What Does It Really Mean to Be Transgender?

An estimated 1.4 million Americans identify as transgender.

In June 2018, the World Health Organization (WHO) announced that being transgender will no longer be considered a mental illness when defined in the International Classification of Diseases beginning in 2022.

This is good news for transgender people around the world, as well as the estimated 1.4 million living in the United States. Yet, while it represents a step forward in wider understanding and acceptance, there remain many misconceptions about what it means to be transgender.

What does the term transgender really mean?
The non-medical term transgender takes on many different meanings for many different people. However, being transgender, or “trans,” means a person identifies differently from the gender they were thought to be at birth, says the National Center for Transgender Equality.

This means a transgender woman is living as a woman today, but was assigned a male gender at birth. And a transgender man is living as a man today but was assigned a female gender at birth. In addition, some transgender people are non-binary or genderqueer, meaning they do not live as a man or a woman, but rather a blend of the two or a different gender altogether.

Gender identity is something all people have—even if they’re not transgender. The difference is, most people grow up and live as the sex they were at birth, and transgender people do not.

How do transgender people know they’re transgender?
The road to becoming transgender is different for everyone and the realization of being transgender can occur at any point in your life. Some people have such feelings as a child and some feel as though they’ve never fit in but have no idea why.

The American Psychological Association explains that children who have significant trouble identifying with the gender assigned to them at birth—a phenomenon known as gender dysphoria—are more likely to be transgender later in life. Those with gender dysphoria have a strong desire to be of the other gender, which can cause extreme distress that interferes with daily activities. However, not all transgender people experience gender dysphoria.

Usually, people who distinguish themselves as transgender have given their gender identity a lot of thought. But the process can be challenging, since those who are transgender often experience criticism, harassment and discrimination.

How does one transition from one gender to another?
One common misconception about transgender people is that everyone has surgery to transition from one gender to another. And while some do, there are other options for physician-led transitioning. Not to mention, some people can identify as transgender without seeking medical or surgical gender reassignment. A person’s preferences and priorities will determine the medical options available.

One of the most common non-surgical therapies for transitioning genders is hormone therapy. Some hormone therapy is done before reconstructive surgery, and some individuals opt to do hormone therapy alone.

These hormones help transgender individuals develop physical features associated with their gender identity. For example, taking estrogen may help a transgender woman—an individual who had masculine characteristics at birth but identifies as a woman—develop breasts. It’s a process that may take many years.

According to the Endocrine Society, these transition options require multidisciplinary teams, which should include an appropriately trained physician, mental health professional (especially for adolescents) and endocrinologist. And treatment availability, options and timing are based on a patient’s needs and age.

It’s worth noting that there are some risks associated with hormone therapy. Among transgender women, estrogen may increase the risk of thrombosis, a blood clotting condition. Among transgender men, androgen treatment may up the risk of polycythemia, an excess of red blood cells. It’s important that individuals speak with their primary care physician or endocrinologist about the risks involved with treatment.

There are various surgery options
Not all transgender people seek gender confirmation surgery, but it is an option for those wishing to possess the physical features of their gender identity. Those contemplating surgery should speak with a doctor to learn about what the surgeries can and cannot achieve, what the risks entail and whether or not hormone therapy is needed in conjunction with surgery.

Transgender women may elect:

  • Facial feminization to increase feminine facial features 
  • Breast augmentation to add size to the breast area
  • Genital reconstruction like vaginoplasty, to remove the scrotum and testes and to construct a vagina, clitoris and labia

For transgender men, some surgeries are done after one to two years of hormone therapy, and may include:

  • Chest reconstruction surgery to reduce breast size
  • Oophorectomy to remove the ovaries
  • Hysterectomy to remove the uterus
  • Vaginectomy to remove the vagina
  • Neophallus (penis) creation

Many insurance plans do not cover services related to sex change, so those who desire surgery should call their insurance provider to confirm what’s covered and what’s not.

The transgender community still faces a lot of challenges
Even though the actions by the WHO and other organizations represent significant steps towards easing the stigma associated with being transgender, many people still do not understand transgender people and may view them as socially or sexually deviant. In more serious cases, transgender people are bullied or harassed by others who don’t fully accept them as they are. And, while some organizations like the Department of Education are taking strides toward non-discrimination laws for policies in the workplace and schools, some states have passed specific laws that actually prevent transgender people from using public restrooms that match their gender identity.   

An April 2019 study of 3,075 transgender adults and 719,484 non-transgender adults, found that those who were transgender were more likely to report that they smoked, had a sedentary lifestyle and lacked health insurance than the non-transgender adults. According to the study published in JAMA Internal Medicine, the transgender individuals were also 30 percent more likely to report being in “fair” or “poor” health when assessing how they felt over the previous month and 66 percent admit they experienced severe mental distress, defined as having 14 or more mentally unhealthy days in the previous month.

These challenges may hinder efforts to live healthy and satisfying lives and prevent transgender people from getting needed help and support. They may also increase the risk of suicide and self-harm. According to The National Transgender Discrimination Survey (NTDS), of the 6,450 transgender and gender non-conforming participants, 41 percent admitted to attempting suicide, compared to 1.6 percent of the general population.

If you know someone who has questions about being transgender or who’s having trouble with their own gender identity, you should encourage them to reach out for help.

  • The Trans Lifeline (877-565-8860) is run by transgender people who are available to talk with those struggling with their gender identity, have questions about being transgender or are in a crisis situation and feel like they are going to hurt themselves.
  • The Trevor Project is a national organization that offers crisis and suicide prevention services in the form of chat lines and other plans and programs. The group is known for providing a judgment-free place for those looking to talk or to learn more about being transgender.
  • It’s especially important for those who are having suicidal thoughts or experiencing emotional distress to utilize these resources or to call the National Suicide Prevention Lifeline at 800-273-8255.

Transgender people finding more acceptance
While significant challenges remain for the transgender community, awareness is growing, thanks in part to public figures working to bring greater understanding to gender identity and issues. Activists like author Janet Mock, Orange is the New Black actress Laverne Cox and Chaz (nee Chastity) Bono—all transgender themselves—are among those speaking up.

Whether you’re transgender yourself, you know someone who is, or you just want to learn more, it’s important that you turn to health professionals or other trustworthy resources for answers. The National Center for Transgender Equality provides information about the transgender community, ways you can get involved locally and information to help you navigate some of the challenges associated with being transgender.

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