What is Gender Transitioning?

WARNING: this post contains in-depth language and information about suicide and self-harm. If you are in acute crisis looking for help, please call the National Suicide Prevention Lifeline at 988 or dial 911.

Gender transitioning is the process of aligning the way you live your life with the gender you feel on the inside, rather than the gender you were assigned at birth. Nearly two percent of U.S. teens identify as transgender and transitioning allows them the opportunity to change the way that they feel about themselves, as well as the way that others view them. 

Transitioning isn’t always easy, but it can be an empowering and transformative (literally) process for transgender and nonbinary youth. As a reminder, transgender is a term for people whose gender identity and/or gender expression is different from what is typically associated with the sex they were assigned at birth, and nonbinary means that a person doesn’t identify as male or female. 

Choosing the path that’s right for your gender transition is a very personal decision. There are different ways to transition—or affirm your gender identity, including: 

Social affirmations

Social affirmations are reversible changes such as modifying your clothing or hairstyle or declaring your preferred pronouns. This strategy is often used by children and younger teens who are easing into their chosen gender. 

Medical transitioning

Medication transitioning is the alteration of a person’s physical and sexual characteristics to help make their body better reflect the gender they identify with. 

Legal modifications 

Transitioning can also involve legal items such as changing your name or updating the gender marker on identity documents like a driver’s license or passport. 

Here, we’ll discuss the benefits and barriers to gender transition and accessing gender-affirming care, as well as advice for transgender and nonbinary youth on how to find a LGBTQIA+ friendly healthcare provider. 

Types of gender-affirming care

Gender-affirming care includes a variety of social, behavioral, and medical interventions that are designed to support the process of transitioning genders.

As described by Dr. Ley Cray, Charlie Health’s Director of LGBTQIA+ Programming, “at the core of gender-affirming care is:

(i) accepting LGBTQIA+ identities as valid and hence, not as “conditions” to be “cured;” 

(ii) recognizing that social factors often play a significant role in causing or exacerbating clinical levels of stress among LGBTQIA+ persons; and 

(iii) following evidence-based best practices, as recommended by all major medical and mental health organizations.”

Below are several forms of gender-affirming care that are designed to support an individual’s gender identity.

• Social affirmations
• Puberty blockers
• Surgical interventions
• Hormone therapy
• Gender-affirming therapy

Benefits of gender transition

Leading medical organizations—including the American Academy of Child and Adolescent Psychiatry, the Endocrine Society, the American Medical Association, and the American Psychiatric Association to name a few—have issued statements supporting gender transition for youth. As described by the American Academy of Child and Adolescent Psychiatry, there are “natural variations in gender identity and expression” and clinical guidance “promotes nondiscriminatory, supportive interventions for gender diverse youth based on the current evidence base.”

As expected, this support is based on sound science. Research from 16 studies totaling more than 30,000 transgender and gender-diverse youth consistently showed that access to gender-affirming care was associated with improved mental health outcomes. That same research suggested that a lack of access is directly linked to higher rates of suicide, depression, and self-harming behavior, according to a review published by Psychology Today.

Gender transition can also help teens cope with something called gender dysphoria—the cognitive dissonance that occurs when someone doesn’t identify with the gender they were assigned at birth. Similarly, changing genders can help youth avoid body dysmorphia, a condition in which a person is fixated on one or more perceived defects or flaws in their appearance.

Barriers to accessing gender-affirming care

Google the phrase “gender transition” and it’s easy enough to find resources outlining the various steps to changing genders. However, many transgender and nonbinary youth will find that making their dream a reality is easier said than done. 

Despite the fact that all Americans (regardless of race, religion, sexual orientation, and gender identity) are entitled to basic rights like access to health care and the ability to use public facilities, there’s still work to be done to achieve equality.

As stated by the American Psychiatric Association in 2012:

“Being transgender or gender variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression.… [Such] discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals.”

Some of the most common barriers to accessing gender-affirming care are finances, bias from medical professionals, shortage of available services, and other fears or worries, according to one recent study.

Provider bias

Research looking at gender-affirming care for transgender youth has shone a spotlight on systemic issues and incidents of bias within the medical and behavioral health fields. Although medical organizations largely support the practice, a lack of awareness and education among medical providers can be a real barrier in connecting some youth with care. 

Among other feedback, transgender and nonbinary youth have reported experiencing misgendering, invasive scrutiny into their personal lives, dismissive behavior toward their requests, or simply a refusal to be treated. 

For your knowledge, the following examples of discriminatory treatment from health care providers are all prohibited by federal law:

• Refusing to admit or treat you because you are transgender
• Refusing to treat you according to your gender identity
• Refusing to respect your gender identity in making room assignments
• Forcing you to have intrusive and unnecessary examinations because you are transgender
• Refusing to provide you services that are available to other patients because you are transgender
• Requiring you to participate in “conversion therapy” to change your gender identity

Legal barriers

The federal government has instituted several federal policies to increase access to health care for LGBTQ+ people and to ban discrimination based on gender identity and sexual orientation.

That said, the nation is facing a record number of state-level anti-transgender bills that could have negative implications for the health and wellbeing of transgender and nonbinary youth. 

Insurance issues 

Cost can be another prohibitive factor to pursuing care. It’s no secret that healthcare in the U.S. is expensive and gender-affirming hormones, surgery, and other associated procedures can be extremely expensive if paid out-of-pocket.

And although transgender individuals are protected under federal and state laws from both public and private insurance discrimination, there are still occasional problems such limited provider coverage or exclusions for specific health plans. Luckily, there are resources—such as this one from the National Center for Transgender Equality—to help transgender individuals find coverage for transition-related services.

So, should I transition?

No one can answer this question but you. Transitioning is a very personal process and there’s no right or wrong way to navigate the process. If it’s something that’s on your mind, below are a few questions to help further your consideration. 

• Am I transgender, non-binary, or gender diverse? 
• What exactly is my gender identity?
• Will transitioning help me to lead a healthy, fulfilling life?
• Will I be supported by family and friends? And if not, does that impact my decision? 
• Am I interested in a medical procedure, or something more temporary for my transition?

It can also help to speak with a healthcare professional to review your options. Deciding to transition doesn’t happen overnight and working with a mental health professional can provide some clarity. LGBTQIA+ therapy, in particular, focuses on gender identity and mental well-being, while providing a safe environment to build healthy coping skills.

The Gay and Lesbian Medical Association (GLMA) offers a provider directory that’s a useful resource for searching primary care providers, specialists, and dentists in your area. Planned Parenthood also offers a variety of services, including transgender hormone therapy. And though it may seem obvious, an easy place to start is by simply Googling “clinic near me + LGBTQIA.”

Prioritize your mental health with Charlie Health

Charlie Health is committed to serving LGBTQIA+ teens and young adults in a safe, compassionate, and empowering environment. Our virtual programs are designed to meet individual needs through assigning patients to therapists who understand their unique challenges, and connect teens with LGBTQIA+ specific group therapy to build community.

Interested in learning more? Connect with Charlie Health today.