some very modern dilemmas: the usefulness of identity politics; the accommodations that should be made for small subgroups; how to work towards inclusion without triggering a backlash.

Further heightening tensions, many countries are considering changing the way someone can legally change gender from a process mediated by medical professionals to one of gender self-identification, and a few have already done so. On July 3rd Britain launched a public consultation on this issue: under government proposals, a simple statutory declaration would suffice to change your legal gender, and enable you to change the sex stated on your birth certificate and other official records.

To coincide with the consultation, The Economist is hosting a series of essays from a range of people with interesting and varied viewpoints, insights and arguments on transgender identities. The series will run over two weeks, with two or three essays published each day in the first week, and further comments and discussion between our participants published next week. On July 13th I will wrap up the event, drawing out the points that most struck me from the essays, and from readers’ comments.

This online event is part of The Economist ’s Open Future project, which aims to remake the case for liberalism today. One of the liberal values we seek to uphold is open debate. When it comes to transgender issues, and gender self-identification in particular, positions have become entrenched. Debate has become polarised, toxic and unilluminating. We hope our event will help to change that.

In the interests of fostering open debate we have set ground rules, both for essays and reader comments: use the pronouns people want you to use, and avoid all slurs, including TERF (trans-exclusionary radical feminist), which may have started as a descriptive term but is now used to try to silence a vast swathe of opinions on trans issues, and sometimes to incite violence against women. Comments will be open but closely moderated.

We are grateful to our contributors, who have agreed with grace and good humour to step onto this contested ground. We hope they will all find the fortnight interesting and perhaps even illuminating. We have enormously enjoyed reading their thoughts, and have already learned a great deal.

Essays published so far:

Vic Valentine: “ Self-declaration would bring Britain into line with international best practice ”

Debbie Hayton: “ Gender identity needs to be based on objective evidence rather than feelings ”

Kristina Harrison: “ A system of gender self-identification would put women at risk ”

Charlie Kiss: “ The idea that trans men are “lesbians in denial” is demeaning and wrong ”

Pippa Fleming: “ The gender-identity movement undermines lesbians ”

Sarah Ditum: “ Trans rights should not come at the cost of women’s fragile gains ”

Emily Brothers: “ Making transitioning simpler would not usurp the rights of women ”

James Kirkup: “ I am neither trans nor a woman. Can I write about the issues they face? ”

Kathleen Stock: “ Changing the concept of “woman” will cause unintended harms ”

Adam Smith: “ The struggle for trans rights has parallels to that for gay rights ”

Adam Smith: “ The online debate over transgender identity needs more speech, not less ”

Debbie Hayton: “ Society needs to dismantle sexism before revising legal definitions of sex ”

Sarah Dittum: “ Transgender issues are not yet a schism between conservatives and liberals in Britain ”

Dig deeper:

“ Making sense of the culture war over transgender identity ,” The Economist , November 16th 2017.

“ Children are victims in the latest identity-driven culture war ,” The Economist , Leader, November 16th 2017

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Understanding the transgender community.

Transgender people come from all walks of life, and HRC Foundation has estimated that there are more than 2 million of us across the United States. We are parents, siblings, and kids. We are your coworkers, your neighbors, and your friends. We are 7-year-old children and 70-year-old grandparents. We are a diverse community, representing all racial and ethnic backgrounds, as well as all faith traditions.

The word “transgender” – or trans – is an umbrella term for people whose gender identity is different from the sex assigned to us at birth. Although the word “transgender” and our modern definition of it only came into use in the late 20th century, people who would fit under this definition have existed in every culture throughout recorded history.

Alongside the increased visibility of trans celebrities like Laverne Cox, Jazz Jennings or the stars of the hit Netflix series “Pose,” three out of every ten adults in the U.S. personally knows someone who is trans. As trans people become more visible, we aim to increase understanding of our community among our friends, families, and society.

What does it mean to be trans?

The trans community is incredibly diverse. Some trans people identify as trans men or trans women, while others may describe themselves as non-binary, genderqueer, gender non-conforming, agender, bigender or other identities that reflect their personal experience. Some of us take hormones or have surgery as part of our transition, while others may change our pronouns or appearance. Roughly three-quarters of trans youth that responded to an HRC Foundation and University of Connecticut survey identified with terms other than strictly “boy” or “girl.” This suggests that a larger portion of this generation’s youth are identifying somewhere on the broad trans spectrum.

What challenges do trans people face?

While trans people are increasingly visible in both popular culture and in daily life, we still face severe discrimination, stigma and systemic inequality. Some of the specific issues facing the trans community are:

• Lack of legal protection – Trans people face a legal system that often does not protect us from discrimination based on our gender identity. Despite a recent U.S. Supreme Court Decision that makes it clear that trans people are legally protected from discrimination in the workplace, there is still no comprehensive federal non-discrimination law that includes gender identity - which means trans people may still lack recourse if we face discrimination when we’re seeking housing or dining in a restaurant. Moreover, state legislatures across the country are debating – and in some cases passing – legislation specifically designed to prohibit trans people from accessing public bathrooms that correspond with our gender identity, or creating exemptions based on religious beliefs that would allow discrimination against LGBTQ+ people.
• Poverty – Trans people live in poverty at elevated rates, and for trans people of color, these rates are even higher. Around 29% of trans adults live in poverty , as well 39% of Black trans adults, 48% of Latine trans adults and 35% of Alaska Native, Asian, Native Americans and Native Hawaiian or Pacific Islander trans adults.
• Stigma, Harassment and Discrimination – About half a decade ago, only one-quarter of people in the United States supported trans rights, and support increased to 62% by the year 2019. Despite this progress, the trans community still faces considerable stigma due to more than a century of being characterized as mentally ill, socially deviant and sexually predatory. While these intolerant views have faded in recent years for lesbians and gay men, trans people are often still ridiculed by a society that does not understand us. This stigma plays out in a variety of contexts – from lawmakers who leverage anti-trans stigma to score cheap political points; to family, friends or coworkers who reject trans people upon learning about our trans identities; and to people who harass, bully and commit serious violence against trans people. This includes stigma that prevents them from accessing necessary services for their survival and well-being. Only 30% of women’s shelters are willing to house trans women. While recent legal progress has been made, 27% of trans people have been fired, not hired or denied a promotion due to their trans identity. Too often, harassment has led trans people to avoid exercising their most basic rights to vote. HRC Foundation’s research shows that 49% of trans adults, and 55% of trans adults of color said they were unable to vote in at least one election in their life because of fear of or experiencing discrimination at the polls.
• Violence Against Trans People – Trans people experience violence at rates far greater than the average person. Over a majority ( 54% ) of trans people have experienced some form of intimate partner violence, 47% have been sexually assaulted in their lifetime and nearly one in ten were physically assaulted in between 2014 and 2015. This type of violence can be fatal. At least 27 trans and gender non-conforming people have been violently killed in 2020 thus far, the same number of fatalities observed in 2019.
• Lack of Healthcare Coverage – An HRC Foundation analysis found that 22% of trans people and 32% of trans people of color have no health insurance coverage. More than one-quarter ( 29% ) of trans adults have been refused health care by a doctor or provider because of their gender identity. This sobering data reveals a healthcare system that fails to meet the needs of the trans community.
• Identity Documents – The widespread lack of accurate identity documents among trans people can have an impact on every aspect of their lives, including access to emergency housing or other public services. Without identification, one cannot travel, register for school or access many services that are essential to function in society. Many states do not allow trans people to update their identification documents to match their gender identity. Others require evidence of medical transition – which can be prohibitively expensive and is not something that all trans people want – as well as fees for processing new identity documents, which may make them unaffordable for some members of the trans community.

While advocates continue working to remedy these disparities, change cannot come too soon for trans people. Visibility – especially positive images of trans people in the media and society – continues to make a critical difference for us; but visibility is not enough and can come with real risks to our safety, especially for those of us who are part of other marginalized communities. That is why the Human Rights Campaign is committed to continuing to support and advocate for the trans community, so that the trans Americans who are and will become your friends, neighbors, coworkers and family members have an equal chance to succeed and thrive.

Related Resources

Transgender

HRC’s Brief Guide to Reporting on Transgender Individuals

Transgender, Health & Aging, Workplace

Debunking the Myths: Transgender Health and Well-Being

Bisexual, Allies, Coming Out, Transgender

Glossary of Terms

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13.7 Cosmos & Culture

Transgender prejudice and the belief in a biological basis for gender.

Tania Lombrozo

As June comes to an end, so do many events associated with Pride Month , a month-long celebration of sexual diversity and gender variance — often geared towards increasing the visibility of the LGBTQIA community, as well as combatting stigma and advocating for equal rights.

But the battle to eliminate stigma and achieve these rights will certainly continue, as recent debates about which bathrooms transgender men and women should use illustrate all too well.

For years here at 13.7 , Barbara J. King has been writing about what she calls the spectrum of gender expression, and "the fact that gender identity isn't only — or even mostly — about biology and that it's most certainly not reducible to the sex one is assigned at birth." That's an especially important lesson in light of new research that identifies one of the sources of prejudice against transgender individuals: the (mostly mistaken) belief that men's and women's stereotypical characteristics do, in fact, come down to some immutable feature of one's biology.

In the new study , forthcoming in the journal Sex Roles , researchers Boby Ho-Hong Ching and Jason Teng Xu presented 132 university students in Hong Kong with one of three articles to read. One article was intended to reinforce the idea that gender differences have a biological basis, one was intended to question this view, and a third was entirely unrelated to gender differences and served as a baseline comparison.

The article advocating a biological basis for gender presented a study purporting to find that "the brains of men and women are wired up differently," which "could explain some of the differences in personality and behaviour between male and female." It went on to describe the study and quote fictional experts, including "Professor Schneider," who summarized: "There is a neurological cause of sex differences, which suggests that these differences are difficult to change."

The alternative article reported the same study, but also included some cautionary remarks. For instance, the researchers noted that men and women "still have many similarities in terms of the brain architecture" and that "the relations between brain and human behavior are complex." In this version, Prof. Schneider instead warned that the studies do not "offer insights into the socio-biological developmental processes that lead to observed male/female differences...The neurological associations with sex differences are not fixed, but amenable to change by environmental factors."

After reading one of the three articles and completing an unrelated task, participants then responded to various questions designed to evaluate their stereotypes about transgender individuals, as well as their attitudes towards them. For example, they indicated how much they agreed with statements including, "transgenderism endangers the institution of the family," and "I would feel comfortable if I learned that my neighbor was a transgendered individual." A final set of questions concerned civil rights, with items such as: "Post-operative transsexuals in Hong Kong should have the right to get married in their new sex," and "Transgender people in Hong Kong should have the right to change their birth certificates."

The researchers found that those participants who had read the article endorsing a biological basis for gender differences were significantly more likely than participants who read either of the other articles to report negative stereotypes about transgender individuals, to report prejudicial attitudes, and to reject equal rights. Responses for participants who read the alternative article or the control article did not differ from each other.

The authors suggest that the article endorsing a biological basis for gender differences reinforced what psychologists call an "essentialist" view of gender — the idea that men and women belong to fundamentally different categories that have some inherent basis (some "essence"), such that the categories have sharp and immutable boundaries, and such that members of the same category share many important similarities with each other. On a view like this, it's hard to make sense of a mismatch between a person's gender identity and their assigned sex, if it's the biological basis for their assigned sex that's taken to reflect their true "essence." This, in turn, could support a more prejudicial attitude towards people who identify with a gender other than the one assigned at birth.

Prior work supports several of these ideas: that a biological basis for gender differences plays into psychological essentialism; and that psychological essentialism can foster prejudice. For example, one study found that after reading a fictional news article that explained a sex difference in biological terms, participants were more likely to report that people cannot easily change, and to associate men and women with their stereotypical attributes, such as being nurturing for women and competitive for men. Another study found that people who thought of a particular social category in more essentialist terms tended to regard the group as lower status. Finally, a survey study found that the belief that gender has a biological basis was correlated with opposition to transgender civil rights.

The new study by Ching and Xu goes beyond this prior work in showing a causal relationship between beliefs about the biological basis of gender and a host of beliefs about transgender individuals, with a particular role for the essentialist commitments that a biological basis is taken to entail. Among other things, the findings suggest that if people appreciate the non-dichotomous and diverse nature of gender identity, they're less likely to maintain negative views towards people who are transgender, and less likely to oppose their rights.

Tania Lombrozo is a psychology professor at the University of California, Berkeley. She writes about psychology, cognitive science and philosophy, with occasional forays into parenting and veganism. You can keep up with more of what she is thinking on Twitter: @TaniaLombrozo

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Americans’ Complex Views on Gender Identity and Transgender Issues

Most favor protecting trans people from discrimination, but fewer support policies related to medical care for gender transitions; many are uneasy with the pace of change on trans issues, table of contents.

• A rising share say a person’s gender is determined by their sex at birth
• Many Americans point to science when asked what has influenced their views on whether gender can differ from sex assigned at birth
• Public sees discrimination against trans people and limited acceptance
• About four-in-ten say society has gone too far in accepting trans people
• Plurality of adults say views on gender identity issues are changing too quickly
• Most say they’re not paying close attention to news about bills related to transgender people 
• About six-in-ten would favor requiring that transgender athletes compete on teams that match their sex at birth
• Views on many policies related to transgender issues vary by age, party, and race and ethnicity 
• Sizable shares say forms and government documents should include options other than ‘male’ and ‘female’
• About three-in-ten parents of K-12 students say their children have learned about people who are trans or nonbinary at school 
• Acknowledgments
• The American Trends Panel survey methodology
• Panel recruitment
• Sample design
• Questionnaire development and testing
• Data collection protocol
• Data quality checks
• Dispositions and response rates
• A note about the Asian sample

Pew Research Center conducted this study to better understand Americans’ views about gender identity and people who are transgender or nonbinary. These findings are part of a larger project that includes findings from six focus groups on  the experiences and views of transgender and nonbinary adults  and estimates of the  share of U.S. adults who say their gender is different from the sex they were assigned at birth . 

This analysis is based on a survey of 10,188 U.S. adults. The data was collected as a part of a larger survey conducted May 16-22, 2022. Everyone who took part is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way, nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the  ATP’s methodology . See here to read more about the  questions used for this report and the report’s methodology .

References to White, Black and Asian adults include only those who are not Hispanic and identify as only one race. Hispanics are of any race.

All references to party affiliation include those who lean toward that party. Republicans include those who identify as Republicans and those who say they lean toward the Republican Party. Democrats include those who identify as Democrats and those who say they lean toward the Democratic Party.

References to college graduates or people with a college degree comprise those with a bachelor’s degree or more. “Some college” includes those with an associate degree and those who attended college but did not obtain a degree.

The terms “transgender” and “trans” are used interchangeably throughout this report to refer to people whose gender is different from the sex they were assigned at birth.

As the United States addresses issues of transgender rights and the broader landscape around gender identity continues to shift, the American public holds a complex set of views around these issues, according to a new Pew Research Center survey.

Roughly eight-in-ten U.S. adults say there is at least some discrimination against transgender people in our society, and a majority favor laws that would protect transgender individuals from discrimination in jobs, housing and public spaces. At the same time, 60% say a person’s gender is determined by their sex assigned at birth, up from 56% in 2021 and 54% in 2017.

The public is divided over the extent to which our society has accepted people who are transgender: 38% say society has gone too far in accepting them, while a roughly equal share (36%) say society hasn’t gone far enough. About one-in-four say things have been about right. Underscoring the public’s ambivalence around these issues, even among those who see at least some discrimination against trans people, a majority (54%) say society has either gone too far or been about right in terms of acceptance.

The fundamental belief about whether gender can differ from sex assigned at birth is closely aligned with opinions on transgender issues. Americans who say a person’s gender  can  be different from their sex at birth are more likely than others to see discrimination against trans people and a lack of societal acceptance. They’re also more likely to say that our society hasn’t gone far enough in accepting people who are transgender. But even among those who say a person’s gender is determined by their sex at birth, there is a diversity of viewpoints. Half of this group say they would favor laws that protect trans people from discrimination in certain realms of life. And about one-in-four say forms and online profiles should include options other than “male” or “female” for people who don’t identify as either.   

Related:  The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. adults

When it comes to issues surrounding gender identity, young adults are at the leading edge of change and acceptance. Half of adults ages 18 to 29 say someone can be a man or a woman even if that differs from the sex they were assigned at birth. This compares with about four-in-ten of those ages 30 to 49 and about a third of those 50 and older. Adults younger than 30 are also more likely than older adults to say society hasn’t gone far enough in accepting people who are transgender (47% vs. 39% of 30- to 49-year-olds and 31% of those 50 and older) 

These views differ even more sharply by partisanship. Democrats and those who lean to the Democratic Party are more than four times as likely as Republicans and Republican leaners to say that a person’s gender can be different from the sex they were assigned at birth (61% vs. 13%). Democrats are also much more likely than Republicans to say our society hasn’t gone far enough in accepting people who are transgender (59% vs. 10%). For their part, 66% of Republicans say society has gone  too far  in accepting people who are transgender.

Amid a national conversation over these issues, many states are considering or have put in place  laws or policies  that would directly affect the lives of transgender and nonbinary people – that is, those who don’t identify as a man or a woman. Some of these laws would limit protections for transgender and nonbinary people; others are aimed at safeguarding them. The survey finds that a majority of U.S. adults (64%) say they would favor laws that would protect transgender individuals from discrimination in jobs, housing and public spaces such as restaurants and stores. But there is also a fair amount of support for specific proposals that would limit how trans people can participate in certain activities and navigate their day-to-day lives. 

Roughly six-in-ten adults (58%) favor proposals that would require transgender athletes to compete on teams that match the sex they were assigned at birth (17% oppose this, 24% neither favor nor oppose). 1 And 46% favor making it illegal for health care professionals to provide someone younger than 18 with medical care for a gender transition (31% oppose). The public is more evenly split when it comes to making it illegal for public school districts to teach about gender identity in elementary schools (41% favor and 38% oppose) and investigating parents for child abuse if they help someone younger than 18 get medical care for a gender transition (37% favor and 36% oppose). Across the board, views on these policies are deeply divided by party. 

When asked what has influenced their views on gender identity – specifically, whether they believe a person can be a different gender than the sex they were assigned at birth – those who believe gender can be different from sex at birth and those who do not point to different factors. For the former group, the most influential factors shaping their views are what they’ve learned from science (40% say this has influenced their views a great deal or a fair amount) and knowing someone who is transgender (38%). Some 46% of those who say gender is determined by sex at birth also point to what they’ve learned from science, but this group is far more likely than those who say a person’s gender can be different from their sex at birth to say their religious beliefs have had at least a fair amount of influence on their opinion (41% vs. 9%).   

The nationally representative survey of 10,188 U.S. adults was conducted May 16-22, 2022.  Previously published findings from the survey  show that 1.6% of U.S. adults are trans or nonbinary, and the share is higher among adults younger than 30. More than four-in-ten U.S. adults know someone who is trans and 20% know someone who is nonbinary. Among the other key findings in this report:

Nearly half of U.S. adults (47%) say it’s extremely or very important to use a person’s new name if they transition to a gender that is different from the sex they were assigned at birth and change their name.  A smaller share (34%) say the same about using someone’s new pronouns (such as “he” instead of “she”). A majority of Democrats (64%) – compared with 28% of Republicans – say it’s at least very important to use someone’s new name if they go through a gender transition and change their name. And while 51% of Democrats say it’s extremely or very important to use someone’s new pronouns, just 14% of Republicans say the same.

Many Americans express discomfort with the pace of change around issues of gender identity.  Some 43% say views on issues related to people who are transgender or nonbinary are changing too quickly, while 26% say things aren’t changing quickly enough and 28% say the pace of change is about right. Adults ages 65 and older are the most likely to say views on these issues are changing too quickly; conversely, those younger than 30 are the most likely to say they’re not changing quickly enough. 

More than four-in-ten (44%) say forms and online profiles that ask about a person’s gender should include options other than “male” and “female” for people who don’t identify as either.  Some 38% say the same about government documents such as passports and driver’s licenses. Half of adults younger than 30 say government documents that ask about a person’s gender should provide more than two gender options, compared with about four-in-ten or fewer among those in older age groups. Views differ even more widely by party: While majorities of Democrats say forms and online profiles (64%) and government documents (58%) should offer options other than “male” and “female,” about eight-in-ten Republicans say they should  not  (79% say this about forms and online profiles and 83% say this about government documents). 

Democrats and Republicans who agree that a person’s gender is determined by their sex at birth often have different views on transgender issues.  A majority (61%) of Democrats – but just 31% of Republicans – who say a person’s gender is determined by the sex they were assigned at birth say there is at least a fair amount of discrimination against transgender people in our society today. And while 62% of Democrats who say gender is determined by sex at birth say they would favor policies that protect trans individuals against discrimination, fewer than half of their Republican counterparts say the same. 

Democrats’ views on some transgender issues vary by age.  Among Democrats younger than 30, about seven-in-ten (72%) say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, and 66% say society hasn’t gone far enough in accepting people who are transgender. Smaller majorities of Democrats 30 and older express these views. Age is less of a factor among Republicans. In fact, similar shares of Republicans ages 18 to 29 and those 65 and older say a person’s gender is determined by their sex at birth (88% each) and that society has gone too far in accepting people who are transgender (67% of Republicans younger than 30 and 69% of those 65 and older).  

About three-in-ten parents of K-12 students (29%) say at least one of their children has learned about people who are transgender or nonbinary from a teacher or another adult at their school.  Similar shares across regions and in urban, suburban and rural areas say their children have learned about this in school, as do similar shares of Republican and Democratic parents. Views on whether it’s good or bad that their children have or haven’t learned about people who are trans or nonbinary at school vary by party and by children’s age. For example, among parents of children in elementary school, 45% say either that their children  have  learned about this and that’s a  bad  thing or that they  haven’t  learned about it and that’s a  good  thing. A smaller share of parents of middle and high schoolers (34%) say the same. Republican parents are much more likely than Democratic parents to say this, regardless of their child’s age.

Six-in-ten U.S. adults say that whether a person is a man or a woman is determined by their sex assigned at birth. This is up from 56%  one year ago  and 54% in  2017 . No single demographic group is driving this change, and patterns in who is more likely to say this are similar to what they were in past years.

Today, half or more in all age groups say that gender is determined by sex assigned at birth, but this is a less common view among younger adults. Half of adults younger than 30 say this, lower than the 60% of 30- to 49-year-olds who say the same. Even higher shares of those 50 to 64 (66%) and those 65 and older (64%) say a person’s gender is determined by their sex at birth.

The party gap on this issue remains wide. The vast majority of Republicans and those who lean toward the GOP say gender is determined by sex assigned at birth (86%), compared with 38% of Democrats and Democratic leaners. Most Democrats say that whether a person is a man or a woman can be different from their sex at birth (61% vs. just 13% of Republicans). Liberal Democrats are particularly likely to hold this view – 79% say a person’s gender can be different from sex at birth, compared with 45% of moderate or conservative Democrats. Meanwhile, 92% of conservative Republicans say gender is determined by sex at birth and 74% of moderate or liberal Republicans agree.

Democrats ages 18 to 29 are also substantially more likely than older Democrats to say that someone’s gender can be different from their sex assigned at birth, although majorities of Democrats across age groups share this view. About seven-in-ten Democrats younger than 30 say this (72%), compared with about six-in-ten or fewer in the older age groups. Among Republicans, there is no clear pattern by age. About eight-in-ten or more Republicans across age groups – including 88% each among those ages 18 to 29 and those 65 and older – say a person’s gender is determined by their sex at birth. 

The view that a person’s gender is determined by their sex assigned at birth is more common among those with lower levels of educational attainment and those living in rural areas or in the Midwest or South. This view is also more prevalent among men and Black Americans. 

A solid majority of those who do  not  know a transgender person say that whether a person is a man or a woman is determined by sex assigned at birth (68%), while those who  do  know a trans person are more evenly split. About half say gender is determined by sex assigned at birth (51%), while 48% say gender and sex assigned at birth can be different. 

Though Republicans who know a trans person are more likely than Republicans who don’t to say gender can be different from sex assigned at birth, more than eight-in-ten in both groups (83% and 88%, respectively) say gender is determined by sex at birth. Meanwhile, there are large differences between Democrats who do and do  not  know a transgender person. A majority of Democrats who  do  know a trans person (72%) say someone can be a man or a woman even if that differs from their sex assigned at birth, while those who don’t know anyone who is transgender are about evenly split (48% say gender is determined by sex assigned at birth while 51% say it can be different). 

When asked about factors that have influenced their views about whether someone’s gender can be different from the sex they were assigned at birth, 44% say what they’ve learned from science has had a great deal or a fair amount of influence. About three-in-ten (28%) point to their religious views and about two-in-ten (22%) say knowing someone who is transgender has influenced their views at least a fair amount. Smaller shares say what they’ve heard or read in the news (15%) or on social media (14%) has had a great deal or a fair amount of influence on their views.

The factors people point to on this topic differ by whether or not they say gender is determined by sex at birth. Among those who say that whether someone is a man or a woman is determined by the sex they were assigned at birth, 46% say what they’ve learned from science has influenced their views on this at least a fair amount, while 41% say the same about their religious views. About one-in-ten point to what they’ve heard or read in the news (12%), what they’ve heard or read on social media (11%) or knowing someone who’s transgender (11%). 

Among those who say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, 40% say their views on this topic have been influenced at least a fair amount by what they’ve learned from science. A similar share say the same about knowing a transgender person (38%). Smaller shares in this group say what they’ve heard or read in the news (19%) or on social media (18%) or their religious views (9%) have had a great deal or a fair amount of influence.

Among those who say gender is determined by sex assigned at birth, adults younger than 30 stand out as being more likely than their older counterparts to say their knowledge of science (60%), what they’ve heard or read on social media (22%) or knowing someone who is trans (17%) influenced this view a great deal or a fair amount. In turn, those ages 65 and older tend to be more likely than younger age groups to cite their religious views (51% in the older group say this has had at least a fair amount of influence). 

Republicans who say gender is determined by sex assigned at birth are more likely than Democrats with the same view to say their knowledge of science (52% vs. 40%) and their religious views (45% vs. 34%) have had at least a fair amount of influence, while Democrats are more likely than Republicans to say the news (17% vs. 10%), social media (16% vs. 10%) and knowing someone who is trans (15% vs. 9%) have influenced them – though the shares are still small among both groups.

On the flip side, among those who say someone’s gender can be  different  from the sex they were assigned at birth, adults younger than 30 are also more likely than older adults to say social media has contributed to this view at least a fair amount (33% vs. 15% or fewer among older age groups). Adults ages 65 and older are more likely than their younger counterparts to say what they’ve learned from science has influenced their view (46% vs. 40% or fewer). 

Democrats who say whether someone is a man or a woman can be different from their sex at birth are more likely than Republicans with the same view to say that what they’ve learned from science (43% vs. 26%) and knowing someone who is transgender (40% vs. 26%) has influenced their view a great deal or a fair amount.

Roughly eight-in-ten Americans say transgender people face at least some discrimination, and relatively few believe our society is extremely or very accepting of people who are trans. These views differ widely by partisanship and by beliefs about whether someone’s gender can differ from the sex they were assigned at birth.

Overall, 57% of adults say there is a great deal or a fair amount of discrimination against transgender people in our society today. An additional 21% say there is some discrimination against trans people, and 14% say there is a little or none at all. 

There are modest differences in views on this issue across demographic groups. Women (62%) are more likely than men (52%) to say there is a great deal or a fair amount of discrimination against transgender people, and college graduates (62%) are more likely than those with less education (55%) to say the same. 

There is, however, a wide partisan divide in these views: While 76% of Democrats and those who lean to the Democratic Party say there is a great deal or a fair amount of discrimination against trans people, 35% of Republicans and Republican leaners share that assessment. One-in-four Republicans see little or no discrimination against this group, compared with 5% of Democrats. 

These views are also linked with underlying opinions about whether a person’s gender can be different from their sex assigned at birth. Among those who say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, 83% say there is a great deal or a fair amount of discrimination against trans people. Even so, some 42% of those who hold the alternative point of view – that gender is determined by sex assigned at birth – also see at least a fair amount of discrimination. Among Democrats who say gender is determined by sex at birth, that share rises to 61%. 

Relatively few adults (14%) say society is extremely or very accepting, while about a third (35%) say it is somewhat accepting. A plurality (44%) says our society is a little or not at all accepting of trans people. 

Again, these views are strongly linked with partisanship. Democrats have a much more negative view than Republicans, with 54% of Democrats saying society is a little accepting or not at all accepting of transgender people, compared with a third of Republicans. 

And, as with views of discrimination, assessments of societal acceptance are linked to underlying views about how gender is determined. Those who say one’s gender can be different from the sex they were assigned at birth see less acceptance: 56% say society is a little accepting or not accepting at all of people who are transgender. This compares with 37% among those who say gender is determined by sex at birth. Republicans who say gender is determined by sex at birth are more likely than Democrats who say the same to believe that society is at least somewhat accepting of people who are transgender (61% vs. 47%).

While a majority of Americans see at least a fair amount of discrimination against transgender people and relatively few see widespread acceptance, 38% say our society has gone too far in accepting them. Some 36% say society has not gone far enough in accepting people who are trans, and 23% say the level of acceptance has been about right.

These views differ along demographic and partisan lines. Young adults (ages 18 to 29) and those with a bachelor’s degree or more education are among the most likely to say society hasn’t gone far enough in accepting people who are trans. Men, White adults and those without a four-year college degree are among the most likely to say society has gone too far in this regard. 

There is a wide partisan divide as well. Roughly six-in-ten Democrats (59%) say society hasn’t gone far enough in accepting people who are transgender, while 15% say it has gone too far (24% say it’s been about right). Republicans’ views are almost the inverse: 10% say society hasn’t gone far enough and 66% say it’s gone too far (22% say it’s been about right). 

Even among those who see at least some discrimination against trans people, a majority (54%) say society has either gone too far in accepting trans people or been about right; 44% say society hasn’t gone far enough.

Many say it’s important to use someone’s new name, pronouns when they’ve gone through a gender transition

Nearly half of adults (47%) say it’s extremely or very important that if a person who transitions to a gender that’s different from their sex assigned at birth changes their name, others refer to them by their new name. An additional 22% say this is somewhat important. Three-in-ten say this is a little or not at all important (18%) or that it shouldn’t be done (12%).

Smaller shares say that if a person transitions to a gender that’s different from their sex assigned at birth and starts going by different pronouns (such as “she” instead of “he”), it’s important that others refer to them by their new pronouns. About a third (34%) say this is extremely or very important, and 21% say this is somewhat important. More than four-in-ten say this is a little or not at all important (26%) or it should not be done (18%).

These views differ along many of the same dimensions as other topics asked about. While 80% of those who believe someone’s gender can be different from their sex assigned at birth also say it’s extremely or very important to use a person’s new name when they’ve gone through a gender transition, 27% of those who think gender is determined by one’s sex assigned at birth share this opinion. The pattern is similar when it comes to use of preferred pronouns. 

Democrats are much more likely than Republicans to say it’s extremely or very important to refer to a person using their new name or pronouns. When it comes to pronouns, a majority of Republicans (55%), compared with only 17% of Democrats, say using someone’s new pronouns when they’ve been through a gender transition is not at all important or should not be done.  

There are some demographic differences as well, with women more likely than men and those with a four-year college degree more likely than those with less education to say it’s extremely or very important to use a person’s new name or pronouns when referring to them.

In addition, people who say they know someone who is trans are more likely than those who do not to say this is extremely or very important. Even so, substantial shares of those who don’t know a trans person view this as important. For example, 39% of those who don’t know someone who is transgender say it’s extremely or very important to refer to a person who goes through a gender transition and changes their name by their new name. 

Many Americans are not comfortable with the pace of change that’s occurring around issues involving gender identity. Some 43% say views on issues related to people who are transgender and nonbinary are changing too quickly. About one-in-four (26%) say things are not changing quickly enough, and 28% say they are changing at about the right speed.

Women (30%) are more likely than men (21%) to say views on these issues are not changing quickly enough, and adults younger than 30 are more likely than their older counterparts to say the same. Among those ages 18 to 29, 37% say views on these issues are not changing quickly enough; this compares with 26% of those ages 30 to 49, 22% of those ages 50 to 64 and 19% of those 65 and older. At the same time, White adults (46%) are more likely than Black (34%), Hispanic (39%) or Asian (31%) adults to say views are changing  too quickly .

Opinions also differ sharply by partisanship. Among Democrats, a plurality (42%) say views on issues involving transgender and nonbinary people are not changing fast enough, and 21% say they are changing too quickly. About a third (35%) say the speed is about right. By contrast, 70% of Republicans say views on these issues are changing too quickly, while only 7% say views aren’t changing fast enough. About one-in-five Republicans (21%) say they’re changing at about the right speed. 

Respondents were asked in an open-ended format why they think views are changing too quickly or not quickly enough, when it comes to issues surrounding transgender and nonbinary people. For those who say things are changing too quickly, responses fell into several different categories. Some indicated that new ways of thinking about gender were inconsistent with their religious beliefs. Others expressed concern that the long-term consequences of medical gender transitions are not well-known, or that changing views on gender identity are merely a fad that’s being pushed by the media. Still others said they worry that there’s too much discussion of these issues in schools these days.

For those who say views are not changing quickly enough, some pointed to discrimination and a lack of acceptance of trans and nonbinary people. Others pointed to legislative initiatives in some states aimed at restricting the rights of trans and nonbinary people. Many also said that too many people in our society aren’t open to change when it comes to these issues. 2

In their own words: Why do some people think views on issues related to transgender people and those who don’t identify as a man or a woman are changing  too quickly ?

General concerns about the pace of change

“The issue is so new to me I can’t keep up. I don’t know what to think about all of this new information. I’m baffled by so many changes.”

“It takes quite a bit of time for society to accept changes. I have not been aware of this issue for very long. I am relatively conservative and feel that changes need time to be accepted.”

Religious reasons

“People now believe everyone should just forget about their birth identity and just go along with what they think they are. God made us all for a reason and if He intended us to pick our gender then there would be no reason to be born with specific male or female parts .”

“I have a personal religious belief that sex is an essential part of our eternal identity and that identifying as something other than you are … just doesn’t make a lot of sense.”

“I believe GOD created a man and a woman. We have overstepped our bounds in messing with the miracle of life. I side with my creator.”

Concerns about long-term medical consequences

“We do not know the long-term health problems of hormone therapy, especially in young children.”

“More time needs to pass to study mental, physical, emotional ramifications of medications & surgeries, especially when done before puberty and/or adulthood.”

“Accepting gender fluidity, especially for younger children, seems quick. Also, medical treatments related to gender for people under 18 seems to be being accepted without longer term studies.”

It’s a fad/Driven by the media

“I respect people’s views about themselves, and I will refer to them in the way they want to be referred to, but I believe it’s become trendy because it’s being pushed so much in culture, especially for children.”

“News media, social media and entertainment media companies are trying to change, and it seems they have been succeeding in changing public opinion on this issue for many people.”

“It is encouraging kids who are easily influenced to participate in the ‘in’ fad when their brains are not fully developed.”

Concerns about schools

“Elementary school students should not be subjected to instruction on sex identity, any questions the child asks should be referred to a parent.”

“I think that young people are exposed to these issues at too early an age. I believe that it is up to the parents, and I oppose schools that want to include it in the ‘curriculum.’”

“It’s being pushed on society and especially on younger children, confusing them all the more. This is not something that should be taught in schools.”

In their own words: Why do some people think views on issues related to transgender people and those who don’t identify as a man or a woman are changing  too slowly ?

Discrimination

“There is far too much discrimination, hate, and violence directed toward people who are brave enough to stand up for who they truly are. We, as a country and as a society, need to respect how people want to identify themselves and be kind toward one another, end of story.”

“Protections for basic rights to self-determination in identity, health care choices, privacy, and consensual relationships should be a bare minimum that our society can provide for everyone – transgender people included . ”

“There’s too much discrimination. People need to quit controlling other people’s private lives. I consider them very brave for having the courage to be who they identify with . ”

“Equal protection has not kept up with trans issues, including trans youth and the right to gender-affirming care.”

Legislative efforts

“Acceptance is not changing quick enough. There remains discrimination and elected officials are passing laws that make it more difficult for transgender individuals in society to live, work and exist.”

“We are going backwards with all the anti-gay & -trans legislation that is being passed.”

“For every step forward, it feels like there are two steps back with reactive conservative laws.”

“These laws are working to restrict the rights of trans and nonbinary people, and also discrimination is still very high which results in elevated rates of suicide, poverty, violence and homelessness especially for people of color.”

“The spate of laws being proposed that would take away the rights of transgender people is evidence that we’re a long way from treating them right.”

Society is not open to change

“Too many people are simply stuck in the binary. We, as a society, need to just accept that someone else’s gender identity is whatever they say it is and it rarely has any bearing on the lives of others.”

“These are people. Who they say they are is all that matters. Society, mostly conservatives, doesn’t understand change in any form. So, they fight it. And they hinder the ability for others to learn about themselves and others, which slows growing as a society to a crawl.” 

“It’s an issue that has been in the closet for centuries. It’s time to acknowledge and accept that gender identity is a spectrum and not binary.” 

“We are not accepting the changes. We refuse to see what is in front of us. We care too much about not changing the status quo as we know it.” 

“Society often views this as a phase or a period of uncertainty in their life. Instead, it’s about a person bringing their gender identity in line with what they have experienced internally all their life.”

Many states are  considering legislation  related to people who are transgender, but a relatively small share of U.S. adults (8%) say they’re following news about these bills extremely or very closely. Another 24% say they’re following this somewhat closely, while about two-thirds say they’re following it either a little closely (23%) or not all closely (44%). 3

Only about one-in-ten or less across age, racial and ethnic groups, and across levels of educational attainment, say they are following news about bills related to people who are transgender extremely or very closely. Six-in-ten or more across demographic groups say they’re following news about these bills a little closely or not closely at all. 

Liberal Democrats and Democratic-leaning independents (46%) are more likely than moderate and conservative Democrats (29%) to say they are following news about state bills related to people who are transgender at least somewhat closely. Conservative Republicans and Republican leaners (31%) are more likely than their moderate and liberal counterparts (24%) – but less likely than liberal Democrats – to be following news about these bills at least somewhat closely. Still, half or more among each of these groups say they have been following news about this a little or not at all closely. 

The survey asked respondents how they feel about some current laws and policies that are either in place or being considered across the U.S. related to transgender issues. Only two of seven items are either endorsed or rejected by a majority: 64% say they would favor policies that protect transgender individuals from discrimination in jobs, housing, and public spaces such as restaurants and stores, and 58% say they would favor policies that require that transgender athletes compete on teams that match the sex they were assigned at birth rather than the gender they identify with. 

Even though there is not a majority consensus on most of these laws or policies, there are gaps of at least 10 percentage points on three items. Some 46% say they would favor making it illegal for health care professionals to provide someone younger than 18 with medical care for gender transitions, and 41% would favor requiring transgender individuals to use public bathrooms that match the sex they were assigned at birth rather than the gender they identify with; 31% say they would oppose each of these. Meanwhile, more say they would  oppose  (44%) than say they would favor (27%) requiring health insurance companies to cover medical care for gender transitions. 

Views are more divided when it comes to laws and policies that would make it illegal for public school districts to teach about gender identity in elementary schools (41% favor and 38% oppose) or that would investigate parents for child abuse if they helped someone younger than 18 get medical care for a gender transition (37% favor and 36% oppose). Some 21% and 27%, respectively, say they’d neither favor nor oppose these policies. 

Majorities of U.S. adults across age groups express support for laws and policies that would protect transgender individuals from discrimination in jobs, housing, and public spaces such as restaurants and stores. About seven-in-ten adults ages 18 to 29 (70%) and 30 to 49 (68%) say they favor such protections, as do about six-in-ten adults ages 50 to 64 (60%) and 65 and older (59%). 

But adults younger than 30 are more likely than those in each of the older age groups to say they favor laws or policies that would require health insurance companies to cover medical care for gender transitions (37% among those younger than 30 vs. about a quarter among each of the older age groups). They’re also less likely than older adults to express support for bills and policies that would restrict the rights of people who are transgender or limit what schools teach about gender identity. On most items, those ages 50 to 64 and those 65 and older express similar views. 

Views differ even more widely along party lines. For example, eight-in-ten Democrats say they favor laws or policies that would protect trans individuals from discrimination, compared with 48% of Republicans. Conversely, by margins of about 40 percentage points or more, Republicans are more likely than Democrats to express support for laws or policies that would do each of the following: require trans athletes to compete on teams that match the sex they were assigned at birth (85% of Republicans vs. 37% of Democrats favor); make it illegal for health care professionals to provide someone younger than 18 with medical care for a gender transition (72% vs. 26%); make it illegal for public school districts to teach about gender identity in elementary schools (69% vs. 18%); require transgender individuals to use public bathrooms that match the sex they were assigned at birth (67% vs. 20%); and investigate parents for child abuse if they help someone younger than 18 get medical care for a gender transition (59% vs. 17%). 

Overall, White adults tend to be more likely than Black, Hispanic and Asian adults to express support for laws and policies that would restrict the rights of transgender people or limit what schools can teach about gender identity. But among Democrats, White adults are often  less  likely than other groups to favor such laws and policies, particularly compared with their Black and Hispanic counterparts. And White Democrats are more likely than Black, Hispanic and Asian Democrats to say they favor protecting trans individuals from discrimination and requiring health insurance companies to cover medical care for gender transitions. 

About four-in-ten Americans (38%) say government documents such as passports and driver’s licenses that ask about a person’s gender should include options other than “male” and “female” for people who don’t identify as either; a larger share (44%) say the same about forms and online profiles that ask about a person’s gender.

Half of adults younger than 30 say government documents that ask about gender should include options other than “male” and “female,” compared with 39% of those ages 30 to 49, 35% of those 50 to 64 and 33% of adults 65 and older. When it comes to forms and online profiles, 54% of adults younger than 30 and 47% of those ages 30 to 49 say these forms should include more than two gender options; smaller shares of adults ages 50 to 64 and 65 and older (37% each) say the same. 

Views on this vary considerably by party. A majority of Democrats and Democratic-leaning independents say forms and online profiles (64%) and government documents (58%) that ask about a person’s gender should include options other than “male” and “female.” In contrast, about eight-in-ten or more Republicans and Republican leaners say forms and online profiles (79%) and government documents (83%) should  not  include more than these two gender options. 

Those who say they know someone who is nonbinary are more likely than those who don’t know anyone who’s nonbinary to say forms and government documents should include gender options other than “male” and “female.” Still, 39% of those who don’t know anyone who’s nonbinary say forms and online profiles shouldinclude other gender options, and 33% say the same about government documents that ask about a person’s gender. Conversely, 31% of those who say they know someone who’s nonbinary say forms and online profiles should  not  include options other than “male” and “female,” and 41% say this about government documents. 

In recent months, lawmakers in several states have introduced legislation that would  prohibit or limit instruction on sexual orientation or gender identity  in schools. The survey asked parents of K-12 students whether any of their children have learned about people who are transgender or who don’t identify as a boy or a girl from a teacher or another adult at their school and how they feel about the fact that their children have or have not learned about this.

Some 37% of parents with children in middle or high school say their middle or high schoolers have learned about people who are transgender or who don’t identify as a boy or a girl from a teacher or another adult at their school; a much smaller share of parents of elementary school students (16%) say the same. Overall, 29% of parents with children in elementary, middle or high school say at least one of their K-12 children have learned about this at school. 

Similar shares of parents of K-12 students in urban (31%), suburban (27%) and rural (32%) areas – and in the Northeast (34%), Midwest (33%), South (26%) and West (28%) – say their school-age children have learned about people who are transgender or who don’t identify as a boy or a girl. And Republican (27%) and Democratic (31%) parents are also about equally likely to say their children have learned about this in school. None of these differences are statistically significant.

Many parents of K-12 students don’t think it’s good for their children to learn about people who are transgender or nonbinary from their teachers or other adults at school. Among parents of elementary school students, 45% either say their children have learned about people who are trans or nonbinary at school and see this is a  bad  thing or say their children have  not  learned about this and say this is a  good  thing. A far smaller share (13%) say it’s a good thing that their elementary school children have learned about people who are trans or nonbinary or that it’s a bad thing that they  haven’t  learned about this. And about four-in-ten (41%) say it’s neither good nor bad that their elementary school children have or haven’t learned about people who are transgender or nonbinary. 

Among parents with children in middle or high school, 34% say it’s a bad thing that their children have learned about people who are trans or nonbinary at school  or  that it’s a good thing that they haven’t; 14% say it’s good that their middle or high schoolers have learned about this  or  that it’s bad that they haven’t; and 51% say it’s neither good nor bad that their children have or haven’t learned about this in school. 

Republican and Republican-leaning parents with children in elementary, middle and high school are more likely than their Democratic and Democratic-leaning counterparts to say it’s a bad thing that their children have learned about people who are trans or nonbinary at school or that it’s a good thing that they haven’t. In turn, Democratic parents are more likely to say it’s  good  that their children  have  learned about this or  bad  that they  haven’t . They are also more likely to say it’s neither good nor bad that their children have or haven’t learned about people who are trans or nonbinary at school. 

• For each policy item, respondents were also given the option of answering “neither favor nor oppose.”  ↩
• Open-ended responses (quotations) have been lightly edited for clarity and length. ↩
• The shares who say they are following news about this a little or not at all closely do not add up to the combined share shown in the chart due to rounding.  ↩

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Integrating transgender care into mainstream medicine—an essay by Guy T’Sjoen and Joz Motmans

• Related content
• Peer review
• Guy T Sjoen , head of department of endocrinology ,
• Joz Motmans , professor of gender studies
• 1 Ghent University Hospital, Belgium
• 2 Ghent University, Belgium
• Correspondence to: G T’Sjoen Guy.TSjoen{at}ugent.be

All healthcare professionals will find themselves supporting care for a transgender or gender diverse person at some point, and education and research need to be widened, write Guy T’Sjoen and Joz Motmans

Population estimates show that transgender and gender diverse identities or experiences can no longer be considered a rarity. The prevalence of transgender identities is cited as 0.3% to 0.5% among adults and 1.2% to 2.7% among children and adolescents 1 ; data from the 2021 Canadian census, to pick one example, showed 0.33% of the 30.5 million citizens identifying as transgender or non-binary ( box 1 ). 2 3 These numbers can be understood through the evolving awareness of gender diversity in societies, the improved legal framework in many regions around the world, access to information over the internet and through social media, and the existing possibilities for gender affirming care. 4 5

Gender diverse terminology

Transgender or trans are umbrella terms used to describe people whose gender identities or gender expressions are not what is typically expected for the sex to which they were assigned at birth.

Transgender women, trans women, or women of trans experience are people who were assigned male at birth and who have gender identities as women. They may, or may not have undergone any transition.

Transgender men, trans men, or men of trans experience are people who were assigned female at birth and who have gender identities as men. They may or may not, have undergone any transition.

Gender diverse is a term used to describe people with gender identities or expressions that are different from social and cultural expectations attributed to their sex assigned at birth. This includes people who identify as non-binary, gender expansive, gender non-conforming, and others who do not identify as cisgender.

As more people feel comfortable in outing themselves, more transgender and gender diverse people are seeking psychological or medical care, with rising referrals reported by gender clinics. 6 Moreover, it is almost inevitable that anyone working in healthcare will sooner or later have at least one transgender patient under their care. Emergency staff may be confronted with a trans person brought in after a car crash; a general practitioner may be puzzled with gender reversed lab results; a radiologist may see unexpected organs on magnetic resonance imaging. All healthcare professionals therefore need at least some knowledge on the composition of diverse bodies, and on the health needs of this patient population so that even simple care is not delayed.

Moreover, healthcare professionals have an important role in supporting gender diverse people to care for themselves through provision of reliable information or access to medication, self-testing, and other self-care practices. This can help to improve health outcomes and support their mental health, among other benefits. But the lack of access to supportive quality care inhibits people’s ability to effectively self-care. Feeding into this is the poor knowledge and education of healthcare professionals that can affect clinical judgement and communications with transgender and gender diverse people.

The first commitment of all healthcare workers is to quality of care with compassion, with the goal of improving lives. Inappropriate curiosity, such as asking about their genitals or surgery history when this is not relevant for the specific medical issue being treated—often cited as the most common experience of transgender and gender diverse people seeking healthcare—should be avoided. 7 A non-judgmental and open approach is important, and attention to sensitivities in language can contribute to building trust with patients. 8 9 A single patient should never be the only source of information, and healthcare professionals need to be as well informed about transgender and gender diverse health issues as their patients. As such, knowledge and education around transgender care should no longer be managed by the few specialised interdisciplinary gender care facilities.

Getting started

Many healthcare professionals have not received any training on transgender health as it is not systematically included in curriculums. Results from an online survey among European healthcare professionals showed that only 52.7% reported some form of training on transgender health and that training led to increased confidence. 10 GPs had significantly lower confidence than nurses, psychosocial care providers, and other medical specialists. Ninety per cent of healthcare professionals believed that training would raise their competence, and this belief was significantly higher among professionals who had received some training. 10

Healthcare professionals who are more specialised in transgender care often start working in this field through personal interest or after meeting a transgender and gender diverse patient. They rarely get a chance to dedicate more than a few hours a week to train in aspects that may help. This is why most gender clinics are made up of part time and largely self-taught “gender specialists.”

Transgender healthcare is a relatively new field, so healthcare professionals need to spend more time offering not just good quality care but dealing with policy makers and administration, not to mention the time and effort it takes to argue for space, time, specialist staff, and recognition for transgender and gender diverse patients within existing healthcare frameworks.

Outdated guidelines on frequency of outpatient visits for patients receiving hormone treatment also create an unnecessary workload. 11 12 Three monthly follow-up sessions on starting treatment have often in reality been reduced to only two visits in the first year, at three and 12 months, as few problems are raised at follow-up and treatment strategies rarely need adjustment. These decisions have been partly determined by the long waiting lists. In some countries the waiting times for specialised gender clinics are now up to three to five years, 13 14 15 making it necessary to rethink the organisation of care. 15 Our centre in Ghent, Belgium, for example, saw 487 patients for an initial appointment in 2021. But a further 863 people contacted our service (an increase of 170% compared with 2016) and had to be put on the waiting list. At the same time, in many regions of the world no care is available at all or clinics are few, apply restrictive criteria, or require long travel times. 7

A lack of available care and barriers to accessing it may add to a higher prevalence of mental health problems such as suicide and depression among trans and gender diverse people, 16 and may lead some to self-manage with unprescribed gender affirming hormone treatment. 17 Care professionals see substantial numbers of patients who self-medicate, especially trans women taking contraceptive pills. 18 This is largely because of waiting lists, unavailability of care, or distrust in healthcare professionals. 7 Health professionals may get irritated with patients or turn them away if they declare self-administration (or self-initiation) because they do not meet the requirement of being without hormone treatment at presentation for mental health evaluation. Patients may then have to start again at the bottom of a waiting list for another centre or to turn to private (and more expensive) practices. Although it is understandable that doctors will not accept responsibility for treatments not started through the health system, respect and dignity for all is crucial. These patients need reassurance about the effectiveness and safety of their treatment and may want professional guidance and adaptation of their treatment. Nevertheless, to minimise health risks, it is crucial to motivate patients to adhere to prescription drugs and to avoid the risks of inappropriate dosing and counterfeit medicines on the black market. 19

The increased visibility of transgender and gender diverse people, and especially the increase in referrals of children, has resulted in a more critical approach to transgender care and severely polarised opinions. This may partly explain why many healthcare professionals hesitate to get involved. Members of specialised gender teams need to build a network with colleagues in other disciplines, including primary care, so that continuation of care is not hindered and established gender clinics can stop being the bottleneck of care. International networking among other trans care providers is also needed to share new insights, fresh ideas, and learn from one another’s experience.

Mainstream educational programmes

Research shows that healthcare professionals working in transgender care services have mostly sought knowledge from less reliable sources on the internet 20 or from more specialised conferences, published papers, or guidelines. 10 This implies that postgraduate training is much needed for healthcare professionals licensed some years ago.

A recent review of transgender health content in medical education found that most current training consisted of single session interventions facilitated by instructors with a range of professional experience; half covered more general LGBT+ content, and half was trans health specific. 21 The authors detected several facilitators (such as scaffolding learning throughout the curriculum, drawing on expertise of transgender people, and engaging learners in skills based training) as well as barriers (lack of educational materials, lack of faculty expertise, time or cost constraints, and challenges in recruiting and compensating transgender guest speakers).

The original guidelines and care protocols for transgender care were written in the late 1960s and have been regularly rewritten since. 11 The shift from experience based approaches to more evidence based approaches is notable over the past decade. An update of the World Professional Association for Transgender Health’s standards of care 22 is due to be published in autumn 2022. Based on a strong peer reviewed process, it will provide information on current knowledge and practices. As a result, many aspects from current training programmes will need further debate and update. Topics that are heavily debated focus on the one-size-fits-all gender affirming hormonal therapy, and the need for specific protocols for treating non-binary people. Other topics include the time required for different stages of transitioning, such as length of mental health counselling, the requirement for hormonal therapy before irreversible surgical interventions, and the age restrictions in adolescent care.

Quality care is rapidly evolving in this field and needs to move beyond purely medical knowledge and content. The broader social and psychological wellbeing and quality of life aspects determine health as well, hence the need to work interdisciplinarily in trans care facilities. For example, many restrictive concerns about the safety and effectiveness of gender affirming hormonal therapy need to be revised. One example is the monitoring of liver function tests, which were once described as mandatory but are not necessary if there is no other medical indication. 23 Hormonal therapy in fact has few serious side effects, although you will still find long lists of (relative and absolute) contraindications and safety measures in current guidelines.

With the aim of mainstreaming transgender care, GPs need to be trained and educated about the necessary (and often) lifelong follow-up of transgender patients taking gender affirming hormonal therapy. A recent study found just 50% of surveyed GPs are willing to take on such care, with willingness related to religious identity and perceived capability of providing routine care. 24 Training of healthcare professionals is also important for supporting self-care of people taking hormonal therapy.

Research and funding support

Transgender healthcare is a relatively new specialty, as are many of its interventions. Thus, work with transgender and gender diverse patients also means engaging in clinical research. Gender clinics have to divide their attention between seeing many patients and setting up research efforts, well aware that time spent in research will only increase the ever expanding waiting list. Research is, however, needed so that gender clinics obtain the scientific information to train and support their colleagues.

Funding agencies have been slow to adapt their frameworks to accommodate research into transgender healthcare, making it difficult. Nevertheless, more progressive examples such as the National Institutes of Health’s sexual and gender minority research office exist. 1 The reason so many clinical research questions remain today is because the right questions haven’t been asked or questionnaires were not adapted to the studied population and clinical researchers did not find access to substantial funding.

To keep our finger on the pulse and to avoid mistakes from the past, new holistic population health surveys should include questions on gender identity to discover a detailed and realistic sample. Equally important, medical research is too often blind to part of a reality that includes a socioeconomic context, stigma, and minority stress, among other issues. Insights from broader general health surveys should ideally inform healthcare professionals about new developments, including concerns that have not yet entered the consultation room. For example, the medical world has been blind too long to the specific health needs of people with non-binary identities. The life stories of transgender and gender diverse people and real life data collected with a scientific approach may hopefully influence those opposing trans related care, and may trump the many ill-advised opinions out there.

Current transgender research is mostly confined to people who are receiving clinical care. A challenge will be to also reach people unknown to or outside the healthcare system. Access to online communities and recruitment through collaboration with peer recruiters will open these doors. Research on trans health also needs to apply specific ethical considerations. 25 26

Doing better

It is unacceptable to ignore the needs of the growing number of transgender and gender diverse people who wish to access gender services. This requires reorganisation of transgender care so that it is not only available in overloaded specialty services. We call on governments to invest more in training programmes for healthcare professionals, both as a structural component in the curriculum and in lifelong learning programmes. Research shows clearly that education increases confidence and competence, and well informed healthcare providers will lower many obstacles transgender and gender diverse people experience in accessing care. Putting care into the mainstream is the only way to cope with the increases in demand we witness, and to decrease self-medication and the terrible effects that long waiting lists have on the mental health of transgender and gender diverse people.

At the same time, more long term follow-up research is needed. Studies have often excluded participants who had started hormone treatment before their first visit. This is no longer tenable given the high percentage of new patients who already self-administer hormones. The inclusion and exclusion criteria for (expensive) endocrine research have been strict. Including people who self-administer would be a leap forward in breaking down these research walls, by including a broader spectrum of people taking gender affirming hormonal therapy and thus creating larger databases. Comparing their data on first encounter to those of study participants with similar duration of prescribed hormone treatment within a provided context (such as the European Network for the Investigation of Gender Incongruence 27 ) will elucidate differences in safety and effectiveness. Psychosocial variables must also be included in this type of research.

The need for more education and more research puts an important responsibility on educational committees and research funding agencies to push this long ignored field forward.

Biographies

Guy T’Sjoen is a clinical researcher and principal investigator for the endocrine part of the multicenter ENIGI (European Network for the Investigation of Gender Incongruence) study. He is as past-president of EPATH their representative at the WPATH board (European and World Professional Associations for Transgender Health).

Joz Motmans is the president of EPATH and the coordinator of the Transgender Infopunt, the Flemish expertise centre on transgender topics.

Competing interests:We have read and understood BMJ policy on declaration of interests and declare the following interests: GT has received scientific grants from Ipsen, Bayer Shering and Sandoz. He is associate editor for the International Journal of Transgender Health and the Journal of Sexual Medicine .

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of a series proposed by the UNDP/UNFPA/Unicef/WHO/World Bank Special Programme for Human Reproduction (HRP) and commissioned by The BMJ. The BMJ retained full editorial control over external peer review, editing, and publication of these articles. Open access fees are funded by HRP.

This is an Open Access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited.

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• ↵ Canada is the first country to provide census data on transgender and non-binary people. 2022. https://www150.statcan.gc.ca/n1/daily-quotidien/220427/dq220427b-eng.htm
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• ↵ Dewey C. How the internet black market profits off trans discrimination. Washington Post 2016 Jan 29. https://www.washingtonpost.com/news/the-intersect/wp/2016/01/29/how-an-ugly-internet-black-market-profits-off-trans-discrimination/
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Rates of distress, depression have doubled among transgender Americans since 2014: Study

by Ernie Mundell

The rate of self-reported mental distress and depression among American adults who identify as transgender or gender-diverse (TGD) has more than doubled between 2014 and 2022, an analysis of federal health data reveals.

During that time, "a record number of enacted laws has threatened the rights and protections of TGD people, including restricting access to gender-affirming care and permitting discrimination in public accommodations," noted a team of researchers led by health care policy investigator Michael Liu, of Harvard Medical School.

The findings are published in the journal JAMA Internal Medicine .

Liu's team tracked survey data from the federal government's ongoing Behavioral Risk Factor Surveillance System, which follows the self-reported physical and mental health of U.S. adults over time.

The analysis started in 2014, the first year in which gender identity was added to the survey, and tracked data through 2022.

Liu's team found that the "prevalence of frequent mental distress increased from 18.8% in 2014 to 38.9% in 2022" among transgender or gender-diverse people.

In contrast, the rise in mental distress was less steep among cisgender people—from 11.2% to 15.5%.

Depression rates among transgender and gender-diverse adults also rose sharply between 2014 and 2022—more than doubling from 19.7% to 51.3%, Liu's group found. Over the same time period, depression rates among cisgender adults rose only slightly, from 18.6% to 21.1%.

Even physical health was affected: During the study period, the percentage of transgender/gender-diverse adults who rated their health as just "fair" or "poor" went from 26.6% to 35.1%, while that number remained stable at just over 17% among cisgender people.

In a linked journal editorial, three experts in health policy say the Harvard findings are not unexpected.

Dr. Carl Streed of Boston University, Kellan Baker of the Johns Hopkins School of Public Health in Baltimore, and Arjee Javellana Restar of the University of Washington School of Public Health in Seattle point to hundreds of state bills "explicitly targeting transgender and nonbinary populations" proposed in 2023 and 2024.

"These efforts to exclude transgender and nonbinary people from civic life threaten the well-being of the more than 1.6 million transgender and nonbinary people in the U.S.," the experts said.

Increasing stigma means transgender and gender-diverse Americans are dealing with daily assaults on mental health, including deliberate misuse of pronouns, issues around restroom access, discrimination on the job and even acts of violence, the editorialists said.

It's probably not going to get better anytime soon.

"Given the sociopolitical trajectory of the U.S. regarding increasing discrimination and political attacks on transgender and nonbinary people, we can expect to see worsening mental health in these populations for the foreseeable future," the experts said.

Carl G. Streed et al, Association of Political Assaults With the Health of Transgender and Nonbinary Persons, JAMA Internal Medicine (2024). DOI: 10.1001/jamainternmed.2024.2553

Find out more about the impact of discrimination on health at the Mental Health Foundation .

2024 HealthDay. All rights reserved.

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JK Rowling will 'struggle to support' Labour with Starmer's stance on gender

Rowling, who has always denied being transphobic, has been widely condemned in recent years for her views on transgender rights, having claimed that she would rather go to jail than refer to a trans person by their preferred pronouns.

Political reporter

Friday 21 June 2024 23:09, UK

JK Rowling has said she will "struggle to support" Labour if Sir Keir Starmer keeps his current stance on gender recognition.

The Harry Potter author has authored a 2,000-word essay in The Times in which she outlines her dissatisfaction with the Labour Party 's current position.

In the piece, she criticises Sir Keir , as well as shadow home secretary Yvette Cooper, shadow equalities secretary Anneliese Dodds, shadow foreign secretary David Lammy and shadow attorney general Emily Thornberry.

Election latest: Starmer makes 'Swift pit stop'

Rowling has been outspoken in her belief that biological women should be able to have separate spaces, and trans women - who were born male - should not be allowed access.

She has been criticised for her position, being widely condemned in recent years for her views on transgender rights, for example claiming that she would rather go to jail than refer to a trans person by their preferred pronouns.

Transgender newsreader India Willoughby recently responded to comments by Rowling as "genuinely disgusted".

She added: "Grotesque transphobia, which is upsetting. I am every bit as much a woman as JK Rowling."

Daniel Radcliffe, who became a worldwide star after playing schoolboy wizard Harry in the blockbuster adaptations of the novels, has also criticised her views, and said in an interview last month that the fallout with Rowling " makes me really sad ".

In the article, the author speaks about how she thought she "misheard" Sir Keir in 2021 when he criticised Labour candidate Rosie Duffield for saying only women have a cervix.

Sir Keir was asked about this statement in a recent leaders debate, at which point he said he agreed with Sir Tony Blair that women have vaginas and men have penises.

Rowling says she felt the Labour leader gave "the impression that until Tony Blair sat him down for a chat, he'd never understood how he and his wife had come to produce children".

She added that she "really wanted to give him the benefit of the doubt".

In her article, Rowling claims to "have been a Labour voter, a member (no longer), donor (not recently) and campaigner (ditto) all my adult life" - and she wants to see the end of the Conservative government.

According to Electoral Commission records, she gave £1m to the party in 2008, and £8,000 in 2015.

Read more: Troll who threatened to kill Rowling and Duffield avoids jail Rowling accuses Starmer of 'misrepresenting equalities law' Starmer says 99.9% of women 'haven't got a penis'

In the article, the author highlighted Ms Dodds for saying what a woman is "depends on what the context is".

Ms Cooper is criticised for saying she was "not going to get into rabbit holes on this".

Rowling points to Ms Thornberry for saying: "some women will have penises. Frankly, I'm not looking up their skirts, I don't care".

And Mr Lammy draws ire for saying women like Rowling are "dinosaurs hoarding rights".

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The Harry Potter author also claims Mr Lammy said that a cervix is "something you can have following various procedures and hormone treatments".

Rowling wrote: "It's very hard not to suspect that some of these men don't know what a cervix is, but consider it too unimportant to Google."

The NHS definition of the cervix is the opening between the vagina and the womb.

Rowling says the debate for "left-leaning" women like herself "isn't, and never has been, about trans people enjoying the rights of every other citizen, and being free to present and identify however they wish".

Instead, she says it is "about the right of women and girls to assert their boundaries".

She adds: "It's about freedom of speech and observable truth.

"It's about waiting, with dwindling hope, for the left to wake up to the fact that its lazy embrace of a quasi-religious ideology is having calamitous consequences."

The author says she met a mother of a girl with learning difficulties who was "smeared as a bigot and a transphobe for wanting female-only intimate care" for her.

"I cannot vote for any politician who takes issue with that mother's words," Rowling adds.

Keep up with all the latest news from the UK and around the world by following Sky News

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She concludes: "An independent candidate is standing in my constituency who's campaigning to clarify the Equality Act.

"Perhaps that's where my X will have to go on 4 July.

"As long as Labour remains dismissive and often offensive towards women fighting to retain the rights their foremothers thought were won for all time, I'll struggle to support them.

"The women who wouldn't wheesht didn't leave Labour. Labour abandoned them."

Earlier in the day, Sir Keir ruled out lifting the block on the Scottish government's controversial gender reforms.

Sky News has approached the Labour Party for comment.

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At the Paris Olympics, Sex Testing Will Be in Full Force. How Did We Get Here?

By Michael Waters

Michael Waters is the author of “The Other Olympians: Fascism, Queerness, and the Making of Modern Sports.”

Sometime in May 1936, a reporter for The Western Morning News, a newspaper based in Plymouth, England, arrived at the doorstep of Mark Weston, a retired shot putter who had embarked on a career as a massage therapist. Mr. Weston brought the reporter into the sitting room, where he handed over a certificate recently signed by his doctor. The certificate stated, “This is to certify that Mr. Mark Weston, who has always been brought up as a female, is a male, and should continue life as such.”

Mr. Weston, born in 1905 in Plymouth, had been labeled a girl for most of his life. Throughout his sports career, he played in women’s leagues. But in early 1936, he began seeing a doctor about living as a man. He checked into Charing Cross Hospital for what turned out to be two sex-reassignment operations — one in April, another in May. Mr. Weston explained to the reporter, “I realize I am now in my true element.”

The Morning News published its article on May 28, 1936, under the headline “Devon Woman Athlete Who Has Become a Man.” Compared with the contentious discussion of trans and intersex athletes today, the article and the coverage that followed were striking for their empathy. The paper focused on explaining how a gender transition like Mr. Weston’s was possible. But eventually, the focus shifted. Mr. Weston’s story made its way to two prominent sports officials — a sports doctor who often advised federations on medical matters and a member of what was then the International Amateur Athletic Federation and is today World Athletics, the track-and-field federation — who responded by drafting early iterations of its modern sex testing policies, the first of their kind in contemporary sports. Mr. Weston did not want to return to sports, much less women’s sports, but the officials worried that gender transitions like his would poke holes in existing male and female categories. Since then, international sports bodies have continued to deny or restrict opportunities for trans and intersex athletes to compete at the highest level, in some cases barring them from competition completely — all for failing to meet a subjective definition of “female.”

When I first encountered this historical coverage of Mr. Weston, I saw that we had missed a chance to chart an alternate path — to organize sports without the regimes of gender surveillance that dominate it today. We still have an opportunity, though, to design policies that acknowledge male and female sports categories as imperfect and permeable and that place the humanity and dignity of athletes first and foremost.

Advocates of sex-testing policies cloak themselves in the guise of fairness; they exist, proponents claim, to exclude anyone with a perceived biological advantage in women’s sports. That group ranges from trans women, who are banned from most major sports even after undergoing a medical transition, to many cisgender and intersex women who have not undergone any medical transition but who have testosterone levels considered higher than normal for women. Yet little evidence supports the idea that these women have physical advantages, in strength or otherwise, over other women.

These sex testing policies also fail to acknowledge natural variations in human bodies. There’s no single way to cleave people into binary categories, but that hasn’t stopped sports officials from trying.

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Composition courses that offer many sections (ENGL 101, 201, 277 and 379) are not listed on this schedule unless they are tailored to specific thematic content or particularly appropriate for specific programs and majors.

• 100-200 level

ENGL 201.ST2 Composition II: The Mind/Body Connection

Dr. sharon smith.

In this online section of English 201, students will use research and writing to learn more about problems that are important to them and articulate ways to address those problems. The course will focus specifically on issues related to the body, the mind, and the relationship between them. The topics we will discuss during the course will include the correlation between social media and body image; the psychological effects of self-objectification; and the unique mental and physical challenges faced by college students today, including food insecurity and stress.

English 201 S06 and S11: Composition II with an emphasis in Environmental Writing

S06: MWF at 10–10:50 a.m. in Yeager Hall Addition 231

S11: MWF at 12–12:50 p.m. in Crothers Engineering Hall 217

Gwen Horsley

English 201 will help students develop skills to write effectively for other university courses, careers, and themselves. This course will provide opportunities to further develop research skills, to write vividly, and to share their own stories and ideas. Specifically, in this class, students will (1) focus on the relationships between world environments, land, animals and humankind; (2) read various essays by environmental, conservational, and regional authors; and (3) produce student writings. Students will improve their writing skills by reading essays and applying techniques they witness in others’ work and those learned in class. This class is also a course in logical and creative thought. Students will write about humankind’s place in the world and our influence on the land and animals, places that hold special meaning to them or have influenced their lives, and stories of their own families and their places and passions in the world. Students will practice writing in an informed and persuasive manner, in language that engages and enlivens readers by using vivid verbs and avoiding unnecessary passives, nominalizations, and expletive constructions.

Students will prepare writing assignments based on readings and discussions of essays included in Literature and the Environment and other sources. They will use The St. Martin’s Handbook to review grammar, punctuation, mechanics, and usage as needed.

Required Text: Literature and the Environment: A Reader On Nature and Culture. 2nd ed., edited by Lorraine Anderson, Scott Slovic, and John P. O’Grady.

LING 203.S01 English Grammar

TuTh 12:30-1:45 p.m.

Dr. Nathan Serfling

The South Dakota State University 2023-2024 Undergraduate Catalog describes LING 203 as consisting of “[i]nstruction in the theory and practice of traditional grammar including the study of parts of speech, parsing, and practical problems in usage.”

“Grammar” is a mercurial term, though. Typically, we think of it to mean “correct” sentence structure, and, indeed, that is one of its meanings. But Merriam-Webster reminds us “grammar” also refers to “the principles or rules of an art, science, or technique,” taking it beyond the confines of syntactic structures. Grammar also evolves in practice through application (and social, historical, economic changes, among others). Furthermore, grammar evolves as a concept as scholars and educators in the various fields of English studies debate the definition and nature of grammar, including how well its explicit instruction improves students’ writing. In this course, we will use the differing sensibilities, definitions, and fluctuations regarding grammar to guide our work. We will examine the parts of speech, address syntactic structures and functions, and parse and diagram sentences. We will also explore definitions of and debates about grammar. All of this will occur in units about the rules and structures of grammar; the application of grammar rhetorically and stylistically; and the debates surrounding various aspects of grammar, including, but not limited to, its instruction.

ENGL 210 Introduction to Literature

Jodi andrews.

Readings in fiction, drama and poetry to acquaint students with literature and aesthetic form. Prerequisites: ENGL 101. Notes: Course meets SGR #4 or IGR #3.

ENGL 222 British Literature II

TuTh 9:30-10:45 a.m.

This course serves as a chronological survey of the second half of British literature. Students will read a variety of texts from the Romantic period, the Victorian period, and the twentieth and twenty-first centuries, placing these texts within their historical and literary contexts and identifying the major characteristics of the literary periods and movements that produced them.

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A survey of the history of literature written for children and adolescents, and a consideration of the various types of juvenile literature.

ENGL 240.ST1 Juvenile Literature: 5-12 Grade

In English 240 students will develop the skills to interpret and evaluate various genres of literature for juvenile readers. This particular section will focus on various works of literature at approximately the 5th-12th grade level.

Readings for this course include works such as Night, Brown Girl Dreaming, All American Boys, Esperanza Rising, Anne Frank’s Diary: A Graphic Adaptation, Animal Farm, Fahrenheit 451, The Giver, The Hobbit, Little Women, and Lord of the Flies . These readings will be paired with chapters from Reading Children’s Literature: A Critical Introduction to help develop understanding of various genres, themes, and concepts that are both related to juvenile literature, and also present in our readings.

In addition to exploring various genres of writing (poetry, non-fiction, fantasy, historical, non-fiction, graphic novels, etc.) this course will also allow students to engage in a discussion of larger themes present in these works such as censorship, race, rebellion and dissent, power and oppression, gender, knowledge, and the power of language and the written word. Students’ understanding of these works and concepts will be developed through readings, discussion posts, quizzes and exams.

ENGL 240.ST2 Juvenile Literature Elementary-5th Grade

April myrick.

A survey of the history of literature written for children and adolescents, and a consideration of the various genres of juvenile literature. Text selection will focus on the themes of imagination and breaking boundaries.

ENGL 242.S01 American Literature II

TuTh 11 a.m.-12:15 p.m.

Dr. Paul Baggett

This course surveys a range of U.S. literatures from about 1865 to the present, writings that treat the end of slavery and the development of a segregated America, increasingly urbanized and industrialized U.S. landscapes, waves of immigration, and the fulfilled promise of “America” as imperial nation. The class will explore the diversity of identities represented during that time, and the problems/potentials writers imagined in response to the century’s changes—especially literature’s critical power in a time of nation-building. Required texts for the course are The Norton Anthology of American Literature: 1865 to the Present and Toni Morrison’s A Mercy.

WMST 247.S01: Introduction to Women, Gender and Sexuality Studies

As an introduction to Women, Gender and Sexuality studies, this course considers the experiences of women and provides an overview of the history of feminist thought and activism, particularly within the United States. Students will also consider the concepts of gender and sexuality more broadly to encompass a diversity of gender identifications and sexualities and will explore the degree to which mainstream feminism has—and has not—accommodated this diversity. The course will focus in particular on the ways in which gender and sexuality intersect with race, class, ethnicity, and disability. Topics and concepts covered will include: movements for women’s and LGBTQ+ rights; gender, sexuality and the body; intersectionality; rape culture; domestic and gender violence; reproductive rights; Missing and Murdered Indigenous Women (MMIW); and more.

ENGL 283.S01 Introduction to Creative Writing

MWF 1-1:50 p.m.

Prof. Steven Wingate

Students will explore the various forms of creative writing (fiction, nonfiction and poetry) not one at a time in a survey format—as if there were decisive walls of separation between then—but as intensely related genres that share much of their creative DNA. Through close reading and work on personal texts, students will address the decisions that writers in any genre must face on voice, rhetorical position, relationship to audience, etc. Students will produce and revise portfolios of original creative work developed from prompts and research. This course fulfills the same SGR #2 requirements ENGL 201; note that the course will involve creative research projects. Successful completion of ENGL 101 (including by test or dual credit) is a prerequisite.

English 284: Introduction to Criticism

This course introduces students to selected traditions of literary and cultural theory and to some of the key issues that animate discussion among literary scholars today. These include questions about the production of cultural value, about ideology and hegemony, about the patriarchal and colonial bases of Western culture, and about the status of the cultural object, of the cultural critic, and of cultural theory itself.

To address these and other questions, we will survey the history of literary theory and criticism (a history spanning 2500 years) by focusing upon a number of key periods and -isms: Greek and Roman Classicism, The Middle Ages and Renaissance, The Enlightenment, Romanticism, Realism, Formalism, Historicism, Political Criticism (Marxism, Post-Colonialism, Feminism, et al.), and Psychological Criticism. We also will “test” various theories we discuss by examining how well they account for and help us to understand various works of poetry and fiction.

• 300-400 level

ENGL 330.S01 Shakespeare

TuTh 8-9:15 a.m.

Dr. Michael S. Nagy

This course will focus on William Shakespeare’s poetic and dramatic works and on the cultural and social contexts in which he wrote them. In this way, we will gain a greater appreciation of the fact that literature does not exist in a vacuum, for it both reflects and influences contemporary and subsequent cultures. Text: The Riverside Shakespeare: Complete Works. Ed. Evans, G. Blakemore and J. J. M. Tobin. Boston: Houghton Mifflin, 1997.

ENGL 363 Science Fiction

MWF 11-11:50 a.m.

This course explores one of the most significant literary genres of the past century in fiction and in film. We will focus in particular on the relationship between science fiction works and technological and social developments, with considerable attention paid to the role of artificial intelligence in the human imagination. Why does science fiction seem to predict the future? What do readers and writers of the genre hope to find in it? Through readings and viewings of original work, as well as selected criticism in the field, we will address these and other questions. Our reading and viewing selections will include such artists as Ursula K. LeGuin, Octavia Butler, Stanley Kubrick and Phillip K. Dick. Students will also have ample opportunity to introduce the rest of the class to their own favorite science fiction works.

ENGL 383.S01 Creative Writing I

MWF 2-2:50 p.m.

Amber Jensen

Creative Writing I encourages students to strengthen poetry, creative nonfiction, and/or fiction writing skills through sustained focus on creative projects throughout the course (for example, collections of shorter works focused on a particular form/style/theme, longer prose pieces, hybrid works, etc.). Students will engage in small- and large-group writing workshops as well as individual conferences with the instructor throughout the course to develop a portfolio of creative work. The class allows students to explore multiple genres through the processes of writing and revising their own creative texts and through writing workshop, emphasizing the application of craft concepts across genre, but also allows students to choose one genre of emphasis, which they will explore through analysis of self-select texts, which they will use to deepen their understanding of the genre and to contextualize their own creative work.

ENGL 475.S01 Creative Nonfiction

Mondays 3-5:50 p.m.

In this course, students will explore the expansive and exciting genre of creative nonfiction, including a variety of forms such as personal essay, braided essay, flash nonfiction, hermit crab essays, profiles and more. Through rhetorical reading, discussion, and workshop, students will engage published works, their own writing process, and peer work as they expand their understanding of the possibilities presented in this genre and the craft elements that can be used to shape readers’ experience of a text. Students will compile a portfolio of polished work that demonstrates their engagement with course concepts and the writing process.

ENGL 485.S01 Writing Center Tutoring

MW 8:30-9:45 a.m.

Since their beginnings in the 1920s and 30s, writing centers have come to serve numerous functions: as hubs for writing across the curriculum initiatives, sites to develop and deliver workshops, and resource centers for faculty as well as students, among other functions. But the primary function of writing centers has necessarily and rightfully remained the tutoring of student writers. This course will immerse you in that function in two parts. During the first four weeks, you will explore writing center praxis—that is, the dialogic interplay of theory and practice related to writing center work. This part of the course will orient you to writing center history, key theoretical tenets and practical aspects of writing center tutoring. Once we have developed and practiced this foundation, you will begin work in the writing center as a tutor, responsible for assisting a wide variety of student clients with numerous writing tasks. Through this work, you will learn to actively engage with student clients in the revision of a text, respond to different student needs and abilities, work with a variety of writing tasks and rhetorical situations and develop a richer sense of writing as a complex and negotiated social process.

ENGL 492.S01 The Vietnam War in Literature and Film

Tuesdays 3-5:50 p.m.

Dr. Jason McEntee

In 1975, the United States officially included its involvement in the Vietnam War, thus marking 2025 as the 50th anniversary of the conclusion (in name only) of one of the most chaotic, confusing, and complex periods in American history. In this course, we will consider how literature and film attempt to chronicle the Vietnam War and, perhaps more important, its aftermath. I have designed this course for those looking to extend their understanding of literature and film to include the ideas of art, experience, commercial products, and cultural documents. Learning how to interpret literature and movies remains the highest priority of the course, including, for movies, the study of such things as genre, mise-en-scene (camera movement, lighting, etc.), editing, sound and so forth.

We will read Dispatches , A Rumor of War , The Things They Carried , A Piece of My Heart , and Bloods , among others. Some of the movies that we will screen are: Apocalypse Now (the original version), Full Metal Jacket , Platoon , Coming Home , Born on the Fourth of July , Dead Presidents , and Hearts and Minds . Because we must do so, we will also look at some of the more fascinatingly outrageous yet culturally significant fantasies about the war, such as The Green Berets and Rambo: First Blood, Part II .

ENGL 492.S02 Classical Mythology

TuTh 3:30-4:45 p.m.

Drs. Michael S. Nagy and Graham Wrightson

Modern society’s fascination with mythology manifests itself in the continued success of novels, films and television programs about mythological or quasi-mythological characters such as Hercules, the Fisher King, and Gandalf the Grey, all of whom are celebrated for their perseverance or their daring deeds in the face of adversity. This preoccupation with mythological figures necessarily extends back to the cultures which first propagated these myths in early folk tales and poems about such figures as Oðin, King Arthur, Rhiannon, Gilgamesh, and Odysseus, to name just a few. English 492, a reading-intensive course cross-listed with History 492, primarily aims to expose students to the rich tradition of mythological literature written in languages as varied as French, Gaelic, Welsh, Old Icelandic, Greek, and Sumerian; to explore the historical, social, political, religious, and literary contexts in which these works flourished (if indeed they did); and to grapple with the deceptively simple question of what makes these myths continue to resonate with modern audiences. Likely topics and themes of this course will include: Theories of myth; Mythological Beginnings: Creation myths and the fall of man; Male and Female Gods in Myth; Foundation myths; Nature Myths; The Heroic Personality; the mythological portrayal of (evil/disruptive) women in myth; and Monsters in myth.

Likely Texts:

• Dalley, Stephanie, trans. Myths from Mesopotamia: Creation, the Flood, Gilgamesh, and Others. Oxford World’s Classics, 2009
• Faulkes, Anthony, trans. Edda. Everyman, 1995
• Gregory, Lady Augusta. Cuchulain of Muirthemne: The Story of the Men of the Red Branch of Ulster. Forgotten Books, 2007
• Jones, Gwyn, Thomas Jones, and Mair Jones. The Mabinogion. Everyman Paperback Classics, 1993
• Larrington, Carolyne, trans. The Poetic Edda . Oxford World’s Classics, 2009
• Matarasso, Pauline M., trans. The Quest of the Holy Grail. Penguin Classics, 1969
• Apollodorus, Hesiod’s Theogony
• Hesiod’s Works and Days
• Ovid’s Metamorphoses, Homeric Hymns
• Virgil’s Aeneid
• Iliad, Odyssey
• Apollonius of Rhodes Argonautica
• Ovid’s Heroides
• Greek tragedies: Orestaia, Oedipus trilogy, Trojan Women, Medea, Hippoolytus, Frogs, Seneca's Thyestes, Dyskolos, Amphitryon
• Clash of the Titans, Hercules, Jason and the Argonauts, Troy (and recent miniseries), Oh Brother, Where Art Thou?

ENGL 492.ST1 Science Writing

Erica summerfield.

This course aims to teach the fundamentals of effective scientific writing and presentation. The course examines opportunities for covering science, the skills required to produce clear and understandable text about technical subjects, and important ethical and practical constraints that govern the reporting of scientific information. Students will learn to present technical and scientific issues to various audiences. Particular emphasis will be placed on conveying the significance of research, outlining the aims, and discussing the results for scientific papers and grant proposals. Students will learn to write effectively, concisely, and clearly while preparing a media post, fact sheet, and scientific manuscript or grant.

Graduate Courses

Engl 575.s01 creative nonfiction.

In this course, students will explore the expansive and exciting genre of creative nonfiction, including a variety of forms such as personal essay, braided essay, flash nonfiction, hermit crab essays, profiles, and more. Through rhetorical reading, discussion, and workshop, students will engage published works, their own writing process, and peer work as they expand their understanding of the possibilities presented in this genre and the craft elements that can be used to shape readers’ experience of a text. Students will compile a portfolio of polished work that demonstrates their engagement with course concepts and the writing process.

ENGL 592.S01: The Vietnam War in Literature and Film

Engl 704.s01 introduction to graduate studies.

Thursdays 3-5:50 p.m.

Introduction to Graduate Studies is required of all first-year graduate students. The primary purpose of this course is to introduce students to modern and contemporary literary theory and its applications. Students will write short response papers and will engage at least one theoretical approach in their own fifteen- to twenty-page scholarly research project. In addition, this course will further introduce students to the M.A. program in English at South Dakota State University and provide insight into issues related to the profession of English studies.

ENGL 792.ST1 Grant Writing

This online course will familiarize students with the language, rhetorical situation, and components of writing grant proposals. Students will explore various funding sources, learn to read an RFP, and develop an understanding of different professional contexts and the rhetorical and structural elements that suit those distinct contexts. Students will write a sample proposal throughout the course and offer feedback to their peers, who may be writing in different contexts, which will enhance their understanding of the varied applications of course content. Through their work in the course, students will gain confidence in their ability to find, apply for, and receive grant funding to support their communities and organizations.