Trans women face discrimination in employment, housing and health care. They also experience violence and hate crimes. They are often at increased risk of HIV infection and mortality.
Research suggests that coping efforts can increase resilience for trans women of color. These coping strategies can include not internalizing stigmatizing beliefs and accessing gender affirmative health care.
Gender dysphoria
Gender dysphoria is a feeling of distress related to the difference between your assigned sex at birth and your gender identity. It may be relieved by transitioning socially (using the name, pronouns and public bathroom associated with your affirmed gender), medically with hormones or surgically, or any combination of these. Distress caused by gender dysphoria is often accompanied by relationship problems, substance use disorders and increased risk of suicide attempts among transgender people.
Receiving mental health treatment with a therapist who specializes in transgender identities can help you manage the feelings of distress. Therapists can also work with you to navigate relationships with friends and family as you come out. They can assist you with navigating bullying and discrimination as well as addressing concerns such as puberty suppression in children and adolescents.
Gender identity
Gender identity is the innermost concept that people have about themselves as male, female or a combination. It is separate from sexual orientation and physical anatomy. People with gender identities that are outside the sex assigned at birth are called transgender.
Children often play in ways that society associates with the opposite sex, such as boys playing with dolls or wearing dresses. Many of these children continue to identify as trans or gender diverse as adults.
Some trans women may choose to consistently present as male or female in alignment with societal norms, while others prefer genderfluid presentation or a hybrid of both. Gender identity is important because it influences how a person is treated by the world around them. For example, using the pronouns a person requests can make them feel supported and valued.
Gender expression
Gender expression is the way a person presents their gender through their name, pronouns, clothes, hairstyle and other behaviors. Gender expression can be seen on a continuum and varies by culture and historical period. It can include, but is not limited to, androgynous, femme, male/man/masculine, or non-binary.
When the sex that is assigned at birth does not match their body, trans or gender diverse people experience higher rates of discrimination, depression, self-harm and suicidal thoughts than the general population. This is called gender dysphoria and needs to be treated.
Some people can have hormone therapy or other medical procedures to make their physical sex reflect their gender identity. These are called transition surgeries. They are widely considered medically necessary and should be covered by private or public insurance.
Sexuality
Trans women can be heterosexual, bisexual, lesbian, gay, asexual, or pansexual. Sexual orientation is how a person feels about being attracted to different genders and can change as people experience different physical changes.
Many trans women choose to undergo genital affirmation surgeries like a vulvoplasty and clitoroplasty, plus the removal of their testes and penis. Some trans women can’t have or don’t want a functioning vagina, and may instead opt for a neovagina made from intestinal tissue.
Some trans women are allosexual, and feel no attraction to either males or females. Others are androsexual, and attracted to masculine expression, presentation, and characteristics. Some are demisexual, and feel sexual attraction after building an emotional bond or connection. Fluid individuals note their sexuality is ever-changing and can shift based on the people they interact with.
Health
A trans woman who is HIV positive may face many health care challenges. These include finding a doctor who provides gender-affirming hormone treatments, which are necessary to prevent ovarian cancer and other complications. Often, these health care issues are exacerbated by lack of access to employment and housing. Transgender women are twice as likely to be unemployed and seven times as likely to experience homelessness compared to their non-transgender counterparts.
The stress of these factors can cause transgender people to seek preventive health care and screenings less often. It is important for all individuals to find a health care provider who is welcoming and understanding, regardless of gender identity or expression. The best provider is one who can provide routine screenings for gynecologic cancer, such as the uterus and cervix, as well as breast cancer.