Planned Parenthood


Transgender Identity

What are the differences between sex, gender identity and gender expression?

One's biology. Sex is determined by one's biological chromosomes, hormones and anatomy. Researchers have determined five biological sexes, but the two primary sexes are male and female.

Gender Identity
One's psychological sense of self. A person's sense of being male, female or other gendered. The gender to which one feels they belong.

Gender Expression
One's communication of gender. A person's sense of being masculine, feminine or androgynous. This may or may not be related to one's gender identity.

What's the difference between someone who identifies as transgender vs. transsexual?


  • It's used as the umbrella term for the transgender and transsexual community.
  • Specifically defined as anyone whose gender expression (communication of gender) is considered non-traditional for the sex they were assigned at birth, such as transsexuals, cross dressers, drag artists, androgynous individuals, genderqueers, masculine women, feminine men and other gender variant individuals.


  • A person who identifies psychologically as one gender/sex other than the one to which they were assigned at birth.
  • To match their outer body to their inner sense of gender/sex, a transsexual person may change or have changed their body through hormone therapy and gender confirmation surgeries.

If I'm transsexual, what steps should I take to transition?

Everyone’s transition is unique. These suggestions may or may not apply to you. State law can also impact how you legally transition.

Your Health Care

  • Work with a therapist. Usually you’ll need a letter from a therapist prior to starting hormones or undergoing surgical procedures.
  • Use an endocrinologist or general practitioner to prescribe hormones and monitor your general health.
  • You may choose to have a surgeon perform top surgery (FtM) or breast augmentation (MtF).
  • For FtMs, visit an OB/GYN and consider a hysterectomy. It’s highly recommended that you have your hysterectomy two-to-five years after starting testosterone due to the risks of cancer, tumors and/or cysts.
  • Research surgeons for your lower surgery. Surgeons typically require letters from two psychologists prior to performing genital surgery.

Your Legal Documents

  • File your name change with the court system.  You’ll receive a court order upon approval of your name change which you’ll use to change your name on all other documents.
  • Change your name and/or gender on your driver’s license through your local DMV.
  • Change your name and/or gender on your social security card through your State’s Federal building.
  • Change your name and/or gender on your  birth certificate through your State’s Vital Records.

These items are in sequential order.  To change your gender marker on documents, agencies will require a letter from the surgeon that performed your surgery.  The letter must state that you've, "successfully completed irreversible sex reassignment surgery.”

Transitioning in the Midwest is possible.

The Midwest has many open-minded providers who have been working with the transgender community for many years and support you in your transition.

Planned Parenthood has been a trusted provider of transgender support since 2004. For more information and resources, please click here.

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Transgender Identity