Transgender: What It Means & How to Find Support

What Does Transgender Mean?

The American Psychiatric Organization uses the following more formal definition: “The term ‘transgender’ refers to a person whose sex assigned at birth (i.e. the sex assigned at birth, usually based on external genitalia) does not align with their gender identity (i.e., one’s psychological sense of their gender).”¹ Those who are not transgender are referred to as cisgender, which means their gender and sex assigned at birth align, or are the same.

In the past, transgender people were referred to as transexual, but since gender and sex define distinct aspects of a person’s identity, the term transexual is inappropriate. While some transgender people have started using the term transexual more frequently, many still view it as outdated, offensive, and misleading.

Never assume the language someone uses to refer to themself. Many people now say sex is assumed at birth instead of sex assigned at birth since there are many variations of biological sex, and, for some, biological sex characteristics can change during puberty. Therefore, sex can only be assumed at birth.

Gender Vs. Sex

Gender and sex are often confused as being the same. Gender refers to the social construct of man and woman. Since there are many social and cultural influences, describing or defining them fully can be difficult. Definitions and meanings can differ depending on where you live, your experiences, or the resources you can access. It can also change over time. For example: before the 1950’s blue was considered a “girl” color, and “pink” was seen as a “boy” color; however, now people in Western cultures assume and expect the opposite.

Sex refers to someone as being male or female based on their biology. For example, hormones, genitals, and other genetic factors or physical characteristics are used to label someone’s sex. How someone dresses or behaves does not define their sex. The easiest way to remember the difference is to remember; sex is biologically defined, whereas gender is socially defined and constructed.

Transgender Vs. Non-Binary

Transgender can be seen as an umbrella term used to describe those whose sex and gender do not align but do feel masculine or feminine in some form. Non-binary can also be seen as an umbrella term to describe those whose sex and gender also do not align, but non-binary people do not necessarily identify as masculine or feminine. Instead, they may feel their gender falls somewhere between or entirely outside these categories. Non-binary people can also be transgender, but it’s important not to assume someone who is transgender is non-binary or that someone who is non-binary is transgender. While they are similar, they are not interchangeable.

Transgender Vs. Sexuality

Just like gender and sex are sometimes mistaken as the same thing, many confuse gender and sexuality. This confusion can be partly due to the LGBTQIA+ acronym, which includes lesbian, gay, bisexual, and transgender people. While the acronym places all these individuals together, it does not mean they are the same. Sexuality describes who a person does or does not feel sexually or physically attracted to, which is not the same as gender. Someone who is gay is not necessarily transgender, but transgender people can be gay, lesbian, or bisexual.

Transgender Vs. Intersex

Transgender and intersex people are also often grouped together. Like sexuality, intersex people can be transgender, but not all transgender people are intersex. Intersex people are born with sexual or reproductive anatomy that falls outside the medical definition of “male” and “female.” Some intersex people aren’t found to be intersex until puberty, and others never discover they are intersex. Remember, transgender refers to someone’s gender identity, not their biological sex characteristics.

Gender Dysphoria & Being Transgender

Many transgender people experience gender dysphoria, which can be described as “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.”¹ How often someone experiences gender dysphoria and their experience will be unique to each person, and how they cope and navigate these feelings will also be unique to them.

Gender dysphoria can increase for some people or makes symptoms of anxiety, depression, and low self-esteem worse. Many transgender people experience suicidal ideation and engage in self-harm behaviors or substance use due to their distress. As a result, transgender people may seek social, medical, and legal transition steps to help ease the dysphoria they experience.

Gender dysphoria differs from gender euphoria, which can be described as “the feeling of significant right-ness or comfort with one’s biological sex, gender identity, or expression.”² Gender euphoria is frequently overlooked in healthcare and research but is an important protective factor for transgender people.

Do You Have to Transition to Be Transgender?

For years it has been assumed if you are transgender, then you must transition. But, many transgender people may not want to transition or may not be able to transition. For example, gender-affirming surgeries can cost between $2,000-$10,000+ and are often hard to have covered by insurance. While many transgender people take steps to transition, some may not for personal reasons.

It’s important to know that someone does not have to transition to be transgender, and transitioning should never be used as a prerequisite or requirement for being transgender.

Since there are many options and steps to transition (e.g., medical, legal, social), this process will be unique to each person, but the goal is to express themselves as their true gender.

Examples of expressing one’s true gender:

• Changing clothing and grooming habits to reflect the appearance of the desired gender
• Changing your name and pronouns
• Changing sex and gender designation on personal identity documents
• Beginning gender-affirming hormone therapy treatments
• Undergoing medical procedures to modify the body to match gender identity
• Cutting hair or growing their hair out
• Changing clothing or style
• Wearing makeup, painting nails, or accessorizing
• Starting a new hobby
• Receiving vocal coaching

Some people may have a gender expression different from their sex assumed at birth and gender, but this does not mean they are automatically transgender. Never assume someone is transgender based on gender expression.

Categories or Types of Transgender People

As mentioned above, transgender and non-binary can be umbrella terms. There are other gender identities people can have, and they may or may not refer to themselves as transgender.

Below are common categories of transgender identities:

• Transgender (Trans): A general term a transgender person may use to describe themselves. Short for transgender.
• Male-to-Female (MTF): This means an individual was assumed to be male at birth but experiences their gender as female.
• Female-to-Male (FTM): This means an individual was assumed to be female at birth but experiences their gender as male.
• Assigned/Assumed Female at Birth (AFAB): Used by some trans people, but also by health professionals in notes.
• Assigned/Assumed Male at Birth (AMAB): Also used by some trans people and by health professionals in notes.
• Transmasc: Individuals who are transgender but experience their gender as primarily masculine
• Transfem: People who are transgender but experience their gender as primarily feminine
• Transwoman: Another way to refer to MTF, AMAB, or Transfem people
• Transman: Another way to refer to FTM, AFAB, or Transmasc people

Non-Binary Identities

Other identities that describe individuals whose sex and gender do not align fall under the non-binary umbrella. While non-binary people may also be transgender, not everyone who is non-binary is also transgender and vice versa.

Below are common categories of non-binary identities:

• Enby: Another term used to refer to non-binary people and said “en-bee,” like the letters NB
• Genderqueer: a term used for people whose gender does not fall within the traditional categories of male or female. Instead, these people may feel their gender is a blend of both or neither.
• Androgynous: Historically referred to people who had both feminine and masculine characteristics. Less commonly used now, but it can refer to people who do not feel their gender is female or male.
• Multi-gendered: A person who experiences more than one gender. This could be male, female, neither, or a feeling of transcending gender altogether.
• Gender nonconforming: people who do not follow or feel their gender fits in the traditional categories of male or female. The term is slowly becoming less used because many think the use of “nonconforming” puts them at risk of being labeled as deviant or abnormal.

Gender Expression Examples Often Confused With Transgender People

The following are often confused and paired with transgender people but are not the same:

• Cross-dressers: People who wear clothing different from the sex assumed at birth. People cross-dress for various reasons and may or may not be part of the LGBTQ+ community.
• Drag queens: A typically male performer who adopts a feminine persona. The persona often exaggerates what people assume are feminine qualities for entertainment purposes.
• Drag kings: A typically female performer who adopts a masculine persona. The persona often exaggerates what people assume are masculine qualities for entertainment purposes.

Is Being Transgender a Mental Health Disorder?

All major medical associations, such as the American Academy of Medicine, The American Psychiatric Association, The American Psychological Association, and The Endocrine Society, agree that being transgender is not a mental health disorder. While transgender people are more likely to experience mental health difficulties such as depression and anxiety, this is not because they are transgender but because of the stigma, prejudice, and stress that comes with being transgender.

Social support and gender-affirming care are two of the most crucial protective factors for transgender people. The American Psychological Association states transgender people “are more likely to experience positive life outcomes when they receive social support or trans-affirmative care.”³

Stigma & Being Transgender

As mentioned above, the stigma, prejudice, and stress of being transgender can lead to increased mental health difficulties and psychological stress. Legal protections that protect transgender people from discrimination vary by state. The Human Rights Campaigns State Equality Index⁴ reported that in 2022 states like Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, etc., still did not have comprehensive protections for transgender people. Transgender people have limited protection in housing, employment, public accommodations, and medical treatments, which makes it harder for transgender people to live and access the care they need.

How to Support a Transgender Person

Transgender people deserve support, but many are unsure how to be supportive or worry they might get it wrong.

The following are ways to support a transgender person:

• Ask people what names and pronouns they use
• Use their name and pronouns ALWAYS
• Educate yourself about transgender issues and people, don’t just rely on the transgender person in your life to educate you
• Don’t make assumptions about people’s sexual orientation or gender
• Advocate for transgender rights and get involved
• Hold other people in your life accountable to be affirming and supportive
• Contact local representatives and vote against anti-trans and anti-lgbt legislation
• Donate or volunteer for trans-affirming organizations

Finding Gender-Affirming Care

Finding Gender-Affirming care can be costly, time-consuming, and difficult. But having it is life-saving. Not only can it help transgender people feel more like who they truly are, but it can also offer support and guidance. Mental healthcare is particularly hard to find, but there are ways to find an LGTBGQ+ therapist, and there are LGTBQ+ online therapy options. Companies like Plume and Folx offer affordable gender-affirming hormone therapy and other medical care for transgender people.

In My Experience

Being supportive and inclusive of transgender individuals is important, and there is support. Know you aren’t alone, and there are people who care. In my experience, many people aren’t given the language they need growing up about transgender and non-binary individuals. Instead, expectations are placed on them, and they may or may not feel like the best fit for them. I spend a lot of time helping people explore their gender, feel affirmed, and feel more confident about who they are. We also sometimes spend time grieving the childhood we feel they could not have due to societal gender norms placed on them. Being transgender can come with many emotions, and talking about them with a professional never hurts.