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FAQs – gender reassignment

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What does it mean for someone to have the protected characteristic of “gender reassignment” under the Equality Act 2010? The government, public bodies, many employers and even employment tribunals are often confused about this.

FAQs – gender reassignment

Having the protected characteristic of gender reassignment does not mean that someone’s sex has changed or give them the right to make other people pretend that it has. 

These FAQs cover the definition of the characteristic and who it covers – and what this means for employers and service providers. 

Download these gender reassignment FAQs as a PDF.

What is the protected characteristic of “gender reassignment”?

What does it mean to have this characteristic , who can have this characteristic , does having the protected characteristic of gender reassignment mean that a person must be treated as the opposite sex , does the equality act outlaw “misgendering”, is it harassment to “out” a person as transgender , can employers have policies which require people to refer to transgender people in particular situations in a particular way , what should employers and service providers do to avoid the risk of harassment claims , should schools have rules about “misgendering”.

The Equality Act 2010 at Section 7 defines the protected characteristic of “gender reassignment” as relating to a person who is: 

“proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.”

The law refers to this as being “transsexual”. But the term more commonly used today is “transgender” or “trans”. This broadly relates to anyone at any stage of a personal process. For example:

  • A man tells his employer that he is considering “transitioning” and is seeing a therapist with the potential result of being referred for medical treatment.
  • A man identifies as a “transwoman” without having any surgery or treatment.
  • A woman identified as a “transman” for several years and took testosterone, but has now stopped and “detransitioned”.

The Equality Act protects people from direct and indirect discrimination, harassment or victimisation in situations that are covered by the Equality Act, such as in the workplace or when receiving goods or services.

Direct discrimination

Direct discrimination is when you are treated worse than another person or other people because:

  • you have a protected characteristic
  • someone thinks you have that protected characteristic (known as discrimination by perception)
  • you are connected to someone with that protected characteristic (known as discrimination by association).

For example: an employee tells their employer that they intend to transition. Their employer alters their role against their wishes to avoid them having contact with clients.

The comparator is a person who is materially similar in other aspects but does not have the protected characteristic (“is not trans”). 

Indirect discrimination

Indirect discrimination happens when a policy applies in the same way for everybody but disadvantages a group of people who share a protected characteristic, and you are disadvantaged as part of this group. This is unlawful unless the person or organisation applying the policy can show that there is a good reason for the policy. This is known as objective justification .

For example: an airport has a general policy of searching passengers according to their sex. Everyone travelling needs to follow the same security procedures and processes, but it makes transgender travellers feel uncomfortable. This could be indirect discrimination, so the airport reviews its policy and changes it so that any passenger may ask to be searched by a staff member of either sex and have a private search, out of view of other passengers. 

Harassment is unwanted behaviour connected with a protected characteristic that has the purpose or effect of violating a person’s dignity or creating a degrading, humiliating, hostile, intimidating or offensive environment.

For example: a transgender person is having a drink in a pub with friends and is referred to by the bar staff as “it” and mocked for their appearance.

Victimisation

Victimisation is when you are treated badly because you have made a complaint of gender-reassignment discrimination under the Equality Act or are supporting someone who has made a complaint of gender-reassignment discrimination. For example:

For example: a person proposing to undergo gender reassignment is being harassed by a colleague at work. He makes a complaint about the way his colleague is treating him and is sacked.

The Equality Act also provides that if a person is absent from work because of gender-reassignment treatment, their employer cannot treat them worse than they would be treated if absent for illness or injury. 

Does a person have to be under medical supervision?

No. This was explicitly removed from the definition in 2010. Gender reassignment can be a personal process. 

Must they have a gender-recognition certificate or be in the process of applying for one?

No. The protected characteristic is defined without reference to the Gender Recognition Act.

Do they have to have made a firm decision to transition? 

No. Protection against discrimination and harassment attaches to a person who is proposing to undergo, is undergoing or has undergone a process (or part of a process).

During the passage of the Equality Act, the Solicitor General stated in Parliament: 

“Gender reassignment, as defined, is a personal process, so there is no question of having to do something medical, let alone surgical, to fit the definition. “Someone who was driven by a characteristic would be in the process of gender reassignment, however intermittently it manifested itself.  “At what point [proposing to undergo] amounts to ‘considering undergoing’ a gender reassignment is pretty unclear. However, proposing’ suggests a more definite decision point, at which the person’s protected characteristic would immediately come into being. There are lots of ways in which that can be manifested – for instance, by making their intention known. Even if they do not take a single further step, they will be protected straight away. Alternatively, a person might start to dress, or behave, like someone who is changing their gender or is living in an identity of the opposite sex. That too, would mean they were protected. If an employer is notified of that proposal, they will have a clear obligation not to discriminate against them.” 

In the case of Taylor v Jaguar Land Rover , a male employee told his employer that he was “gender fluid” and thought of himself as “part of a spectrum, transitioning from the male to the female gender identity”. He said to his line manager: “I have no plans for surgical transition.” He started wearing women’s clothing to work, asked to be referred to by a woman’s name and raised a question about which toilets he should use. The Employment Tribunal concluded that he was covered by the protected characteristic. 

Can children have the protected characteristic? 

Yes. In the case of AA, AK & Ors v NHS England , NHS England argued that children who are waiting for assessment by the Tavistock Gender Identity Development Service (GIDS) do not have the protected characteristic as they have not yet reached the stage of proposing to transition. The Court of Appeal rejected this argument. It noted that the definition of “gender reassignment” does not require medical intervention and can include actions such as changing “one’s name and/or how one dresses or does one’s hair”.

The court concluded:

“There is no reason of principle why a child could not satisfy the definition in s.7 provided they have taken a settled decision to adopt some aspect of the identity of the other gender.”

It noted that the decision did not have to be permanent. 

Is “Gillick competence” relevant to the protected characteristic?

No. “Gillick competence” refers to the set of criteria that are used for establishing whether a child has the capacity to provide consent for medical treatment, based on whether they have sufficient understanding and intelligence to fully understand it.

Having the protected characteristic of gender reassignment (that is, being able to bring a claim for gender-reassignment discrimination) does not depend on having any diagnosis or medical treatment. Therefore Gillick competence is not relevant to the Equality Act criteria. 

No. There is nothing in the Equality Act which means that people with the protected characteristic of “gender reassignment” need to be treated in a particular way, or differently from people without the characteristic. 

Article 9 and 10 of the European Convention of Human Rights protect the fundamental human rights of freedom of speech and freedom of belief. 

In the case of Forstater v CGDE [2021] it was established that the belief that men are male and women are female, and that this cannot change and is important, is protected under Article 9 and in relation to belief discrimination in the Equality Act. 

This means that employers and service providers must not harass or discriminate against people because they recognise that “transwomen” are men and “transmen” are women. Employers and service providers cannot require people to believe that someone has changed sex, or impose a blanket constraint on expressing their belief. 

No. “Misgendering” is not defined or outlawed by the Equality Act. 

In general, people who object to “misgendering” mean any reference to a person who identifies as transgender by words that relate to their sex. This can include using the words woman, female, madam, lady, daughter, wife, mother, she, her and so on about someone who identifies as a “transman”, or man, male, sir, gentleman, son, husband, father, he, him and so on about someone who identifies as a “transwoman”. 

Any form of words may be harassment, but this depends on the circumstances and the purpose and effect of the behaviour. Harassment is unwanted conduct related to a relevant protected characteristic that has the purpose or effect of violating a person’s dignity, or creating an intimidating, hostile, degrading, humiliating or offensive environment for a person.   An employment tribunal would also consider:

  • that person’s perception
  • the other circumstances of the case
  • whether it is reasonable for the conduct to have that effect.

Tribunals have emphasised that when judging harassment context is everything, and warned against a culture of hypersensitivity to the perception of alleged victims.

Employment tribunal judgments

As Lord Justice Nicholas Underhill found in Dhellwal v Richmond Pharmacology [2009], a case decided under the Race Relations Act:

“What the tribunal is required to consider is whether, if the claimant has experienced those feelings or perceptions, it was reasonable for her to do so. Thus if, for example, the tribunal believes that the claimant was unreasonably prone to take offence, then, even if she did genuinely feel her dignity to have been violated, there will have been no harassment within the meaning of the section.”

In the Forstater case, the employment appeal tribunal said that it was not proportionate to “impose a requirement on the Claimant to refer to a trans woman as a woman to avoid harassment”. It said that:

“ Whilst the Claimant’s belief, and her expression of them by refusing to refer to a trans person by their preferred pronoun, or by refusing to accept that a person is of the acquired gender stated on a GRC, could amount to unlawful harassment in some circumstances, it would not always have that effect. In our judgment, it is not open to the Tribunal to impose in effect a blanket restriction on a person not to express those views irrespective of those circumstances.”

In the case of de Souza v Primark Stores [2017] , a transgender claimant who went by the name of Alexandra, but whose legal name was Alexander, was found to have been harassed by colleagues who made a point of using the male form of name when they knew he did not want them to, but not by being issued with a “new starter” badge that showed his legal name. 

In the case of Taylor v Jaguar Land Rover [2020] , a male claimant who wore women’s clothing  to work was judged to have been exposed to harassment by colleagues saying “What the hell is that?”, “So what’s going on? Are you going to have your bits chopped off?”, “Is this for Halloween?” and referring to the claimant as “it”. 

Not necessarily. 

A person can be “outed” as transgender in two different ways: 

  • Their sex is commonly known and recorded, but their transsexualism is not (for example a man who cross-dresses at the weekend and is considering transitioning is “outed” at work by someone who has seen them at a social event).
  • They are disappointed in the expectation of being treated as one sex when they are actually the other (for example a person who identifies as a “trans woman” is referred to as male by a woman in a changing room).

In Grant v HM Land Registry [2011] , which concerned the unwanted disclosure that an employee was gay, Lord Justice Elias found that this did not amount to harassment: 

“Furthermore, even if in fact the disclosure was unwanted, and the claimant was upset by it, the effect cannot amount to a violation of dignity, nor can it properly be described as creating an intimidating, hostile, degrading, humiliating or offensive environment. Tribunals must not cheapen the significance of these words. They are an important control to prevent trivial acts causing minor upsets being caught by the concept of harassment.”

The perception (or hope) of transgender people that they “pass” as the opposite sex is often not realistic. Their sex is not in fact hidden, but is politely ignored by some people in some situations. It is not reasonable for them to be offended by other people recognising their sex, particularly if they are seeking access to a single-sex service. Acknowledging someone’s sex, particularly where there is a good reason, is unlikely to be harassment. 

In the first-instance case of Chapman v Essex Police , a transgender police officer felt embarrassed and upset when a police control-room operator double-checked his identity over the radio because his male voice did not match the female name that the operator could see. The tribunal did not uphold a complaint of harassment, finding that the claimant was “too sensitive in the circumstances”.

Yes, but those policies must be proportionate. Employers cannot have blanket policies against “misgendering”, but can have specific policies concerning how staff should refer to transgender people in particular situations. Organisations should recognise that these policies constrain the expression of belief, and therefore they should seek to achieve their specific aims in the least intrusive way possible.

When determining whether an objection to a belief being expressed is justified, a court will undertake a balancing exercise. This test is set out in the case of Bank Mellat v HM Treasury :

  • Is the objective the organisation seeks to achieve sufficiently important to justify the limitation of the right in question?
  • Is the limitation rationally connected to that objective?
  • Is a less intrusive limitation possible that does not undermine the achievement of the objective in question?
  • Does the importance of the objective outweigh the severity of the limitation on the rights of the person concerned?

For example: 

  • A company provides a specialist dress service to transsexual and transvestites. The men who use the service expect to be called “she” and “her” and referred to as Madam. It is justified for the employer to train and require staff to use this language when serving customers. 
  • Staff at a full-service restaurant greet customers as “Sir” and “Madam” as they arrive. The restaurant’s policy is that staff should use the terms which appear most appropriate based on gendered appearance, and to defer to customer preference if one is expressed. This is justified by the aim of creating the service and ambience that the restaurant owners seek to provide. 
  • A public body assesses claimants for medical benefits, including individuals with mental-health conditions. It directs its staff to refer to claimants using the terms which the claimants prefer, including using opposite-sex pronouns when requested, in order to make them feel comfortable. However, it recognises that in recording medical information, assessors must be able to be accurate about claimants’ sex. This is justified by the aim of providing a service that is accessible and effective for vulnerable clients. 

The case of David Mackereth v AMP and DWP concerned a doctor who lost his job undertaking claimant health assessments for the Department for Work and Pensions because he refused to comply with its policy on using claimants’ preferred pronouns. The employer’s policy was found not to have amounted to unlawful harassment or discrimination against Dr Mackereth, in the particular circumstances of his job. However, the Employment Appeal Tribunal stated that “misgendering” would not necessarily be harassment: 

“Such behaviour may well provide grounds for a complaint of discrimination or harassment but, as the EAT in Forstater made clear, that will be a fact-specific question to be determined in light of all the circumstances of the particular case.”

Relevant considerations

In Higgs v Farmor’s School [2023] Mrs Justice Eady sets out the considerations that are likely to be relevant considering whether constraining the expression of a belief (“manifestation”)  in order to avoid harassment or discrimination is justified in the context of employment. These include:

  • the content of the manifestation
  • the tone used
  • the extent of the manifestation
  • the worker’s understanding of the likely audience
  • the extent and nature of the intrusion on the rights of others, and any consequential impact on the employer’s ability to run its business
  • whether the worker has made clear that the views expressed are personal, or whether they might be seen as representing the views of the employer, and whether that might present a reputational risk
  • whether there is a potential power imbalance given the nature of the worker’s position or role and that of those whose rights are intruded upon;
  • the nature of the employer’s business, in particular where there is a potential impact on vulnerable service users or clients
  • whether the limitation imposed is the least intrusive measure open to the employer.

Employers cannot force employees to believe that people can change sex, or prevent them expressing that lack of belief except in limited circumstances. So what should employers do to protect transgender people from harassment, and themselves from liability? 

They should have ordinary policies against bullying and harassment, including jokes, name-calling, humiliation, exclusion and singling people out for different treatment.

They should seek to avoid putting people in situations they will reasonably experience as hostile or humiliating.

Ambiguous rules put people in situations where it is reasonable to feel offended. For example, an employer provides “female” toilets, showers and changing rooms, but allows some male staff in because they identify as transgender. This creates a hostile environment: 

  • female staff are surprised, shocked, humiliated and upset to find themselves sharing with a colleague of the opposite sex
  • male staff members who want people to treat them as women may be challenged or face comments that are intended to intimidate, humiliate or degrade them.

This was the situation faced by the Sheffield Hospital Trust , which had a policy that transgender staff could use opposite-sex facilities. It had to deal with the fall-out when women complained about seeing a half-naked male in their changing room and the male staff member sued for harassment after being questioned about this.

Rather than putting these two groups of people together in a environment where both will reasonably feel harassed, employers should have clear rules about facilities that are single-sex, and also, where possible, provide a unisex alternative for anyone who needs it, including people who feel that they have “transitioned away from their sex” and therefore do not wish to use single-sex facilities shared with members of their own sex. The EHRC last year provided guidance on single-sex services which encouraged clear rules and policies.

It should be made clear to people who have the protected characteristic of “gender reassignment” that having this characteristic does not mean it is reasonable for them to expect others to believe or pretend to believe they have changed sex, or for them to be allowed to break (or expect to be an exception to) rules that aim to protect the dignity and privacy of others. 

If a person breaks a clear rule against entering a space provided for the opposite sex, it is not reasonable for them to feel offended when this is pointed out. 

No. It would not be lawful for schools to have a policy that forbids, punishes or denigrates pupils who use clear words about the sex of other people (such as pronouns, but also boy/girl, male/female and so on), nor to require pupils to refer to some classmates as if they were the opposite sex.

  • To do so constrains the freedom of speech of pupils in a way that is unjustified and discriminates against them on the basis of belief. 
  • It is inconsistent with schools’ safeguarding duty of care , and with their record-keeping responsibilities, for staff to misrepresent the sex of pupils in their records or in introducing them to their peers. 
  • In order to explain and enforce sex-based rules designed to keep children safe (such as who is allowed in which showers, toilets, dormitories or sports teams), schools must be able to use clear and unequivocal language. 
  • It is not reasonable to expect that a child at school, or transferring between schools, can avoid being “outed” as the sex that they are . 

We do not think that any policy which tells teachers or pupils to lie about the sex of pupils, constrains them from using clear sex-based language or treats them detrimentally if they do would pass the proportionality test. It is an unreasonable constraint on speech that is neither required nor justified in order to avoid discrimination on the basis of gender reassignment. 

Schools form part of a system that is regulated at a national level. In England that system is the responsibility of the Secretary of State for Education. It is the responsibility of the Secretary of State to make this legal situation clear across the English school system by issuing the long-awaited DfE guidance. 

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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.

A chart showing Most favor protecting trans people from discrimination, even as growing share say gender is determined by sex 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

Chart showing Young adults, Democrats more likely to say society hasn’t gone far enough in accepting people who are transgender

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. 

Views of laws and policies related to transgender issues differ widely 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.

Majority of U.S. adults say gender is determined by sex assigned at birth

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.

Chart showing More than four-in-ten U.S. adults say science has influenced their views of gender and sex at least a fair amount

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.

U.S. adults with different viewpoints on gender and sex say their opinions have been influenced by different factors

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. 

Chart showing Most Americans say there is at least some discrimination against trans people in the U.S.

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. 

Chart showing Plurality of Americans say there is little or no societal acceptance of transgender 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. 

Chart showing Public is divided over whether society has gone too far or not far enough in accepting transgender people

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 say it’s important to use someone’s new name if they change their name  as part of 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.  

Chart showing People who know a trans person place more importance on using a person’s new name, pronouns if they transition

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 .

Chart showing More than four-in-ten Americans say societal views on gender identity 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.”

Chart showing Liberal Democrats are more likely than other groups to be following news about bills related to trans people closely

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. 

Chart showing Most Americans say they would favor laws that would protect transgender people from discrimination in jobs, housing and public spaces

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. 

Chart showing Views of laws and policies related to transgender issues differ by age

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. 

Chart showing About four-in-ten or more say forms and government documents should offer options other than ‘male’ and ‘female’

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.

Chart showing Views on children learning about people who are trans or nonbinary at school differ by party, children’s age

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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More Inclusive Gender Questions Added to the General Social Survey

gender reassignment question

The General Social Survey, or GSS, is one of the most important data sources for researchers studying American society. For the first time ever in its nearly 50-year history, the survey’s 2018 data release includes information on respondents’ self-identified sex and gender. The new data will allow researchers to measure the size of the transgender and gender non-binary populations and identify the challenges they face, information that can in turn shape public policy. The research of former Clayman Institute faculty fellow, Aliya Saperstein, supported this important change.

First fielded in 1972, the GSS is an especially important source of longitudinal data for social scientists. Longitudinal data derive value in part by asking identically worded questions at each time point. This allows researchers to attribute changes in how respondents answer demographic, attitudinal, and behavioral questions to real changes over time rather than to changes in question wording. Changing or adding questions is not simple. Old questions may be known to be valid, whereas new questions may pose challenges related to understandability and reliability. Researchers may be uncertain about whether new questions really measure what they believe they do. However, over time, old questions may not accurately reflect newer academic understandings of the concepts they are meant to measure. When budgets are fixed, survey designers make tradeoffs when deciding whether to keep an old question or update it.

On previous surveys, interviewers selected “male” or “female” on behalf of—and without directly asking—respondents. Yet, since the GSS’s first iteration, social scientists’ understanding of sex has changed markedly in ways that conflict with this measurement.

These tensions are embodied by the measurement of sex historically used by the GSS. On previous surveys, interviewers selected “male” or “female” on behalf of—and without directly asking—respondents. Yet, since the GSS’s first iteration, social scientists’ understanding of sex has changed markedly in ways that conflict with this measurement. For one, many scholars differentiate sex from gender. They understand sex to be based in biological factors, like anatomy, and comprised of categories like “male,” “female,” and “intersex.” Gender, on the other hand, involves behavioral expectations and is comprised of categories like “men,” “women,” “transgender,” and more. Additionally, social scientists acknowledge the importance of self-identification, and so seek to know how the respondent describes their own gender rather than how the interviewer describes it.

In recent years, sociologists have raised concerns about how surveys measure sex. Laurel Westbrook, associate professor of sociology at Grand Valley State University, and Aliya Saperstein, associate professor of sociology at Stanford University and former Clayman Institute faculty fellow, examined the questions used to measure sex on four of the largest and longest-running social science surveys, including the GSS. In an article published in Gender & Society in 2015, they critiqued survey questions for treating sex and gender as equivalent, immutable, and easily identified by others. According to Saperstein, precisely measuring sex and gender is an essential step in drawing attention to issues, like discrimination, faced by transgender and gender non-binary people. Saperstein said, “Whether we like it or not, numbers are what convince policymakers, what people turn to when they’re trying to make powerful rhetorical arguments about why something matters. They want a percentage.” Yet previously available data did not allow researchers to measure the size of the transgender and gender non-binary populations, let alone determine whether they are disadvantaged.

In the spring of 2014, Saperstein and Westbrook submitted a proposal to the GSS Board of Overseers to add several new questions related to sex and gender to the 2016 survey. Among these questions was a so-called two-step gender question, which asked respondents to separately identify the sex they were assigned at birth and their current gender. To illustrate that these questions were valid, Saperstein and Westbrook pre-tested the questions using national surveys. ( Their pre-test data is publicly available at openICPSR.) According to Saperstein, the board was unable to add their proposed questions to the 2016 GSS because of budgetary constraints.

Other sociologists had similar concerns about the sex measure on the GSS. D’Lane Compton, associate professor of sociology at the University of New Orleans, Kristen Schilt, associate professor of sociology at the University of Chicago, and Danya Lagos, doctoral candidate in sociology at the University of Chicago, submitted a proposal to add questions to the 2018 GSS. In addition to proposing several attitudinal questions, they advocated for the two-step gender question. Using previously published studies and other datasets, they provided evidence  to the members of the GSS Board of Overseers that the two-step question was reliable. Brian Powell, professor of sociology at Indiana University Bloomington and then-board member, said board members were concerned about measurement error—for instance, resulting from respondents misunderstanding the question—and small sample size. Still, many board members were convinced that the sex question historically used by the GSS did not accurately reflect the experience of some people in the United States and needed to be changed. “I think it’s worth it, and the board thought it was worth it,” Powell said.

The two-step gender question was adopted by the board and fielded in 2018. The adoption represents, in Powell’s words, a “truly collective effort” between the sociologists who advocated for the change, the GSS Board of Overseers, the GSS principal investigators, funders of the GSS such as the National Science Foundation, and NORC, the independent research organization at the University of Chicago that runs the GSS. Westbrook credits a number of researchers for advocating for the change in recent years, including Clayman Institute Director Shelley J. Correll and Stanford Professor (Emerita) of Social Sciences Cecilia Ridgeway, as well as Powell, Compton, Schilt and Lagos.

The two-step gender question was fielded to just over 1,400 respondents. The first question reads, “What sex were you assigned at birth? (For example, on your birth certificate)” and allows respondents to select “Female,” “Male,” “Intersex,” or “No answer.” The second question asks, “What is your current gender?” Respondents were able to select “Woman,” “Man,” “Transgender,” “A gender not listed here,” and “No answer.”

The 2018 data was released in March of this year, so researchers already can access its more than 1,000 variables, including the new two-step gender question. Saperstein said that nine, or 0.6%, of the 1,397 respondents who answered the two-step gender questions can be considered transgender or gender non-binary. Saperstein noted that, because of the small sample size, the data cannot yet be used to answer the most pressing, statistical questions about the transgender and gender non-binary populations. Researchers will have to wait for future data releases, which also will include the two-step gender question. For now, Saperstein said, “Just having the questions on the survey offers a different kind of a power, a kind of symbolic power that recognizes the actual gender diversity of the population.” 

The data eventually can be used to assess any disadvantages transgender and gender non-binary people are experiencing, which can be used to shape public policy. Compton, the sociologist from the University of New Orleans, said, “I think if we want to make real change and have resources and rights, we do need to have these numbers. Those are important.” 

(photo by Zackary Drucker for The Gender Spectrum Collection)

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A decision to undertake gender reassignment is made when an individual feels that his or her gender at birth does not match their gender identity. This is called ‘gender dysphoria’ and is a recognised medical condition.

Gender reassignment refers to individuals, whether staff, who either:

  • Have undergone, intend to undergo or are currently undergoing gender reassignment (medical and surgical treatment to alter the body).
  • Do not intend to undergo medical treatment but wish to live permanently in a different gender from their gender at birth.

‘Transition’ refers to the process and/or the period of time during which gender reassignment occurs (with or without medical intervention).

Not all people who undertake gender reassignment decide to undergo medical or surgical treatment to alter the body. However, some do and this process may take several years. Additionally, there is a process by which a person can obtain a Gender Recognition Certificate , which changes their legal gender.

People who have undertaken gender reassignment are sometimes referred to as Transgender or Trans (see glossary ).

Transgender and sexual orientation

It should be noted that sexual orientation and transgender are not inter-related. It is incorrect to assume that someone who undertakes gender reassignment is lesbian or gay or that his or her sexual orientation will change after gender reassignment. However, historically the campaigns advocating equality for both transgender and lesbian, gay and bisexual communities have often been associated with each other. As a result, the University's staff and student support networks have established diversity networks that include both Sexual Orientation and Transgender groups.

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  • Gender dysphoria

Your health care provider might make a diagnosis of gender dysphoria based on:

  • Behavioral health evaluation. Your provider will evaluate you to confirm the presence of gender dysphoria and document how prejudice and discrimination due to your gender identity (minority stress factors) impact your mental health. Your provider will also ask about the degree of support you have from family, chosen family and peers.
  • DSM-5. Your mental health professional may use the criteria for gender dysphoria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Gender dysphoria is different from simply not conforming to stereotypical gender role behavior. It involves feelings of distress due to a strong, pervasive desire to be another gender.

Some adolescents might express their feelings of gender dysphoria to their parents or a health care provider. Others might instead show symptoms of a mood disorder, anxiety or depression. Or they might experience social or academic problems.

  • Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your gender dysphoria-related health concerns Start Here

Treatment can help people who have gender dysphoria explore their gender identity and find the gender role that feels comfortable for them, easing distress. However, treatment should be individualized. What might help one person might not help another.

Treatment options might include changes in gender expression and role, hormone therapy, surgery, and behavioral therapy.

If you have gender dysphoria, seek help from a doctor who has expertise in the care of gender-diverse people.

When coming up with a treatment plan, your provider will screen you for mental health concerns that might need to be addressed, such as depression or anxiety. Failing to treat these concerns can make it more difficult to explore your gender identity and ease gender dysphoria.

Changes in gender expression and role

This might involve living part time or full time in another gender role that is consistent with your gender identity.

Medical treatment

Medical treatment of gender dysphoria might include:

  • Hormone therapy, such as feminizing hormone therapy or masculinizing hormone therapy
  • Surgery, such as feminizing surgery or masculinizing surgery to change the chest, external genitalia, internal genitalia, facial features and body contour

Some people use hormone therapy to seek maximum feminization or masculinization. Others might find relief from gender dysphoria by using hormones to minimize secondary sex characteristics, such as breasts and facial hair.

Treatments are based on your goals and an evaluation of the risks and benefits of medication use. Treatments may also be based on the presence of any other conditions and consideration of your social and economic issues. Many people also find that surgery is necessary to relieve their gender dysphoria.

The World Professional Association for Transgender Health provides the following criteria for hormonal and surgical treatment of gender dysphoria:

  • Persistent, well-documented gender dysphoria.
  • Capacity to make a fully informed decision and consent to treatment.
  • Legal age in a person's country or, if younger, following the standard of care for children and adolescents.
  • If significant medical or mental concerns are present, they must be reasonably well controlled.

Additional criteria apply to some surgical procedures.

A pre-treatment medical evaluation is done by a doctor with experience and expertise in transgender care before hormonal and surgical treatment of gender dysphoria. This can help rule out or address medical conditions that might affect these treatments This evaluation may include:

  • A personal and family medical history
  • A physical exam
  • Assessment of the need for age- and sex-appropriate screenings
  • Identification and management of tobacco use and drug and alcohol misuse
  • Testing for HIV and other sexually transmitted infections, along with treatment, if necessary
  • Assessment of desire for fertility preservation and referral as needed for sperm, egg, embryo or ovarian tissue cryopreservation
  • Documentation of history of potentially harmful treatment approaches, such as unprescribed hormone use, industrial-strength silicone injections or self-surgeries

Behavioral health treatment

This treatment aims to improve your psychological well-being, quality of life and self-fulfillment. Behavioral therapy isn't intended to alter your gender identity. Instead, therapy can help you explore gender concerns and find ways to lessen gender dysphoria.

The goal of behavioral health treatment is to help you feel comfortable with how you express your gender identity, enabling success in relationships, education and work. Therapy can also address any other mental health concerns.

Therapy might include individual, couples, family and group counseling to help you:

  • Explore and integrate your gender identity
  • Accept yourself
  • Address the mental and emotional impacts of the stress that results from experiencing prejudice and discrimination because of your gender identity (minority stress)
  • Build a support network
  • Develop a plan to address social and legal issues related to your transition and coming out to loved ones, friends, colleagues and other close contacts
  • Become comfortable expressing your gender identity
  • Explore healthy sexuality in the context of gender transition
  • Make decisions about your medical treatment options
  • Increase your well-being and quality of life

Therapy might be helpful during many stages of your life.

A behavioral health evaluation may not be required before receiving hormonal and surgical treatment of gender dysphoria, but it can play an important role when making decisions about treatment options. This evaluation might assess:

  • Gender identity and dysphoria
  • Impact of gender identity in work, school, home and social environments, including issues related to discrimination, abuse and minority stress
  • Mood or other mental health concerns
  • Risk-taking behaviors and self-harm
  • Substance misuse
  • Sexual health concerns
  • Social support from family, friends and peers — a protective factor against developing depression, suicidal thoughts, suicide attempts, anxiety or high-risk behaviors
  • Goals, risks and expectations of treatment and trajectory of care

Other steps

Other ways to ease gender dysphoria might include use of:

  • Peer support groups
  • Voice and communication therapy to develop vocal characteristics matching your experienced or expressed gender
  • Hair removal or transplantation
  • Genital tucking
  • Breast binding
  • Breast padding
  • Aesthetic services, such as makeup application or wardrobe consultation
  • Legal services, such as advanced directives, living wills or legal documentation
  • Social and community services to deal with workplace issues, minority stress or parenting issues

More Information

Gender dysphoria care at Mayo Clinic

  • Pubertal blockers
  • Feminizing hormone therapy
  • Feminizing surgery
  • Gender-affirming (transgender) voice therapy and surgery
  • Masculinizing hormone therapy
  • Masculinizing surgery

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Coping and support

Gender dysphoria can be lessened by supportive environments and knowledge about treatment to reduce the difference between your inner gender identity and sex assigned at birth.

Social support from family, friends and peers can be a protective factor against developing depression, suicidal thoughts, suicide attempts, anxiety or high-risk behaviors.

Other options for support include:

  • Mental health care. You might see a mental health professional to explore your gender, talk about relationship issues, or talk about any anxiety or depression you're experiencing.
  • Support groups. Talking to other transgender or gender-diverse people can help you feel less alone. Some community or LGBTQ centers have support groups. Or you might look online.
  • Prioritizing self-care. Get plenty of sleep. Eat well and exercise. Make time to relax and do the activities you enjoy.
  • Meditation or prayer. You might find comfort and support in your spirituality or faith communities.
  • Getting involved. Give back to your community by volunteering, including at LGBTQ organizations.

Preparing for your appointment

You may start by seeing your primary care provider. Or you may be referred to a behavioral health professional.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

  • Your symptoms , including any that seem unrelated to the reason for your appointment
  • Key personal information , including major stresses, recent life changes and family medical history
  • All medications, vitamins or other supplements you take, including the doses
  • Questions to ask your health care provider
  • Ferrando CA. Comprehensive Care of the Transgender Patient. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 8, 2021.
  • Hana T, et al. Transgender health in medical education. Bulletin of the World Health Organization. 2021; doi:10.2471/BLT.19.249086.
  • Kliegman RM, et al. Gender and sexual identity. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 8, 2021.
  • Ferri FF. Transgender and gender diverse patients, primary care. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed Nov. 8, 2021.
  • Gender dysphoria. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Nov. 8, 2021.
  • Keuroghlian AS, et al., eds. Nonmedical, nonsurgical gender affirmation. In: Transgender and Gender Diverse Health Care: The Fenway Guide. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Accessed Nov. 8, 2021.
  • Coleman E, et al. Surgery. In: Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People. Version 7. World Professional Association for Transgender Health; 2012. https://www.wpath.org/publications/soc. Accessed Nov. 3, 2021.

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Frequently Asked Questions about Transgender People

Transgender people come from every region of the United States and around the world, from every racial and ethnic background, and from every faith community. Transgender people are your classmates, your coworkers, your neighbors, and your friends. With approximately 1.4 million transgender adults in the United States—and millions more around the world—chances are that you've met a transgender person, even if you don't know it.

What does it mean to be transgender?

Transgender people are people whose gender identity is different from the gender they were thought to be at birth. “Trans” is often used as shorthand for transgender.

When we're born, a doctor usually says that we're male or female based on what our bodies look like. Most people who were labeled male at birth turn out to actually identify as men, and most people who were labeled female at birth grow up to be women. But some people's gender identity – their innate knowledge of who they are – is different from what was initially expected when they were born. Most of these people describe themselves as transgender .

A transgender woman lives as a woman today, but was thought to be male when she was born. A transgender man lives as a man today, but was thought to be female when he was born. Some transgender people identify as neither male nor female, or as a combination of male and female. There are a variety of terms that people who aren't entirely male or entirely female use to describe their gender identity, like non-binary or genderqueer .

(Note: NCTE uses both the adjectives “male” and “female” and the nouns “man” and “woman” to refer to a person’s gender identity.)

Everyone—transgender or not—has a gender identity. Most people never think about what their gender identity is because it matches their sex at birth.

Being transgender means different things to different people. Like a lot of other aspects of who people are, like race or religion, there's no one way to be transgender, and no one way for transgender people to look or feel about themselves. The best way to understand what being transgender is like is to talk with transgender people and listen to their stories.

How does someone know that they are transgender?

People can realize that they're transgender at any age. Some people can trace their awareness back to their earlier memories – they just knew. Others may need more time to realize that they are transgender. Some people may spend years feeling like they don't fit in without really understanding why, or may try to avoid thinking or talking about their gender out of fear, shame, or confusion. Trying to repress or change one’s gender identity doesn’t work; in fact, it can be very painful and damaging to one’s emotional and mental health. As transgender people become more visible in the media and in community life across the country, more transgender people are able to name and understand their own experiences and may feel safer and more comfortable sharing it with others.

For many transgender people, recognizing who they are and deciding to start gender transition can take a lot of reflection. Transgender people risk social stigma, discrimination, and harassment when they tell other people who they really are. Parents, friends, coworkers, classmates, and neighbors may be accepting—but they also might not be, and many transgender people fear that they will not be accepted by their loved ones and others in their life. Despite those risks, being open about one’s gender identity, and living a life that feels truly authentic, can be a life-affirming and even life-saving decision.

Thought Exercise: Thinking About Your Own Gender It can be difficult for people who are not transgender to imagine what being transgender feels like. Imagine what it would be like if everyone told you that the gender that you’ve always known yourself to be was wrong. What would you feel like if you woke up one day with a body that’s associated with a different gender? What would you do if everyone else—your doctors, your friends, your family—believed you’re a man and expected you to act like a man when you’re actually a woman, or believed you’re a woman even though you’ve always known you’re a man?  

What's the difference between sexual orientation and gender identity?

Gender identity and sexual orientation are two different things. Gender identity refers to your internal knowledge of your own gender—for example, your knowledge that you're a man, a woman, or another gender. Sexual orientation has to do with whom you’re attracted to. Like non-transgender people, transgender people can have any sexual orientation. For example, a transgender man (someone who lives as a man today) may be primarily attracted to other men (and identify as a gay man), may be primarily attracted to women (and identify as a straight man), or have any other sexual orientation.

What's the difference between being transgender and being intersex?

People sometimes confuse being transgender and being intersex. Intersex people have reproductive anatomy or genes that don’t fit typical definitions of male or female, which is often discovered at birth. Being transgender, meanwhile, has to do with your internal knowledge of your gender identity. A transgender person is usually born with a body and genes that match a typical male or female, but they know their gender identity to be different.

Some people think that determining who is male or female at birth is a simple matter of checking the baby's external anatomy, but there's actually a lot more to it. Every year, an estimated one in 2,000 babies are born with a set of characteristics that can't easily be classified as "male" or "female." People whose bodies fall in the vast continuum between "male" and "female" are often known as intersex people. There are many different types of intersex conditions. For example, some people are born with XY chromosomes but have female genitals and secondary sex characteristics. Others might have XX chromosomes but no uterus, or might have external anatomy that doesn't appear clearly male or female. To learn more about what it's like to be intersex, check out this video or click here .

While it's possible to be both transgender and intersex, most transgender people aren't intersex, and most intersex people aren’t transgender. For example, many intersex people with XY (typically male) chromosomes but typically female anatomy are declared female at birth, are raised as girls, and identify as girls; in fact, many of these girls and their families never even become aware that their chromosomes are different than expected until much later in life. However, some intersex people come to realize that the gender that they were raised as doesn’t fit their internal sense of who they are, and may make changes to their appearance or social role similar to what many transgender people undergo to start living as the gender that better matches who they are.

What is the difference between being transgender and being gender non-conforming?

Being gender non-conforming means not conforming to gender stereotypes. For example, someone’s clothes, hairstyle, speech patterns, or hobbies might be considered more "feminine" or "masculine" than what's stereotypically associated with their gender.

Gender non-conforming people may or may not be transgender. For example, some women who were raised and identify as women present themselves in ways that might be considered masculine, like by having short hair or wearing stereotypically masculine clothes. The term “tomboy” refers to girls who are gender non-conforming, which often means they play rough sports, hang out with boys, and dress in more masculine clothing.

Similarly, transgender people may be gender non-conforming, or they might conform to gender stereotypes for the gender they live and identify as.

What does it mean to have a gender that's not male or female?

Most transgender people are men or women. But some people don't neatly fit into the categories of "man" or "woman" or “male” or “female.” For example, some people have a gender that blends elements of being a man or a woman, or a gender that is different than either male or female. Some people don't identify with any gender. Some people's gender fluctuates over time.

People whose gender is not male or female may use many different terms to describe themselves. One term that some people use is non-binary , which is used because the gender binary refers to the two categories of male and female. Another term that people use is genderqueer . If you're not sure what term someone uses to describe their gender, you should ask them politely.

It's important to remember that if someone is transgender, it does not necessarily mean that they have a "third gender." Most transgender people do have a gender identity that is either male or female, and they should be treated like any other man or woman.

For more information about what it's like to have a gender other than male or female or how you can support the non-binary people in your life, read NCTE's guide Understanding Non-Binary People .

Why don’t transgender people get counseling to accept the gender they were assigned at birth?

Counseling aimed at changing someone’s gender identity, sometimes known as conversion therapy, doesn’t work and can be extremely harmful. The belief that someone’s gender identity can be changed through therapy runs counter to the overwhelming consensus in the medical community. Telling someone that a core part of who they are is wrong or delusional and forcing them to change it is dangerous, sometimes leading to lasting depression, substance abuse, self-hatred and even suicide. Because of this, a growing number of states have made it illegal for licensed therapists to try to change a young person’s gender identity (laws apply to those under 18). However, many transgender people find it helpful to get counseling to help them decide when to tell the world they are transgender and deal with the repercussions of stigma and discrimination that comes afterward.

What does "gender transition" mean?

Transitioning is the time period during which a person begins to live according to their gender identity, rather than the gender they were thought to be at birth. While not all transgender people transition, a great many do at some point in their lives. Gender transition looks different for every person. Possible steps in a gender transition may or may not include changing your clothing, appearance, name, or the pronoun people use to refer to you (like “she,” “he,” or “they”). Some people are able to change their identification documents, like their driver’s license or passport, to reflect their gender. And some people undergo hormone therapy or other medical procedures to change their physical characteristics and make their body better reflect the gender they know themselves to be.

Transitioning can help many transgender people lead healthy, fulfilling lives. No specific set of steps is necessary to “complete” a transition—it’s a matter of what is right for each person. All transgender people are entitled to the same dignity and respect, regardless of which legal or medical steps they have taken.

What are some of the official records transgender people may change when they're transitioning?

Some transgender people make or want to make legal changes as part of their transition, like by changing their name or updating the gender marker on their identity documents.

Not all transgender people need or want to change their identity documents, but for many, it's a critical step in their transition. For many transgender people, not having identity documents like driver's licenses or passports that match their gender means that they might not be able to do things that require an ID, like getting a job, enrolling in school, opening a bank account, or traveling. Some transgender people who use an ID that doesn't match their gender or their presentation face harassment, humiliation, and even violence.

Transgender people may need to change a number of documents in order to live according to their gender identity, such as their:

  • Driver’s license
  • Social Security card
  • Bank accounts and records
  • Credit cards
  • Paychecks and other job-related documents
  • Medical records
  • Birth certificate
  • Academic records

It's important to know that not all transgender people be able to make the changes they need to their IDs and other official documents. Unfortunately, these changes are often expensive, burdensome, and complicated, putting them out of reach for many people. For example, some states still require proof of surgery or a court order to change a gender marker. In many states, the process can be time-consuming and involve many steps, or cost hundreds of dollars. As a result, only one-fifth (21%) of transgender people who have transitioned have been able to update all of their IDs.

NCTE works to modernize all of these outdated requirements. States are increasingly adopting more accessible and straightforward policies for changing one's name and gender marker.

To find out the requirements for updating a driver’s license or birth certificate in your state or territory, as well as get information on changing federal IDs and records, visit NCTE’s ID Documents Center .

What medical treatments do some transgender people seek when transitioning?

Some, but not all, transgender people undergo medical treatments to make their bodies more congruent with their gender identity and help them live healthier lives.

While transition-related care is critical and even life-saving for many transgender people, not everyone needs medical care to transition or live a fulfilling life.

Different transgender people may need different types of transition-related care. People should make decisions about their care based on their individual needs. Medical procedures can include:

  • hair growth or removal treatments
  • hormone therapy
  • various surgeries to make one's face, chest, and anatomy more in line with one's gender identity

While not everyone needs transition-related medical treatments, there is an overwhelming consensus in the medical community that they are medically necessary for many transgender people and should be covered by private and public insurance. Every major medical organization in the United States has affirmed that transition-related medical care is safe and effective, and that everyone who needs it should be able to access it. Unfortunately, this critical care is often denied by insurance companies, often in spite of state and federal laws.

What is gender dysphoria?

For some transgender people, the difference between the gender they are thought to be at birth and the gender they know themselves to be can lead to serious emotional distress that affects their health and everyday lives if not addressed. Gender dysphoria is the medical diagnosis for someone who experiences this distress.

Not all transgender people have gender dysphoria. On its own, being transgender is not considered a medical condition. Many transgender people do not experience serious anxiety or stress associated with the difference between their gender identity and their gender of birth, and so may not have gender dysphoria.

Gender dysphoria can often be relieved by expressing one’s gender in a way that the person is comfortable with. That can include dressing and grooming in a way that reflects who one knows they are, using a different name or pronoun, and, for some, taking medical steps to physically change their body. All major medical organizations in the United States recognize that living according to one’s gender identity is an effective, safe and medically necessary treatment for many people who have gender dysphoria.

It's important to remember that while being transgender is not in itself an illness, many transgender people need to deal with physical and mental health problems because of widespread discrimination and stigma. Many transgender people live in a society that tells them that their deeply held identity is wrong or deviant. Some transgender people have lost their families, their jobs, their homes, and their support, and some experience harassment and even violence. Transgender children may experience rejection or even emotional or physical abuse at home, at school, or in their communities. These kinds of experiences can be challenging for anyone, and for some people, it can lead to anxiety disorders, depression, and other mental health conditions. But these conditions are not caused by having a transgender identity: they're a result of the intolerance many transgender people have to deal with. Many transgender people – especially transgender people who are accepted and valued in their communities – are able to live healthy and fulfilling lives.

Why is transgender equality important?

Transgender people should be treated with the same dignity and respect as anyone else and be able to live, and be respected , according to their gender identity. But transgender people often face serious discrimination and mistreatment at work, school, and in their families and communities.

For example, transgender people are more likely to:

  • Be fired or denied a job
  • Face harassment and bullying at school
  • Become homeless or live in extreme poverty
  • Be evicted or denied housing or access to a shelter
  • Be denied access to critical medical care
  • Be incarcerated or targeted by law enforcement
  • Face abuse and violence

For statistics about these types of discrimination, go to the National Transgender Discrimination Survey page.

Living without fear of discrimination and violence and being supported and affirmed in being who they are is critical for allowing transgender people to live healthy, safe, and fulfilling lives. In recent years, laws, policies and attitudes around the country have changed significantly, allowing more transgender people than ever to live fuller, safer, and healthier lives.

The transgender movement is part of a long tradition of social justice movements of people working together to claim their civil rights and better opportunities in this country. These challenges are connected. Discrimination that transgender people of color face is compounded by racism, and lower-income transgender people face economic challenges and classism. NCTE believes that progress towards transgender equality requires a social justice approach that fights all forms of discrimination.  

Learn more about transgender people >>

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Preparation and Procedures Involved in Gender Affirmation Surgeries

If you or a loved one are considering gender affirmation surgery , you are probably wondering what steps you must go through before the surgery can be done. Let's look at what is required to be a candidate for these surgeries, the potential positive effects and side effects of hormonal therapy, and the types of surgeries that are available.

Gender affirmation surgery, also known as gender confirmation surgery, is performed to align or transition individuals with gender dysphoria to their true gender.

A transgender woman, man, or non-binary person may choose to undergo gender affirmation surgery.

The term "transexual" was previously used by the medical community to describe people who undergo gender affirmation surgery. The term is no longer accepted by many members of the trans community as it is often weaponized as a slur. While some trans people do identify as "transexual", it is best to use the term "transgender" to describe members of this community.

Transitioning

Transitioning may involve:

  • Social transitioning : going by different pronouns, changing one’s style, adopting a new name, etc., to affirm one’s gender
  • Medical transitioning : taking hormones and/or surgically removing or modifying genitals and reproductive organs

Transgender individuals do not need to undergo medical intervention to have valid identities.  

Reasons for Undergoing Surgery

Many transgender people experience a marked incongruence between their gender and their assigned sex at birth.   The American Psychiatric Association (APA) has identified this as gender dysphoria.

Gender dysphoria is the distress some trans people feel when their appearance does not reflect their gender. Dysphoria can be the cause of poor mental health or trigger mental illness in transgender people.

For these individuals, social transitioning, hormone therapy, and gender confirmation surgery permit their outside appearance to match their true gender.  

Steps Required Before Surgery

In addition to a comprehensive understanding of the procedures, hormones, and other risks involved in gender-affirming surgery, there are other steps that must be accomplished before surgery is performed. These steps are one way the medical community and insurance companies limit access to gender affirmative procedures.

Steps may include:

  • Mental health evaluation : A mental health evaluation is required to look for any mental health concerns that could influence an individual’s mental state, and to assess a person’s readiness to undergo the physical and emotional stresses of the transition.  
  • Clear and consistent documentation of gender dysphoria
  • A "real life" test :   The individual must take on the role of their gender in everyday activities, both socially and professionally (known as “real-life experience” or “real-life test”).

Firstly, not all transgender experience physical body dysphoria. The “real life” test is also very dangerous to execute, as trans people have to make themselves vulnerable in public to be considered for affirmative procedures. When a trans person does not pass (easily identified as their gender), they can be clocked (found out to be transgender), putting them at risk for violence and discrimination.

Requiring trans people to conduct a “real-life” test despite the ongoing violence out transgender people face is extremely dangerous, especially because some transgender people only want surgery to lower their risk of experiencing transphobic violence.

Hormone Therapy & Transitioning

Hormone therapy involves taking progesterone, estrogen, or testosterone. An individual has to have undergone hormone therapy for a year before having gender affirmation surgery.  

The purpose of hormone therapy is to change the physical appearance to reflect gender identity.

Effects of Testosterone

When a trans person begins taking testosterone , changes include both a reduction in assigned female sexual characteristics and an increase in assigned male sexual characteristics.

Bodily changes can include:

  • Beard and mustache growth  
  • Deepening of the voice
  • Enlargement of the clitoris  
  • Increased growth of body hair
  • Increased muscle mass and strength  
  • Increase in the number of red blood cells
  • Redistribution of fat from the breasts, hips, and thighs to the abdominal area  
  • Development of acne, similar to male puberty
  • Baldness or localized hair loss, especially at the temples and crown of the head  
  • Atrophy of the uterus and ovaries, resulting in an inability to have children

Behavioral changes include:

  • Aggression  
  • Increased sex drive

Effects of Estrogen

When a trans person begins taking estrogen , changes include both a reduction in assigned male sexual characteristics and an increase in assigned female characteristics.

Changes to the body can include:

  • Breast development  
  • Loss of erection
  • Shrinkage of testicles  
  • Decreased acne
  • Decreased facial and body hair
  • Decreased muscle mass and strength  
  • Softer and smoother skin
  • Slowing of balding
  • Redistribution of fat from abdomen to the hips, thighs, and buttocks  
  • Decreased sex drive
  • Mood swings  

When Are the Hormonal Therapy Effects Noticed?

The feminizing effects of estrogen and the masculinizing effects of testosterone may appear after the first couple of doses, although it may be several years before a person is satisfied with their transition.   This is especially true for breast development.

Timeline of Surgical Process

Surgery is delayed until at least one year after the start of hormone therapy and at least two years after a mental health evaluation. Once the surgical procedures begin, the amount of time until completion is variable depending on the number of procedures desired, recovery time, and more.

Transfeminine Surgeries

Transfeminine is an umbrella term inclusive of trans women and non-binary trans people who were assigned male at birth.

Most often, surgeries involved in gender affirmation surgery are broken down into those that occur above the belt (top surgery) and those below the belt (bottom surgery). Not everyone undergoes all of these surgeries, but procedures that may be considered for transfeminine individuals are listed below.

Top surgery includes:

  • Breast augmentation  
  • Facial feminization
  • Nose surgery: Rhinoplasty may be done to narrow the nose and refine the tip.
  • Eyebrows: A brow lift may be done to feminize the curvature and position of the eyebrows.  
  • Jaw surgery: The jaw bone may be shaved down.
  • Chin reduction: Chin reduction may be performed to soften the chin's angles.
  • Cheekbones: Cheekbones may be enhanced, often via collagen injections as well as other plastic surgery techniques.  
  • Lips: A lip lift may be done.
  • Alteration to hairline  
  • Male pattern hair removal
  • Reduction of Adam’s apple  
  • Voice change surgery

Bottom surgery includes:

  • Removal of the penis (penectomy) and scrotum (orchiectomy)  
  • Creation of a vagina and labia

Transmasculine Surgeries

Transmasculine is an umbrella term inclusive of trans men and non-binary trans people who were assigned female at birth.

Surgery for this group involves top surgery and bottom surgery as well.

Top surgery includes :

  • Subcutaneous mastectomy/breast reduction surgery.
  • Removal of the uterus and ovaries
  • Creation of a penis and scrotum either through metoidioplasty and/or phalloplasty

Complications and Side Effects

Surgery is not without potential risks and complications. Estrogen therapy has been associated with an elevated risk of blood clots ( deep vein thrombosis and pulmonary emboli ) for transfeminine people.   There is also the potential of increased risk of breast cancer (even without hormones, breast cancer may develop).

Testosterone use in transmasculine people has been associated with an increase in blood pressure, insulin resistance, and lipid abnormalities, though it's not certain exactly what role these changes play in the development of heart disease.  

With surgery, there are surgical risks such as bleeding and infection, as well as side effects of anesthesia . Those who are considering these treatments should have a careful discussion with their doctor about potential risks related to hormone therapy as well as the surgeries.  

Cost of Gender Confirmation Surgery

Surgery can be prohibitively expensive for many transgender individuals. Costs including counseling, hormones, electrolysis, and operations can amount to well over $100,000. Transfeminine procedures tend to be more expensive than transmasculine ones. Health insurance sometimes covers a portion of the expenses.

Quality of Life After Surgery

Quality of life appears to improve after gender-affirming surgery for all trans people who medically transition. One 2017 study found that surgical satisfaction ranged from 94% to 100%.  

Since there are many steps and sometimes uncomfortable surgeries involved, this number supports the benefits of surgery for those who feel it is their best choice.

A Word From Verywell

Gender affirmation surgery is a lengthy process that begins with counseling and a mental health evaluation to determine if a person can be diagnosed with gender dysphoria.

After this is complete, hormonal treatment is begun with testosterone for transmasculine individuals and estrogen for transfeminine people. Some of the physical and behavioral changes associated with hormonal treatment are listed above.

After hormone therapy has been continued for at least one year, a number of surgical procedures may be considered. These are broken down into "top" procedures and "bottom" procedures.

Surgery is costly, but precise estimates are difficult due to many variables. Finding a surgeon who focuses solely on gender confirmation surgery and has performed many of these procedures is a plus.   Speaking to a surgeon's past patients can be a helpful way to gain insight on the physician's practices as well.

For those who follow through with these preparation steps, hormone treatment, and surgeries, studies show quality of life appears to improve. Many people who undergo these procedures express satisfaction with their results.

Bizic MR, Jeftovic M, Pusica S, et al. Gender dysphoria: Bioethical aspects of medical treatment . Biomed Res Int . 2018;2018:9652305. doi:10.1155/2018/9652305

American Psychiatric Association. What is gender dysphoria? . 2016.

The World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender-nonconforming people . 2012.

Tomlins L. Prescribing for transgender patients . Aust Prescr . 2019;42(1): 10–13.  doi:10.18773/austprescr.2019.003

T'sjoen G, Arcelus J, Gooren L, Klink DT, Tangpricha V. Endocrinology of transgender medicine . Endocr Rev . 2019;40(1):97-117. doi:10.1210/er.2018-00011

Unger CA. Hormone therapy for transgender patients . Transl Androl Urol . 2016;5(6):877-884.  doi:10.21037/tau.2016.09.04

Seal LJ. A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria . Ann Clin Biochem . 2016;53(Pt 1):10-20.  doi:10.1177/0004563215587763

Schechter LS. Gender confirmation surgery: An update for the primary care provider . Transgend Health . 2016;1(1):32-40. doi:10.1089/trgh.2015.0006

Altman K. Facial feminization surgery: current state of the art . Int J Oral Maxillofac Surg . 2012;41(8):885-94.  doi:10.1016/j.ijom.2012.04.024

Therattil PJ, Hazim NY, Cohen WA, Keith JD. Esthetic reduction of the thyroid cartilage: A systematic review of chondrolaryngoplasty . JPRAS Open. 2019;22:27-32. doi:10.1016/j.jpra.2019.07.002

Top H, Balta S. Transsexual mastectomy: Selection of appropriate technique according to breast characteristics . Balkan Med J . 2017;34(2):147-155. doi:10.4274/balkanmedj.2016.0093

Chan W, Drummond A, Kelly M. Deep vein thrombosis in a transgender woman . CMAJ . 2017;189(13):E502-E504.  doi:10.1503/cmaj.160408

Streed CG, Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular disease among transgender adults receiving hormone therapy: A narrative review . Ann Intern Med . 2017;167(4):256-267. doi:10.7326/M17-0577

Hashemi L, Weinreb J, Weimer AK, Weiss RL. Transgender care in the primary care setting: A review of guidelines and literature . Fed Pract . 2018;35(7):30-37.

Van de grift TC, Elaut E, Cerwenka SC, Cohen-kettenis PT, Kreukels BPC. Surgical satisfaction, quality of life, and their association after gender-affirming aurgery: A follow-up atudy . J Sex Marital Ther . 2018;44(2):138-148. doi:10.1080/0092623X.2017.1326190

American Society of Plastic Surgeons. Gender confirmation surgeries .

American Psychological Association. Transgender people, gender identity, and gender expression .

Colebunders B, Brondeel S, D'Arpa S, Hoebeke P, Monstrey S. An update on the surgical treatment for transgender patients . Sex Med Rev . 2017 Jan;5(1):103-109. doi:10.1016/j.sxmr.2016.08.001

Graphic image of an adolescent consulting a doctor

‘An explosion’: what is behind the rise in girls questioning their gender identity?

As the NHS reviews gender referrals, parents, clinicians and young people reveal the social, medical and emotional challenges they face

Earlier this year, a team of NHS researchers was asked to investigate why there has been such a huge rise in the number of adolescent biological girls seeking referrals to gender clinics.

The figures alone do seem remarkable.

According to a study commissioned by NHS England, 10 years ago there were just under 250 referrals, most of them boys, to the Gender Identity Development Service (Gids), run by the Tavistock and Portman NHS foundation trust in London.

Last year, there were more than 5,000 , which was twice the number in the previous year. And the largest group, about two-thirds, now consisted of “birth-registered females first presenting in adolescence with gender-related distress”, the report said.

The review team is looking into the causes behind “the considerable increase in the number of referrals” and the changing case mix, but is not expected to publish any findings until next year.

Meanwhile, clinicians and parents are trying to make sense of it themselves.

Over recent months, the Guardian has interviewed 11 parents of gender-questioning adolescent biological girls (some of whom have transitioned to become trans boys), and six paediatricians and child psychiatrists, to discuss their views and experiences. For many of them, it has been a difficult and emotionally draining time.

Their testimony reflects the lack of consensus within the medical profession about how best to proceed if a child experiences gender dysphoria – and, in turn, how this confusion contributes to the central dilemma faced by concerned parents: how should they support their child during what may be the most challenging period of their lives?

Do they accept them changing their name, gender and pronouns at home and at school and investigating medical options, or should they try to help their child to accept their natal sex?

While some parents said they had embraced their child’s decision and welcomed the societal changes that had made this step possible, others felt confused by their child’s desire to change their body.

Several parents said they had been relaxed when their daughters initially began identifying as non-binary, but became uneasy when they said they wanted to take puberty blockers or cross-sex hormones and began binding their breasts.

Some spoke of their anxiety and uncertainty about how to respond, particularly when their child was unhappy.

The mother of one girl who came out as trans at the age of 12 said it was “very difficult to describe the feeling of being the parent of a trans-identified child”.

This mother feared they were heading towards medical intervention that might prove unnecessary. “As she got older … we had less control. Living with that fear is one of the toughest experiences I’ve had.”

(Her child, who recently started university, now describes herself as non-binary and uses a gender-neutral name, but is happy to be referred to as she, and is no longer seeking medical treatment.)

The uncertainty parents felt was compounded by the highly polarised debate – within the NHS, politics and the media – about how parents and professionals should respond to children who express distress about their gender.

“We were terrified of being accused of being bigoted,” said the woman, who asked to remain anonymous to protect her child’s privacy.

“We felt we were expected to accept her decision unhesitatingly. I felt so apologetic that I was questioning whether my miserable teenage daughter was genuinely a boy,” she said.

An ‘explosion’ in referrals

The rise in the number of biological girls seeking referrals to Gids was set out in an interim report by Dr Hilary Cass, the paediatrician commissioned to conduct a review of the services provided by the NHS to children and young people questioning their gender identity.

Dr Hilary Cass.

The trend was confirmed by clinicians who spoke to the Guardian.

“In the past few years it has become an explosion. Many of us feel confused by what has happened, and it’s often hard to talk about it to colleagues,” said a London-based psychiatrist working in a child and adolescent mental health unit, who has been a consultant for the past 17 years.

Like all NHS employees interviewed, she asked for anonymity due to the sensitivity of the subject.

“I might have seen one child with gender dysphoria once every two years when I started practising. It was very niche and rare.” Now, somewhere between 10% and 20% of her caseload is made up of adolescents registered as female at birth who identify as non-binary or trans, with just an occasional male-registered teenager who identifies as trans.

Another senior child psychiatrist said girls who wanted to transition made up about 5% of her caseload.

“In the last five to 10 years we’ve seen a huge surge in young women who, at the age of around 12 or 13, want to become boys. They’ve changed their name and they are pressing … to have hormones or puberty blockers”

The psychiatrist added: “Often those girls are children who are going through the normal identity and developmental problems of adolescence and finding a solution for themselves in this way.”

Greater awareness of trans issues is likely to be one common-sense explanation for the rise in requests for referrals.

“Left-handedness increased over time after we stopped punishing left-handed children in schools, because some children are naturally left-handed and were now able to express it,” said Cleo Madeleine, a spokesperson for the trans support group Gendered Intelligence.

“In the same way, increased visibility and acceptance of trans people has led to a gradual increase in young people who feel comfortable expressing their trans identity. The most important thing is to recognise that this is not a problem to be solved or a bad outcome to be avoided.”

The mother of a 17-year-old A-level student (who came out as trans at 13, leaving a handwritten letter for his parents on his bed) agreed: “It’s discussed so much more – on Facebook and on social media. It’s no longer a taboo.”

She is confident this was the right decision for her child. “I think I wondered if this was a phase, but I didn’t look to dissuade him. As he began to socially transition he was a different person. It has made him happier,” she said.

Her trans son has a weekend job to pay for his private testosterone prescription, because the NHS waiting list is too long, and the family is saving up for the £6,000 cost of breast removal.

“He would like to get it done as close to his 18th birthday as possible, so he can start afresh at university.”

Increased awareness may well be a factor. But most of the research in this field has been based on predominantly birth-registered males – not females .

The Cass report explained that relatively little was known about the causes of gender dysphoria in girls, or the outcomes for those who received treatment.

“At present, we have the least information for the largest group of patients – birth-registered females first presenting in early teen years,” it said.

“Since the rapid increase in this group began around 2015, they will not reach late 20s for another five-plus years, which would be the best time to assess longer-term wellbeing.”

The NHS review will help to shine some light on this issue – but it may be years before a clear picture emerges.

Graphic composition of a person’s head and shoulders

Silence, disagreement and polarisation

The dilemma for parents has hardly been helped by the confusing guidelines.

They are puzzled by the conflicting advice they get from doctors and trans rights groups about what their child may be going through.

Could it be a temporary exploration of gender identity, potentially the manifestation of other forms of distress? Or is it an innate experience for which treatment is required?

The definition of gender dysphoria is controversial in itself, and in England there is no consensus among clinicians over whether an adolescent’s desire to transition should be quickly affirmed or they should be encouraged to pause before changing their name and starting hormone treatment.

The Cass report revealed there was “a lack of agreement, and in many instances a lack of open discussion” about the best approach to take.

“The disagreement and polarisation is heightened when potentially irreversible treatments are given to children and young people, when the evidence base underlying the treatments is inconclusive,” it added.

Anyone looking for clarity from NHS England’s most recent draft guidelines on how to support under-18s experiencing what it calls “gender incongruence” may not find it helpful.

Published in October, the draft seems to put greater emphasis on the possibility that, for some, particularly pre-pubescent, children, this may be a “transient phase”.

It also suggests it is not a “neutral act” to help children transition socially (by using preferred names and pronouns) while they explore their gender identity, and stresses that more research is needed to “gather further evidence on the safety, potential benefits and harms” of puberty blockers.

In terms of practical advice, it does not go much beyond that.

Many of the parents who spoke to the Guardian admitted they struggled with the uncertainty involved, even in cases where they acknowledged that medical transition may be the correct outcome for some adolescent girls with gender dysphoria.

The Tavistock stresses that there is no set treatment pathway, and only about 20% of those referred to the service go on to be prescribed puberty blockers or cross-sex hormones on the NHS (although long waiting lists mean some people seek treatment in the private sector, or will receive treatment only when they have progressed to adult NHS services at 18). Parental confusion has been heightened by NHS England’s announcement in July that the Tavistock’s gender identity clinic would close next year and be replaced by new regional centres . This happened after the Cass review said the current model, with its long delays, was leaving young people “at considerable risk” of poor mental health and distress, and that having one clinic was not “a safe or viable long-term option”.

Parental anxiety: ‘We went from nothing to everything in three months’

With little research to draw upon, no consensus among clinicians and confusing guidelines, parents have differing explanations for what might have prompted their child’s desire to identify as male.

Some point to puberty, periods and unease with a changing body shape coinciding with the interest in becoming gender non-conforming.

Others have questioned whether their child’s autism might be a relevant factor. (The Cass report stated that approximately one-third of children and young people being referred to the Tavistock had autism or other types of neurodiversity.)

The Tavistock Centre in London.

And others wonder if pre-existing signs of depression and mental health problems have been the cause or the result of gender uncertainty.

Possible influences they cite include childhood bullying, sexual harassment and abuse and the hyper-sexualisation of society, or a child’s early understanding of sexism, making them feel it may be easier to live as a man than as a woman.

Some believe the extended isolation children experienced during Covid is relevant (for example, Google searches for “top surgery”, double mastectomies, soared during this period).

Many are aware of online content that has educated their children about gender, and of the influence of YouTubers, Tumblr accounts and TikTok personalities where individuals’ medical transitions are documented in detail (footage of recoveries from double mastectomies and phalloplasty, or “bottom surgery”, has been watched by hundreds of thousands).

A 20-year-old medical student who came out as a trans boy at 16, having told his parents the year before that he was a lesbian, and who spent £8,000 on private breast removal earlier this year, said the realisation was “a lightbulb moment”. He had watched a lot of YouTube content on LGBTQ+ issues.

“From watching that I was able to educate myself. I’d always felt that something was not right. Everything made much more sense afterwards,” he said. His parents were “incredibly supportive”.

But some parents have been frustrated by the speed with which schools have adopted their child’s new identity, without parental consent, uncertain about the implications.

One father, whose child came out as a trans boy three years ago at the age of 11, with the approval of his estranged wife, said he had initially supported the decision. However, had become increasingly sceptical about whether it was helping his child. He said he felt disconcerted by the school’s readiness to adopt the child’s male identity before any specialist assessment had occurred.

“We went from nothing to everything in three months. I know now that a lot of the explanations of what they were feeling came from an internet script. All my concerns were minimised,” he said. “Everyone told me it was a totally benign step to change names, and pronouns.

“The school’s position was: ‘If you say you are a boy, you’re a boy,’” he said. “At the time I was shocked, but I trusted them that it was a good idea.”

He struggles with the new pronouns but agreed to the new male name, and reluctantly bought, at the 11-year-old’s request, a crocheted penis and testicles to wear inside their underwear.

“I’ve said no to a chest binder and puberty blockers. I kept asking: ‘What’s wrong with being a girl? What problem are we trying to fix?’” He said he believes the decision was triggered by severe bullying in primary school, undiagnosed autism and a few influential YouTubers.

“She’s interested in boys now and describes herself as a gay boy. None of this has made her happier.”

One mother of an adolescent who came out as a lesbian aged 13 three years ago, and came out as a trans boy nine months later, said she and her husband had wanted to be supportive.

“We said: ‘OK, no matter what, we love you,’ and tried to be very neutral about it. She told me she wanted to go to the GP to get a referral to the Tavistock, so we went and we were referred. I was absolutely fine with gender non-conformity.”

But her views on social, medical and surgical transition evolved as she did more research. She said no when her child asked to speed up the process by going private, which would have allowed them to start puberty blockers.

“My daughter has barely spoken to me for three years because I haven’t continued with the referral process. Parents are in a very difficult position.”

Two years ago, a grassroots support group started campaigning for “evidence-based care”. Called Bayswater Support, it now represents the parents of about 500 trans-identified adolescents – and its membership is growing rapidly.

The group says around 70% of the children it represents were registered as female at birth; 80% experienced bullying prior to identifying as trans and more than 50% had come out as lesbian, gay or bisexual.

A spokesperson said: “Our members commonly describe their child’s trans identity as overshadowing factors such as poor mental health, neurodevelopmental conditions like autism and ADHD, social factors like bullying and not fitting in with their peer group, emerging same-sex attraction, serious safeguarding issues – and often puberty itself.”

‘Trans kids weren’t as hotly debated then, it was much less politicised’

There is one thing that all sides on this debate would probably agree on: the increased scrutiny of the subject has made life much harder for trans adolescents and their families.

A 29-year-old charity worker who transitioned 13 years ago, in the summer after sitting GCSEs, told the Guardian: “Trans kids weren’t as hotly debated then, it was much less politicised. Trans people didn’t have that level of visibility – and that might be seen as a negative, but it also meant that trans people were left alone.”

He said he now tried to avoid reading newspaper reports, and was suspicious of the research into what might be causing an increase in the number of biological girls wanting to identify as boys.

“I would guess it’s because trans people are more able to find other trans people. Research into the cause of a marginalised identity can make you feel nervous. It makes me wonder: why would you want to ask that question?”

A nurse preparing a hormone blocker.

He said his mother was very supportive of his decisions, and they had attended a summer residential camp organised by the charity Mermaids. She paid for a private referral and supported him through medical transition, including cross-sex hormones, a hysterectomy and double mastectomy.

“Initially she was confused. She was obviously concerned about what I would go through. She had, I suppose, the normal feelings that any parent would have when suddenly their child tells them: ‘Actually, I’m a boy and I don’t feel comfortable in my body, and I want to go through these processes.’ I imagine it’s a very helpless feeling.

“Now she talks to other parents to help them understand that if your child comes out as trans, their life will be fine with the right support. I have a flat, a partner, a good job – it is not all doom and gloom. Trans kids turn into trans adults, and that’s fine. Of course there’s anxiety because it’s an unknown, but keep talking.”

He said that now he barely thinks about the process of transitioning, and does not have an easy answer to what it means to be a man.

“I can’t tell you, and I think if you asked my [male] partner, he wouldn’t know either. I’m very comfortable living as a guy, I’ve done that for 15 years.”

Case studies

A 20-year-old student who describes herself as trans -adjacent spent five years living as a boy, from the age of 13. She hadn’t had many close friends at primary school and had been diagnosed with autism when she was 12. She spent a lot of time on Tumblr following trans groups and became close to a friend at her girls’ school who also came out as trans. Shortly after she came out as trans, a third person in the year also came out; the two others have subsequently medically transitioned, but she has decided not to.

“I don’t know how much of it is because I am autistic. I felt I didn’t fit in with any of the girls,” said the student, who now uses a gender-neutral name but said she was happy to be described using she/her pronouns. She didn’t initially want to tell her mother she was trans because of a misunderstanding they had when she came out as gay at the age of 12.

“My mum said: ‘That’s fine, but you’re too young to know.’ I think now what she was trying to say was: ‘No matter what, we will accept you, but you’re really young, you don’t need to worry about what box you’re in.’

“I think then I took it much too literally. So I didn’t talk to her about being trans at the start.

“I was really struggling in secondary school. I think being a girl is hard for a lot of people when you are going through puberty and you are really unhappy. It’s quite easy to want to escape from that.”

She was on antidepressants. Her parents began the process of a referral to the Tavistock, but decided against pursuing it.

“I started binding with duct tape because I didn’t have access to a breast binder. I wanted my chest to be flat. I slept with it. It helped me alleviate a lot of my distress. I still have pain in my ribs. I identified as trans masculine, as a trans man.

“I wasn’t so obsessed with being referred to as male but I did want the school to use he pronouns.”

When she moved to a sixth-form college to do A-levels, she became more interested in her work and less interested in her identity. She is still known by her new name but is no longer thinking about transitioning.

She said: “I think there might be people who identify as trans, who were like me, who were just unhappy, and there are others who are just trans. There are people who have medically transitioned and for whom that is completely the right option. Trans people have existed for a very long time.”

The mother of a 20-year-old trans student said the process had been stressful but, on balance, she believed her child had become happier.

“My son, who was then my daughter, came out as a lesbian at 13 or 14. After they turned 15 my husband and I were called into school by my child’s year head, and it turned out to be for an announcement that my daughter was now my son. I think the meeting was done that way because my son was concerned particularly about how his dad would react, and he needed there to be other people there. His dad’s reaction was quite hostile. He said that, for one thing, my son was being ridiculous, and for another thing, about to ruin his life.

“I didn’t understand everything, but I wanted to support him. I didn’t feel I should interfere in my son’s treatment. Instead I got involved in helping him with the practicalities of getting his name changed, speaking to the school about toilets and changing rooms. He went on testosterone at 18. I don’t think he will have surgery; the thought of it makes him quite anxious so I’m not sure how actively he wants to pursue it. In any case he has passed as male for quite some time now.”

She said the increased awareness of trans issues via the media made it easier for children who might be trans to communicate with others. “In the 90s, when trans people began to be presented in the media it was very much done for shock value. Things have changed since then.”

She said the process had been stressful. “But in the end I realised that people make all sorts of decisions in their lives that have long-term, knock-on effects that can’t be imagined at the time the decision is made. I think transitioning has been a positive step for my son. His mental health is much improved – he socialises now rather than just hiding away.”

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Census Bureau Invites Expert Feedback on New Sexual Orientation and Gender Identity Questions

  • By: Deborah Carr
  • May 10, 2024

The U.S. Census Bureau seeks expert input on a proposed test of questions about sexual orientation and gender identity in the American Community Survey. View the federal register notice and submit feedback by May 30. 2024. 

The information collected in the 2024 ACS Sexual Orientation and Gender Identity (SOGI) test will be used to evaluate the quality of data from questions on sexual orientation and gender identity. The research will inform recommendations for potential production ACS implementation on question wording and response options, whether a confirmation question is asked of everyone or only of those people with discrepant responses for sex at birth and current gender identity, and the style of write-in boxes to use for internet respondents. The data will also be used to produce descriptive statistics on the test topics, assess the impact on other questions on the survey that have changed, and gain insight into terminology by analyzing write-in responses and responses to qualitative questions asked in the test. Data will be assessed by mode of response as well as type of respondent (proxy or self-reported data), in addition to other sub-groups of interest.

Because the questions being tested under this clearance have yet to be asked in the American Community Survey, the data gathered will not be considered official statistics of the Census Bureau or other Federal agencies. Test results will be included in research reports that will be published on the Census Bureau’s website. Results may also be prepared for presentations at professional meetings and conferences or for publication in professional journals. All published test results will be statistical products that contain only aggregated data that do not reveal individual responses.

Details of the questions being tested and test plans are available in Supporting Statements A and B and associated attachments. See directions below for how to find these documents online on www.reginfo.gov .

Written comments and recommendations for the proposed information collection should be submitted within 30 days of the publication of this notice on the following website www.reginfo.gov/​public/​do/​PRAMain . Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by using the search function and entering either the title of the collection or the OMB Control Number 0607-0936.

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Gender Reassignment: Transgender Employment Rights -Where Are We Now?

Shah qureshi reviews the current position on transgender rights in the workplace.

Transgender, or trans, is a term which describes someone whose gender identity does not match the sex they were assigned at birth. Under s7 of the Equality Act 2010, someone who identifies as transgender is someone who: … is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.

If the person in question decides to live permanently as the opposite gender without having any gender-changing surgery or hormone treatment, they are still protected from discrimination under the gender reassignment provisions of the Equality Act. 

In the workplace, the fact that someone identifies as transgender should not influence any decision about promotion, pay, benefits, training or redundancy just as someone’s race, religion and so on should not. Like individuals with any of the other eight protected characteristics, trans people are protected from unlawful direct and indirect discrimination, discrimination by perception or association, harassment and victimisation.

To take some examples: to amount to harassment, a comment or act does not have to be targeted at a specific person – for instance, an employee who has reassigned their gender might overhear colleagues making an offensive joke about trans people; a person does not need to have the protected characteristic themselves to claim harassment – for instance, an employee who is not transgender might be offended by transphobic comments; an employee associated with a transgender person (such as their partner, spouse or friend) is protected from victimisation and discrimination because of that association; and it could be unlawful discrimination to dismiss a trans woman because she was wrongly perceived as no longer being able to do a physically demanding job. 

The Equality Act also makes additional provisions specifically for gender reassignment. Under s16, trans employees are entitled to take time off work for reasons relating to their gender reassignment. Therefore, employers must treat a trans employee equally to other members of staff who require a period of absence from the workplace, otherwise they will be discriminating against that employee.  Gender Recognition Act 2004 

The Gender Recognition Act (GR Act) allows people over the age of 18 to obtain a gender recognition certificate if they wish to legally change their gender. This certificate allows the person to obtain a replacement birth certificate, marry or enter into a civil partnership in their acquired gender and also receive a state pension and benefits.

It is important to note that the Equality Act does not require a transgender person to obtain legal certification of their elected gender in order to be protected from discrimination. Not having a certificate should make no difference to how an employer treats a trans employee or assesses their performance; it should treat the person as being the gender that they identify as. 

The certificate does, however, add an extra layer of protection for the employee against discrimination. Under the GR Act, it is an offence punishable by a fine for an employer to disclose whether an employee holds a gender recognition certificate. It is also unlawful for an employer to ask for a certificate as a requirement of the person’s employment. There are some circumstances in which employers are allow to disclose such information, for example in relation to court proceedings or a criminal investigation as detailed under s22(4) of the GR Act.  Government position on the law

In September 2020, the government launched a consultation on the GR Act. It concluded that the current legislation has a sufficient balance for those who want to change their gender in law and no significant reform is required. In analysing the consultation responses, the government referred to a survey which it initiated in 2017, in which 38% of over 108,000 respondents said that the process of obtaining a gender recognition certificate is too complicated. 

The government agreed that the process needs to be made easier and modernised, so it plans to move the process online. It also committed to reducing the application fee significantly to make the process more accessible. It is evident that the government firmly believes the Equality Act is robust enough to protect transgender people from discrimination, whether that be in the workplace or wider society.

This may seem a blow to the transgender community given the significant time and cost required to obtain a certificate. However, the Equality Act does provide the backbone to anyone’s employment rights and it has proven successful in many cases since it was brought into force. 

Does protection go far enough? 

Transgender employees and workers receive some additional protection under the Equality Act against unlawful discrimination. However, there is a question mark over whether the current provisions adequately protect individuals who identify as gender fluid or nonbinary. 

Until recently, it was widely accepted that the Act only protected individuals whose gender reassignment is permanent and well established. However, this position has been challenged by the employment tribunal’s decision in Taylor v Jaguar Land Rover Ltd [2020] (see ‘Key steps to support non-binary employees after landmark ruling’ by Jennifer Millins, Molly Flood and Morgan Reardon, ELJ215 (November 2020)). 

The tribunal found that Rose Taylor, an engineer who self-identified as gender fluid, suffered unlawful harassment and bullying because of her protected characteristic of gender reassignment. The employment judge found that ‘gender is a spectrum’ and that being non-binary or gender fluid comes within the protected characteristic of gender reassignment. 

It should be borne in mind that this is a first instance decision and does not set a legal precedent. Jaguar Landrover may well appeal the decision. Nevertheless, the judgment is welcome to many in that it recognises that gender identity can take many forms and workers and employees should not be discriminated against for this reason.

This article was first published in Employment Law Journal .

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Nigel Barber Ph.D.

The Gender Reassignment Controversy

When people opt for surgery, are they satisfied with the outcome.

Posted March 16, 2018 | Reviewed by Ekua Hagan

In an age of increasing gender fluidity, it is surprising that so many find it difficult to accept the gender of their birth and take the drastic step of changing it through surgery. What are their motives? Are they satisfied with the outcome?

Gender may be the most important dimension of human variation, whether that is either desirable, or inevitable. In every society, male and female children are raised differently and acquire different expectations, and aspirations, for their work lives, emotional experiences, and leisure pursuits.

These differences may be shaped by how children are raised but gender reassignment, even early in life, is difficult, and problematic. Reassignment in adulthood is even more difficult.

Such efforts are of interest not just for medical reasons but also for the light they shed on gender differences.

The first effort at reassignment, by John Money, involved David Reimer whose penis was accidentally damaged at eight months due to a botched circumcision.

The Money Perspective

Money believed that while children are mostly born with unambiguous genitalia, their gender identity is neutral. He felt that which gender a child identifies with is determined primarily by how parents treat it and that parental views are shaped by the appearance of the genitals.

Accordingly, Money advised the parents to have the child surgically altered to resemble a female and raise it as “Brenda.” For many years, Money claimed that the reassignment had been a complete success. Such was his influence as a well-known Johns Hopkins gender researcher that his views came to be widely accepted by scholars and the general public.

Unfortunately for Brenda, the outcome was far from happy. When he was 14, Reimer began the process of reassignment to being a male. As an adult, he married a woman but depression and drug abuse ensued, culminating in suicide at the age of 38 (1).

Money's ideas about gender identity were forcefully challenged by Paul McHugh (2), a leading psychiatrist at the same institution as Money. The brunt of this challenge came from an analysis of gender reassignment cases in terms of both motivation and outcomes.

Adult Reassignment Surgery Motivation

Why do people (predominantly men) seek surgical reassignment (as a woman)? In a controversial take, McHugh argued that there are two main motives.

In one category fall homosexual men who are morally uncomfortable about their orientation and see reassignment as a way of solving the problem. If they are actually women, sexual interactions with men get redefined as heterosexual.

McHugh argued that many of the others seeking reassignment are cross-dressers. These are heterosexual men who derive sexual pleasure from wearing women's clothing. According to McHugh, surgery is the logical extreme of identifying with a female identity through cross-dressing.

If his thesis is correct, McHugh denies that reassignment surgery is ever either medically necessary or ethically defensible. He feels that the surgeon is merely cooperating with delusional thinking. It is analogous to providing liposuction treatment for an anorexic who is extremely slender but believes themselves to be overweight.

To bolster his case, McHugh looked at the clinical outcomes for gender reassignment surgeries.

Adult Reassignment Results

Anecdotally, the first hurdle for reassignment is how the result is perceived by others. This problem is familiar to anyone who looked at Dustin Hoffman's depiction of a woman ( Tootsie ). Diligent as the actor was in his preparation, his character looked masculine.

For male-to-female transsexuals, the toughest audience to convince is women. As McHugh reported, one of his female colleagues said: “Gals know gals, and that's a guy.”

According to McHugh, although transsexuals did not regret their surgery, there were little or no psychological benefits:

“They had much the same problems with relationships, work, and emotions, as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled (2)”.

gender reassignment question

Thanks to McHugh's influence, gender reassignment surgeries were halted at Johns Hopkins. The surgeries were resumed, however, and are now carried out in many hospitals here and around the world.

What changed? One likely influence was the rise of the gay rights movement that now includes transgender people under its umbrella and has made many political strides in work and family.

McHugh's views are associated with the religious right-wing that has lost ground in this area.

Transgender surgery is now covered by medical insurance reflecting more positive views of the psychological benefits.

Aspirational Surgery

Why do people who are born as males want to be women? Why do females want to be men? There seems to be no easy biological explanation for the transgender phenomenon (2).

Transgender people commonly report a lifelong sense that they feel different from their biological category and express satisfaction after surgery (now called gender affirmation) that permits them to be who they really are.

The motivation for surgical change is thus aspirational rather than medical, as is true of most cosmetic surgery also. Following surgery, patients report lower gender dysphoria and improved sexual relationships (3).

All surgeries have potential costs, however. According to a Swedish study of 324 patients (3, 41 percent of whom were born female) surgery was associated with “considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.”

1 Blumberg, M. S. (2005). Basic instinct: The genesis of behavior. New York: Thunder's Mouth Press.

2 McHugh, P. R. (1995). Witches, multiple personalities, and other psychiatric artifacts. Nature Medicine, 1, 110-114.

3 Dhejne, S., Lichtenstein, P., Boman, M., et al. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study of Sweden . Plos One.

Nigel Barber Ph.D.

Nigel Barber, Ph.D., is an evolutionary psychologist as well as the author of Why Parents Matter and The Science of Romance , among other books.

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David Reimer and John Money Gender Reassignment Controversy: The John/Joan Case

In the mid-1960s, psychologist John Money encouraged the gender reassignment of David Reimer, who was born a biological male but suffered irreparable damage to his penis as an infant. Born in 1965 as Bruce Reimer, his penis was irreparably damaged during infancy due to a failed circumcision. After encouragement from Money, Reimer’s parents decided to raise Reimer as a girl. Reimer underwent surgery as an infant to construct rudimentary female genitals, and was given female hormones during puberty. During childhood, Reimer was never told he was biologically male and regularly visited Money, who tracked the progress of his gender reassignment. Reimer unknowingly acted as an experimental subject in Money’s controversial investigation, which he called the John/Joan case. The case provided results that were used to justify thousands of sex reassignment surgeries for cases of children with reproductive abnormalities. Despite his upbringing, Reimer rejected the female identity as a young teenager and began living as a male. He suffered severe depression throughout his life, which culminated in his suicide at thirty-eight years old. Reimer, and his public statements about the trauma of his transition, brought attention to gender identity and called into question the sex reassignment of infants and children.

Bruce Peter Reimer was born on 22 August 1965 in Winnipeg, Ontario, to Janet and Ron Reimer. At six months of age, both Reimer and his identical twin, Brian, were diagnosed with phimosis, a condition in which the foreskin of the penis cannot retract, inhibiting regular urination. On 27 April 1966, Reimer underwent circumcision, a common procedure in which a physician surgically removes the foreskin of the penis. Usually, physicians performing circumcisions use a scalpel or other sharp instrument to remove foreskin. However, Reimer’s physician used the unconventional technique of cauterization, or burning to cause tissue death. Reimer’s circumcision failed. Reimer’s brother did not undergo circumcision and his phimosis healed naturally. While the true extent of Reimer’s penile damage was unclear, the overwhelming majority of biographers and journalists maintained that it was either totally severed or otherwise damaged beyond the possibility of function.

In 1967, Reimer’s parents sought the help of John Money, a psychologist and sexologist who worked at the Johns Hopkins Hospital in Baltimore, Maryland. In the mid twentieth century, Money helped establish the views on the psychology of gender identities and roles. In his academic work, Money argued in favor of the increasingly mainstream idea that gender was a societal construct, malleable from an early age. He stated that being raised as a female was in Reimer’s interest, and recommended sexual reassignment surgery. At the time, infants born with abnormal or intersex genitalia commonly received such interventions.

Following their consultation with Money, Reimer’s parents decided to raise Reimer as a girl. Physicians at the Johns Hopkins Hospital removed Reimer’s testes and damaged penis, and constructed a vestigial vulvae and a vaginal canal in their place. The physicians also opened a small hole in Reimer’s lower abdomen for urination. Following his gender reassignment surgery, Reimer was given the first name Brenda, and his parents raised him as a girl. He received estrogen during adolescence to promote the development of breasts. Throughout his childhood, Reimer was not informed about his male biology.

Throughout his childhood, Reimer received annual checkups from Money. His twin brother was also part of Money’s research on sexual development and gender in children. As identical twins growing up in the same family, the Reimer brothers were what Money considered ideal case subjects for a psychology study on gender. Reimer was the first documented case of sex reassignment of a child born developmentally normal, while Reimer’s brother was a control subject who shared Reimer’s genetic makeup, intrauterine space, and household.

During the twin’s psychiatric visits with Money, and as part of his research, Reimer and his twin brother were directed to inspect one another’s genitals and engage in behavior resembling sexual intercourse. Reimer claimed that much of Money’s treatment involved the forced reenactment of sexual positions and motions with his brother. In some exercises, the brothers rehearsed missionary positions with thrusting motions, which Money justified as the rehearsal of healthy childhood sexual exploration. In his Rolling Stone interview, Reimer recalled that at least once, Money photographed those exercises. Money also made the brothers inspect one another’s pubic areas. Reimer stated that Money observed those exercises both alone and with as many as six colleagues. Reimer recounted anger and verbal abuse from Money if he or his brother resisted orders, in contrast to the calm and scientific demeanor Money presented to their parents. Reimer and his brother underwent Money’s treatments at preschool and grade school age. Money described Reimer’s transition as successful, and claimed that Reimer’s girlish behavior stood in stark contrast to his brother’s boyishness. Money reported on Reimer’s case as the John/Joan case, leaving out Reimer’s real name. For over a decade, Reimer and his brother unknowingly provided data that, according to biographers and the Intersex Society of North America, was used to reinforce Money’s theories on gender fluidity and provided justification for thousands of sex reassignment surgeries for children with abnormal genitals.

Contrary to Money’s notes, Reimer reports that as a child he experienced severe gender dysphoria, a condition in which someone experiences distress as a result of their assigned gender. Reimer reported that he did not identify as a girl and resented Money’s visits for treatment. At the age of thirteen, Reimer threatened to commit suicide if his parents took him to Money on the next annual visit. Bullied by peers in school for his masculine traits, Reimer claimed that despite receiving female hormones, wearing dresses, and having his interests directed toward typically female norms, he always felt that he was a boy. In 1980, at the age of fifteen, Reimer’s father told him the truth about his birth and the subsequent procedures. Following that revelation, Reimer assumed a male identity, taking the first name David. By age twenty-one, Reimer had received testosterone therapy and surgeries to remove his breasts and reconstruct a penis. He married Jane Fontaine, a single mother of three, on 22 September 1990.

In adulthood, Reimer reported that he suffered psychological trauma due to Money’s experiments, which Money had used to justify sexual reassignment surgery for children with intersex or damaged genitals since the 1970s. In the mid-1990s, Reimer met Milton Diamond, a psychologist at the University of Hawaii, in Honolulu, Hawaii, and academic rival of Money. Reimer participated in a follow-up study conducted by Diamond, in which Diamond cataloged the failures of Reimer’s transition.

In 1997, Reimer began speaking publicly about his experiences, beginning with his participation in Diamond’s study. Reimer’s first interview appeared in the December 1997 issue of Rolling Stone magazine. In interviews, and a later book about his experience, Reimer described his interactions with Money as torturous and abusive. Accordingly, Reimer claimed he developed a lifelong distrust of hospitals and medical professionals.

With those reports, Reimer caused a multifaceted controversy over Money’s methods, honesty in data reporting, and the general ethics of sex reassignment surgeries on infants and children. Reimer’s description of his childhood conflicted with the scientific consensus about sex reassignment at the time. According to NOVA, Money led scientists to believe that the John/Joan case demonstrated an unreservedly successful sex transition. Reimer’s parents later blamed Money’s methods and alleged surreptitiousness for the psychological illnesses of their sons, although the notes of a former graduate student in Money’s lab indicated that Reimer’s parents dishonestly represented the transition’s success to Money and his coworkers. Reimer was further alleged by supporters of Money to have incorrectly recalled the details of his treatment. On Reimer’s case, Money publicly dismissed his criticism as antifeminist and anti-trans bias, but, according to his colleagues, was personally ashamed of the failure.

In his early twenties, Reimer attempted to commit suicide twice. According to Reimer, his adult family life was strained by marital problems and employment difficulty. Reimer’s brother, who suffered from depression and schizophrenia, died from an antidepressant drug overdose in July of 2002. On 2 May 2004, Reimer’s wife told him that she wanted a divorce. Two days later, at the age of thirty-eight, Reimer committed suicide by firearm.

Reimer, Money, and the case became subjects of numerous books and documentaries following the exposé. Reimer also became somewhat iconic in popular culture, being directly referenced or alluded to in the television shows Chicago Hope , Law & Order , and Mental . The BBC series Horizon covered his story in two episodes, “The Boy Who Was Turned into a Girl” (2000) and “Dr. Money and the Boy with No Penis” (2004). Canadian rock group The Weakerthans wrote “Hymn of the Medical Oddity” about Reimer, and the New York-based Ensemble Studio Theatre production Boy was based on Reimer’s life.

  • Carey, Benedict. “John William Money, 84, Sexual Identity Researcher, Dies.” New York Times , 11 July 2016.
  • Colapinto, John. "The True Story of John/Joan." Rolling Stone 11 (1997): 54–73.
  • Colapinto, John. As Nature Made Him: The Boy who was Raised as a Girl . New York: HarperCollins Publishers, 2000.
  • Colapinto, John. "Gender Gap—What were the Real Reasons behind David Reimer’s Suicide." Slate (2004).
  • Dr. Money and the Boy with No Penis , documentary, written by Sanjida O’Connell (BBC, 2004), Film.
  • The Boy Who Was Turned Into a Girl , documentary, directed by Andrew Cohen (BBC, 2000.), Film.
  • “Who was David Reimer (also, sadly, known as John/Joan)?” Intersex Society of North America . http://www.isna.org/faq/reimer (Accessed October 31, 2017).

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slide toggle Demystifying and Navigating Your Options: Gender Reassignment Surgery

Do you have any questions? Check our F.A.Q. section or contact us directly!

Demystifying and Navigating Your Options: Gender Reassignment Surgery

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Medically reviewed by Paul Gonzales on March 25, 2024.

gender reassignment question

Previously, the term gender reassignment surgery (GRS) referred to genital reconstruction bottom surgeries like vaginoplasty, vulvoplasty, phalloplasty, or metoidioplasty. Individuals who look up this term on a search engine do so looking for information on gender-affirming procedures generally for transgender, non-binary and gender non-conforming people. This detailed guide breaks down everything you need to know about these procedures, their costs, their eligibility requirements, the potential benefits and risks and more. If you are interested in undergoing any gender-affirming or “gender reassignment” surgery, you can schedule a free, virtual consultation with one of our surgeons.

At the Gender Confirmation Center (GCC), we generally avoid using terminology like GRS in a clinical setting out of the recognition that for the vast majority of our patients, surgeries do not “reassign” anyone’s gender. Rather, surgery can help individuals experience greater alignment with their bodies and greater gender euphoria as a result.

Types of Gender “Reassignment” Surgeries: “Female to Male (FTM)”

Female to Male (FTM) is outdated terminology that the GCC does not use in our clinical practice. This abbreviation leaves out the experiences of many trans masculine and non-binary patients who do not identify with being labeled as a “woman becoming a man.” 

In the past, “FTM gender confirmation surgery” was used to describe surgical procedures that reverse the effects of an initial estrogenic puberty or procedures that reconstruct a patient’s genitals. We still receive various inquiries about which “FTM” procedures we offer, so below you can find a list of surgeries that have typically been placed under this label. 

Please note that patients can seek out any of these procedures regardless of their gender identity. The goal of our practice is not to make our patients “into men,” but to help them feel more comfortable, affirmed, and/or aligned with their bodies.

Chest Surgery or Top Surgery

“FTM” top surgery is an antiquated term that refers to gender-affirming chest reconstruction and/or breast reduction. Practices who use this acronym sometimes have limited experience meeting the unique needs of non-binary patients seeking top surgery . Patients who would like to remove their chest tissue to have a flatter chest can choose from a variety of incision options to reach their desired results around chest tightness, contour and/or scar shape. 

Not all patients who pursue top surgery want flat chests. Whether you would like to opt for a breast reduction or a chest reconstruction with some volume left behind, the button buttonhole incision is the most commonly pursued type.

Top surgery patients who would like to maintain an erotic or a high level of sensation in their nipples can ask their surgeon about nerve-preservation techniques . Inversely, many patients who get top surgery choose to have their nipples removed .

Genital Reconstruction or Bottom Surgery

While the following bottom surgery procedures are traditionally put under the “FTM” category, we recognize that not all patients who pursue these procedures identify as men nor are they looking to “masculinize” their genitals.

Two procedures can be used to reconstruct a penis or “neophallus”: metoidioplasty and phalloplasty. Metoidioplasty or “meta” releases the ligaments around the erectile tissue (called a clitoris or penis) to extend it to about 2-4 inches in length. A phalloplasty uses a donor flap (usually from the forearm or thigh) to construct a penis of 4 inches in length or more (depending on availability of tissue). Both procedures can be specialized to allow a patient to maintain erotic sensation in their genitals (nerve preservation) and/or urinate standing up (urethroplasty).

Associated procedures include the removal of the uterus (hysterectomy), the removal of the vaginal canal (vaginectomy), the construction of a scrotum (scrotoplasty), the insertion of penile/testicular implants, and more.

Body Masculinization Surgery (BMS)

Body Masculinization Surgery (BMS) refers to a series of body contouring procedures. Most often, BMS involves liposuction of one or more of the following areas: abdomen, flanks, hips, thighs, buttocks, or arms. BMS can also involve removing unwanted, excess skin from fat loss or liposuction. Occasionally, some patients may opt for silicone pectoral implants alongside or after their top surgery results.

Facial Masculinization Surgery (FMS)

Facial Masculinization Surgery (FMS) refers to a series of procedures that patients can choose from to give their face a more angular, conventionally masculine appearance. In the bottom third of the face, the chin, jaw, or laryngeal prominence (aka Adam’s apple) can be augmented or increased in size. In the middle third of the face, the appearance of the nose and/or cheeks can be altered. In the top third of the face, the hairline’s position can be changed and the forehead can be augmented.

Types of Gender “Reassignment” Surgeries: “Male to Female (MTF)”

Male to Female (MTF) is outdated terminology that we do not use in our clinical practice. This abbreviation leaves out the experiences of many trans feminine and non-binary patients who do not identify with being labeled as a “man becoming a woman.”

In the past, “MTF gender confirmation surgery” was used to describe surgical procedures that reverse the effects of an initial androgenic (testosterone-dominant) puberty and/or reconstruct a patient’s genitals. As a practice, we still get asked by prospective patients about the “MTF” procedures we offer, which is why we have compiled a guide of surgeries that have typically been placed under this category.

Please note that patients can seek out any of these procedures regardless of their gender identity. The goal of our practice is not to make our patients turn “into women,” but to help them feel greater gender congruence with their bodies.

Breast Augmentation or “MTF” Top Surgery

Typically, for trans feminine and non-binary patients who prefer to have more volume on their chest, breast augmentation with saline or silicone implants allows for greater success in their desired outcomes. Fat grafting procedures limit the amount of volume transferred to the chest based on available body fat that can be safely removed.

Genital Reconstruction or Bottom Surgeries

The most common surgeries that are placed under this category are vaginoplasty and vulvoplasty (also called zero-depth vaginoplasty) procedures. The most common vaginoplasty uses a penile-inversion technique to reconstruct a vaginal canal. However, a penile-preserving vaginoplasty is also another option for patients. Lifelong dilation after this procedure is necessary to maintain the depth of the canal so that it can be used for penetrative sex. Labiaplasty revisions are sometimes sought out by patients wishing to adjust the size, shape and symmetry of their labia and/or clitoral hood.

Before a vaginoplasty, patients may opt to remove the testicles ( orchiectomy ). Patients of varying gender identities undergo orchiectomies for many reasons, such as chronic pain or to simplify their hormone therapy.  For patients who plan to have a vaginoplasty in the future, it’s best to consider the timing of an orchiectomy procedure since scrotal tissue can be used to construct the labia.

Facial Feminization Surgery (FFS)

FFS refers to a series of procedures that a patient can choose from to give their face a softer, more conventionally feminine appearance. In the bottom third of the face, the laryngeal prominence (or Adam’s apple), chin, or jaw can be reduced in size. In the middle third of the face, the appearance of the nose and/or cheeks can be altered. In the top third of the face, the hairline’s position can be changed and the forehead can be reduced.

Body Feminization Surgery (BFS)

BFS encompasses a series of body contouring procedures. Most often, BFS involves removal of fat through liposuction of one or more of the following areas: the thighs, the abdomen/waist, or the arms. The fat removed from these areas of the body can be transferred to the buttocks and/or hip areas and is commonly referred to as a Brazilian butt lift (BBL). BFS can also involve removing unwanted excess skin from fat loss or liposuction, a procedure often referred to as a tummy tuck or abdominoplasty.

Evaluating Candidacy for Gender Affirmation Surgery

Strict guidelines evaluate patient readiness for life-altering GRS procedures.

Informed consent

The GCC follows an informed consent model for surgery because it gives patients autonomy over their health. Under this model, adults can consent to procedures if they have received adequate education about their risks, advantages, and potential effects on their health given their unique medical history. Historically, TGD people have had a difficult time accessing quality gender-affirming health care in part because of gatekeeping and discrimination based on requirements set by insurance companies. For example, letters from medical and mental health providers are a part of these requirements. We recognize that therapists and other healthcare providers are invaluable sources of support for patients undergoing a medical gender transition. 

Health factors

We recommend our patients get medical clearance from their primary care provider (PCP) before surgery. If you have medical conditions that may affect your surgery, we can work with your PCP or specialist to ensure a safe recovery. Patients should inform their surgeons of any cardiovascular or respiratory issues, history of anorexia, diabetes, or use of immunosuppressant medications.

Different surgeons may consider a patient’s Body Mass Index (BMI) as part of their eligibility for surgery. You can read more about our requirements and recommendations around BMI here .

We require all our patients to stop smoking or consuming any form of nicotine for at least 3 weeks before and 3 weeks after surgery, as this can lead to significant problems with delayed wound healing. Please do not drink alcohol for at least 1 week before and 1 week after surgery or until prescription pain medications are discontinued.

Insurance requirements

Patients who wish to have their insurance cover their gender affirming surgery need to fulfill certain requirements. You will need to get a letter of support from a mental health professional to confirm that the procedure is medically necessary. If the surgeon is outside of your insurance’s in-network providers, you will need to get a referral letter from your primary care provider (PCP). Additionally, some insurance companies may require that a patient undergo gender-affirming hormone therapy to cover surgery.

Hormone Therapy Considerations

At GCC, we do not require our patients to undergo hormone therapy to access medically necessary, gender-affirming surgeries. That said, undergoing hormones before surgery can help some patients improve the appearance of post-op results.

  • Facial surgery: It may take up to 1.5 years on hormone therapy before soft tissue changes can appear on the face so patients should consider waiting to undergo facial surgery until these changes have settled.
  • Bottom surgery: Maximal bottom growth may take up to 2 years for patients on a standard dose of testosterone so patients should consider undergoing metoidioplasty until maximal growth is achieved for optimal outcomes.
  • Breast augmentation: Maximal breast growth may take up to 1.5 to 2 years for patients on a standard dose of estrogen so patients should consider undergoing breast augmentation until maximal growth is achieved.
  • Body contouring: It may take up to 1.5 years on hormone therapy before the fat redistribution process settles so patients should consider waiting until then before undergoing liposuction or fat grafting procedures.

When it comes to age and eligibility for surgery, we are typically asked about 2 populations: adolescents and seniors. The World Professional Association for Transgender Health (WPATH) has outlined in their Standards of Care (SOC), Version 8 , the need for the involvement of caregivers/parents and mental health professionals in the informed consent process for adolescents. If these protocols are followed, the only type of gender-affirming surgery that an adolescent can undergo is top surgery.

As long they are in good health and cleared for surgery, senior patients are eligible for surgery regardless of their age and can achieve good aesthetic outcomes. It’s important to consider what accommodations are necessary to support post-op recovery. You can read more about our eligibility standards here .

Weighing GRS Benefits Against Complications

The decision to undergo “gender reassignment surgery” is a highly personal one. Understanding both the pros and cons provides critical insight.

How GRS Can Transform Lives

The WPATH’s SOC 8 reviews the medical research literature around the long-term effects of gender-affirming surgery on trans and non-binary patients. Gender-affirming procedures report greater satisfaction and lower regret rates compared to similar cosmetic and reconstructive procedures performed in cisgender patients.

  • Improved mental health
  • Improved body-image, etc.
  • Enhanced quality of life

Rates of anxiety, depression, and suicide risk all tend to decrease substantially following surgery for those who need it, which is why these procedures are considered medically necessary for many patients.

Risk Factors and Long-Term Effects

All surgeries carry risks of complications. Generally speaking, patients who optimize their health prior to surgery (e.g., do not smoke tobacco) and manage any pre-existing medical conditions can greatly reduce their risk for complications. Undergoing surgery with a board-certified surgeon who has hospital access privileges can help ensure the integrity of your surgical process. If you have specific questions about surgical complications and how to prevent them, you can consult our content library on this question.

Navigating Emotions

Surgery not only takes a physical, but also an emotional toll on the body. Experiencing pain, inflammation, discomfort and limitations on physical activity occasionally mat result in temporary postoperative depression. Likewise, having to wait weeks or months to have a sense of what your final results from surgery will look like can give some patients temporary feelings of regret during recovery. For this reason, we highly encourage patients to tap into their support networks of friends, (chosen) family and/or mental health professionals during this time. To learn more about the emotional recovery process, click here .

Conclusion: Is Gender Reassignment Surgery the Right Choice?

While gender-affirming surgery has been proven to be positively life-changing for many trans and non-binary individuals. Whether you seek surgery or not, we remain dedicated to your health, empowerment, and right to be your authentic self.

More Articles

Understanding the cost of double incision top surgery: a comprehensive guide, gatekeeping vs. empowerment: accessing gender affirming care, treating gender dysphoria in adolescents, sign up for instructions to get a virtual consultation.

The virtual consultation will be billed to your insurance company. We will accept the insurance reimbursement as payment in full.

gender reassignment question

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Appeals Court Finds a Constitutional Right to Gender Reassignment Surgery

gender reassignment question

The 14th Amendment to the Constitution is truly a magical amendment. It was used to justify attempts to kick Donald Trump off the 2024 ballot. Through the decades, judges who want to play at social engineering have used it frequently to justify questionable law. 

It's even been invoked to bypass Congress to raise the debt limit.

Now, the Fourth Circuit Court of Appeals has decided that the amendment's "equal protection" clause means that state Medicaid programs have to cover gender reassignment surgeries.

The appeals court ruled that West Virginia's Medicaid rules on mastectomies are unconstitutional because they violate the "equal protection standard" by not covering mastectomies for gender dysphoria.

Yes, really.

The ruling also includes a North Carolina Medicaid case that the state government won't cover "sex changes." The Fourth Circuit nullified the state ban on gender change surgeries, citing the 14th Amendment’s guarantee of “equal protection of the laws.”

This was a court looking for an excuse to make law.

Judge Roger Gregory who wrote the majority opinion in Kadel v. Folwell (8-6) asked, “Is removing a patient’s breasts to treat cancer the same procedure as removing a patient’s breasts to treat gender dysphoria?” He continued, “There is no case law to ground this discussion nor obvious first principles.”

Wall Street Journal:

He is undeterred, and he concludes that gender dysphoria and transgender status are intertwined, so that such insurance exclusions are nothing more than a proxy for discriminating against gender identity. Then he goes further, finding that West Virginia’s and North Carolina’s policies also unconstitutionally discriminate based on sex. How so? Imagine, Judge Gregory says, an unidentified patient seeking a vaginoplasty. Is this a biological female with a rare birth defect? Is it a transgender patient? “By virtue of the fact that they are seeking a vaginoplasty, we know that they were born without a vagina,” he writes. “But we do not know what sex they were assigned at birth. Without that information, we cannot say whether the Plan or Program will cover the surgery.” Ergo, sex discrimination.

Gregory gets even nuttier.

The differences in coverage "is rooted in a gender stereotype: the assumption that people who have been assigned female at birth are supposed to have breasts, and that people assigned male at birth are not."

It's not a "gender stereotype." It's a biological fact. 

"No doubt, the majority of those assigned female at birth have breasts, and the majority of those assigned male at birth do not. But we cannot mistake what is for what must be.”

Not just a "majority." It's a universal biological fact with a tiny number of exceptions.

Treating different things differently doesn’t violate the 14th Amendment’s Equal Protection Clause, and jurists aren’t supposed to ignore the obvious. Writing in dissent at the Fourth Circuit, Judge Julius Richardson struggles to contain his exasperation. “The states,” he says, “have chosen to cover alterations of a person’s breasts or genitalia only if the person experiences physical injury, disease, or (in West Virginia) congenital absence of genitalia.” That determination does not turn on the patient’s sex or gender. “Christopher Fain—one of the plaintiffs below—received coverage for a hysterectomy based on a diagnosis unrelated to Fain’s transgender status,” the dissent says. Likewise, males with gynecomastia qualify for surgery coverage in West Virginia only “if they have physical symptoms, like breast pain,” meaning that isn’t a procedure done merely “to affirm a patient’s biological sex.”

The ruling that opened this can of worms was Bostock v. Clayton County, a case that "held that Title VII of the Civil Rights Act of 1964 protects employees against discrimination because of  sexuality or gender identity." Now, as a dissenting judge in Kadel v. Folwell,  Judge J. Harvie Wilkinson III is saying that this ruling could be a Roe v Wade  ruling for the transgender community.

“This is imperial judging at its least defensible,” he says, “What plaintiffs propose is nothing less than to use the Constitution to establish a nationwide mandate that States pay for emerging gender dysphoria treatments.”

He's not wrong. But getting the ruling past this Supreme Court would be a stretch. 

Rick Moran

Rick Moran has been writing for PJ Media for 18 years. His work has appeared in dozens of media outlets including the Washington Times  and ABC News. He was an editor at American Thinker for 14 years. His own blog is Right Wing Nut House . For media inquiries, please contact [email protected] .

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COMMENTS

  1. FAQs

    The Equality Act 2010 at Section 7 defines the protected characteristic of "gender reassignment" as relating to a person who is: "proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person's sex by changing physiological or other attributes of sex.".

  2. Americans' Complex Views on Gender Identity and Transgender Issues

    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 ...

  3. Questionable Questions About Transgender Identity

    Answering the Question: A transgender woman is someone who was born a boy, but deeply understands herself to be a woman. Transgender women may dress in ways that appear more feminine, but, like many non-transgender women, may not. Some transgender women love dresses and makeup, while others don't.

  4. More Inclusive Gender Questions Added to the General Social Survey

    The General Social Survey, or GSS, is one of the most important data sources for researchers studying American society. For the first time ever in its nearly 50-year history, the survey's 2018 data release includes information on respondents' self-identified sex and gender. The new data will allow researchers to measure the size of the transgender and gender non-binary populations and ...

  5. Answers to your questions about transgender people, gender identity

    Gender identity refers to a person's internal sense of being male, female or something else; gender expression refers to the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice or body characteristics. "Trans" is sometimes used as shorthand for "transgender.". While transgender is ...

  6. What is gender reassignment

    16May. What is gender reassignment A decision to undertake gender reassignment is made when an individual feels that his or her gender at birth does not match their gender identity. This is called 'gender dysphoria' and is a recognised medical condition. Gender reassignment refers to individuals, whether staff, who either: Have undergone ...

  7. Gender dysphoria

    Gender dysphoria can be lessened by supportive environments and knowledge about treatment to reduce the difference between your inner gender identity and sex assigned at birth. Social support from family, friends and peers can be a protective factor against developing depression, suicidal thoughts, suicide attempts, anxiety or high-risk behaviors.

  8. What Do I Need to Know About the Transitioning Process?

    Social transitioning may include things like: coming out to your friends and family as transgender or nonbinary; asking people to use pronouns that feel right for you; going by a different name; dressing/grooming in ways that feel right for you when other people can see you; and. using your voice differently when talking to other people.

  9. Sexual orientation, gender identity and gender reassignment

    Sexual orientation discrimination and gender reassignment discrimination are illegal in the UK, and are listed as protected characteristics in the UK Equality Act 2010. Discrimination takes place when someone is unfairly disadvantaged for reasons related to their sexual orientation or because they are transsexual* (transgender).

  10. Sex and gender identity question development for Census 2021

    Like gender reassignment, "sex" is also a protected characteristic, as set out in the Equality Act 2010. We concluded that none of our approaches to a gender identity question to that point would fully meet user needs. We therefore committed to undertaking further question development and testing, before recommending that gender identity ...

  11. Psychological and Neuropsychological Assessment with Transgender and

    Transgender, gender nonbinary and gender diverse clients may present for psychological assessment for the same reasons as cisgender clients. These assessments may be necessary in order to obtain appropriate supports or treatment. However, in the case of clients who do not identify as cisgender, use of gender in the scoring procedure may harm ...

  12. PDF Collecting information on gender identity

    The term 'gender reassignment' applies to the process of transitioning from one gender to another. The term used in the Equality Act to describe people who intend to transition, are transitioning or have transitioned is 'transsexual'. So, a person who intends to undergo, is undergoing or has undergone a process of gender reassignment ...

  13. Frequently Asked Questions about Transgender People

    July 9, 2016. Download PDF: Frequently Asked Questions about Transgender People. Transgender people come from every region of the United States and around the world, from every racial and ethnic background, and from every faith community. Transgender people are your classmates, your coworkers, your neighbors, and your friends.

  14. Gender Affirmation Surgeries: Common Questions and Answers

    Gender affirmation surgery, also known as gender confirmation surgery, is performed to align or transition individuals with gender dysphoria to their true gender. A transgender woman, man, or non-binary person may choose to undergo gender affirmation surgery. The term "transexual" was previously used by the medical community to describe people ...

  15. Guidance for questions on sex, gender identity and sexual orientation

    For the sex question, guidance for the 2011 Census informed the 2021 guidance. Guidance on gender identity and sexual orientation will be new for 2021. An initial draft of the guidance for these three questions was shared with stakeholders in May 2019. A wide range of stakeholders representing lesbian, gay and bisexual (LGB) people, trans ...

  16. 'An explosion': what is behind the rise in girls questioning their

    According to a study commissioned by NHS England, 10 years ago there were just under 250 referrals, most of them boys, to the Gender Identity Development Service (Gids), run by the Tavistock and ...

  17. Census Bureau Invites Expert Feedback on New Sexual Orientation and

    The research will inform recommendations for potential production ACS implementation on question wording and response options, whether a confirmation question is asked of everyone or only of those people with discrepant responses for sex at birth and current gender identity, and the style of write-in boxes to use for internet respondents.

  18. Preparing for Gender Affirmation Surgery: Ask the Experts

    Request an Appointment. 844-546-5645 United States. +1-410-502-7683 International. To help provide guidance for those considering gender affirmation surgery, two experts from the Johns Hopkins Center for Transgender Health answer questions about what to expect before and after your surgery.

  19. Gender Reassignment Transgender Employment Rights Where Are We Now

    The Equality Act also makes additional provisions specifically for gender reassignment. Under s16, trans employees are entitled to take time off work for reasons relating to their gender reassignment. Therefore, employers must treat a trans employee equally to other members of staff who require a period of absence from the workplace, otherwise ...

  20. The Gender Reassignment Controversy

    When he was 14, Reimer began the process of reassignment to being a male. As an adult, he married a woman but depression and drug abuse ensued, culminating in suicide at the age of 38 (1). Money's ...

  21. David Reimer and John Money Gender Reassignment Controversy: The John

    In the mid-1960s, psychologist John Money encouraged the gender reassignment of David Reimer, who was born a biological male but suffered irreparable damage to his penis as an infant. Born in 1965 as Bruce Reimer, his penis was irreparably damaged during infancy due to a failed circumcision. After encouragement from Money, Reimer's parents decided to raise Reimer as a girl.

  22. PDF Guidelines for Psychosocial Assessments for Sexual Reassignment Surgery

    transsexual or gender non-conforming patients to reduce gender dysphoria and improve their quality of life.1 Genital surgical procedures may be referred to as Sex Reassignment Surgery (SRS) or Gender Confirmation Surgery (GCS) or Gender Affirmation Surgery (GAS). International guidelines from the World Professional Association of

  23. Analyzing Your Gender Reassignment Surgery Options: Risks & Rewards

    The WPATH's SOC 8 reviews the medical research literature around the long-term effects of gender-affirming surgery on trans and non-binary patients. Gender-affirming procedures report greater satisfaction and lower regret rates compared to similar cosmetic and reconstructive procedures performed in cisgender patients. Improved mental health.

  24. Ethical Questions Concerning Sex Reassignment Surgery: Revisions for

    Ethical Questions Concerning Sex Reassignment Surgery: ... Sex reassignment surgery is radical in that genitalia may be removed and replaced with reconstructed genitalia that may not have a completely normal appearance or function. The surgeon operating in this arena must, first of all, believe that the condition of gender identity disorder is ...

  25. Appeals Court Finds a Constitutional Right to Gender Reassignment

    The Fourth Circuit nullified the state ban on gender change surgeries, citing the 14th Amendment's guarantee of "equal protection of the laws." This was a court looking for an excuse to make ...