A person who identifies as a gender different from the one assigned at birth and seeks medical intervention, such as hormone therapy and surgery, to align their body with that identity. Some people who seek this intervention have a name change and/or legal changes on identity documents.
Transsexual can also refer to a person who is transitioning or has transitioned to the opposite gender – male-to-female (FtM) or female-to-male (MtF). See this article for more information.
Physical Changes
Transgender people often change their bodies to more closely match their gender identity. They may start taking estrogen hormone therapy to increase feminine body characteristics and suppress male sex traits such as facial hair, voice and muscle mass.
As they begin to take estrogen hormones, transgender women’s strength and LBM decline relative to cisgender women but still remain above their male counterparts for longer durations of hormone treatment (up to 36 months). Their athletic performance remains better than cisgender men.
While the physical changes can be dramatic, many transitioning transgender people prefer a more subtle or non-conformist approach to their gender expression. This is called “gender nonconforming” or genderfluid and can include everything from wearing makeup to getting manicures. It is important to respect a person’s preference when they make it known.
Gender Identity
Gender identity refers to the person’s internal sense of gender that may differ from their assigned sex at birth. People who transition to the sex they identify with often seek medical help, including hormone therapy and surgery, to align their physical body with their gender identity.
Some transsexual people may also be androgynous or bigender, meaning they have some culturally feminine and masculine characteristics and behaviors. Others prefer to use pronouns that are neither masculine nor feminine, such as he or she or zie or hir, and may ask for their legal name and gender to be changed on official documents.
Try to avoid using terms that can hurt or offend, such as transsexual or transgender, unless the person indicates that it is a term they prefer. Instead, use cisgender or transgender when appropriate, but always ask the person which terms they prefer.
Hormones
Generally speaking, hormone therapy is safe for trans women. Those with co-occurring conditions such as diabetes or thyroid disease are likely to experience a slower response and higher levels of side effects. Blood tests for estradiol, the primary estrogen in your body and testosterone will be performed periodically to make sure that you have hormone levels within a healthy range.
Feminizing hormone therapy can cause breast development, softening of the skin and redistribution of fat towards a gynoid distribution. It can also reduce muscle mass and strength.
Some people may choose to add progestogens to feminizing hormone regimens. There are no well-designed studies on the use of progestogens in the setting of gender affirming hormone treatment, but many patients and providers anecdotally report improved breast or areolar development as a result of their use.
Surgery
Transgender people often have a lot of surgery during their transition. These surgeries can help to make them feel more like their gender. The surgery also helps to resolve any issues that the person might have with their body. It is important to research the surgeons and find one that has a track record of success.
Many transgender people will eventually need top surgery. Some insurance plans will cover this surgery, but others will not. It is important to research the surgeons before you decide on the type of surgery you want to have.
The number of people who have had sex reassignment surgery (SRS) has been increasing, but the procedure is not available to everyone. In 2019, the waiting list for genital surgery at the only hospital in South Africa that offers it was 26 years long.
Social Acceptance
The ability to interact socially in gender-conforming ways is crucial for many transgender people. This is evident in studies that report social stigma as a major point of concern for both TGNC people and their relational partners.
Some of the most common social changes that occur during a transsexual relationship are coming out to family and friends; changing name and sex on legal documents; hormone therapy; and, if necessary, surgery. All of these can contribute to a person’s perceived sense of self.
Research also shows that TGNC individuals have the opportunity to build and cultivate relationships through both proximal and online connections. However, participants often describe parental concerns for their children’s transgender identities which may contribute to a heightened level of caution when it comes to romantic experiences.