What It Means to Be Transgender

When a child is born, a doctor says, "It's a boy" or "It's a girl."

Assigning someone's sex is based on biology -- chromosomes, anatomy, and hormones. But a person's gender identity -- the inner sense of being male, female, or both -- doesn't always match their biology. Transgender people say they were assigned a sex that isn't true to who they are.

Many people have assumptions about what it means to be transgender, but it isn't about surgery, or sexual orientation, or even how someone dresses. It's how they feel inside.

The Williams Institute says there are nearly 700,000 people living publicly as transgender in the U.S. Each one is unique, and their journeys are personal. Some say they are the opposite sex of what they were assigned at birth. Some feel they are both male and female. Still others don't identify as either gender.

"It takes a lot of courage to buck the culture's norm that gender is binary," says Helen R. Friedman, PhD, a clinical psychologist in St. Louis who specializes in gender identity and transgender issues. "The truth is, gender does exist on a continuum." Meaning, there's a lot of in-between.

People Transition to Be True to Themselves

When people make changes to match the way they feel inside, it's called transitioning.

Some change their clothing, hair, and name. Some ask others to change the pronouns they use to identify them. (They may choose "he," "she," "they," or even "ze.") Some use hormones or surgery to alter how they look and feel.

"It varies a lot from person to person, and there's no set pattern," says Michael L. Hendricks, PhD, a clinical psychologist in Washington, DC, who works with transitioning clients.

Mitch Kellaway, from Massachusetts, spent 6 years thinking about transitioning to male. His approach wasn't typical. Once he made the decision, he made several changes at the same time.

"When I was emotionally, spiritually, and financially ready to begin transitioning, I decided to start medical, social, and legal [changes] all at once," Kellaway says.

In the same week, he told his loved ones his decision, changed his name legally and publicly, and began talking with a gender therapist about hormone therapy.


Transgender People Can Be Straight, Gay, or Bisexual

Don't assume a trans person is gay. It has nothing to do with the kind of people they have romantic feelings toward.

"Gender identity is the gender with which you identify," Friedman says. "Sexual orientation is the gender to which you're attracted."

Deciding to Let Others Know Is Stressful

When transgender people tell others about their gender identities, it's referred to as "coming out." It's an unveiling of truth, like telling someone your sexual orientation.

It's a big step. There's no way for a person to know how others will react.

Some people are supportive right away. Others may need time to process the news before they can understand how they feel about it. And some may never be accepting. It can come as a shock, and it's a lot to take in, just as there's a lot that goes into deciding to transition.

If someone you care about comes out to you, they are looking to you for support. "Reassure them that you will be friends regardless of their gender, and you want them to be happy," Friedman says. It's important for someone who comes out to have support.

Years ago, there wasn't much of a community for transgender people, and many felt isolated.

Today, "It's more [mentioned in] the media, more on the Internet," Hendricks says. "It's safer to come out. There's a community."

Because of this, more people are choosing to transition at younger ages. Teens and adults who need advice can seek support and guidance from others who have already gone through the coming-out process. Transition for young people is different from adults. Sometimes, doctors use hormones to delay puberty until a child is old enough make decisions about their gender.

People of All Ages Are Transgender

Although some people think they may be transgender in childhood, some don't realize it until they're teens or adults. It's not unusual for someone to come out as transgender after they've had kids or retired. They may feel they couldn't express themselves before, or didn't realize they were trans until later in life.


Not every child who questions his or her gender will become a trans adult. "Gender is a bit more fluid in childhood, and puberty clarifies a lot of things," Hendricks says. Respect a child's thoughts and provide love and support. Don't insist that they "act like a boy" or "act like a girl."

"Parents should let the child lead, not trying to force them back into the gender stereotype assigned at birth, but not pushing them toward other things," Hendricks says.

Transgenderism Isn't a Mental Illness

Many trans people seek counseling, but being transgender isn't a mental illness. Many trans people are depressed or anxious or become socially isolated, but often it's the fear that loved ones will reject them (or have already done so) that bring those feelings.

"People struggle with anxiety or depression when they feel they can't be who they are," Friedman says.

For some, it can lead to clinical depression, alcohol and drug abuse, or other mental health problems that need treatment.

For many, the decision to come out brings relief and pride.

Charles (Chloe) Anderson, as she asked to be called, is a transgender woman in Florida. She felt bad about herself for years and was afraid nobody would understand her. Then she got counseling and came out. Her family didn't support her, but her life got better. She started hormone therapy last year and plans to legally change her name.

"It has given me a sense of triumph," Anderson says. "Knowing that at the core level I have started accepting who I really am is allowing me to start rebuilding my life."

The happiness and relief some people feel once they are living in their true gender "allows them to go forward in other aspects of their lives," Friedman says.

How to Offer Support

Here are some tips to help you understand and communicate respectfully with someone who is transgender:

  • You can't tell someone is trans by looking.
  • Don't assume anything about their sexual orientation.
  • If you don't know what pronoun to use, ask them. (And if you make a mistake, just apologize.)
  • Don't ask what their "real name" or "birth name" is.
  • Avoid backhanded compliments like "You look just like a real woman."
  • Don't ask whether they plan to take hormones or have surgery.

You can find more tips on GLAAD's web site.

WebMD Feature Reviewed by Neha Pathak, MD on July 27, 2017



Helen R. Friedman, PhD, clinical psychologist, St. Louis.

Michael L. Hendricks, PhD, ABPP, clinical psychologist, Washington Psychological Center, Washington, DC; past president, Society for the Psychological Study of LGBT Issues; fellow, American Psychological Association; member, APA Task Force charged with developing Guidelines for Psychological Practice with Transgender and Gender Nonconforming Clients; member and previous treasurer, American Association of Suicidology; member, World Professional Association for Transgender Health.

The Williams Institute, UCLA School of Law: "How many people are lesbian, gay, bisexual and transgender?"

Mitch Kellaway, transgender man, Massachusetts.

Charles (Chloe) Anderson, transgender woman, Florida.

American Psychiatric Association: "Gender Dysphoria."

Human Rights Campaign: "Transgender FAQ."

Steensma, T. Clinical Child Psychology and Psychiatry, January 2011.

GLAAD: "Tips for Allies of Transgender People."

American Psychological Association: "What does transgender mean?"

Human Rights Campaign: "Transgender Visibility: A Guide to Being You."

American Psychological Association: "Answers to your questions about transgender people, gender identity and gender expression."

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