Table of ContentsView AllTable of ContentsWhat It MeansWhat It InvolvesSocial TransitioningLegal TransitioningMedical TransitioningBarriersWhere to Find SupportHow to Be an Ally
Table of ContentsView All
View All
Table of Contents
What It Means
What It Involves
Social Transitioning
Legal Transitioning
Medical Transitioning
Barriers
Where to Find Support
How to Be an Ally
Gender transitioning describes the process of affirming and expressing one’s internal sense of gender rather than the gender assigned to them at birth. It is a process through whichtransgenderandgender-nonconformingpeople align their presentation or sex characteristics with theirgender identity.
Gender transitioning, known more commonly today as gender affirmation, not only involves aesthetic appearances but may also involve changes in social roles, legal recognitions, or physical aspects of the body. Gender transitioning is often described as a binary (male or female) but can also benon-binary, meaning a person is neither strictly male nor female.
This article describes what gender transitioning involves as well as the social, legal, and physical aspects of gender affirmation.
Verywell / Theresa Chiechi
What Does It Mean to Transition?
Many transgender and gender-nonconforming people prefer the term “gender affirmation” to “gender transitioning”—in part because transitioning is often taken to mean the process of transforming one medically. In fact, a person doesn’t need to undergo medical treatment to affirm their identity, and some transgender people avoid hormones or gender-affirming surgery.
Gender transitioning is a holistic process, addressing all aspects of who a person is inwardly and outwardly. It can be broadly categorized into three types:
Exploring Your Gender Identity
Gender transitioning is a process that often starts in response togender dysphoria. Gender dysphoria describes the persistent sense of unease that occurs when the gender you were assigned at birth does not match how you experience or express your gender internally. Some people have experienced symptoms of gender dysphoria as early as 3 or 4 years of age.
The unease can be expressed in children in different ways, including:
For many, gender dysphoria fully emerges during puberty when awareness about how their body defines them creates internal distress. Feelings of unease may be amplified when a child is described as “tomboy” or “sissy,” or is criticized and attacked for “acting like a girl” or “acting like a boy.”
With physical changes during puberty, long-standing feelings that “I don’t fit in” may evolve into feelings that “I don’t fit into my own body.” It is then that children or teens may undergo a process referred to as internal transitioning. This is when you start to change how you see yourself.
Gender transitioning/affirmation is the next step. There is no set course as to how a person aligns their internal sense of gender with their outward expression of gender identity. Gender transitioning is not about “changing” or “recreating” oneself. It’s about expressing one’s authentic self and asserting who you are socially, legally, and/or medically.
Social transitioning involves how a person publicly expresses their gender to the world at large.
Social transition can take many forms:
Social affirmation may also include playing certain sports, pursuing different lines of work, or partaking in activities that some might typically see as “male” or “female.”
Legal transitioning is about legal recognition. It involves changing legal documents to reflect your chosen name, gender, and pronouns.
This includes governmental and non-government documents such as:
Some states will only allow changes if “bottom surgery” (genital reconstruction) is performed, while others will allow you to do so without any form of gender-affirming surgery. Other states have begun to offer an “X” gender option for people who are non-binary.
Medical transitioning most commonly involveshormone therapyto develop some of the desired secondary male or female sex characteristics. It can also involve surgery to change certain physical aspects that hormone therapy alone can’t change.
Hormone Therapy
Hormone therapy helps people look physically more like the gender they identify as. They are sometimes used on their own and may also be used before gender-affirming surgery to improve outcomes.
Gender-affirming hormone therapy takes two forms:
Gender-Affirming Surgery
Gender affirmation surgeryis used to align a person’s physical appearance to their gender identity. Many hospitals offer gender-affirming surgery through a department of transgender medicine.
Gender-affirming medical procedures include:
What to Know About Gender-Affirming Surgery
Barriers to Gender Transitioning
Transgender people are protected from public and private insurance discrimination under federal and state laws, including Medicare and Medicaid.
Medicarealso has no consistent policy regarding the approval of gender-affirming surgery. It instead relies on precedents in individual states to direct whether a treatment is approved or not.As such, states in which Medicaid coverage is denied may also be more likely to deny Medicare coverage.
In terms of private insurance, most providers have removed restrictions on gender-affirming care. Although larger insurers (like Aetna and Cigna) usually cover a more comprehensive array of services, in full or in part, many smaller insurers do not (or may only cover things like hormone therapy).
Even if treatments are covered, private insurers will often require psychological evaluations and health screenings that non-transgender people would never be asked to undergo (such as for breast reconstruction).
Another barrier is stigma and discrimination. Studies have shown that no less than 53% of transgender people report being harassed or bullied in public.Others report family or partner disapproval as the main reason why they abandon gender affirmation.
These factors can discourage transgender people from seeking gender-affirming care or embarking on treatments they would otherwise desire.
Gender transitioning can be complex and overwhelming, but there are organizations that can help with everything from insurance coverage to simply having someone to share your feelings with.
Here are some of the leading support organizations:
Health Disparities in Transgender People of Color
If you know someone who is transgender or is considering transitioning, learning how to be supportive is the best way to be an ally. Educate yourself about gender and gender transitioning. Everyone’s transition is different, and there is no right or wrong way to do it.
Summary
Gender transitioning may involve social affirmation (such as dressing differently or coming out to friends and family), legal affirmation (changing your name and gender on legal documents), or medical affirmation (using hormones and/or surgery to change certain physical aspects of your body). Transgender people can pursue some or all of these.
Barriers to gender transitioning include cost, lack of insurance, stigma, discrimination, and lack of family or partner support.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gülgöz S, Glazier JJ, Enright EA, et al.Similarity in transgender and cisgender children’s gender development.PNAS. 2019;116(49):24480-24485. doi: 10.1073/pnas.1909367116King WM, Gamerel KE.A scoping review examining social and legal gender affirmation and health among transgender populations.Transgend Health.2021;6(1):5–22.. doi:10.1089/trgh.2020.0025Irwig MS, Childs K, Hancock AB.Effects of testosterone on the transgender male voice.Andrology. 2017;5(1):107-112. doi: 10.1111/andr.12278Tangpricha V, den Heijer M.Oestrogen and anti-androgen therapy for transgender women.Lancet Diabetes Endocrinol. 2017;5(4):291-300. doi: 10.1016/S2213-8587(16)30319-9National Center for Transgender Equality.Know Your Rights in Health Care.Kaiser Family Foundation.Update on Medicaid coverage of gender-affirming health services.Center of Medicare and Medicaid Services.Gender dysphoria and gender reassignment surgery.Transgender Legal Defense and Education Fund.Health insurance medical policies.National Center for Transgender Equality and National Gay and Lesbian Task Force.Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.Turban JL, Loo SS, Almazan AN, Keuroghlian AS.Factors leading to “detransition” among transgender and gender diverse people in the United States: a mixed-methods analysis.LGBT Health.May/June 2021;8(4):273–80. doi:10.1089/lgbt.2020.0437
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gülgöz S, Glazier JJ, Enright EA, et al.Similarity in transgender and cisgender children’s gender development.PNAS. 2019;116(49):24480-24485. doi: 10.1073/pnas.1909367116King WM, Gamerel KE.A scoping review examining social and legal gender affirmation and health among transgender populations.Transgend Health.2021;6(1):5–22.. doi:10.1089/trgh.2020.0025Irwig MS, Childs K, Hancock AB.Effects of testosterone on the transgender male voice.Andrology. 2017;5(1):107-112. doi: 10.1111/andr.12278Tangpricha V, den Heijer M.Oestrogen and anti-androgen therapy for transgender women.Lancet Diabetes Endocrinol. 2017;5(4):291-300. doi: 10.1016/S2213-8587(16)30319-9National Center for Transgender Equality.Know Your Rights in Health Care.Kaiser Family Foundation.Update on Medicaid coverage of gender-affirming health services.Center of Medicare and Medicaid Services.Gender dysphoria and gender reassignment surgery.Transgender Legal Defense and Education Fund.Health insurance medical policies.National Center for Transgender Equality and National Gay and Lesbian Task Force.Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.Turban JL, Loo SS, Almazan AN, Keuroghlian AS.Factors leading to “detransition” among transgender and gender diverse people in the United States: a mixed-methods analysis.LGBT Health.May/June 2021;8(4):273–80. doi:10.1089/lgbt.2020.0437
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gülgöz S, Glazier JJ, Enright EA, et al.Similarity in transgender and cisgender children’s gender development.PNAS. 2019;116(49):24480-24485. doi: 10.1073/pnas.1909367116King WM, Gamerel KE.A scoping review examining social and legal gender affirmation and health among transgender populations.Transgend Health.2021;6(1):5–22.. doi:10.1089/trgh.2020.0025Irwig MS, Childs K, Hancock AB.Effects of testosterone on the transgender male voice.Andrology. 2017;5(1):107-112. doi: 10.1111/andr.12278Tangpricha V, den Heijer M.Oestrogen and anti-androgen therapy for transgender women.Lancet Diabetes Endocrinol. 2017;5(4):291-300. doi: 10.1016/S2213-8587(16)30319-9National Center for Transgender Equality.Know Your Rights in Health Care.Kaiser Family Foundation.Update on Medicaid coverage of gender-affirming health services.Center of Medicare and Medicaid Services.Gender dysphoria and gender reassignment surgery.Transgender Legal Defense and Education Fund.Health insurance medical policies.National Center for Transgender Equality and National Gay and Lesbian Task Force.Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.Turban JL, Loo SS, Almazan AN, Keuroghlian AS.Factors leading to “detransition” among transgender and gender diverse people in the United States: a mixed-methods analysis.LGBT Health.May/June 2021;8(4):273–80. doi:10.1089/lgbt.2020.0437
Gülgöz S, Glazier JJ, Enright EA, et al.Similarity in transgender and cisgender children’s gender development.PNAS. 2019;116(49):24480-24485. doi: 10.1073/pnas.1909367116
King WM, Gamerel KE.A scoping review examining social and legal gender affirmation and health among transgender populations.Transgend Health.2021;6(1):5–22.. doi:10.1089/trgh.2020.0025
Irwig MS, Childs K, Hancock AB.Effects of testosterone on the transgender male voice.Andrology. 2017;5(1):107-112. doi: 10.1111/andr.12278
Tangpricha V, den Heijer M.Oestrogen and anti-androgen therapy for transgender women.Lancet Diabetes Endocrinol. 2017;5(4):291-300. doi: 10.1016/S2213-8587(16)30319-9
National Center for Transgender Equality.Know Your Rights in Health Care.
Kaiser Family Foundation.Update on Medicaid coverage of gender-affirming health services.
Center of Medicare and Medicaid Services.Gender dysphoria and gender reassignment surgery.
Transgender Legal Defense and Education Fund.Health insurance medical policies.
National Center for Transgender Equality and National Gay and Lesbian Task Force.Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.
Turban JL, Loo SS, Almazan AN, Keuroghlian AS.Factors leading to “detransition” among transgender and gender diverse people in the United States: a mixed-methods analysis.LGBT Health.May/June 2021;8(4):273–80. doi:10.1089/lgbt.2020.0437
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
