What Is Transgender?
Diverse gender identities fall under the transgender umbrella
Medically reviewed by Anita Sadaty, MD
Transgender is a term used to describe people whose gender identity does not conform with the gender they were assigned at birth. A person designated male at birth who identifies as female is a transgender woman, while a person designated female at birth who identifies as male is a transgender man.
In recent years, transgender has become an umbrella term that includes not only people who are binary (male or female) but also those who are non-binary or gender-non-conforming.
Gender affirmation, or the process of aligning one's outward expression of gender with one's inward sense of gender, is central to the transgender identity. Medical treatments or surgery may be involved, but not always.
This article explains what it means to be transgender, including the terminology used and how to use it correctly. It also describes the process of gender affirmation and some of the serious challenges faced by transgender people today.
What It Means to Be Transgender
Transgender traditionally means to identify as male if you were assigned female at birth or to identify as female if you were assigned male at birth. And, to many, that remains the definition of "transgender," described on the male-female binary.
But not everyone sees gender in the same way.
Those who are non-binary view gender on a spectrum where roles and expectations aren't automatically assigned based on what genitals a person is born with. As such, a non-binary person may identify as male and female, as neither male nor female, or as their own unique gender (described by some as the "third gender").
In the current vernacular, non-binary people may fall under the "transgender umbrella" when they consciously move away from expected gender roles and align themselves, their presentation, and sometimes their bodies with their own gender identity.
In the end, gender identity is one's internal sense of gender even if that means no gender at all. Examples include:
Agender: Identifying with no gender
Bigender: Identifying with both male and female gender characteristics
Cisgender: Identifying with the sex you were assigned at birth
Genderfluid or genderqueer: Shifting between genders or outside of society's expectations of gender
Pangender or polygender: Displaying or experiencing parts of all genders
Third Spirit: An umbrella term that describes different sexualities and genders in Indigenous Native American people
Gender Identity vs. Sexual Orientation
Gender and sex are not the same thing, and neither are gender identity and sexual orientation.
Gender identity is the personal sense of one's own gender, which can correspond to a person's assigned sex or differ from it. Sexual orientation is a person's identity in relation to the gender or genders they are sexually attracted to.
Gender Affirmation and Gender Expression
Whether binary or non-binary, the one characteristic that connects all transgender people is that the gender assigned to them at birth does not match their own internal sense of gender identity.
This mismatch can be felt from as early as three to five years in some transgender children. Others may not recognize it until puberty when changes in their bodies create a palpable sense of unease about their gender and all that implies. Others still may not recognize this until later in life.
This uneasiness is referred to as gender dysphoria. Gender dysphoria is not a psychological illness. It simply describes distress caused by the misalignment of a person's assigned gender and gender identity.
In response to gender dysphoria, a transgender person may pursue gender affirmation in its different forms to align their gender identity (their inward sense of gender) with their gender expression (their outward expression of their gender).
Gender affirmation (formerly known as gender transitioning) can include one or all of the following:
Social affirmation, which may involve changing your name and pronouns, your manner (such as the way you sit and talk), your appearance (such as your clothing and hair), and the washroom you use
Legal affirmation, which may involve changing your name and gender on your driver's license, birth certificate, bank accounts, passport, medical records, and other governmental and non-governmental records
Medical affirmation, which may involve gender-affirming hormone therapy and gender-affirming surgeries (such as breast augmentation, vaginoplasty, phalloplasty, orchiectomy, or facial feminization)
Do All Transgender People Have Surgery?
Despite what many people think, a person does not have to undergo medical treatments to be transgender. Social and/or legal affirmation may be far more important to some people.
While many transgender people will take hormones to align their physical expression with their gender identity, there are many who don't and have no desire to.
Terminology and Appropriate Usage
Transgender is an adjective (as in "he is a transgender man"). It is not used as a noun (such as "he is a transgender")" or a verb ("he is transgendered").
"Trans" is often used as a shorthand for transgender, so it is usually acceptable to describe a transgender man as a trans man and a transgender woman as a trans woman.
If someone identifies as transgender, you would typically use the pronouns "he" and "him" for a transgender man and "she" and "her" for a transgender woman. Even so, non-binary or gender-non-conforms people may prefer "them" and "they" or other pronouns, so ask first if you are unsure.
If in doubt, err on the side of caution by offering your pronouns first and then asking the person what pronouns they use.
Mistakes can occur, but to intentionally or repeatedly use the wrong pronouns is a disrespectful act known as misgendering.
Equally disrespectful is calling someone by their "dead name" (their name prior to gender affirmation) rather than their "affirmed name." This is true even if you're a family member or have grown up with that person.
Terms to Avoid
There are other terms that have been displaced because they mischaracterize was being transgender is about. Others still are considered offensive and should never be used.
These include:
Biological sex: "Biological" is often construed to mean authentic as in "biologically male" or "biologically female." It also suggests that genitals are physical and gender identity is somehow psychological.
Gender-confirming: A transgender person does not need to confirm or "prove" their gender. A transgender person affirms their gender by asserting their authentic self. Gender-affirming surgery is preferred, for example, over gender-confirming surgery.
Gender reassignment: In the same vein, a transgender person's gender is not changed or reassigned. This is especially true if you are non-binary and identify as neither male nor female.
Sex change: This is an outdated and largely offensive term that suggests that being transgender is about changing one's genitals.
Transsexual: This is another outdated and offensive term that equates transgender identity with surgery, such as when describing a "pre-op transsexual" and "post-op transsexual."
Tranny, She-Male, or She-He: These are defamatory terms used to dehumanize transgender people.
Transgenderism: This is a term used by anti-trans activists that suggests that there is a movement to "recruit" or "push" people toward becoming transgender.
Discrimination and Transphobia
It is estimated that about 0.5% of adults in the United States (1.3 million) and 1.4% of youth between the ages of 13 and 17 years (or 300,000) identify as transgender.
Studies have shown that being transgender in the United States is fraught with challenges, including transphobia and discrimination in all realms of employment, education, healthcare, safety, and daily living.
The National Transgender Discrimination Survey is the largest survey to assess the experiences of transgender people in the United States. It has been performed twice—first in 2008 with 6,450 respondents and then in 2013 with more than 27,000
Both reports described high rates of discrimination across every facet of life. Discrimination took the form of everything from verbal harassment to sexual assault, and many individuals were forced to leave school or jobs as a result of those experiences.
Transgender individuals also reported many experiences of discrimination in health care. Many individuals were denied access to gender-affirming medical and surgical care.
Perhaps even more disturbing, numerous people reported being denied access to emergency care and general medical care as well as verbal and physical harassment in healthcare spaces.
Because of this, many transgender people report avoiding medical care, for fear of experiencing additional discrimination or abuse. Others report avoiding care because they lacked financial or other resources.
Among the key statistics:
One in six trans children has had to leave or change schools due to mistreatment.
One in four trans children has been physically attacked.
One in eight trans children has been sexually assaulted.
Nearly half of all trans people were sexually assaulted over the course of their lifetime.
One in three trans adults has been fired, denied a promotion, or experienced mistreatment in the workplace due to their gender expression.
One in three trans people has experienced mistreatment in healthcare, ranging from the refusal of service to verbal, physical, or sexual abuse.
Discrimination is even worse for transgender people of color, who may experience bias based on both their skin color and their gender identity.
The survey found that Latinx, American Indian, multiracial, and Black respondents were more than three times as likely as the general U.S. population to be living in poverty.
How to Be an Ally
Gender diversity is a normal part of a functioning society and has been reported throughout history. Although transgender individuals have an increased risk of certain negative health outcomes, research suggests that this does not reflect any inherent issue with being transgender. Instead, it reflects the minority stress related to being part of a society that may not be accepting.
Indeed, research suggests that one of the most important factors associated with the health of transgender people is access to an affirming environment and desired medical care. This is particularly true for transgender children and adolescents, who have been shown to do as well as their cisgender peers when their families are supportive and accepting.
While not all transgender individuals are interested in medical or surgical affirmation, all people need health care at some point during their lives. Therefore, it is important to make all healthcare facilities safe and affirming for people of diverse genders. Lack of access to affirming health care is a risk factor for health concerns for transgender people of all ages.
