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Transgender, often shortened as trans, people have a gender identity or gender expression that differs from their sex assignment at birth. Trans men and trans women are people whose gender identity is the opposite of their assigned sex (these terms refer to the person's gender identity). Some transgender people who desire medical assistance to transition from one sex to another identify as ''transsexual''.R Polly, J Nicole, ''Understanding the transsexual patient: culturally sensitive care in emergency nursing practice'', in the ''Advanced Emergency Nursing Journal'' (2011): "The use of terminology by transsexual individuals to self-identify varies. As aforementioned, many transsexual individuals prefer the term transgender, or simply trans, as it is more inclusive and carries fewer stigmas. There are some transsexual individuals however, who reject the term transgender; these individuals view transsexualism as a treatable congenital condition. Following medical and/or surgical transition, they live within the binary as either a man or a woman and may not disclose their transition history." ''Transgender'' is also an umbrella term that may include people who are non-binary or ''genderqueer''. "Yet Jordan and Nick represent a segment of transgender communities that have largely been overlooked in transgender and student development research – individuals who express a non-binary construction of gender Other definitions include people who belong to a third gender, or else conceptualize transgender people ''as'' a third gender. The term may be defined very broadly to include cross-dressers (the older term being ''transvestite''). The opposite term is ''cisgender'', which describes persons whose gender identity matches their assigned sex. Being transgender is distinct from sexual orientation. Transgender people may identify as heterosexual, homosexual, bisexual, asexual, or may decline to label their sexual orientation. The term ''transgender'' is also distinct from ''intersex'', a term that describes people born with physical sex characteristics "that do not fit typical binary notions of male or female bodies". The degree to which individuals feel genuine, authentic, and comfortable within their external appearance and accept their genuine identity has been called ''transgender congruence''. Many transgender people experience gender dysphoria, and some seek medical treatments such as hormone replacement therapy, sex reassignment surgery, or psychotherapy.Maizes, Victoria. ''Integrative Women's Health'' (2015, ), p. 745: "Many transgender people experience gender dysphoriadistress that results from the discordance of biological sex and experienced gender (American Psychiatric Association, 2013). Treatment for gender dysphoria, considered to be highly effective, includes physical, medical, and/or surgical treatments ..some ransgender peoplemay not choose to transition at all." Not all transgender people desire these treatments, and some cannot undergo them for financial or medical reasons. Many transgender people face discrimination in the workplace and in accessing public accommodationsGay and Lesbian Alliance Against Defamation
"Groundbreaking Report Reflects Persistent Discrimination Against Transgender Community"
, ''GLAAD'', February 4, 2011. Retrieved 2011-02-24.
and healthcare. In many places, they are not legally protected from discrimination. The trans rights movement works on these issues and the broader LGBT movement fights for all LGBT people (the T in LGBT stands for "trans").


Terminology





''Transgender''


Psychiatrist John F. Oliven of Columbia University coined the term ''transgender'' in his 1965 reference work ''Sexual Hygiene and Pathology'', writing that the term which had previously been used, ''transsexualism'', "is misleading; actually, 'transgenderism' is meant, because sexuality is not a major factor in primary transvestism." The term ''transgender'' was then popularized with varying definitions by various transgender, transsexual, and transvestite people, including Virginia Prince, who used it in the December 1969 issue of ''Transvestia'', a national magazine for cross dressers she founded. By the mid-1970s both ''trans-gender'' and ''trans people'' were in use as umbrella terms,* In April 1970, ''TV Guide'' published an article which referenced a post-operative transsexual movie character as being "transgendered."() * In the 1974 edition of ''Clinical Sexuality: A Manual for the Physician and the Professions'', ''transgender'' was used as an umbrella term and the Conference Report from the 1974 "National TV.TS Conference" held in Leeds, West Yorkshire, UK used "trans-gender" and "trans.people" as umbrella terms.(), (2006). The Transgender Phenomenon () * However ''A Practical Handbook of Psychiatry'' (1974) references "transgender surgery" noting, "The transvestite rarely seeks transgender surgery, since the core of his perversion is an attempt to realize the fantasy of a phallic woman."() while ''transgenderist'' and ''transgenderal'' were used to refer to people who wanted to live cross-gender without sex reassignment surgery (SRS). By 1976, ''transgenderist'' was abbreviated as ''TG'' in educational materials. By 1984, the concept of a "transgender community" had developed, in which ''transgender'' was used as an umbrella term. In 1985, Richard Elkins established the "Trans-Gender Archive" at the University of Ulster. By 1992, the International Conference on Transgender Law and Employment Policy defined ''transgender'' as an expansive umbrella term including "transsexuals, transgenderists, cross dressers", and anyone transitioning. Leslie Feinberg's pamphlet, "Transgender Liberation: A Movement Whose Time has Come", circulated in 1992, identified ''transgender'' as a term to unify all forms of gender nonconformity; in this way ''transgender'' has become synonymous with ''queer''. In 1994, gender theorist Susan Stryker defined ''transgender'' as encompassing "all identities or practices that cross over, cut across, move between, or otherwise queer socially constructed sex/gender boundaries", including, but not limited to, "transsexuality, heterosexual transvestism, gay drag, butch lesbianism, and such non-European identities as the Native American berdache or the Indian Hijra". Between the mid-1990s and the early 2000s, the primary terms used under the transgender umbrella were "female to male" (FtM) for men who transitioned from female to male, and "male to female" (MtF) for women who transitioned from male to female. These terms have now been superseded by "trans man" and "trans woman", respectively, and the terms "trans-masculine" or "trans-feminine" are increasingly in use. This shift in preference from terms highlighting biological sex ("transsexual", "FtM") to terms highlighting gender identity and expression ("transgender", "trans woman") reflects a broader shift in the understanding of transgender people's sense of self and the increasing recognition of those who decline medical reassignment as part of the transgender community. ''Transgendered'' is a common term in older literature; many within the transgender community now deprecate it on the basis that ''transgender'' is an adjective, not a verb. Organizations such as GLAAD and ''The Guardian'' also state that ''transgender'' should never be used as a noun (e.g., "Max is ''transgender''" or "Max is a ''transgender man''", not "Max is ''a transgender''"). However, ''transgender'' is also used as a noun equivalent to the broader topic of ''transgenderism'', i.e. transgender identity and experience. Health-practitioner manuals, professional journalistic style guides, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender person's past. In contrast, people whose sense of personal identity corresponds to the sex and gender assigned to them at birth – that is, those who are neither transgender nor non-binary or genderqueer – are called ''cisgender''.


''Transsexual''


The term ''transsexual'' was introduced to English in 1949 by David Oliver CauldwellMagnus Hirschfeld coined the German term ''Transsexualismus'' in 1923, which Cauldwell translated into English. and popularized by Harry Benjamin in 1966, around the same time ''transgender'' was coined and began to be popularized. Since the 1990s, ''transsexual'' has generally been used to refer to the subset of transgender people''Transgender Rights'' (2006, ), edited by Paisley Currah, Richard M. Juang, Shannon MinterA. C. Alegria, ''Transgender identity and health care: Implications for psychosocial and physical evaluation'', in the ''Journal of the American Academy of Nurse Practitioners'', volume 23, issue 4 (2011), pages 175–182: "Transgender, Umbrella term for persons who do not conform to gender norms in their identity and/or behavior (Meyerowitz, 2002). Transsexual, Subset of transgenderism; persons who feel discordance between natal sex and identity (Meyerowitz, 2002)." who desire to transition permanently to the gender with which they identify and who seek medical assistance (for example, sex reassignment surgery) with this. Distinctions between the terms ''transgender'' and ''transsexual'' are commonly based on distinctions between ''gender'' (psychological, social) and ''sex'' (physical). Hence transsexuality may be said to deal more with physical aspects of one's sex, while transgender considerations deal more with one's psychological gender disposition or predisposition, as well as the related social expectations that may accompany a given gender role. Many transgender people reject the term ''transsexual''.A Swenson, ''Medical Care of the Transgender Patient'', in ''Family Medicine'' (2014): "While some transsexual people still prefer to use the term to describe themselves, many transgender people prefer the term transgender to transsexual." Christine Jorgensen publicly rejected ''transsexual'' in 1979 and instead identified herself in newsprint as ''trans-gender'', saying, "gender doesn't have to do with bed partners, it has to do with identity." Some have objected to the term ''transsexual'' on the basis that it describes a condition related to gender identity rather than sexuality.The recurring concern that ''transsexual'' implies ''sexuality'' stems from the tendency of many informal speakers to ignore the sex and gender distinction and use ''gender'' for any male/female difference and ''sex'' for sexual activity. () Some transsexual people object to being included in the ''transgender'' umbrella.Valentine, David. ''Imagining Transgender: An Ethnography of a Category'', Duke University, 2007Stryker, Susan. "Introduction". In Stryker and S. Whittle (eds.), ''The Transgender Studies Reader'', New York: Routledge, 2006. pp. 1–17. . In his 2007 book ''Transgender, an Ethnography of a Category'', anthropologist David Valentine asserts that ''transgender'' was coined and used by activists to include many people who do not necessarily identify with the term and states that people who do not identify with the term ''transgender'' should not be included in the transgender spectrum. Leslie Feinberg likewise asserts that ''transgender'' is not a self-identifier (for some people) but a category imposed by observers to understand other people. According to the Transgender Health Program (THP) at Fenway Health in Boston, there are no universally-accepted definitions, and confusion is common because terms that were popular at the turn of the 21st century may now be deemed offensive. The THP recommends that clinicians ask clients what terminology they prefer, and avoid the term ''transsexual'' unless they are sure that a client is comfortable with it. Harry Benjamin invented a classification system for transsexuals and transvestites, called the Sex Orientation Scale (SOS), in which he assigned transsexuals and transvestites to one of six categories based on their reasons for cross-dressing and the relative urgency of their need (if any) for sex reassignment surgery.Benjamin, H. (1966). ''The transsexual phenomenon''. New York: Julian Press, page 23. Contemporary views on gender identity and classification differ markedly from Harry Benjamin's original opinions.Ekins, Richard (2005). Science, politics and clinical intervention: Harry Benjamin, transsexualism and the problem of heteronormativity ''Sexualities'' July 2005 vol. 8 no. 3 306-328 doi: 10.1177/1363460705049578 Sexual orientation is no longer regarded as a criterion for diagnosis, or for distinction between transsexuality, transvestism and other forms of gender-variant behavior and expression. Benjamin's scale was designed for use with trans women, and trans men's identities do not align with its categories.Hansbury, Griffin (2008). The Middle Men: An Introduction to the Transmasculine Identities. ''Studies in Gender and Sexuality'' Volume 6, Issue 3, 2005 doi:10.1080/15240650609349276


Related identities and practices





Non-binary and androgyny


Non-binary (or genderqueer) identities are not specifically male or female. They can be agender, androgynous, bigender, pangender, or genderfluid, and exist outside of cisnormativity. Bigender and androgynous are overlapping categories; bigender individuals may identify as moving between male and female roles (genderfluid) or as being both masculine and feminine simultaneously (androgynous), and androgynes may similarly identify as beyond gender or genderless (postgender, agender), between genders (intergender), moving across genders (genderfluid), or simultaneously exhibiting multiple genders (pangender). ''Androgyne'' is also sometimes used as a medical synonym for an intersex person. Non-binary gender identities are independent of sexual orientation.


Transvestism and cross-dressing


A transvestite is a person who cross-dresses, or dresses in clothes typically associated with the gender opposite the one they were assigned at birth.E. D. Hirsch, Jr., E.D., Kett, J.F., Trefil, J. (2002) "Transvestite: Someone who dresses in the clothes usually worn by the opposite sex." i
Definition of the word "transvestite"
fro
The New Dictionary of Cultural Literacy, Third Edition
. Retrieved 2007-08-13.
various (2006) "trans·ves·tite... (plural trans·ves·tites), noun. Definition: somebody who dresses like opposite sex:" i

from th
Encarta World English Dictionary (North American Edition)
. Retrieved 2007-08-13.
The term ''transvestite'' is used as a synonym for the term ''cross-dresser'',Raj, R (2002) "transvestite (TV): n. Synonym: crossdresser (CD):" i

from the International Journal of Transgenderism 6,2. Retrieved 2007-08-13.
Hall, B. et al. (2007) "...Many say this term (crossdresser) is preferable to transvestite, which means the same thing..." and "...transvestite (TV) – same as cross-dresser. Most feel cross-dresser is the preferred term..." i

from th
Ontario Human Rights Commission
. Retrieved 2007-08-13.
although ''cross-dresser'' is generally considered the preferred term.Green, E., Peterson, E.N. (2006) "...The preferred term is 'cross-dresser', but the term 'transvestite' is still used in a positive sense in England..." i
LGBTTSQI Terminology
fro
Trans-Academics.org
. Retrieved 2007-08-13.
The term ''cross-dresser'' is not exactly defined in the relevant literature. Michael A. Gilbert, professor at the Department of Philosophy, York University, Toronto, offers this definition: " cross-dresseris a person who has an apparent gender identification with one sex, and who has and certainly has been birth-designated as belonging to hatsex, but who wears the clothing of the opposite sex because it is that of the opposite sex." This definition excludes people "who wear opposite sex clothing for other reasons," such as "those female impersonators who look upon dressing as solely connected to their livelihood, actors undertaking roles, individual males and females enjoying a masquerade, and so on. These individuals are cross dressing but are not cross dressers."Gilbert, Michael ‘Miqqi Alicia’ (2000) "The Transgendered Philosopher" i
Special Issue on What is Transgender?
fro
The International Journal of Transgenderism, Special Issue July 2000
. Retrieved 2007-10-09.
Cross-dressers may not identify with, want to be, or adopt the behaviors or practices of the opposite gender and generally do not want to change their bodies medically or surgically. The majority of cross-dressers identify as heterosexual. The term ''transvestite'' and the associated outdated term ''transvestism'' are conceptually different from the term ''transvestic fetishism'', as ''transvestic fetishist'' refers to those who intermittently use clothing of the opposite gender for fetishistic purposes.World Health Organisation (1992) "...Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines...." i
ICD-10, Gender Identity Disorder, category F65.1
published by th
World Health Organisation
. Retrieved 2007-08-13.
APA task force (1994) "...The paraphiliac focus of Transvestic Fetishism involves cross-dressing. Usually the male with Transvestic Fetishism keeps a collection of female clothes that he intermittently uses to cross-dress. While cross dressed, he usually masturbates..." i

published by the American Psychiatric Association. Retrieved 2007-08-13.
In medical terms, ''transvestic fetishism'' is differentiated from cross-dressing by use of the separate codes 302.3 in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and F65.1 in the ICD.


Drag


Drag is clothing and makeup worn on special occasions for performing or entertaining, unlike those who are transgender or who cross-dress for other reasons. Drag performance includes overall presentation and behavior in addition to clothing and makeup. Drag can be theatrical, comedic, or grotesque. Drag queens have been considered caricatures of women by second-wave feminism. Drag artists have a long tradition in LGBT culture. Generally the term ''drag queen'' covers men doing female drag, ''drag king'' covers women doing male drag, and ''faux queen'' covers women doing female drag. Nevertheless, there are drag artists of all genders and sexualities who perform for various reasons. Drag performers are not inherently transgender. Some drag performers, transvestites, and people in the gay community have embraced the pornographically-derived term ''tranny'' for drag queens or people who engage in transvestism or cross-dressing; however, this term is widely considered offensive if applied to transgender people.


LGBT community


The concepts of gender identity and transgender identity differ from that of sexual orientation.Answers to Your Questions About Transgender Individuals and Gender Identity
report from the website of the American Psychological Association - "What is the relationship between transgender and sexual orientation?"
Sexual orientation is an individual's enduring physical, romantic, emotional, or spiritual attraction to another person, while gender identity is one's personal sense of being a man or a woman. Transgender people have more or less the same variety of sexual orientations as cisgender people.Tobin, H.J. (2003) "...It has become more and more clear that trans people come in more or less the same variety of sexual orientations as non-trans people...
Sexual Orientation
from Sexuality in Transsexual and Transgender Individuals.
In the past, the terms ''homosexual'' and ''heterosexual'' were incorrectly used to label transgender individuals' sexual orientation based on their birth sex.Blanchard, R. (1989) The classification and labeling of nonhomosexual gender dysphorias from Archives of Sexual Behavior, Volume 18, Number 4, August 1989. Retrieved vi
SpringerLink
on 2007-04-06.
Professional literature often uses terms such as ''attracted to men'' (androphilic), ''attracted to women'' (gynephilic), ''attracted to both'' (bisexual), or ''attracted to neither'' (asexual) to describe a person's sexual orientation without reference to their gender identity.APA task force (1994) "...For sexually mature individuals, the following specifiers may be noted based on the individual's sexual orientation: Sexually Attracted to Males, Sexually Attracted to Females, Sexually Attracted to Both, and Sexually Attracted to Neither..." i
DSM-IV: Sections 302.6 and 302.85
published by the American Psychiatric Association. Retrieved vi
Mental Health Matters
on 2007-04-06.
Therapists are coming to understand the necessity of using terms with respect to their clients' gender identities and preferences.Goethals, S.C. and Schwiebert, V.L. (2005) "...counselors to rethink their assumptions regarding gender, sexuality and sexual orientation. In addition, they supported counselors' need to adopt a transpositive disposition to counseling and to actively advocate for transgendered persons..." Counseling as a Critique of Gender: On the Ethics of Counseling Transgendered Clients from the International Journal for the Advancement of Counselling, Vol. 27, No. 3, September 2005. Retrieved vi
SpringerLink
on 2007-04-06.
For example, a person who is assigned male at birth, transitions to female, and is attracted to men would be identified as heterosexual. Despite the distinction between sexual orientation and gender, throughout history the gay, lesbian, and bisexual subculture was often the only place where gender-variant people were socially accepted in the gender role they felt they belonged to; especially during the time when legal or medical transitioning was almost impossible. This acceptance has had a complex history. Like the wider world, the gay community in Western societies did not generally distinguish between sex and gender identity until the 1970s, and often perceived gender-variant people more as homosexuals who behaved in a gender-variant way than as gender-variant people in their own right. In addition, the role of the transgender community in the history of LGBT rights is often overlooked, as shown in Transforming History.


Sexual orientation of transgender people


In 2015, the American National Center for Transgender Equality conducted a National Transgender Discrimination Survey. Of the 27,715 transgender and non-binary people who took the survey, 21% said the term ''queer'' best described their sexual orientation, 18% said "pansexual", 16% said ''gay'', ''lesbian'', or ''same-gender-loving'', 15% said ''straight'', 14% said ''bisexual'', and 10% said ''asexual''. And a 2019 survey of trans and non-binary people in Canada called ''Trans PULSE Canada'' showed that out of 2,873 respondents, when it came to sexual orientation, 13% identified as asexual, 28% identified as bisexual, 13% identified as gay, 15% identified as lesbian, 31% identified as pansexual, 8% identified as straight or heterosexual, 4% identified as two-spirit, and 9% identified as unsure or questioning.


Healthcare





Mental healthcare


Most mental health professionals recommend therapy for internal conflicts about gender identity or discomfort in an assigned gender role, especially if one desires to transition. People who experience discord between their gender and the expectations of others or whose gender identity conflicts with their body may benefit by talking through their feelings in depth; however, research on gender identity with regard to psychology, and scientific understanding of the phenomenon and its related issues, is relatively new.Brown, M.L. & Rounsley, C.A. (1996) ''True Selves: Understanding Transsexualism – For Families, Friends, Coworkers, and Helping Professionals'' Jossey-Bass: San Francisco The terms ''transsexualism'', ''dual-role transvestism'', ''gender identity disorder in adolescents or adults,'' and ''gender identity disorder not otherwise specified'' are listed as such in the International Statistical Classification of Diseases (ICD) by the WHO or the American ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM) under codes F64.0, F64.1, 302.85, and 302.6 respectively.Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994) The validity of the diagnosis and its presence in the forthcoming ICD-11 is debated. France removed gender identity disorder as a diagnosis by decree in 2010, but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed. In 2017, the Danish parliament abolished the F64 Gender identity disorders. The ''DSM-5'' refers to the topic as ''gender dysphoria'' (GD) while reinforcing the idea that being transgender is not considered a mental illness. Transgender people may meet the criteria for a diagnosis of gender dysphoria "only if eing transgendercauses distress or disability."Answers to Your Questions About Transgender Individuals and Gender Identity
report from the website of the American Psychological Association - "Is being transgender a mental disorder?"
This distress may manifest as depression or inability to work and form healthy relationships with others. This diagnosis is often misinterpreted as implying that all transgender people suffer from GD, which has confused transgender people and those who seek to either criticize or affirm them. Transgender people who are comfortable with their gender and whose gender is not directly causing inner frustration or impairing their functioning do not suffer from GD. Moreover, GD is not necessarily permanent and is often resolved through therapy or transitioning. Feeling oppressed by the negative attitudes and behaviors of such others as legal entities does not indicate GD. GD does not imply an opinion of immorality; the psychological establishment holds that people with any kind of mental or emotional problem should not receive stigma. The solution for GD is whatever will alleviate suffering and restore functionality; this solution often, but not always, consists of undergoing a gender transition. Clinical training lacks relevant information needed in order to adequately help transgender clients, which results in a large number of practitioners who are not prepared to sufficiently work with this population of individuals. Many mental healthcare providers know little about transgender issues. Those who seek help from these professionals often educate the professional without receiving help. This solution usually is good for transsexual people but is not the solution for other transgender people, particularly non-binary people who lack an exclusively male or female identity. Instead, therapists can support their clients in whatever steps they choose to take to transition or can support their decision not to transition while also addressing their clients' sense of congruence between gender identity and appearance. Acknowledgment of the lack of clinical training has increased; however, research on the specific problems faced by the transgender community in mental health has focused on diagnosis and clinicians' experiences instead of transgender clients' experiences. Therapy was not always sought by transgender people due to mental health needs. Prior to the seventh version of the Standards of Care (SOC), an individual had to be diagnosed with gender identity disorder in order to proceed with hormone treatments or sexual reassignment surgery. The new version decreased the focus on diagnosis and instead emphasized the importance of flexibility in order to meet the diverse health care needs of transsexual, transgender, and all gender-nonconforming people. The reasons for seeking mental health services vary according to the individual. A transgender person seeking treatment does not necessarily mean their gender identity is problematic. The emotional strain of dealing with stigma and experiencing transphobia pushes many transgender people to seek treatment to improve their quality of life, as one trans woman reflected: "Transgendered individuals are going to come to a therapist and most of their issues have nothing to do, specifically, with being transgendered. It has to do because they've had to hide, they've had to lie, and they've felt all of this guilt and shame, unfortunately usually for years!" Many transgender people also seek mental health treatment for depression and anxiety caused by the stigma attached to being transgender, and some transgender people have stressed the importance of acknowledging their gender identity with a therapist in order to discuss other quality-of-life issues. Others regret having undergone the procedure and wish to detransition. Problems still remain surrounding misinformation about transgender issues that hurt transgender people's mental health experiences. One trans man who was enrolled as a student in a psychology graduate program highlighted the main concerns with modern clinical training: "Most people probably are familiar with the term transgender, but maybe that's it. I don’t think I've had any formal training just going through linicalprograms ... I don’t think most herapistsknow. Most therapistsMaster's degree, PhD levelthey've had ... one diversity class on GLBT issues. One class out of the huge diversity training. One class. And it was probably mostly about gay lifestyle." Many health insurance policies do not cover treatment associated with gender transition, and numerous people are under- or uninsured, which raises concerns about the insufficient training most therapists receive prior to working with transgender clients, potentially increasing financial strain on clients without providing the treatment they need. Many clinicians who work with transgender clients only receive mediocre training on gender identity, but introductory training on interacting with transgender people has recently been made available to health care professionals to help remove barriers and increase the level of service for the transgender population. The issues around psychological classifications and associated stigma (whether based in paraphilia or not) of cross-dressers, transsexual men and women (and lesbian and gay children, who may resemble trans children early in life) have become more complex since CAMH (Centre for Addiction and Mental Health) colleagues Kenneth Zucker and Ray Blanchard were announced to be serving on the DSM-V's Sexual and Gender Identity Disorders Work Group. CAMH aims to "cure" transgender people of their "disorder", especially in children. Within the trans community, this intention has mostly produced shock and outrage with attempts to organize other responses. In February 2010, France became the first country in the world to remove transgender identity from the list of mental diseases. A 2014 study carried out by the Williams Institute (a UCLA think tank) found that 41% of transgender people had attempted suicide, with the rate being higher among people who experienced discrimination in access to housing or healthcare, harassment, physical or sexual assault, or rejection by family. A 2019 follow-up study found that transgender people who wanted and received gender-affirming medical care had substantially lower rates of suicidal thoughts and attempts. Autism is more common in people who are gender dysphoric. It is not known whether there is a biological basis. This may be due to the fact that people on the autism spectrum are less concerned with societal disapproval, and feel less fear or inhibition about coming out as trans than others.


Physical healthcare


Medical and surgical procedures exist for transsexual and some transgender people, though most categories of transgender people as described above are not known for seeking the following treatments. Hormone replacement therapy for trans men induces beard growth and masculinizes skin, hair, voice, and fat distribution. Hormone replacement therapy for trans women feminizes fat distribution and breasts. Laser hair removal or electrolysis removes excess hair for trans women. Surgical procedures for trans women feminize the voice, skin, face, Adam's apple, breasts, waist, buttocks, and genitals. Surgical procedures for trans men masculinize the chest and genitals and remove the womb, ovaries, and fallopian tubes. The acronyms "GRS" and "SRS" refer to genital surgery. The term "sex reassignment therapy" (SRT) is used as an umbrella term for physical procedures required for transition. Use of the term "sex change" has been criticized for its emphasis on surgery, and the term "transition" is preferred.Pfäfflin F., Junge A. (1998) "...This critique for the use of the term sex change in connection to sex reassignment surgery stems from the concern about the patient, to take the patient seriously...." i
Sex Reassignment: Thirty Years of International Follow-Up Studies: A Comprehensive Review, 1961–1991
from the Electronic Book Collection of the International Journal of Transgenderism. Retrieved 2007-09-06.
Availability of these procedures depends on degree of gender dysphoria, presence or absence of gender identity disorder,APA task force (1994) "...preoccupation with getting rid of primary and secondary sex characteristics..." i
DSM-IV: Sections 302.6 and 302.85
published by the American Psychiatric Association. Retrieved vi
Mental Health Matters
on 2007-04-06.
and standards of care in the relevant jurisdiction. Trans men who have not had a hysterectomy and who take testosterone are at increased risk for endometrial cancer because androstenedione, which is made from testosterone in the body, can be converted into estrogen, and external estrogen is a risk factor for endometrial cancer.


Law


Legal procedures exist in some jurisdictions which allow individuals to change their legal gender or name to reflect their gender identity. Requirements for these procedures vary from an explicit formal diagnosis of transsexualism, to a diagnosis of gender identity disorder, to a letter from a physician that attests the individual's gender transition or having established a different gender role. In 1994, the DSM IV entry was changed from "Transsexual" to "Gender Identity Disorder". In many places, transgender people are not legally protected from discrimination in the workplace or in public accommodations. A report released in February 2011 found that 90% of transgender people faced discrimination at work and were unemployed at double the rate of the general population, and over half had been harassed or turned away when attempting to access public services. Members of the transgender community also encounter high levels of discrimination in health care.


Europe


36 countries in Europe require a mental health diagnosis for legal gender recognition and 20 countries still require sterilisation. In April 2017, the European Court of Human Rights ruled that requiring sterilisation for legal gender recognition violates human rights.


Denmark


Since 2014 it has been possible for adults without the requirement of a psychiatric evaluation, medical or surgical treatment, divorce or castration, to after a six-month ‘reflection period’ have their social security number changed and legally change gender.


Germany


In November 2017, the Federal Constitutional Court ruled that the civil status law must allow a third gender option. Thus officially recognising "third sex" meaning that birth certificates will not have blank gender entries for intersex people. The ruling came after an intersex person, who is neither a man nor woman according to chromosomal analysis, brought a legal challenge after attempting to change their registered sex to "inter" or ''divers''.


Canada


Jurisdiction over legal classification of sex in Canada is assigned to the provinces and territories. This includes legal change of gender classification. On June 19, 2017 Bill C-16, after having passed the legislative process in the House of Commons of Canada and the Senate of Canada, became law upon receiving Royal Assent which put it into immediate force. The law updated the Canadian Human Rights Act and the Criminal Code to include "gender identity and gender expression" as protected grounds from discrimination, hate publications and advocating genocide. The bill also added "gender identity and expression" to the list of aggravating factors in sentencing, where the accused commits a criminal offence against an individual because of those personal characteristics. Similar transgender laws also exist in all the provinces and territories.


United States


In the United States, transgender people are protected from employment discrimination by Title VII of the Civil Rights Act of 1964. Exceptions apply to certain types of employers, for example, employers with fewer than 15 employees and religious organizations. In 2020, the U.S. Supreme Court affirmed that Title VII prohibits discrimination against transgender people in the case ''R.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission''. Nicole Maines, a trans girl, took a case to Maine's Supreme Court in June 2013. She argued that being denied access to her high school's women's restroom was a violation of Maine's Human Rights Act; one state judge has disagreed with her, but Maines won her lawsuit against the Orono school district in January 2014 before the Maine Supreme Judicial Court. On May 14, 2016, the United States Department of Education and Department of Justice issued guidance directing public schools to allow transgender students to use bathrooms that match their gender identities. On June 30, 2016, the United States Department of Defense removed the ban that prohibited transgender people from openly serving in the US military. On July 27, 2017, President Donald Trump tweeted that transgender Americans will not be allowed to serve "in any capacity" in the United States Armed Forces. Later that day, Joint Chiefs of Staff Chairman Joseph Dunford announced, "there will be no modifications to the current policy until the president’s direction has been received by the Secretary of Defense and the secretary has issued implementation guidance." In California, the School Success and Opportunity Act authored by Assemblyman Tom Ammiano, which became state law on January 1, 2014, says "A pupil shall be permitted to participate in sex-segregated school programs and activities, including athletic teams and competitions, and use facilities consistent with his or her gender identity, irrespective of the gender listed on the pupil's records."


India


In April 2014, the Supreme Court of India declared transgender to be a 'third gender' in Indian law. The transgender community in India (made up of Hijras and others) has a long history in India and in Hindu mythology. Justice KS Radhakrishnan noted in his decision that, "Seldom, our society realizes or cares to realize the trauma, agony and pain which the members of Transgender community undergo, nor appreciates the innate feelings of the members of the Transgender community, especially of those whose mind and body disown their biological sex", adding: Hijras face structural discrimination including not being able to obtain driving licenses, and being prohibited from accessing various social benefits. It is also common for them to be banished from communities.


Religion


The Roman Catholic Church has been involved in the outreach to LGBT community for several years and continues doing so through Franciscan urban outreach centers, for example, the Open Hearts outreach in Hartford, Connecticut. The Vatican, however, holds that transgender people cannot become god-parents and compares transitioning to self-harm.


Feminism


Some feminists and feminist groups are supportive of transgender people, but others are not. Though second-wave feminism argued for the sex and gender distinction, some feminists believed there was a conflict between transgender identity and the feminist cause; e.g., they believed that male-to-female transition abandoned or devalued female identity and that transgender people embraced traditional gender roles and stereotypes. Many transgender feminists, however, view themselves as contributing to feminism by questioning and subverting gender norms. Third-wave and contemporary feminism are generally more supportive of transgender people.


Discrimination





Employment discrimination


Transgender individuals experience employment discrimination at considerably higher rates than gays and lesbians. Forty-seven percent of employees have encountered an including 44% who were , 23% who were denied a promotion, lastly 26% who were terminated on the grounds that they were transgender.


Scientific studies of transsexuality


A study of Swedes estimated a ratio of 1.4:1 trans women to trans men for those requesting sex reassignment surgery and a ratio of 1:1 for those who proceeded.


Population figures


Little is known about the prevalence of transgender people in the general population and reported prevalence estimates are greatly affected by variable definitions of transgender. According to a recent systematic review, an estimated 9.2 out of every 100,000 people have received or requested gender affirmation surgery or transgender hormone therapy; 6.8 out of every 100,000 people have received a transgender-specific diagnoses; and 355 out of every 100,000 people self-identify as transgender. These findings underscore the value of using consistent terminology related to studying the experience of transgender, as studies that explore surgical or hormonal gender affirmation therapy may or may not be connected with others that follow a diagnosis of “transsexualism,” “gender identity disorder,” or “gender dysphoria,” none of which may relate with those that assess self-reported identity. Common terminology across studies does not yet exist, so population numbers may be inconsistent, depending on how they are being counted.

European Union

According to Amnesty International, 1.5 million transgender people live in the European Union, making up 0.3% of the population.

UK

A 2011 survey conducted by the Equality and Human Rights Commission in the UK found that of 10,026 respondents, 1.4% would be classified into a gender minority group. The survey also showed that 1% had gone through any part of a gender reassignment process (including thoughts or actions).

North America



Canada

The ''Trans PULSE'' survey conducted in 2009 and 2010 suggest that as many as 1 in 200 adults may be trans (transgender, transsexual, or transitioned) in the Canadian province of Ontario. The 2017 survey of Canadian LGBT+ people called ''LGBT+ Realities Survey'' found that of the 1,897 respondents 11% identified as transgender (7% binary transgender, 4% non-binary transgender) and 1% identified as non-binary outside of the transgender umbrella. The 2019 survey of the Two-Spirit and LGBTQ+ population in the Canadian city of Hamilton, Ontario, called ''Mapping the Void: Two-Spirit and LGBTQ+ Experiences in Hamilton'' showed that 27.6% of the 906 respondents identified as transgender.

United States

The Social Security Administration, since 1936, has tracked the sex of citizens. Using this information, along with the Census data, Benjamin Cerf Harris tracked the prevalence of citizens changing to names associated with the opposite sex or changing sex marker. Harris found that such changes had occurred as early as 1936. He estimated that 89,667 individuals included in the 2010 Census had changed to an opposite-gendered name, 21,833 of whom had also changed sex marker. Prevalence in the States varied, from 1.4 to 10.6 per 100,000. While most people legally changed both name and sex, about a quarter of people changed name, and then five years later changed sex. An earlier estimate in 1968, by Ira B. Pauly, estimated that about 2,500 transsexual people were living in the United States, with four times as many trans women as trans men. One effort to quantify the population in 2011 gave a "rough estimate" that 0.3% of adults in the US are transgender. More recent studies released in 2016 estimate the proportion of Americans who identify as transgender at 0.5 to 0.6%. This would put the total number of transgender Americans at approximately 1.4 million adults (). A survey by the Pew Research Center in 2017 found that American society is divided on "whether it's possible for someone to be a gender different from the sex they were assigned at birth." It states, "Overall, roughly half of Americans (54%) say that whether someone is a man or a woman is determined by the sex they were assigned at birth, while 44% say someone can be a man or a woman even if that is different from the sex they were assigned at birth."


Latin America


In Latin American cultures, a travesti is a person who has been assigned male at birth and who has a feminine, transfeminine, or "femme" gender identity. Travestis generally undergo hormonal treatment, use female gender expression including new names and pronouns from the masculine ones they were given when assigned a sex, and might use breast implants, but they are not offered or do not desire sex-reassignment surgery. Travesti might be regarded as a gender in itself (a "third gender"), a mix between man and woman ("intergender/androgynes"), or the presence of both masculine and feminine identities in a single person ("bigender"). They are framed as something entirely separate from transgender women, who possess the same gender identity of people assigned female at birth. Other transgender identities are becoming more widely known, as a result of contact with other cultures of the Western world.A nova geração gay nas Universidades dos EUA
These newer identities, sometimes known under the umbrella use of the term "genderqueer", along with the older ''travesti'' term, are known as non-binary and go along with binary transgender identities (those traditionally diagnosed under the now obsolete label of "transsexualism") under the single umbrella of ''transgender'', but are distinguished from cross-dressers and drag queens and kings, that are held as nonconforming gender expressions rather than transgender gender identities when a distinction is made. Deviating from the societal standards for sexual behavior, sexual orientation/identity, gender identity, and gender expression have a single umbrella term that is known as ''sexodiverso'' or ''sexodiversa'' in both Spanish and Portuguese, with its most approximate translation to English being "queer".


Non-western cultures





Asia


In Thailand and Laos,Doussantousse, S. (2005) "...The Lao Kathoey's characteristics appear to be similar to other transgenders in the region..." i
Male Sexual Health: Kathoeys in the Lao PDR, South East Asia – Exploring a gender minority
from th
Transgender ASIA Research Centre
. Retrieved 2007-07-22.
the term kathoey is used to refer to male-to-female transgender peopleJackson, P. (2003
Performative Genders, Perverse Desires: A Bio-History of Thailand's Same-Sex and Transgender Cultures
in Intersections: Gender, History and Culture in the Asian Context, Issue 9, August 2003.
and effeminate gay men.Winter, S. and Udomsak, N. (2002
Male, Female and Transgender: Stereotypes and Self in Thailand
in the International Journal of Transgender, Volume 6, Number 1, January – March 2002.
Transgender people have also been documented in Iran,Harrison, F. (2005) "...He shows me the book in Arabic in which, 41 years ago, Ayatollah Khomeini wrote about new medical issues like transsexuality. "I believe he was the first Islamic scientist in the world of Islam who raised the issue of sex change," says Hojatulislam Kariminia. The Ayatollah's ruling that sex-change operations were allowed has been reconfirmed by Iran's current spiritual leader..." i
Iran's sex-change operations
, from th
BBC
. Retrieved 2007-07-22.
Japan, "...the male to female cross-dressing (MTFCD) community in Shinjuku, Tokyo, which plays an important role in the overall transgender world and how people in the community think and live..." Nepal,Haviland, C. (2005) "...The Gurung people of western Nepal have a tradition of men called maarunis, who dance in female clothes..." i
Crossing sexual boundaries in Nepal
, from th
BBC
. Retrieved 2007-07-22.
Indonesia,Graham, S. (2002) "...Among the Bugis of South Sulawesi, possibly four genders are acknowledged plus a fifth para-gender identity. In addition to male-men (oroane) and female-women (makunrai)..., there are calalai (masculine females), calabai (feminine males), and bissu..." i
Priests and gender in South Sulawesi, Indonesia
from th
Transgender ASIA Research Centre
. Retrieved 2007-07-22.
Vietnam,Walters, I. (2006) "...In Vietnam, male to female (MtF) transgender people are categorised as lai cai, bong cai, bong lai cai, dong co, or be-de..." i
Vietnam Some notes by Ian Walters
from th
Transgender ASIA Research Centre
. Retrieved 2007-07-22.
South Korea,Shim, S. (2006) "...Rush, catering especially to crossdressers and transgenders, is a cafe owned by a 46-year-old man who goes by the female name Lee Cho-rong. "...Many people in South Korea don't really understand the difference between gay and transgender. I'm not gay. I was born a man but eager to live as a woman and be beautiful," said Lee..." i

from th

. Retrieved 2007-07-22.
Jordan, Singapore,Heng, R. (2005) "...Even if we take Bugis Street as a starting point, we should remember that cross-dressing did not emerge suddenly out of nowhere. Across Asia, there is a tradition of cross-dressing and other forms of transgender behaviour in many places with a rich local lexicon and rituals associated with them...." i
Where queens ruled! - a history of gay venues in Singapore
from IndigNation. Retrieved 2007-07-22.
and the greater Chinese region, including Hong Kong, "...Hong Kong's transgender movement at its current stage, with particular reference to the objectives and activities of the Hong Kong Transgender Equality and Acceptance Movement..."Hung, L. (2007) "...there are many archetypal flamboyant embodiments of female-to-male transgender physicality living and displaying their unrestrained, dashing iconic presence..." i
Trans-Boy Fashion, or How to Tailor-Make a King
from th
Gender Studies programme of The Chinese University of Hong Kong
. Retrieved 2007-07-22.
Taiwan, "...specificities of Taiwanese transgender existence in relation to body- and subject-formations, in hope to not only shed light on the actualities of trans efforts toward self-fashioning, but also illuminate the increasing entanglement between trans self-construction and the evolving gender culture that saturates it..." and the People's Republic of China.Hahn, L. (2005) "...Aware that he often felt more like a woman than a man, Jin Xing underwent a sex change in 1995; a daring move in a conservative Chinese society..." i
Jin Xing TalkAsia Interview Transcript – June 13, 2005
fro
CNN
. Retrieved 2007-07-22.
Wang, Z. and Xie, F. (2006) "...While it is true that not everyone turns into a drag queen when they are feeling stressed out, many young people do seem to be caught up in the fad of androgyny..." i

fro
China Daily
. Retrieved 2007-07-22.
Goldkorn, J. (2006) "...At one point in 2003, there was so much media coverage of transsexuals in China that Danwei started a special section for it..." i
Transsexuals in the Chinese media again
fro
Danwei
. Retrieved 2007-07-22.
The cultures of the Indian subcontinent include a third gender, referred to as hijra in Hindi. In India, the Supreme Court on April 15, 2014, recognized a third gender that is neither male nor female, stating "Recognition of transgenders as a third gender is not a social or medical issue but a human rights issue." In 1998, Shabnam Mausi became the first transgender person to be elected in India, in the central Indian state of Madhya Pradesh.


North America


In what is now the United States and Canada, some Native American and First Nations cultures traditionally recognize the existence of more than two genders, such as the Zuni male-bodied ''lhamana'', the Lakota male-bodied ''winkte'',Medicine, B. (2002
Directions in Gender Research in American Indian Societies: Two Spirits and Other Categories
, taken from Online Readings in Psychology and Culture Center for Cross-Cultural Research, Unit 3, Chapter 2, Western Washington University.
and the Mohave male-bodied ''alyhaa'' and female-bodied ''hwamee''. These traditional people, along with those from other North American Indigenous cultures, are sometimes part of the contemporary, pan-Indian Two-Spirit community. Historically, in most cultures who have alternate gender roles, if the spouse of a third gender person is not otherwise gender variant, they have not generally been regarded as other-gendered themselves, simply for being in a same-sex relationship. In Mexico, the Zapotec culture includes a third gender in the form of the Muxe.


Other


Among the ancient Middle Eastern Akkadian people, a ''salzikrum'' was a person who appeared biologically female but had distinct male traits. ''Salzikrum'' is a compound word meaning ''male daughter.'' According to the Code of Hammurabi, ''salzikrūm'' had inheritance rights like that of priestesses; they inherited from their fathers, unlike regular daughters. A ''salzikrum's'' father could also stipulate that she inherit a certain amount. In Ancient Rome, the Gallae were castrated followers of the Phrygian goddess Cybele and can be regarded as transgender in today's terms.Endres, N
Galli: Ancient Roman Priests
from the GLBTQ: an encyclopedia of gay, lesbian, bisexual, transgender and queer culture.
Brown, K

In early Medina, gender-variantPartial Translation of the Sunan Abu-Dawud, Book 41, Number 4910
USC-MSA Compendium of Muslim Texts, University of Southern California, translated by Prof. Ahmad Hasan.
male-to-female Islamic people were acknowledged in the form of the Mukhannathun. Mahu is a traditional third gender in Hawai'i and Tahiti. Mahu are valued as teachers, caretakers of culture, and healers, such as Kapaemahu. Also, in Fa'asamoa traditions, the Samoan culture allows a specific role for male to female transgender individuals as Fa'afafine.


Coming out


Transgender people vary greatly in choosing when, whether, and how to disclose their transgender status to family, close friends, and others. The prevalence of discrimination and violence (transgender people are 28% more likely to be victims of violence) against transgender persons can make coming out a risky decision. Fear of retaliatory behavior, such as being removed from the parental home while underage, is a cause for transgender people to not come out to their families until they have reached adulthood. Parental confusion and lack of acceptance of a transgender child may result in parents treating a newly revealed gender identity as a "phase" or making efforts to change their children back to "normal" by utilizing mental health services to alter the child's gender identity. The internet can play a significant role in the coming out process for transgender people. Some come out in an online identity first, providing an opportunity to go through experiences virtually and safely before risking social sanctions in the real world.


Media representation


As more transgender people are represented and included within the realm of mass culture, the stigma that is associated with being transgender can influence the decisions, ideas, and thoughts based upon it. Media representation, culture industry, and social marginalization all hint at popular culture standards and the applicability and significance to mass culture as well. These terms play an important role in the formation of notions for those who have little recognition or knowledge of transgender people. Media depictions represent only a minuscule spectrum of the transgender group, which essentially conveys that those that are shown are the only interpretations and ideas society has of them. However, in 2014, the United States reached a "transgender tipping point", according to ''Time''. At this time, the media visibility of transgender people reached a level higher than seen before. Since then, the number of transgender portrayals across TV platforms has stayed elevated. Research has found that viewing multiple transgender TV characters and stories improves viewers' attitudes toward transgender people and related policies.


Events





International Transgender Day of Visibility


International Transgender Day of Visibility is an annual holiday occurring on March 31 dedicated to celebrating transgender people and raising awareness of discrimination faced by transgender people worldwide. The holiday was founded by Michigan-based transgender activist Rachel Crandall in 2009.


Transgender Awareness Week


Transgender Awareness Week is a one-week celebration leading up to Transgender Day of Remembrance. The purpose of Transgender Awareness Week is to educate about transgender and gender non-conforming people and the issues associated with their transition or identity.


Transgender Day of Remembrance


Transgender Day of Remembrance (TDOR) is held every year on November 20 in honor of Rita Hester, who was killed on November 28, 1998, in an anti-transgender hate crime. TDOR serves a number of purposes: * it memorializes all of those who have been victims of hate crimes and prejudice, * it raises awareness about hate crimes towards the transgender community, * and it honors the dead and their relatives


Trans March


Annual marches, protests or gatherings take place around the world for transgender issues, often taking place during the time of local Pride parades for LGBT people. These events are frequently organised by trans communities to build community, address human rights struggles, and create visibility.


Pride symbols


A common symbol for the transgender community is the Transgender Pride Flag, which was designed by the American transgender woman Monica Helms in 1999, and was first shown at a pride parade in Phoenix, Arizona in 2000. The flag consists of five horizontal stripes: light blue, pink, white, pink, and light blue. Helms describes the meaning of the flag as follows: Other transgender symbols include the butterfly (symbolizing transformation or metamorphosis), and a pink/light blue yin and yang symbol. Several gender symbols have been used to represent transgender people, including and .


See also


* List of transgender and transsexual fictional characters * List of transgender people * List of transgender publications * List of transgender-related topics * List of transgender-rights organizations * List of unlawfully killed transgender people * Transgender history * Transgender pornography


Notes





References





Further reading


* * *


External links


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