Find Dr. Cullins' Answers to Common Sexual Health Questions
Q&A with Dr. Cullins
What if you have a guy’s body but you feel like a girl? What if you like your girl’s body but want people to treat you like a guy? What if you can’t stand your woman’s body because it keeps you from being the man you know you are? What if wearing opposite-sex clothing just feels right? What if you don’t feel like either “man” or “woman” accurately describes you?
Millions of people have asked themselves these and other questions about their gender identities. Here are some of the most common questions we hear about trans identities.
Trans (sometimes written as trans*) is a big umbrella term that describes people whose gender identities aren’t in sync with the sex they were assigned at birth and/or most people’s notions of what it means to be a man or a woman. Trans people express their gender identity in lots of different ways. Some trans people use their dress, behavior, and mannerisms in order to be perceived as the gender that feels right for them. Some get surgery and/or take hormones to change their body to match their gender identity. Some trans people reject the traditional understanding of gender as divided between just “male” and “female.”
Transgender people are diverse in their gender identities (the way you feel on the inside), gender expressions (the way you dress and act, that others can see), and sexual orientations (the people you’re attracted to).
People whose gender identities are in sync with the sex they were assigned at birth are called cisgender.
Transitioning is the process of changing the way you look on the outside so that it reflects the gender you feel on the inside. Transitioning can mean lots of different things. For many trans people, transitioning socially includes coming out to friends and family as transgender, asking people to use or responding to different personal pronouns (“she” versus “he”), going by a different name, and wearing different clothes. Some trans people also take hormones and/or get surgery as a part of a medical transition process.
A person who transitions from male to female — M to F, M2F, or MTF — is a woman, and may choose to refer to herself that way. She might also choose to refer to herself as a transwoman. A person who transitions from female to male — F to M, F2M,or FTM — is a man, and may choose to refer to himself that way. Or he might refer to himself as a transman. Some trans people reject the traditional understanding of gender as divided between just “male” and “female,” and might refer to themselves by other words and pronouns.
There are a number of different surgical procedures that trans people may get as part of their transition. These procedures are sometimes referred to as gender confirmation surgeries. “Top” surgery refers to procedures to remove and reconstruct breast tissue (for transmen), or to create breasts (for transwomen). “Bottom” or “lower” surgery refers to procedures that augment alter the genitals. Some trans people also get plastic surgery to make their facial structure look more traditionally feminine or masculine, and some transwomen undergo laser hair removal to remove facial hair.
There are two different bottom surgeries that a transwoman may have. First, the testes are removed. This is called orchiectomy. Then a vagina and clitoris are created from the tissue that makes up the penis. This is called vaginoplasty. For a transman, there are two bottom surgery options. A penis can be constructed by using skin from other parts of the body. This is called phalloplasty. Or the clitoris can be freed from connective tissue to become a penis. The clitoral tissue can be further enlarged with testosterone treatments. This is called metoidioplasty.
Some trans people get surgery and some don’t. A transman who has the vulva and breast tissue he was born with is still a man, and a trans woman who has the penis and chest she was born with is still a woman.
Accessing health care can be challenging for trans people. Regardless of whether they’re using hormones or have had surgery, they may worry about revealing their gender identity. They may feel uncomfortable with their genitals and bodies in general. They may feel that a routine checkup is invasive. Not all health care providers are sensitive to trans issues.
Trans people may also have special health care concerns and needs. They may, for example, seek surgeries or hormone treatments to change their bodies, so expert care is needed to avoid serious health and cosmetic complications.
Trans women and men who want to modify their bodies should seek out qualified medical professionals who can provide all the information needed to decide what treatments are best for an individual. They can also provide the ongoing care that is needed after treatment begins. Unfortunately, these procedures are inaccessible for many trans people who want them — they can be expensive, and finding a provider who offers them can be difficult.
Trans people should not use “street” silicone or hormones. Street silicone can make breasts bigger, but it can also lead to infection. Using hormones without medical guidance is also dangerous. It can increase the risk for blood clots, high blood pressure, liver disease, and other serious health risks. And using syringes and needles from the street can expose people to HIV infection.
Planned Parenthood health services are open to people of all gender identities and sexual orientations. Whether you're transgender or cisgender, you can visit a Planned Parenthood health center for STD testing, birth control, physical exams, other sexual and reproductive health services, and referrals. You can use our health center locator to find your nearest Planned Parenthood health center and learn about the services it offers.
At this time, only some Planned Parenthood health centers are able to offer hormone treatments for trans people:
Gay refers to a sexual orientation. Transgender is a gender identity, not a sexual orientation. But that doesn’t mean some trans people can’t or don’t identify as gay (or lesbian, or bisexual, or queer). Trans people have a variety of sexual orientations. Some transwomen are attracted to men, some are attracted to women, and some are attracted to both. And some trans people find that after they transition, they aren’t attracted to the gender they used to be.
For a trans person, “passing” means having other people perceive you as the gender you present. The way other people perceive your gender is often called “being read” — as in, being read as a woman/man. Passing is extremely important for many trans people. Not only is it emotionally important, but for many trans people passing effectively can provide safety from harassment and violence.
The word “passing,” however, may have negative connotations for some trans people who feel it suggests that their gender presentation is not authentic.
Transphobia is the fear and hatred of people who are transgender, genderqueer, or who cross-dress.
Some people are transphobic because they have the wrong information — family, friends, and religious authorities often encourage negative ideas about trans people and trans identities. And some people are transphobic because they don’t have any information about trans identities — they are not aware of trans people or trans issues.
Transphobia can prevent trans people from being or feeling safe and from living full lives. It leads to discrimination and violence. Trans people may face verbal abuse or physical violence because of their gender identities.
Transphobia can also create subtle forms of discrimination. For example, people who are (or who are perceived to be) trans may not be hired for certain jobs, may not be allowed to rent certain apartments, and may be treated poorly by health care providers.
The stress of being targeted by transphobia can be very harmful. It can cause
There are several simple things you can do to fight against transphobia:
Whether you’re trans yourself or are a trans ally, here are some tips that might help you challenge transphobia in your everyday life:
It can be helpful to find and connect with trans-friendly resources in your community. You can join your local LGBT community center, if there is one. It can provide you with information about gender identity and trans issues. Some offer support groups so you can talk confidentially with other trans folks. You can also visit the GLAAD website for more transgender resources.
"Coming out" as trans is a very personal decision. Some choose to come out before they medically or socially transition, and some choose to come out after.
If you choose to come out as trans, make sure it's to people you trust. And make sure you have a trusted support system in place. This can include friends, family, or a support group. The reality is that not everyone will be accepting, supportive, or even tolerant. It's important to feel as confident as possible that coming out will not jeopardize your safety or health.
The process of coming out is different for everyone. Someone may be out to their friends but not their family, for example, and that’s okay. Every situation is different and personal.
It’s important to recognize that there are differences in what it means to be out for LGB people and transgender or transsexual people. Unfortunately, for trans people, coming out (or being outed) as trans can mean that their identities are misunderstood, negated, or disbelieved. And coming out and being out can mean different things to different trans people, depending on where they are in their journey.
The best way you can support trans partners, relatives, friends, coworkers, or people in general is to accept them as they want to be accepted. Refer to them in the ways they want to be referred to — like their preferred name and pronouns. Be very careful not to out trans folks that you know to other people. You can also be an ally to the trans community by being supportive of trans rights on an individual, social, and political level. The National Center for Transgender Equality is a great resource for more information on trans rights. PFLAG is another great resource.
Q&A with Dr. Cullins