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.

• 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.
• 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 […] We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• 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.
• 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.
• Lesbian, Gay, Bisexual, and Transgender Subculture The pioneers of such campaigns disagree with the ideas and behaviors associated with the LGBT Subculture. These celebrations “have also made it easier for different members of the subculture to network and exchange their views”.
• 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.
• 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 […]
• 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.
• 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 […]
• 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 […]
• Transgender Teenagers and Obstacles They Face Transgender teens are one of the most vulnerable groups of people due to the enormous amount of discrimination and everyday challenges they face.
• 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.
• 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.
• Transgender Athletes in Female Sports Teams Thus, there are two contrasting views: to allow transgender people to compete in the women’s competition or organize separate competitions for them.
• 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 […]
• Transgender in Jewish Religion Transsexual people identify as or desire to live and be accepted as a member of the gender opposite to that assigned at birth.
• 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.
• 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 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 […]
• 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.
• 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 […]
• 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
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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
• Lesbian, Gay, Bisexual, Transgender Activism
• The Issue of Transgender Discrimination
• Transgender People in the Olympic Games
• Transgender People and Healthcare Barriers
• Viviane Namaste and Julia Serano’ Views on Transgenders
• Transgender Offenders in the Criminal Justice System
• Transgender Women Athletes in Professional Sports The inclusivity and legal recognition suggest that transgender athletes are welcome to participate in competitive sport given they meet the established requirements.
• 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.
• 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 People: Prejudice and Discrimination Transgender remains a stereotyped sexual identity, and these individuals face prejudice from critics, religious leaders, and the vast majority of society.
• 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 Support Group Meeting and Its Importance The transgender support groups allow people to connect and talk about issues that they have faced in their lives.
• 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 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.
• 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.
• Critical Thinking and Transgender Ethics Sexual orientation and preference is a debated and complex topic involving biological aspects, including hormones, which can alter and change people’s behavior and feelings.
• 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.
• Gender Non-Conforming or Transgender Children Care The purpose of this paper is to discuss the challenges to be aware of when working with gender non-conforming or transgender children and adolescents.
• 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 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.
• 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.
• Transgender Disorders and Homosexuality There is a lot of evidence of both the genetic mechanisms’ and surroundings’ influence on people’s sexual preferences. However, the environment is more responsible for such choice.
• 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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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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Transgender

A collection of TED Talks (and more) on the topic of Transgender.

Video playlists about Transgender

Celebrating (and deconstructing) the gender spectrum

On coming out

Talks about transgender.

How a sanctuary for self-expression can change lives

Have you met your soulmate?

What my gender transition taught me about womanhood

The trans story includes you

Language around gender and identity evolves (and always has)

The Trans Ban

A playful exploration of gender performance

Scenes from a Black trans life

The aesthetics of survival

The gender-fluid history of the Philippines

A short history of trans people's long fight for equality

Reimagining gender inclusivity in sports

The biology of gender, from DNA to the brain

The story of a parent's transition and a son's redemption

What doctors should know about gender identity

The press trampled on my privacy. Here's how I took back my story

Exclusive articles about transgender, it’s time for everyone to see trans and non-binary people and support them — here’s how, sports are designed around men — and that needs to change, how to raise kids without rigid gender stereotypes.

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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Let’s talk about transgender rights.

Unsure about how to talk with your students about transgender rights and related issues, such as gender identity, media representation, transphobia, and antitrans legislation? Here are some resources to start the conversation.

Boy or girl. He or she. At birth, we are assigned one of two genders. For many people, this binary is inaccurate and limiting. It simply doesn’t reflect who they are. Today, over 1.4 million people in the U.S. identify as transgender, and they’re pushing to be seen and accepted—but, more urgently, to live healthy and safe lives. 

Discrimination and violence against trans people is instigated and perpetuated every day, not only by lawmakers and law enforcement but also neighbors and classmates. Their rights to choose their bathroom and to access appropriate health care are consistently contested. And, just last month, the Trump administration’s ban on transgender recruits from joining the military went into effect.

Meanwhile, as equal employment rights are contested in federal court, twenty states, the District of Columbia, and 400-plus cities and counties already legally protect LGBTQ employees from discrimination in the workplace. In the face of injustice, transgender people continue to come out, demand their rights, and say, “We are still here.”

In this “Let’s Talk About” edition, we provide resources to help educate your students about what it means to be transgender and to get them talking about both the systemic injustices and the radical acts of resistance and advocacy.

How to Use This Collection

Suggested below are steps to a thoughtful and meaningful discussion with your students about transgender rights and their role in their personal lives and in society. Choose what is appropriate for your class.

• Have students complete a  pre-survey   (optional).
• Read the background information to set a baseline understanding of what it means to identify as transgender.
• Choose at least one YES! article and another site’s article for a robust compare-and- contrast activity.
• Use the discussion questions—or craft your own—to gauge your students’ understanding and opinions.
• Have students complete a  post-survey   (optional).
• Explore curriculum if you’d like to dive deeper.

Reading Materials

 background information (read this first).

9 Questions About Gender Identity and Being Transgender You Were Too Embarrassed to Ask (Vox)

YES! Articles

When You’re a Transgender Refugee in Trump’s America  

Austin Police Try to Get Past Trans Misgendering and “Deadnaming”

This Harry Potter Enthusiast Just Came Out As Trans On YouTube—And Thousands of People Are Watching

How to Fight the Latest Attempts to Erase “Transgender”

Why I Decided to Come Out to My Students as a Trans Man

 Outside Articles

Alison’s Story (Denver Post)

U.S. Supreme Court takes up major gay, transgender job discrimination cases (Reuters)

Conservative group hosts anti-transgender panel of feminists ‘from the left’ (NBC)

First Time I Saw Me (GLAAD)

Discussion Questions

1. Why is it hard for some people, particularly young people, to come out as transgender? How are these barriers to coming out different from (or similar to) those who identify as lesbian, gay, bisexual, or queer? What are some acts of discrimination and, even, dangers that trans people may face at home, in their communities, and in the U.S.?

2. Have you noticed transphobia—discrimination against transgender people ranging from misgendering to overt violence—in your school or community? How might you be an ally to trans and gender nonbinary people and help change transphobic beliefs?

3. On April 23, the U.S. Supreme Court agreed to hear the cases of three LGBTQ individuals who claimed workplace discrimination based on sexual orientation and gender identity. These hearings come on the heels of President Trump’s ban on new transgender military recruits. How do these court decisions and federal policies impact transgender rights now and in the future?  

Supporting Trans and Gender Nonconforming (GNC) Students  (GLSEN)

Related Resources

Let’s Talk About Anti-Blackness

Let’s Talk About Fat-Shaming

Let’s Talk About Reproductive Justice

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Geena Rocero did a pretty bold thing at TED2014: She came out. The transgender fashion model chose Vancouver to reveal to the world that she was assigned male at birth. “I am here exposed … to help others live without shame and terror,” she says in today’s talk .

The trans community has had a spotlight fixed on it in this year: a piece in Grantland sparked outrage and sadness after the subject of the story, outed without her permission, committed suicide; Jared Leto won the Best Supporting Actor Oscar for playing a trans woman in Dallas Buyer’s Club ; while Piers Morgan was widely criticized after a poorly handled interview with journalist and activist Janet Mock. Meanwhile the US’s new Affordable Care Act bans discrimination against someone based on their “gender identity or failure to conform to stereotypical notions of masculinity or femininity.” (See also: Why scientist Kate Stone decided to speak up about being transgender a year after giving her own TED Talk .)

As gender issues become more public, it’s clear that the media will play a crucial role in how trans people are treated — but sensitivity starts with the individual, and a good first step is to be thoughtful and precise about our language. Below, find tips and quotes gathered from trans men and women and their allies about positive, helpful ways to have that conversation. Though respectful language is only part of the battle for equality and acceptance, it’s a very good start.

Don’t conflate sex and gender. This concept is fundamental to the trans community — and it’s simultaneously obvious and difficult to grasp. Sex is based on biology and assigned at birth, while gender is cultural and social, based on how a person self-identifies. This is, for many, perhaps the biggest obstacle to understanding by the cisgendered (that is, people whose sex and gender align). Says LGBT activist and TED speaker iO Tillett Wright , “Male and female are the two pillars upon which our society is built. Gender dictates everything from what kind of relationship you get into to where you take a piss. And if you upend that, it’s very threatening for people. It challenges the system by which they live.”

Take the time to find out a trans person’s preferred pronoun. Across the board, experts and activists say this is vital. But isn’t asking someone’s preferred pronoun at a party a bit awkward? According to GLAAD Senior Media Strategist Tiq Milan , most people appreciate it. He says, “People would respect [the question] more than they would reject it, particularly if you have people not on the binary.”

Never use: tranny, transvestite, he-she, she-he, it, sex swapped, sex change. Do use: trans man or woman, male-to-female (m-t-f), or female-to-male (f-t-m), transition. “‘Tranny’ is the same as ‘faggot,’” says Milan . TED speaker Kate Stone agrees: “The worst, to me, is when people shout out ‘tranny’ across the street. It sounds horrible.” Norman Spack , the first doctor in North America to create an interdisciplinary program for transgender adolescents in a pediatric academic medical center, also sees “she-male” as potentially damaging, because the phrase is often used to refer to male sex workers who dress as women to serve a specific fetish.

While many public trans people and allies view careful language as paramount, University of Southern California’s Jack Halberstam has quite a different view: “I’m not a banner. Policing speech is usually the least interesting way of addressing social prejudice, and often it actually misunderstands how you make change — and also what constitutes harm and prejudice. So I’m much less concerned with the word ‘tranny’ and much more concerned with how we might raise kids to expect people to embody lots of different forms of gendering.”

Don’t focus on a person’s anatomy, past or present. As Piers Morgan learned the hard way , belaboring someone’s assigned sex at birth, or their surgical procedures since then, misses the point. Says Stone , “Asking someone you just met, ‘Have you had a sex change?’ is like asking, ‘Have you been circumcised?’” Adds Rocero : “It’s a very private thing. Most people just go there, because there’s a sense of fascination about it, but that’s a big no-no.”

Indeed, sexual definition is becoming less important legally. Says Spack , “I’m glad to see that we no longer use terms that require people to have, let’s say, certain surgeries to qualify as trans. It used to be that in order to get a license or a passport, a person would have to have either top surgery or bottom surgery, and then have the surgeon sign on that, so that they could get the designation of being transsexual.” (As of 2010, the US State Department no longer requires sexual reassignment surgery for a passport gender change.)

Never out a person without their permission. This seems beyond obvious, but it’s precisely what landed Grantland in hot water. How much did outing Dr. V without her permission contribute to her committing suicide? There’s no easy answer, but, says Rocero emphatically, “Nobody has the right to out a person.”

Don’t assume you’ll recognize a trans person — and that’s a good thing. With harassment rates so high (in  a recent survey of 6,450 American trans people, 90 percent reported experiencing harassment, mistreatment or discrimination on the job), it’s no surprise that for some trans people, even going outside can be daunting. Not to mention, as Rocero  says, that media and popular entertainment seem to prefer portraying trans people as victims, drug addicts or prostitutes. Says Milan , “I know so many people, especially trans women, who don’t leave the house during the day. They only come out at night because of the ridicule and the violence.” But this is changing, for the better. Increased visibility is integral to the growth of the trans movement. Says Halberstam , exposure to trans people is the real way to make progress: “There are trans people in every walk of life at this point. There are a large number of trans women who work in software, in computer technology. There are trans people who are politicians, doctors, lawyers, professors. I think that increasingly people do know trans people, though they may not know it.”

Don’t make it a thing if it’s not. If someone’s trans status is irrelevant, don’t focus on it. Definitely don’t dwell on the anatomical and legal details. This particularly applies to reporters. Milan allows that people may be naturally curious, but gender status should not drive the story. When Stone was in the press after being in a horrific accident , one paper published photos of her from before her transition. Says Stone, this suggests that when you find out a person is transgender, the first thing you should rush to do is dig up information about their past. Really, don’t. Of her gender status, “I’d never speak about it at work — not because it’s a secret, but because it’s not relevant.”

“How should we talk about …” is a TED series in which we examine how society tackles sensitive issues — and suggests ways we might do better. See also How should we talk about mental health , featuring insights from seven mental health experts, including Andrew Solomon, Sarah Caddick and Vikram Patel.

UPDATE: In May 2014 Stone filed a complaint with the UK Press Complaints Commission (PCC) regarding the tabloid articles that focused unnecessarily on her gender history. As a result the online “sex swap” headlines were removed. Watch a clip of Stone reflecting on her success.

About the author

Thu-Huong Ha is a freelance writer. Previously she was the books and culture reporter for Quartz and the context editor at TED. Her writing has also appeared on Slate and in The New York Times Book Review. Her debut novel, Hail Caesar, was published in 2007 by PUSH, a YA imprint of Scholastic, and was named an NYPL Book for the Teen Age. Follow her at twitter.com/thu

• Geena Rocero
• iO Tillett Wright
• Norman Spack
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Articles on Transgender rights

Displaying 1 - 20 of 36 articles.

Nex Benedict’s suicide coincides with a wave of anti-LGBTQ + laws – and some people’s misunderstanding about transgender and nonbinary individuals

Marie-Amelie George , Wake Forest University

Dave Chappelle has built a reputation for ‘punching down’ on trans people – and now he’s targeting disabled people

Shane Clifton , University of Sydney and Jemma Clifton , UNSW Sydney

LGBTQ+ workers want more than just pride flags in June

Dorian Rhea Debussy , The Ohio State University

‘Conversion therapy’: UK government kicks ban down the road – and there’s a major problem with what’s been proposed so far

Ilias Trispiotis , University of Leeds

Educated voters in Canada tend to vote for left-leaning parties while richer voters go right

Simon Kiss , Wilfrid Laurier University ; Matt Polacko , University of Toronto , and Peter Graefe , McMaster University

US talks sanctions against Uganda after a harsh anti-gay law – but criminalizing same-sex activities has become a political tactic globally

Nicolette Manglos-Weber , Boston University

Baseless anti-trans claims fuel adoption of harmful laws – two criminologists explain

Henry F. Fradella , Arizona State University and Alexis Rowland , University of California, Irvine

Montana House Rep. Zooey Zephyr’s censure shows that American standards of political decorum are failing

Alauna Safarpour , Harvard Kennedy School

Gender-affirming care has a long history in the US – and not just for transgender people

G. Samantha Rosenthal , Roanoke College

Does public safety trump free speech? History suggests there is a case for banning anti-trans activist Posie Parker from NZ

Kevin Veale , Massey University

What’s going on with the wave of GOP bills about trans teens? Utah provides clues

Kelsy Burke , University of Nebraska-Lincoln and Tyler Lefevor , Utah State University

Why The Sims 4’s new inclusion of transgender and disabled sims matters

Lee Cheng , Anglia Ruskin University

Rights of transgender students and their parents are a challenge for schools, courts

Charles J. Russo , University of Dayton ; Maggie Paino , University of Wisconsin-Madison , and Suzanne Eckes , University of Wisconsin-Madison

As transgender employees become more common, here’s how workplaces can welcome diversity

Jonathan Lord , University of Salford

Transgender women are finding some respect in India, but a traditional gender-nonconforming group – hijras – remains stigmatized

Liz Mount , Flagler College

Indiana, Iowa and Texas advance anti-transgender agendas – part of a longtime strategy by conservatives to rally their base

Alison Gash , University of Oregon

Yes, words can harm young trans people. Here’s what we can do to help

Cristyn Davies , University of Sydney ; Alessandra Chinsen , Murdoch Children's Research Institute ; Ken Pang , Murdoch Children's Research Institute ; Kerry H. Robinson , Western Sydney University , and Rachel Skinner , University of Sydney

More than masks and critical race theory – 3 tasks you should be prepared to do before you run for school board

Casey D. Cobb , University of Connecticut

Trans people have a long history in Appalachia – but politicians prefer to ignore it

A win for transgender athletes and athletes with sex variations: the Olympics shifts away from testosterone tests and toward human rights

Ryan Storr , Swinburne University of Technology ; Madeleine Pape , Université de Lausanne , and Sheree Bekker , University of Bath

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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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These 12 Transgender Americans Would Love You to Mind Your Own Business

By Patrick Healy and Adrian J. Rivera Feb. 9, 2023

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These days, “transgender” has become a charged word, associated with arguments over identity, gender, pronouns, sports, puberty blockers and civil rights. But for many of the approximately 1.3 million transgender Americans today, the word isn’t a topic for debate; it’s who they are. And the questions and fights over being transgender often feel beside the point. Why are so many nontrans Americans judging and opining about trans adults and children rather than listening to them?

We spoke with 12 transgender Americans from across the country and the political spectrum to try to better understand what their lives are like. In the course of our conversation, it became clear that while our participants had some common experiences — 11 of them said they’d experienced discrimination or harassment as a consequence of their trans identity, several said they’d had fraught experiences choosing which restroom to use, and some knew they were trans at a very young age — no two trans experiences are exactly the same. Some participants had families supportive of who they are; others did not. There was no uniform perspective on when or whether children should be allowed to transition or on whether there was too much or not enough media coverage of trans issues (and whether that coverage was getting it right).

But fundamentally, all participants wanted basic respect — to be seen as people, not stereotypes or caricatures or a minority to be lectured to. “I think people might assume that I am unwilling to see our shared humanity,” said Forest, a 26-year-old in the group. “In reality, I’m actually trying really hard to see people who I disagree with as also human, just like me, who have positives and negatives, who have different experiences but who might still be able to change their minds and care about other people, too. I’m trying to.”

In a word, describe your biggest concern about the country.

Xenophobia.

I was also going to say “divided.”

Tell me a little bit about words like “xenophobia,” “racism,” “division.”

There’s no middle ground. It’s conservative versus liberal, Christian versus non-Christian, Fox News or MSNBC, black or white. There’s not a spectrum anymore. We’re forced to choose a side in a lot of situations.

We’re using identity politics and racial politics against each other. There are no real ideas to bring us together. And if you look at the Biden administration, it’s a total disaster.

Black, brown and Indigenous folks are under attack. We continue to be put at the bottom of issues, especially Black trans women — right? — who are usually the ones who are most in dangerous situations.

Wyatt, what did you mean by “yikes”?

We’re in a bit of a mess in general. With the environment, it sometimes feels like we’re doomed.

For those of you who didn’t raise their hand, tell me a little bit about why not.

We have made some change, but when you think about it, we really haven’t.

I feel like we haven’t progressed enough as a society in order for me to say that we have best days ahead of us. It’s just a very slow progress.

The word “progress” doesn’t go with how I feel. I just feel like we’ve given people basic human rights. Have we actually progressed?

We’ll take a step forward, and they’ll take a step and a half back at the same time.

All of you said you identified as part of the transgender community. How does that word, “transgender,” feel to you? Do you prefer a different word to describe yourself?

I just go by “queer.”

I use lots of words. “Trans” definitely has a political resonance for me, in terms of the history of trans rights developing into a queer liberation movement crosscutting into antiracist movements, Black Power movements, queer Latinx, Chicanx in America.

I may use “transmasculine” if I’m trying to be more specific.

When did you realize you were trans?

I always pretty much knew. Since I was 5, I used to dress in my mom’s stuff. I tried to suppress it. I went in the Army, tried all the macho stuff. I said, “This ain’t right,” because I was brought up in a stricter time. One day, I just couldn’t do it anymore. I woke up and told my wife. She went ballistic. I thought maybe this is something we could work out together, and she didn’t want to. She said, “I don’t want to live with another woman.” And I said, “Well, this is what I want to do. I’m going to transition fully, and I plan to in the next five years.” Slow and steady. I’m still working on the voice and everything else, but I’m getting there. I got ridiculed and everything else from my neighbors and all this stuff. They hide themselves with their kids and stuff. I don’t think of myself as a threat to nobody, but they think I am. So I’m getting ready to move, trying to go someplace else.

Michelle, thank you for sharing that. I know these are very personal stories.

I came out as bisexual at first. Then I started seeing other trans people, and I had kind of a conflict. I wondered, “Am I attracted to these people, or do I want to be these people?” And then, wanting to transition, I asked myself, “Am I doing this because I want the privilege of passing as a man?” My partner was not supportive, interestingly enough, even though she was a very big L.G.B.T.Q. advocate where I lived. When I went for my first shot, she asked, “Should I say goodbye to this person now?” We broke up. But it wasn’t until I started immersing myself into the queer community that I really started to feel who I actually was. I think I knew for a while before, though, because I was in a pretty bad, deep depression for probably about three or four years before but I just couldn’t figure out why. Trans people were not a part of my life at that time.

I knew really early, as far back as I can remember. So 2, 3? People would ask me, “What do you want to be when you grow up?” I’d say, “A man.” I just assumed that that’s what I would be when I grew up, that it was going to change. It didn’t. I made the best of it. When I was with my first girlfriend, in 11th grade, at 17, I told her I wanted to transition. Information wasn’t really available then. I guess that’s part of the reason why I don’t go by “transgender” unless I’m hanging out with my transgender friends or my transgender group, because it might be confusing to people. I still have long hair and such. I tried transitioning. I had my testosterone up in the 900s, and I said to my doctor, “When am I going to look other than prepubescent?” And he said I waited too long. Some people just can’t. So yeah, I won’t be able to. But yeah, I just — I always knew.

C.J. and Kayla and Michelle talked about those moments of first realizing and expressing identity. I’d love to know what word people would use to describe how you felt at the beginning of that journey.

I felt shame. My parents were really strict Roman Catholic. I was trying on my mom’s stuff, and basically that’s how it started.

Confident and certain.

Angry that people were putting stuff on me that I didn’t want.

What kind of stuff?

Expectations, stereotypes. I just never really thought that male, female, woman, man were such clear distinctions.

I felt relieved.

Trepidation.

I’m going to have to say “confusion.”

I felt invalidated by the people around me. I felt like they weren’t taking my transness seriously.

Joseph, you said “hollow,” and Amber, you said “relieved.”

When I first realized how different I felt compared to how I actually looked, there was an emptiness. I started feeling whole and complete when I actually first started hormone replacement therapy, and that’s where I first started actually seeing myself and seeing, “OK, I’m going to actually do this.” I’m going to be, and people were going to start realizing and recognizing it outwardly. I wouldn’t have to hide so much.

I was relieved because I think I’ve always known, even as a young child. I was always the jock, but I think pretty much everybody just knew. So it was just more of a release — a relief. I’m more comfortable now than I have ever been. I’ve gone through everybody else’s reasoning. I’ve gone through the confusion. This is who I am. You can’t fight it.

What do people assume about you that they get wrong?

I think a lot of people assume that I am extremely masculine. They look at my appearance, and they just automatically assume, which is not the case.

I feel like people romanticize a certain version of me like in their head. Maybe it’s because I mask a lot. I just feel very misunderstood by a lot of people. I’m that friend that’s always there for people. I wish people would respect me and my feelings more.

People assume that I’m stuck up and I’m full of myself and I’m just so confident, and actually it’s the total opposite. I’m very shy. I have insecurities. And kind of like how Phunky was saying, people expect me to be on all the time, be a psychologist, so they expect me to be their relationship therapist.

I get it. I understand.

I think people might assume that I am unwilling to see our shared humanity. I don’t shave my armpits, I have a mustache, and I have short hair — physical aspects of my appearance, which I think have been used as a tool by conservative media to paint people like me as, like, politically correct Nazis. In reality, I’m actually trying really hard to see people who I disagree with as also human, just like me, who have positives and negatives, who have different experiences but who might still be able to change their minds and care about other people, too. I’m trying to.

Is this something that happens frequently? Has it happened recently?

Just, like, dumb bathroom stuff. I’ve been harassed in the bathroom before for going to the “wrong” one. But what do you want me to do? Should I just go in between the bathrooms?

I pass as what society would consider a man. I’ve been to a bar in D.C. where the men’s bathroom just had urinals, and there was a long line for the women’s. I hate when I have to out myself just to relieve myself. I get so much anxiety. If I walk in and there’s not a stall or not a door on the stall, I pray someone doesn’t walk in. That’s where a lot of the harassment for myself happens. But that’s also in a way because I pass as what this world or society would consider a man.

I definitely agree. The times where I have been harassed, I’ve been trying to use the restroom. I’m on active-duty military. I’m in the Navy, so we all share a ship. To be politically correct, my sex marker hasn’t changed, so I have to shower and use the restroom that the females use, and that’s a bit of a challenge.

My friends and I are all very visibly queer. A lot of times I dress up very, very visibly queer, and people are constantly looking at me, constantly taking pictures of me, constantly making comments, you know?

I wish I could have said zero. I have actively been harassed, had graffiti and all that on my apartment, my lockers at work. I’ve been chased by pickup trucks when I was walking home at night and had beer bottles smashed up against my head just because of who I am.

Chanel, you were at a 1.

I think for me, it’s psychological. I am a Black trans woman. Knowing the amount of Black trans women who are murdered each year and me being at the age past which many trans women are not expected to live, it brings me a lot of fear. And I think it’s more fear of me just being Black in a very white cis society.

How many people say that they feel supported by their families of origin?

My family’s on board. They said it made sense. When I was a teenager, they wouldn’t let me shave my head when I wanted to. And then they were like, “We’re sorry we didn’t let you shave your head when you were a teenager — is this why you wanted to do that?” And yes, that was why.

Same. I wanted to shave my head when I was younger, couldn’t, but then they later found out, and it was an aha moment for them.

My mom doesn’t really acknowledge that I’m trans. She’s not supportive at all. My dad’s not really in my life. But my parents still deadname me and my trans friends. I try and correct them, but literally yesterday, my mom said, “I’m never going to understand that, so stop correcting me.” I’m never going to be supported.

I’m in a small town in the South, so kind of superconservative down here. Nobody knows I’m trans.

My mom and stepdad didn’t know how to place me if I couldn’t be within the binary. There’s a lot of pressure to transition so that they’d know what to tell other people, because they didn’t know how to deal with something outside of that. But I feel a lot more support now with growth in education and time.

If you had to choose one word for what it’s like being trans in America today, what word would you use?

I would have to agree with Michelle. I would say “easier.”

Misunderstood.

In the last couple of years, do you think things are getting better or worse for trans Americans?

I’m comparing from the Trump administration to now, so I think the bar is low. There’s a little bit more openness from this administration.

So I live in New York, and there’s a lot of accessibility for being trans. A lot of surgeries can get covered with your insurance, and I feel like there’s a big queer community here, so it’s very easy to be accepted and to find trans friends and queer friends. And I feel like getting to things like H.R.T. is also really accessible here and it’s very easy to get covered. Mutual aid is really big here, too. Social media has made it very easy for trans people to get help. There’s things like Trans Santa , Trans Lifeline , where they have centers for trans people to call if they’re feeling down. I feel like there are a lot more resources than — I would say, I don’t know — in the ’90s.

I think that’s a tricky question, though, Patrick. Because like somebody mentioned, it got really dicey when Trump was in. And we still have some politicians acting like juveniles.

When it comes to the politics, I pretty much keep to myself. I’m more concerned with the finances. That’s what I do for a living. So I see the numbers, and it’s going to take a few years for the economy to roll back. I think that once that happens, things will definitely change for the better. When it comes to safety, I feel like I’m in a moderate to safe zone.

Joseph, could I ask you what you consider to be the biggest challenges facing transgender Americans today?

I don’t want to be a whole downer, but it almost feels like we’re losing the ground we’ve gained. We continue to get more acceptance and visibility. But when Roe v. Wade was taken away by the courts — I’m honestly terrified that they’re going to find a way to take even more away in some way.

What do people think is standing in the way of progress, of things getting better on issues facing transgender people?

Cis white men. That’s who makes up our government. That’s who’s there. That’s who’s making all these dumb decisions. They’re focusing on the wrong things as well, the whole anti-trans legislation across several states.

Kayla, what’s a specific example of a stupid decision — kind of a specific example — that you see?

The most dangerous, I think, was the one in Texas when they were reporting parents to C.P.S. for supporting their trans kid. Everyone on social media was like, “Well, why can’t they wait until 18?” And I kept having to say to people, “You want them to wait until 18, but the reality, actual, is that they may not actually make it to that age to have that freedom.” These kids actually have supportive parents, and now the state is trying to take that away from them?

Well, there’s too much negative coverage and not enough positive coverage.

Is there something that the news media is missing when it talks about trans issues?

They’re not reporting on the right things, or they report on something, and things just get completely twisted. Facts are wrong, deadnaming people. It’s just not actually information, I guess. Like they’re not actually spreading actual facts or actual news. I feel like a lot of it ends up supporting a lot of misconceptions about trans people. If anything decent comes out about trans people in the news, I’m surprised.

Is there anything about trans people you’ve seen over the last year or two in the papers, on the news, on the radio, on TikTok that you thought got it really wrong about trans people or that you felt was unfair or fearmongering?

Well, I’m very conservative. I did vote for Trump, OK, in 2016. The truth is that Republicans do care about equal rights for everybody. But a lot of people don’t believe that because they’ve been brainwashed by the media.

When you hear political debates over bathroom choice, trans athletes in high school sports, protections against discrimination, what goes through your mind?

I think it’s just sensationalized. It’s a trendy topic to be used as a divisive tool. It’s a sort of dog whistle that you can use to garner more votes and create more fear and more division.

I agree. I think that whenever we are not knowledgeable about something, we tend to be fearful of it. Fear rules the world.

Sometimes when I speak with groups of people who don’t consider themselves part of the transgender community, they say they are worried they might get in trouble if they say the wrong thing or use the wrong pronoun. What do you think when people say these things?

I would rather somebody actually make the effort to try and fail and be corrected at it and actually go, “OK, sorry,” and just move on. Put in the effort.

People say they’re worried about saying the wrong thing. I know that you’re worried. I can feel it. And I can’t make you understand. But if you try to see from my perspective, then I’m pretty sure your imagination will allow you to see from my perspective.

If you’re scared of saying the wrong thing, go educate yourself. And if you do say something wrong, don’t get defensive after. It’s not my job to then carry your feelings. Within my community, people know that I’m a person that they can come to if they want to talk or if they want more information. But not every trans person is that person. So don’t expect an education lesson.

Sometimes people say they support people identifying however they choose, but they don’t believe that federally funded health care should be required to cover medical transitioning. What would you want to say to people who have that position?

Why would you not want trans people to have health care? Why are we not of equal value to anyone else? I don’t get it. No one chose to be trans. People say things like that and then say, “I support trans people.” But no, you don’t. You don’t think I’m equal to you or the same as you. If you want me to die, just say that.

They just don’t understand.

I’m currently on hormones and wish my surgery was covered. For my own spiritual sanity, I would not be able to say anything to someone who doesn’t think the surgery should be covered. I would have to walk away. I just can’t be the convincer. Not right now.

As somebody who has had to pay for medical treatments out of my own pocket, including up to a couple hundred thousand dollars in cancer treatments, why the hell isn’t medical care of all sorts already covered? Why is it even a question at this point? It’s to help us live longer, to have better lives.

Well, I don’t want the government in the middle of my business. Yes, I’m taking money out of my pocket to pay for my care. I’m working and saving to do that, but I’m doing what I want to do. The government can’t run the country. Why would I trust them to run my health care?

How, if at all, do you think ideas around gender identity should be discussed and taught in schools — elementary school, junior high school, high school?

I think it should be taught early on because some kids may not be aware of how they’re feeling. It would have helped me if it had been taught early on.

Yeah. I mean there are lots of kids books that are totally appropriate that just talk about gender in a general way. “ Red: A Crayon’s Story ” is a good one. Don’t separate your class into boys over here and girls over here. That’s a small thing that teachers can do at any classroom age that can make it more comfortable for trans kids to be themselves.

Yeah, I think the sooner, the better. I taught elementary for 10 years, and it was something that I always tied into my lessons. I don’t think a lot of people recognize that racism, transphobic, homophobic thoughts are learned behaviors that are taught to young children from their parents.

I see where Chanel is coming from, but I also think that gender identity should not be taught prior to maybe high school. I just feel like the younger, the more impressionable. Not only will they be trying to figure out other things, aside from themselves, but adding in gender identity is just a bit too much for younger kids, I think.

Do you have any thoughts on the question of when young people with gender dysphoria should be allowed to begin transitioning?

I guess between the age of 13 and maybe 18, somewhere around there. It’s a confusing time, so I think that it starts with family first. They got to decide for their child. If their child comes up to them and says, “Look, something’s not right here,” then have a discussion with that child first. I really don’t think there’s any place for school here because, to me, it’s more of a personal medical issue, a political or social issue.

Family is going to be your main support. It’s going to be up to the family, the parents. And for the child —

Amber, sorry to interrupt, but how do you think parents should approach a young person or teenager who says they’re interested in transitioning?

Get your sources, get your information, get your education. I’m in my late 40s now. If I would have known about these groups much sooner, like when I was even in my — when I was coming out — I know I would have stepped up and taken those actions before I told my mom.

I don’t know how I feel about children medically transitioning at a young age. That’s based on their individual situation. There are things they could do that could help them affirm their gender, like changing their clothes or hairstyle or things like that, physical appearances. But if the child doesn’t have a supportive family, I feel like the school should have some type of peer counseling where these kids could be able to talk about this in a safe space because they’re not being provided with that at home. They should be able to talk about this somewhere, because it needs to be discussed, especially when you feel like no one’s supporting you and your family is invalidating you. There needs to be some type of resource.

Is there an age that’s too young?

As long as there’s nothing irreversible, as long as you can go back on it, your child should be able to transition. I see a lot of children that do transition at a young age, and they don’t detransition or start questioning their gender. But I do feel like it should be more of a one-on-one thing.

If I could have had the chance to actually transition or even just start H.R.T. from a younger age, I would have taken it and not had a second thought. Far too many kids are out there without information about transitioning, and some even consider taking their own lives because they get in a situation where they don’t have any support.

Joseph, do you think there is an age that’s too young for a young person to begin transitioning?

Exactly what Phunky said. I think it should be a very rare, case-by-case basis if they’re going to go ahead and actually do an irreversible change. If you’re talking about going on hormone blockers, especially for teenagers, that can help you buy time to eventually make a bigger decision yourself. But it’s also that gray area I get into: How much do we have to prove to make a decision for ourselves? Some states and some places make it a lot harder for us, so I don’t think there’s a clear-cut answer.

What would you say to parents who say they’re conflicted or uncomfortable with teenagers taking puberty blockers?

I’m 19. I feel like people should be able to have more responsibility, and I feel like it’s very important to affirm your child and your teenager. You don’t know what your child is going through. You don’t know what your teenager is going through. There’s so many trans people that would have loved to be on H.R.T. when they were a teen, would have loved to start their transition. And I feel like there’s not enough recognition around that. There’s not enough supportive parents around that, either, so I feel like they should be able to. There’s not enough cases of people detransitioning versus, like, people that wanted to transition earlier.

Why did you have a kid? Did you have a child so that you could model that child after you, or did you have a child so that you could bring a person into the world who is capable of and confident in making their own decisions? And are you willing to support them as they navigate that?

I believe if the child believes that they want to be that way, they should go to a psychiatrist, talk to counselors, maybe talk to someone in the trans community and everything else first before you even start that. Because once it starts, it’s a slippery slope.

As a parent, you’re responsible for that child until they’re 18, and the frontal lobe’s not developed until 24. That being said, I knew who I was my entire life. Being supported and being able to be who I was was great. I could have done it at 17 or 18, had I known how and had the resources. Then it wouldn’t have been the parent’s responsibility.

Let’s say we were doing a focus group with trans Americans 20 years from now. What do you think it’s going to be like?

Unfortunately, they will probably be talking about a lot of the same issues. I think until there’s more education, we might still be talking about bathrooms. We might still be talking about whether or not we have a right to health care protection.

I think we’re going to be looking back and saying, “Oh, we had this conversation 20 years ago. What’s changed?”

I don’t think it’s going to be different. I hope it is, but there’s too many conservative people and too many people who support them.

We’re really not talking about the true roots of why we have division and why this division continues to happen. We’re going in a circle.

I feel like things could kind of go either way, given how our country is. It’s bad, and it’s only going to get worse is kind of how I feel. But the more I get to know the generation that’s coming up — I’ve got faith in those kids.

My friends who have kids, their little friends came out gay in elementary school, and everybody was fine with it. So unless things keep going sideways politically, I think the younger people coming up — I just have hope, because I’ve seen all this growth in the gay and trans communities.

Is there anything that you would want to leave New York Times readers with, as just a final thought?

Trans people are just people. Not pedophiles and not perverts.

Stop trying to understand us. If you’re not trans, you never will. I feel like a lot of times, people are just trying to make sense of us in their head, and I need you to stop trying to make sense and just respect us as people. We’re human beings, and we’re just going to live our lives just like you are living your lives. Stop trying to understand and interject yourself and just listen.

Just love everybody and let everybody be who they want to be.

I have a quote up in my living room. It says, “I was a woman born with a male defect. After decades of pressure to live with it, I finally fixed it. So why are people so hung up on transitioning? It was a revelation. I didn’t become female. I’ve always been female.” We are who we are, and you don’t need to understand it. It’s not meant for you to understand. What you need to do is learn and just be quiet and listen.

I think we all have a right to self-determination and to self-actualization. The more we just respect each other and trust that we are doing what’s right for ourselves, I think it’s just a happier society and a more loving community that we can create.

Two words: I belong.

Just listen.

Nothing changes if nothing changes, and let’s stop the generational trauma. Let’s all listen and change.

Stop using us as political tools in your campaigns. Every four years, we’re being used. That’s where all the divisiveness and the hate and everything else comes from because they pawn us against everybody.

If we do not make the change that should occur in the world, the next generation is going to do it, and they are not going to be nearly as nice as we have been. So do it, or they are never going to forgive you.

You don’t know someone else’s personal truth better than they do, even if you’re their parent. So just let people make their own decisions.

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Supporting the Transgender People in Your Life: A Guide to Being a Good Ally

Learning to be an ally to the transgender people in your life, or to transgender people overall, is an ongoing process. Some ways to be a good ally are simple and easy, while others require more time, energy, and commitment. Whether you’re looking for information on supporting a transgender person in your life or helping to change the world to be better for transgender people overall, this guide can help.

One of the most important parts of being an ally to transgender people is learning what it means to be transgender. For information on identity, language, and other issues facing transgender people you can visit Frequently Asked Questions about Transgender People , Understanding Non-Binary People , and our About Transgender People hub , which has links to various resources and educational material.

The Basics: Things to Remember about Being an Ally

There is no one way to be a ‘perfect’ ally. The transgender community is diverse and complex, coming from every region of the United States and around the world, from every racial and ethnic background, and from every faith community. This means that different members of the transgender community have different needs and priorities. Similarly, there is no one right way to handle every situation, or interact with every trans person. Be respectful, do your best, and keep trying.

You don’t have to understand someone’s identity to respect it. Some people haven’t heard a lot about transgender identity, or have trouble understanding what it means to be trans, and that’s okay. But all people, even those whose identities you don’t fully understand, deserve respect.

You can’t always tell if someone is transgender simply by looking at them.   Many people expect that they’ll “just know” when someone is trans, and may be surprised to learn that this isn’t always true. Since there is no one transgender experience, there is no one way for transgender people to look, either. Trans people might be in groups or gatherings alongside you without you realizing that we’re there – which makes it even more important to be an outspoken ally and supporter, whether or not you are aware of any trans people around you. 

There is no “one right way” to be transgender. Some transgender people choose to medically transition, and some don’t. Some transgender people choose to legally change their names or ID documents, and some don’t. Some transgender people choose to change their appearance (like their clothing or hair), and some don’t. Likewise, some transgender people may want to do many of those things but are unable to because they can’t afford it or for safety reasons. A transgender person’s identity does not depend on what things they have or haven’t done to transition, and no two transgender people’s journeys are exactly alike.

Continue to educate yourself. One of the simplest ways to be a strong ally is to take your education into your own hands. It’s important to have conversations with the trans people in your life, but it’s also important for you to seek out resources and information on your own. A few great places to start:

• Frequently Asked Questions about Transgender People
• Understanding Non-Binary People
• About Transgender People  

Interacting with Transgender People

This section includes information on respectfully interacting with transgender individuals one-on-one or when in a small group.

Use the language a transgender person uses for themselves. No two transgender people are exactly the same, and different transgender people may use different words to describe themselves. You should follow the lead of each trans person, as they will best know the language that is right for them.

If you don’t know what pronouns to use, ask. A simple way to see what pronouns someone uses—he, she, they, or something else—is to wait and see if it comes up naturally in conversation. If you’re still unsure, ask politely and respectfully, without making a big deal about it. Sharing your own pronouns is a great way to bring up the topic—for example, “Hi, I’m Rebecca and I use she/her/hers as my pronouns. How about you?” If you accidentally use the wrong pronouns, apologize and move on. Making a big deal out of a pronoun mistake may be awkward and often draws unwanted attention to the transgender person.

Be careful and considerate about what other questions you ask. There are many topics—medical transition, life pre-transition, sexual activity—that you may be curious about. That doesn’t mean it’s appropriate to ask a transgender person about them, or expect a transgender person to be comfortable sharing intimate details about themselves. There are two questions you can ask yourself that may help determine if a topic is appropriate to bring up:

“Do I need to know this information to treat them respectfully?” Asking someone’s name and pronoun is almost always appropriate, as we use that information in talking to and about each other every day. Beyond that, though, you may be curious about questions that are not things you truly need to know. For example, a transgender coworker’s surgical history is rarely information that you need to know.

“Would I be comfortable if this question was turned around and asked of me?” Another good way to determine if a question is appropriate is to think about how it would feel if someone asked you something similar. For example, it would probably not feel appropriate for a coworker to ask you about your private areas of your body. Likewise, it’s probably not appropriate to ask similar questions about a transgender coworker’s body.

Here are some specific topics that many transgender people are uncomfortable discussing with anyone but those closest to them:

• Their birth name (never call it their “real” name!) or photographs from before they transitioned
• What hormones they are (or aren’t) taking
• What surgeries they have (or have not) had
• Questions related to sexual relationships

Someone’s transgender identity is their private information to share, or not. Just because someone has told you that they are transgender does not necessarily mean that they have told everyone in their life. A transgender person may not choose to tell others that they are transgender because it is unsafe to do so, because they’re worried they’ll be mistreated or fired, or simply because they don’t want to share that information with someone. It is not up to you to decide who should or shouldn’t know that a particular person is transgender. Similarly, transgender people should be the ones to decide how much information is being shared: a transgender person may be open about being trans, but only want to discuss medical issues with certain close friends. Simply because a transgender person has told you something about their experiences doesn’t mean they want everyone to know.

Avoid compliments or advice based on stereotypes about transgender people, or about how men and women should look or act. People sometimes intend to be supportive but unintentionally hurt transgender people by focusing on their looks or whether they conform to gender stereotypes. Here are some examples of what to avoid , as they often feel like backhanded compliments:

• “You look like a real woman! I never would have known that you’re trans.”
• “You would look less trans if you just got a wig/shaved better/wore more makeup/etc.”
• “No real man would wear clothing like that. You should change if you don’t want people to know you’re transgender.”
• “I’d date him, even though he’s transgender.”  

Being Outspoken

Here's how to be an outspoken ally in larger groups, at work or at school!

Speak out in support of transgender people and transgender rights. Politely correct others if they use the wrong name or pronoun for a transgender person. More broadly, it is important to challenge anti-transgender remarks, jokes, and conversations. It can be scary to speak out, but loud and visible support for transgender rights can show transgender people that they are accepted, encourage other allies to speak out, and help change the minds of people who aren’t supportive of transgender people yet.

Support transgender people who experience discrimination. Transgender people may feel that they don’t have support from others when making complaints about discrimination or bringing their experiences to authorities, administrators, or others in position of power. Make it clear that you will support the transgender people in your life whether or not they decide to make formal complaints.

Think about how you use gendered language . Do you regularly greet groups by saying, “Ladies and gentlemen?” Do you have a coworker who refers to everyone as “guys?” Is there a particular gender-based joke your friend loves to tell? Many transgender people are fine being called ‘ladies’ or ‘gentlemen,’ but you can’t know without first asking. Consider changing your habits to avoid making assumptions about people's gender or pronouns, and encouraging the people in your life to do the same. This can take time and effort, but is an important way to be an ally and support transgender people outside of individual, face-to-face interactions.

Learn about policies affecting transgender people. Are there any laws that protect transgender people where you live? Any policies at work or school that are inclusive of transgender people? It’s important to learn more about the challenges that transgender people face and the goals of transgender advocates, and, if you’re comfortable with it, even help push to change bad laws and policies or support good ones.

Changing Businesses, Schools, and More

Rethink gender on forms and documents. When creating forms and documents, consider whether you need to include gender at all. Many times, we default to asking for gender without considering why or how that information will be used. If you do need to ask for gender information, consider using a blank space for people to fill in as they feel comfortable, rather than a boxes marked “male” and “female,” or make it clear that people can fill in forms in a way that matches their gender identity.

Ensure everyone has access to bathrooms and other facilities. Everyone should be able to safely and comfortably use bathrooms and other gendered facilities. Push to allow people to use the bathroom that matches their gender identity rather than what’s on their ID. In addition, providing gender-neutral or private bathrooms is a great way to provide safe and comfortable space for everyone (but never require anyone to use them if they don’t want!). And if a restroom is designed for just one user at a time, make sure that it’s gender-neutral—there’s no reason to make it a men’s or women’s restroom. Take down that “Women” or “Men” sign and put up new signs that say “Restroom.”

Push for support and inclusivity, not just "tolerance."  A baseline of tolerance—allowing transgender people to exist—is an important start, but we can do more. If your school brings outside speakers or hosts events, make sure that some of them include transgender people and topics. If your business donates to nonprofits, look into partnering with organizations that support the transgender community. If your organization posts community events on social media, include some from the transgender community.

Craft a transgender-inclusive nondiscrimination policy. Shifting the culture of an organization takes time. Crafting a transgender-inclusive nondiscrimination policy can help clarify how your organization supports transgender people, and ensure that there’s a way to respond to those who aren’t supportive.

Changing the World

Call your elected officials. Call your elected local, state, and federal officials to thank them when they do support transgender rights and to provide important criticism when they don’t. Visit Make Your Voice Heard for more information.

Show up in your community. School board meetings, library coun cils, parent-teacher associations , volunteer groups – all of these can have an enormous impact on the everyday lives of trans people. Recently, schools and libraries have come under attack even just for acknowledging that transgender people exist. In these spaces, making it clear that you support trans people can be enormously impactful.  

Work to pass laws in your city or state, and on the federal level, that outlaw discrimination in employment, housing, public accommodations (public spaces like stores and parks), and education based on gender identity/expression. This could be as simple as calling your elected officials, or as involved as a letter-writing campaign or collecting signatures for a ballot measure.

Change the curriculum of medical, health, crisis response and social work programs, or bring in trainers, to teach these providers about transgender people and how to treat transgender people with respect and professionalism. Include information about the rejection, discrimination and violence that transgender people face and how to provide services and support to transgender clients.

Work with schools to make them safe for transgender students by implementing all the recommendations in our Model School District Policy on Transgender and Gender Non-Conforming Students .

Work with homeless shelters to make them safe for transgender people by implementing all the recommendations in Transitioning Our Shelters: A Guide to Making Homeless Shelters Safe for Transgender People .

Work with suicide prevention, HIV prevention and treatment, alcohol and drug abuse treatment, and anti-smoking programs to ensure that their work is trans-inclusive and their staff is knowledgeable about transgender issues. Find trainers and teach them how to deal sensitively with trans people seeking assistance.

Work with police departments to have fair written policies with regard to interacting with transgender members of the public, regardless if they are seeking assistance or being arrested, and make sure all police officers are trained on following the policy and treating transgender people with respect.

Work with jail and prison systems to ensure the respectful and safe treatment of transgender prisoners, starting with implementing the recommendations of Standing with LGBT Prisoners .

Center diversity . Transgender people come from every population, and are of all races, religions, ages, and more. There are transgender immigrants, employees, prisoners, sex workers, and every other category imaginable. Make an effort to be as inclusive as possible of all kinds of transgender people when working to support transgender communities.  

Putting it All into Action

Hopefully by this point you feel armed with the tools and knowledge needed to be an ally to the transgender people in your life, as well as the larger transgender community. Remember: nobody's perfect. No one person could ever be the perfect ally at all times, so it’s just important to provide as much support as you can and to learn from the mistakes you may make along the way.

Thanks for being a strong ally!

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