Transgender refers to people whose gender identity does not match the sex assigned at birth. People who feel this way can experience many kinds of distress.
Participants often cited their chosen families (and less frequently, their families), their therapists or other health care providers, and LGBTQ+ spaces as places where they felt supported and accepted.
Gender Identity
Gender identity refers to a person’s internal sense of being male or female or somewhere on the gender spectrum. It can match a person’s assigned sex at birth or differ from it.
Some people who identify as transgender use words such as nonbinary, gender fluid and intersex to describe themselves. These words reflect a desire to avoid the binary categories of male and female.
Gender identity does not relate to sexual orientation, which is a person’s innate preference for being attracted to people of the same or opposite sex (e.g., heterosexual, homosexual, bisexual). It also does not relate to a person’s physical appearance or genital characteristics. Changing these characteristics through surgery is called gender transition. Often, transgender individuals change their name as part of the process.
Gender Transition
Many transgender people seek to change their bodies to more closely reflect the gender they identify as. They may use hormone therapy or surgery to help make this happen. People who do this are known as transsexual people, and they sometimes prefer to be referred to as men or women.
Some people choose to change their legal name to match their new gender, but this is not possible for everyone. Not having identity documents that accurately match their gender can limit employment and travel opportunities.
Large majorities of Democrats and Democratic-leaning adults say it is important to refer to a person using their preferred pronouns, regardless of the sex assigned at birth or their transition status. Smaller majorities of Republicans and Republican-leaning adults say this is not important.
Gender Expression
People’s gender expression is how they communicate their gender to others. This can include behavior and clothing, names and pronouns. Gender presentation also includes cultural expectations that people display, such as masculine or feminine roles.
Many transgender people experience distress because their gender identity doesn’t match the biological sex they were assigned at birth. This is called gender dysphoria.
Some people recognize their gender identity as a boy or girl as early as childhood. Others become aware of their non-binary or non-conforming gender later in life. Some people who don’t fit into society’s binary sex system may undergo a medical transition to align their external appearance with their gender identity. This can include hormone therapy, sex reassignment surgery or other procedures. Others might choose to socially transition or change their name and pronouns.
Health Issues
Transgender people face many health risks, from discrimination in medical care to poverty and lack of insurance. Nondiscrimination protections can help, but addressing social determinants of health is critical to improving health outcomes.
Stress and anxiety can lead to poor physical health. The risk of depression and suicide is higher for transgender individuals than other populations.
A fear of physical examinations can cause transgender people to avoid or delay needed health care. This can include gynecological and genital exams. Vaccinations to protect against hepatitis A and B are available and recommended.
Keeping gender identity secret from friends and family can cause mental health issues such as isolation. Having a trusted mental health provider who specializes in transgender issues can help. Some gender-expansive people may want to preserve their reproductive potential, and should discuss their options with a doctor.
Legal Issues
Transgender people often face discrimination, including when they are in the workplace. This includes sex-based harassment, which can include teasing, unwanted touching or comments about a person’s body or appearance. In addition, discrimination in housing can lead to homelessness and loss of access to health care.
Laws barring discrimination in the workplace protect transgender employees from being fired, denied employment or not promoted on the basis of their gender identity or expression. The laws also require employers to use the name, pronouns and title a person uses to self-identify at work.
Eight-in-ten Americans say that most people in the United States are at least somewhat accepting of transgender people. However, differences in perceptions are linked to partisanship and opinions about whether a person’s gender can differ from the sex assigned at birth.