Planned Parenthood

Trans and Gender Nonconforming Identities

Transgender is about gender identity.

Transgender is a term that includes the many ways that people's gender identities can be different from the sex they were assigned at birth. There are a lot of different terms transgender people use to describe themselves. For example, sometimes the word transgender is shortened to just trans, trans*, or trans male/trans female. It's always best to use the language and labels that the person prefers.

Transgender people express their gender identities in many different ways. Some people use their dress, behavior, and mannerisms to live as the gender that feels right for them. Some people take hormones and may have surgery to change their body so it matches their gender identity. Some transgender people reject the traditional understanding of gender as divided between just "male" and "female," so they identify just as transgender, or genderqueer, genderfluid, or something else.

Transgender people are diverse in their gender identities (the way you feel on the inside), gender expressions (the way you dress and act), and sexual orientations (the people you're attracted to).

When people's assigned sex and gender identity are the same, they're called cisgender.

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What’s gender dysphoria?

Gender dysphoria is a term that psychologists and doctors use to describe the distress, unhappiness, and anxiety that transgender people may feel about the mismatch between their bodies and their gender identity. A person may be formally diagnosed with gender dysphoria in order to receive medical treatment to help them transition.

Psychologists used to call this "gender identity disorder." However, the mismatch between a person's body and gender identity isn't in itself a mental illness (but it can cause emotional distress), so the term was changed to reflect that.

How is a transgender identity different from sexual orientation?

People often confuse gender identity with sexual orientation. But being transgender isn't the same thing as being lesbian, gay, or bisexual. Gender identity, whether transgender or cisgender, is about who you ARE inside as male, female, both, or none of these. Being lesbian, gay, bisexual, or straight describes who you're attracted to and who you feel yourself drawn to romantically, emotionally, and sexually.

A transgender person can be gay, lesbian, straight, or bisexual, just like someone who's cisgender. A simple way to think about it is: Sexual orientation is about who you want to be with. Gender identity is about who you are.

What does passing mean?

Passing describes the experience of a transgender person being seen by others as the gender they want to be seen as. An example would be a trans woman using the women's bathroom and being seen as female by those around her.

Passing is extremely important for many transgender people. Passing can be emotionally important because it affirms your gender identity. Passing can also provide safety from harassment and violence. Because of transphobia, a transgender person who passes may experience an easier time moving through the world than a person who is known to be transgender or looks more androgynous.

But not all transgender people feel the same way about passing. While passing is important to some people, others feel the word suggests that some people's gender presentation isn't as real as others. They may feel that passing implies that being seen by others as cisgender is more important than being known as transgender. Some transgender people are comfortable with and proud to be out as trans and don't feel the need to pass as a cisgender person.

What does it mean to transition?

Transgender people have a range of experiences with transitioning. Some may transition socially, legally, and medically, some may transition only socially, and some may not do any of these.

Transitioning is the process of changing the way you look and how people see and treat you so that you become the gender you feel on the inside. Transitioning can means lots of different things. It can involve medical treatment and hormones. It can involve changing your name and preferred pronouns. It can involve changing your appearance and dress. It can involve coming out to your friends and family. It can be a long and ongoing process. Or it can be something that happens over a short period of time.

How do transgender people transition?

There are two different types of transition, or ways to affirm your gender: social transition and medical transition.

Social transitioning may include:

  • coming out to your friends and family as transgender
  • asking people to use pronouns (she/her, he/him, they/them) that match your gender identity
  • going by a different name
  • dressing/grooming in ways that match your gender identity

For trans men, or FTM, medical transition may include any of the following:

  • hormone therapy (to create masculine characteristics such as a deeper voice, facial hair growth, muscle growth, redistribution of body fat away from hips and breasts, not getting a period, etc.)
  • male chest reconstruction, or "top surgery" (removal of breasts and breast tissue)
  • hysterectomy (removal of internal female reproductive organs such as the ovaries and uterus)
  • phalloplasty (construction of a penis using skin from other parts of your body)
  • metoidioplasty (surgery that causes your clitoris to work more like a penis, along with hormone treatment to make your clitoris grow larger)
For trans women, or MTF, medical transition may include any of the following: 
  • hormone therapy (to create feminine characteristics such as less body hair, breasts, redistribution of body fat toward hips and breasts, etc.)
  • breast augmentation (implants)
  • orchiectomy (removal of testes)
  • laser hair removal (to remove hair from your face or other parts of your body)
  • tracheal shave (making your Adam's apple smaller)
  • facial feminization surgery (create smaller, more feminine facial features)
  • penile inversion vaginoplasty (creation of a vagina by inverting penile skin)



Does everyone who's transgender decide to transition?

No, not all transgender people transition. For those who do, not all transition in the same way. Some may transition socially and not medically. Some may transition medically by doing one or only a few of the procedures listed above. Some may take hormones and decide not to have any surgeries, or just choose one kind of surgery and none of the others.

There are many reasons for the differences in how people transition. These medical procedures can be very expensive, which means that not everyone can afford them. Some transgender people may have health insurance that covers transition-related procedures, and some may not. And finally, but most importantly — not all trans people want all of the available medical procedures.

Regardless of whether a transgender person chooses to transition and how they choose to do it, they're no more "real" than other trans people who don't transition. Someone's gender identity should always be respected no matter how they decide to transition socially or medically.

What kinds of health care and services do I need if I’m transgender?

Transgender people have the same health care needs as cisgender people, such as basic physical exams, preventive care, and STD testing. But you may also have special health care concerns and needs. If you wish to transition medically by using hormones or having surgery, expert care is needed to avoid problems.

Accessing health care can be challenging for transgender people. Not all nurses and doctors are sensitive to trans issues or informed about the health care needs of transgender people. You may worry about revealing your gender identity regardless of whether you wish to transition medically. You might not feel comfortable with your body or feel comfortable having a nurse or doctor examine you.

Transgender people who want to transition medically should look for qualified nurses and doctors who can provide the best treatments and care. Unfortunately, these treatments are not easy to access for many people who want them — they can be expensive and are often not covered by insurance. You may need a parent or legal guardian's permission if you're under 18. Sometimes finding a provider who offers these treatments can be difficult depending on where you live.

Because finding doctors who will help you safely through medical transition can be difficult, some people use hormones that they obtain from other sources. Using hormones without medical guidance is dangerous — it can increase your risk for blood clots, high blood pressure, liver disease, and other serious complications. If you use needles to give yourself injections without learning how to do it safely from a nurse or doctor, you could increase your risk for HIV, hepatitis, and other infections.

Transgender people who want to feminize their bodies and can't access surgeries may get people who aren't nurses or doctors to inject "street" silicone into their bodies. Street silicone might give your body feminine curves, but it's extremely dangerous and can lead to infections or even death. Some people who use street silicone eventually need to have it removed from their bodies by a doctor.

What health services can Planned Parenthood give me if I’m transgender?

Planned Parenthood health centers are open to people of all gender identities and sexual orientations. Whether you're transgender or cisgender, you can visit your local Planned Parenthood health center for STD testing, birth control, physical exams, other sexual and reproductive health services, and referrals. 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:

What does it mean to “come out” as trans?

Coming out as transgender may mean that you tell people about your preferred pronouns (if you wish to be referred to as he/him, she/her, they/them, etc.). It may also mean that you ask people to call you by a new name and to think of you by the gender identity that you're comfortable with.

Coming out as trans is a very personal decision and different for everyone. Some people choose to come out before they medically or socially transition, and some choose to come out after or during the process. You may choose to come out to different people at different times, or to not come out to some people at all. All of this is okay — only you can decide what's right for you.

Although both involve telling friends and family about your identity, there are differences between coming out as lesbian, gay, or bisexual and coming out as transgender. A lot of people know what it means for a person to be gay, but there's still a lot of confusion and misinformation out there about what it means to be trans.
And sometimes coming out or being outed as transgender can mean your identity is misunderstood, disrespected, or disbelieved.

If you choose to come out as transgender, make sure it's to people you trust and that you have a support system in place. This can include friends, family, or a support group. It's important to feel as confident as possible that coming out won't jeopardize your safety, health, or living situation.

How do I come out to my parents and friends?

There's no one correct way to come out to your family and friends. You're the expert in what feels right to you, and who it feels safest to tell.

Here are some general tips for coming out:

  • When you decide that you're ready to come out, give yourself time to think through how you'll do it and what you'll say.
  • Figure out the people or person in your life that you think will be the most supportive, and come out to them first. You can often get a sense of how friendly someone is to transgender people by watching how they react when the topic comes up in conversation.
  • Do some research so that you have information about being trans, in case they have questions or don't know all the facts.
  • Some people are more comfortable writing a letter or e-mail rather than coming out in person.
  • After you decide who you'll come out to, what you'll say to them, and how you'll say it, be prepared to wait as they digest and accept the new information. Give them the time they need to think about and try to understand what you're going through.
  • Sometimes it takes people awhile to get comfortable with your new pronouns or name, and they may make mistakes when referring to you, even if they don't mean to.
  • Don't assume that everyone will react negatively. Some people may surprise you with their openness and acceptance.

The Human Rights Campaign's Transgender Visibility Guide is a good, step-by-step resource for helping you come out as trans and also includes information to help the people in your life understand your identity.

Where can I find support if I’m transgender?

You can find support in a lot of places, including:

Not everyone lives in a place that has lots of trans people or an LGBTQ community center. If this is your situation, check the Internet for communities and support.

What’s transphobia?

 Transphobia is the fear, hatred, disbelief, or mistrust of people who are transgender, thought to be transgender, or whose gender expression doesn't conform to traditional gender roles. Transphobia can prevent transgender and gender nonconforming people from living full lives free from harm.

Transphobia can take many different forms, including

  • negative attitudes and beliefs
  • aversion to and prejudice against transgender people
  • irrational fear and misunderstanding
  • disbelief or discounting preferred pronouns or gender identity
  • derogatory language and name-calling
  • bullying, abuse, and even violence

Transphobia can create both subtle and overt forms of discrimination. For example, people who are transgender (or even just thought to be transgender) may be denied jobs, housing, or health care, just because they're transgender.

People may hold transphobic beliefs if they were taught them by other people, including parents and families who encourage negative ideas about trans people and who hold strict beliefs about traditional gender roles.

Some people are transphobic because they have misinformation or have no information at all about trans identities. They may not be aware of transgender people or trans issues or personally know anyone who is trans.

The stress of transphobia on trans people can be very harmful and can cause:

  • depression
  • fear
  • isolation
  • feelings of hopelessness
  • suicide

What’s outing?

Outing is the act of revealing someone else's transgender identity or sexual orientation without their consent or permission. Sometimes outing is intentional and sometimes it's accidental, but by sharing information about someone's gender identity against their wishes, you risk making them feel embarrassed, upset, and vulnerable. You may also put them at risk for discrimination and violence.

If someone shares their trans identity with you, remember that this is very personal information and it's an honor that they trusted you enough to tell you. Always ask them what you're allowed to share with others, and respect their wishes.

Where can I get help if I’m dealing with transphobia?

People who experience transphobic harassment often feel alone and afraid to tell anyone what's happening. You should never have to deal with transphobia, and you're not alone.

You may find support from:

  • Other transgender people
  • Online communities for transgender people
  • Trans support groups at your local LGBTQ community center
  • Cisgender people who are allies to trans people
  • National organizations such as the National Center for Transgender Equality, the Human Rights Campaign, the ACLU, or GLAAD.
  • If you're a student, try to find an adult you trust, like a teacher or a school administrator, who's an ally.

Not everyone lives in a place that has a supportive school administration or an LGBTQ community center. In this situation, the Internet can help you find online communities and support with dealing with transphobia and discrimination.

If you're a young person who's experiencing transphobic harassment at school, it's important to tell someone, even if that seems scary. Young people who experience transphobia at school sometimes stop going, which can affect your grades, friendships, and future plans. Some schools may have an anti-bullying and harassment policy, and some states have adopted a Safe Schools Law, which means that your school administrators are legally required to stop the harassment. If possible, find a teacher or adult who's an ally to LGBTQ students and ask for their help.

If you're experiencing transphobia and it's causing you to feel depressed or suicidal, there's help available:

What can I do to help stop transphobia?

No one has the right to discriminate against another person, or to hurt them emotionally or physically. There are things you can do to help stop transphobia:

  • Don't ever use slurs against transgender people.
  • Don't ask personal questions about a transgender person's genitals, surgery, or sex life.
  • Avoid giving trans people compliments that are actually insults. Some examples include: "You look just like a real girl!" or "I never would have guessed you were transgender!"
  • Don't believe stereotypes about trans people or make assumptions about them.
  • Be a vocal supporter of the transgender community, regardless of your own gender identity.
  • Let the transgender people in your life know that you're a friend and ally.
  • Educate yourself on transgender issues.
  • Respect someone's decisions about when and where to come out.
  • If you don't know a person's preferred pronouns or name, ask them.
  • Use gender neutral language, such as "they" and "them" or "folks" and "people" instead of "he/she" or "girls and boys."
  • Respect trans people's chosen pronouns and names and use them.
  • Remember that being transgender is just one part of a person's life.
  • If you feel safe doing so, speak up when other people are being transphobic, like making transphobic jokes, using slurs, or bullying or harassing someone because of their gender identity.

When addressing transphobia in others:

  • Ask questions and stay calm. Often, people don't know what language is insensitive. Avoid insulting them and instead tell them why you find their words offensive.
  • Decide if it's safe to address the issue. Some things to consider: Will you be confronting a stranger in public? Or a friend or family member in private? Do you want to speak up now or wait until you're alone with the person? Would it be safest for you stay quiet and walk away?

It's okay if you mess up a person's pronouns or name by accident sometimes, especially if their transition is new to you. If this happens, apologize and make an effort to use the correct pronoun in the future.

When it comes to language, the following things are bullying:

  • Intentionally calling them the name they no longer use
  • Intentionally using the wrong pronouns

How can I support someone who’s trans?

Support is important. Transgender people are more visible in the media and in our society than ever before. Transgender communities are fighting for equal rights. While great progress has been made, there's still a lot of work to do to make sure everyone feels safe expressing their true gender identity and are given the same rights as cisgender people.

Far too many transgender people are negatively affected by transphobia. Transphobia can result in violence and even murder. It can also result in depression, substance abuse, self-harm, and suicide. A 2011 survey conducted by the National Gay and Lesbian Task Force and National Center for Transgender Equality showed that 41% of trans people had attempted suicide, as compared to 1.6% of the general population.

It's important that everyone — cisgender and transgender — work together to create communities that are welcoming to trans and gender nonconforming people. Everyone deserves to live in a world free of violence and discrimination, including those whose gender identity and expression doesn't match their assigned sex. Everyone can play a part in supporting transgender people and making communities safer and more inclusive.

What do I call people who are transgender?

Respect the words a person uses to describe themselves. Transgender and gender nonconforming people use many different terms to describe their experiences and not all terms fit all people. Some trans people may use terms that others are uncomfortable with. It's important to ask people what language they want you to use. It's okay to ask someone for their preferred name and pronouns. Always use the name and pronouns they choose.

If a trans person isn't sure which identity label fits them best, give them the time to figure it out for themselves. The terms or language a person prefers may change over time, and that's totally normal and okay.

Where can I learn more about transgender rights?

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Trans Identities