The initials in LGBT refer to the global community of lesbian, gay, bisexual and transgender individuals. While most people know what those first three terms mean, the word "transgender" is not as widely understood.
The term describes people whose gender identity differs from the sex to which they were assigned at birth, according to GLAAD, an LGBT media-advocacy organization.
Sex vs. gender
Sex and gender are two different concepts. A person's sex refers to his or her biological status as either male or female. The determination of a person's sex primarily depends on various physical characteristics, including chromosomes, reproductive anatomy and sex hormones, according to the American Psychological Association (APA).
Gender, on the other hand, is a societal construct that deals with the expected behaviors, roles and activities typically associated with the different sexes, the APA said. Gender roles, which differ in different cultures, influence how people act and feel about themselves. Gender identity is how individuals see themselves. It is their sense of being male, female or something else. Their gender identities may or may not align with their sex or the gender roles expected of them by society.
Sexual orientation is different from gender identity. Sexual orientation is a person's physical, emotional or romantic attraction to another person, while gender identity is about one's own sense of self. Transgender people may be straight, lesbian, gay or bisexual. For example, a person born with male genitalia may transition to being female, but may be attracted to females. In this case, the person may identify as lesbian, even though she was born as a male.
Under the transgender umbrella
Transgender people may use more-specific categories to describe themselves, including transsexual, genderqueer and cross-dresser, according to the APA.
Genderqueer individuals don't identify with either male or female descriptions, and instead feel that their gender falls somewhere along a continuum.
People who cross-dress wear clothing that's traditionally worn by people of a different gender. Cross-dressers are generally comfortable with their birth sex, and this type of gender expression isn't necessarily related to sexual desire or erotic activity, GLAAD said. (GLAAD also noted that the term "transvestite" is considered derogatory.)
Making the transition
Trying to change a person's gender identity is no more successful than trying to change a person's sexual orientation, GLAAD said. Some people who are transsexual may take steps to better align their sex with their gender using hormones and surgery.
"So-called 'gender reassignment surgery' (more commonly called 'gender affirmation surgery' by both medical professionals and transgender individuals) usually references transgender genital surgery," said Dr. Joshua Safer, medical director of the Center for Transgender Medicine and Surgery at Boston Medical Center (BMC), who is also in the department of endocrinology at BMC. "There are also chest-reconstruction surgeries and facial feminization surgeries, among other options."
Genital surgery is typically reserved for transgender individuals over the age of 18 who have been treated with hormones, if that is what is medically indicated, and who have lived for at least a year in the gender roles that match their gender identities, explained Safer. Candidates for surgery are reviewed by a medical team that considers mental health and physical health in determining the best treatment strategy, including potentially surgery, for each person. [Infographic: How Gender Reassignment Surgery Works]
Altering the voice so that it better matches gender identity can also be important to those transitioning. "Here, we envision a world where a transgender person feels no need to change their voice or speech. That is, they would live in a world where people accept and respect them as whatever gender they claim, regardless of how their voice sounds," said Dr. Leah Helou, a speech pathologist who leads the University of Pittsburgh Voice Center's Transgender Voice and Communication services.
"However, in the absence of such radical and global acceptance, many trans individuals feel that their communication style is a top priority for making their external self congruent with their inner self," Helou said. "Our goal is to serve and support those people, while advocating for broader acceptance of the transgender population."
As mentioned earlier, altering one's appearance can also extend to facial surgery. Forehead contouring, jaw contouring, Adam's apple reduction, rhinoplasty, facelift surgery and neck-lift surgery are some of the operations that someone who is transitioning or has already transitioned may consider.
"Usually, the patients that are interested in facial feminization surgery have already been seen by a therapist and a hormone specialist that manages their hormone-replacement therapy," said Dr. Vartan Mardirossian, a facial feminization surgeon in Palm Beach, Florida. Mardirossian further explained that several consultations with a surgeon and realistic expectations are important to successful facial surgery.
Research has shown that transgender people are at high risk of experiencing prejudice and mental-health problems. The 2014 National Transgender Discrimination Survey found that 60 percent of health care providers refuse treatment to the transgender community. Additionally, the survey found that 64 to 65 percent of transsexuals suffered physical or sexual violence at work, and 63 to 78 percent suffered physical or sexual violence at school.
Transgender people often face discrimination even when using the bathroom. In a 2016 poll of Americans by CBS and The New York Times, 46 percent of respondents said those who are transgender should use the bathrooms assigned to their birth genders, while 41 percent said such individuals should be able use the bathroom that matches their identities. In May 2016, the U.S. departments of Education and Justice stepped in to advise school districts to permit transgender students to use bathrooms and locker rooms that matched the students' gender identities. In response, several states joined in a lawsuit, stating that the federal government had overreached its authority.
Because of discrimination, the suicide rate among transsexual youth is high. Youth Suicide Prevention Program reports that more than 50 percent of transgender youth will attempt suicide at least once by their 20th birthdays. (The National Suicide Prevention Lifeline is 1-800-273-8255.)
Help for parents
Parents who think that their children may be transgender should seek the assistance of experts. "Determining if children are transgender can be a challenge and should be done with careful evaluation from a knowledgeable multidisciplinary team," said Safer.
It is important to note that many children question their gender identities without being transgender. Safer advised parents to be respectful of the child's feelings and recognize that there will be no actual medical intervention until the child begins puberty. Even then, initial medical treatments are reversible, he said.
- National Center for Transgender Equality
- The Journal of Homosexuality: Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization
- Intersex Society of North America: What's the difference between being transgender or transsexual and having an intersex condition?
- Human Rights Campaign: Transgender FAQ