Trans 101: FAQ

Being gay is about who you love. Being transgender is about who you are.

It’s a common misconception that transgender people are simply extremely feminine gay men or extremely butch lesbians who think life would be easier as a straight woman or man, or will make it easier to attract partners.

However, like everyone else, trans people can be straight, gay, bisexual, asexual or any other sexual orientation.

What makes them someone trans is their gender identity (being a man or woman, boy or girl) and not how masculine or feminine they are.

Many girls enjoy stereotypically masculine interests, such as sports, while having no desire to be boys. Similarly, many men enjoy and excel at things that society labels feminine while still wishing to be seen as men – as brothers and sons, not sisters and daughters. Their interests do not change their gendered sense of self.

In the same way, what a transgender woman desires is not femininity, but to be seen as a woman. Transgender men desire manhood, not masculinity. Non-binary people find that neither ‘man’ nor ‘woman’ accurately describes them. Many trans people also diverge from the stereotypes of their gender – there are masculine trans women and feminine trans men – but this does not make them any less trans.

No. Gender dysphoria (or gender incongruence) was previously categorised as a mental illness due to the psychological distress many transgender people experienced from the dissonance between their gender identity and embodied or perceived selves. It was not an indication that the person was deluded or out of touch with reality. It has since been removed from the mental health category.

Medical authorities continue to recommend transitioning as the appropriate course of action for people who experience gender dysphoria. Transitioning is the only action that has proven to be effective in resolving (rather than suppressing) dysphoria in the long term.

Stress from gender dysphoria and high levels of stigma nonetheless means that transgender people still experience a higher risk of mental health problems such as depression or anxiety. These issues are often alleviated but may not fully resolve with transition.

Poverty, unemployment, homelessness, family rejection, abuse, lack of social acceptance and other factors have an established link with mental health risks in the general population, and are especially prevalent within transgender populations due to social stigma and discrimination.

In contrast, mental health outcomes have been positive – sometimes even outstripping the general population – in trans people who transition early in supportive environments.

A person experiencing delusions would often fit the criteria of a diagnosable mental illness such as psychosis or schizophrenia. They would experience other observable symptoms of the illness, such as hallucinations or hearing voices, and may find it difficult to function on a day-to-day basis. Their delusions are also likely to shift around, and often involve things that are provably false.

This may sometimes include delusions of being someone of another sex, but it manifests in a different way from gender dysphoria. For instance, a schizophrenic man may be convinced that he is the Queen of England and looks exactly like her.

In contrast, a transgender woman is perfectly aware of how her body looks. When she says that she is a woman, she is speaking about her internal sense of self. She is not deluded about her physical characteristics or how others perceive her. It is precisely that awareness that might lead her to transition.

There is no one objective test that can tell you if you are transgender. The desire to be another gender may sometimes be rooted in other causes. In these scenarios, transitioning may worsen rather than improve your situation.

However, if you are feeling uncomfortable with the gender you were assigned at birth, here are some questions that might guide you along in determining what is behind these feelings, and to figure out your identity.

• If you were given a magic button that could instantly and painlessly change your body to the one of your desired sex, and nobody would judge you for it, and there would be no awkwardness to deal with, would you press that button? Would you choose to stay that way?
  • Alternatively, if science develops an immersive virtual reality system where people spend most of their lives, what sex would you want your virtual self to be?
• When you hear the phrase ‘opposite sex’, do you think of men or women? How do you feel about your answer? Does it feel normal, or does it feel wrong?
• When you imagine yourself as an old person having lived a long and contented life, what gender is that person?
• Do you feel pressured to behave a certain way because of the gender you were assigned at birth?
  • How would you feel if you were given the freedom to live life the way you want with the gender you were assigned at birth? Would you be comfortable simply being a feminine man, or masculine woman, if the people around you accepted you or even celebrated you as such?
  • If you feel restricted or frustrated by gender roles, where does this pain stem from? Does it come primarily from the burden of fulfilling these gender roles, or does it stem from a sense that you are being forced into the wrong role to begin with?
    • If women were now made to serve National Service and men were exempt, would you be content being a man?
    • Conversely, if you were magically brought to a world where you no longer had to deal with any sexism or sexual harassment, would you be content being a woman?
• Does the thought that you may not be transgender upset you, or provide relief? Why, or why not?
  • Similarly, does the thought of transitioning fill you with fear because you like your body, but are afraid you secretly want to?
• Are your feelings about your gender more questioning in nature, rather than distressing?
  • Teenagers go through a period of identity formation while they try to work out their place in the world. This may extend to gender. They may grapple with what it means to have a female body in a society that often sexualises and infantilises them, or being male in a society that often expects toughness and emotional repression.
  • If you are a teenager (or a pre-teen), consider giving yourself time to figure out what your identity is. If, however, you experience distress about your assigned gender that seems unusual, you may wish to look further into this with a trusted counsellor.
• Do you want to transition purely because of someone else? This is usually a sign you should reconsider.
  • If you are in or seeking a same-sex relationship and dealing with homophobia, would you still be uncomfortable with your gender if you were free to love your partner and had access to the same legal benefits that straight people have?
  • Are you in an abusive situation and believe that being a different gender will protect you, or enable you to protect others?
  • Do you feel pressured by friends who insist you must be trans, even if you don’t think you are?
  • Do your parents wish that you were a different gender, or scorn you for being the ‘wrong’ gender? Do they treat your siblings better because of their gender, and you wonder if being that gender might make them love you more?
  • Do you want to transition just so a crush would be attracted to you? You should definitely reconsider.

These are just guidelines. There are no right answers, and the trans people you meet may not always give the same answers, but these can act as a starting point.

Ultimately, what you should be asking is not “am I transgender?” but:

• In an ideal world, which gender would I want to be seen as?
• Which sex do I want my body to look like?
• Am I willing to make permanent changes in order to achieve those goals?

Yes; a transgender person is anyone with a gender identity that does not match their assigned gender at birth. The definition of gender dysphoria has recently come to be associated more strongly with distress, but once encapsulated any feelings of dissonance, discomfort, dissociation or disconnect with one’s gender or sexual characteristics, regardless of whether the person was trans or not.

Not all trans people experience distress over their bodies or being misgendered. This is especially true for those in more supportive environments whose identities and transition met little resistance, as well as for those who are easy-going by nature and not easily bothered, or who are used to hardship and very resilient. Others might only come to understand after or during transition that what they have been experiencing for most of their lives was, indeed, dysphoria, but they had just assumed that that was how everyone felt all the time.

Some trans people find it easier to recognise gender euphoria instead when their gender identity is affirmed. Examples would include happiness or a sense of rightness when “mistaken” for the “wrong” gender, such as being called ma’am on the phone when you’re still identifying or presenting as male.

Euphoria might also manifest when you wear clothing or get a haircut associated with your gender identity, or when you are addressed by your chosen name.

Gender euphoria can sometimes be a more reliable confirmation of trans identity than gender dysphoria. People may experience gender dysphoria for reasons other than being trans, but such people are less likely to experience gender euphoria when perceived instead as the other sex. A common thread in many detransition narratives is women talking about how they transitioned because they could not bear the trauma of being female in a sexist world; however, virtually none expressed any excited euphoria at their bodies becoming more male or contented happiness at being finally seen as a man, which is what trans men typically experience.

Yes – you are transgender as long as your gender identity differs from your assigned gender at birth. Gender identity is not determined by how you dress or what body parts you have. Whether you transition is a very personal decision that should not be made lightly, and is something that you will have to decide for yourself.

Transition may be liberating, but will at times be painful or come at a high cost in terms of your safety, relationships, career and finances. If you are considering HRT or genital surgery, you would also need to think about whether you might want to have children (or additional children) in future.

Give yourself some time to think this through! Many trans people spend a long time grappling with their identities and whether or not to transition. Some change their minds multiple times before coming to a decision. That’s normal, because transitioning is scary, and is often a last resort for many people.

Partial social transitioning is also an option – you can dress more masculine or feminine, or privately affirm your gender identity in online spaces or among close friends while continuing to live outwardly as your assigned gender. You might also decide to hold off transition until a future milestone, such as after you graduate, after you become financially independent, or when your children have grown up.

How you choose to resolve or live with your gender dysphoria will ultimately depend on your own personal comfort and circumstances. There is no one path for everyone. If you are struggling, you might find it helpful to speak with a counsellor.

No. Some trans people have little or no body dysphoria and are content dressing and living as the gender they identify as, especially if they are naturally androgynous. They may be happy living their lives as a woman with a typically male body (or vice versa), and experience distress only when society reacts negatively.

Others may be non-binary and prefer a more ambiguous gender expression or one that changes over time. They may opt for short-term or low-dose hormone therapy until they have achieved their desired permanent changes, e.g. voice drop or breast growth.

Some trans people choose not to change their bodies due to their religious beliefs, but find social transition a permissible compromise. They may find other ways to cope with their body dysphoria, or view it as the burden they have to bear in this world.

Some trans people who do experience body dysphoria may find it manageable and decide not to seek medical intervention. Some may decide only begin medically transitioning when their financial or social situation is stable. Others may have medical conditions that make hormones and surgery risky. Still others may only seek medical transition after they manage to store their gametes, as their fertility may be affected.

Transgender identities are a part of human sexual diversity. Trans people have been observed in cultures across the world since the beginning of human civilisation.

There are likely multiple factors at play; biologically, there is robust evidence for the role of pre-natal sex hormones and gene variants that suggest a neurological basis to the bodily aspect of gender dysphoria.

Nonetheless, human sexual differentiation has also never been a neat binary. While human bodies are greatly concentrated on the two poles of male and female, there are people who exist everywhere else on that sexual continuum.

For instance, there are men with atypical sexual characteristics such as high voices, low testosterone levels or attraction to other men; they express male gender identities and are unquestionably accepted as men. Going along that spectrum, there are a smaller group of men whose bodies have female-typical features such as XX chromosomes, ovaries, uteruses and vaginas, in addition to male-typical features. Some were raised as girls, but expressed male gender identities, often desired more masculine bodies, and are classified as (intersex) men.

If we go yet further down that spectrum, biology would then predict the existence of an even smaller minority of men whose bodies have fully female-typical features but who still express male gender identities and often the desire for more masculine bodies – and those would be transgender men. It would be stranger if the spectrum instead ended abruptly.

Regardless of biology, cultural concepts of gender also shape how trans and other gender diverse people come to understand themselves. People we know as non-binary today may in the past have thought of themselves as transgender men or women, or effeminate gay men or butch lesbians, or just gender non-conforming, as those were the only frameworks available to them. With growing cultural awareness of gender and sexuality, learning how their experiences differ from those groups then leads to them finding others like themselves and coming up with new terms.

In societies that deny the existence of trans people altogether, those who may be predisposed to a trans identity may never come to realise they are trans, and instead go through life with a constant feeling of wrongness that could potentially become unbearable.

Many transgender people, especially women, are often accused of portraying caricatures of womanhood or manhood in their mannerisms, interests and appearance.

For those who have not undergone any medical transition, dress and behaviour are the only ways they have to express their gender identities. If a trans woman who has not medically transitioned goes around with short hair and in unisex clothes, acting in a neutral manner, everyone would naturally perceive her as a man. Dressing up and exaggerating her femininity is a major way of correcting that assumption, especially when first coming out. As trans people then transition and start to be consistently seen as their gender, most eventually tone it down to what feels more natural.

Trans people are also under immense pressure from society and healthcare providers to ‘prove’ that they are their gender. Trans women have been accused of not being serious about transition because they turned up for doctors’ appointments in jeans and T-shirt, rather than makeup and dresses, and denied HRT as a result.

Lastly, there is the freedom that comes with finally being able to express a long-repressed identity. A trans woman who has had to repress her feminine side for years might go slightly wild when she can finally do all the feminine things she always wanted, including the things she dreamt of as a child. Early transition is a time of discovering oneself and figuring out the kind of woman, man or non-binary person you are going to be, which may mean lots of experimenting with different clothing styles and mannerisms. A similar process happens to all teenagers, but stands out more in transgender people who transition in adulthood, as most other people would have outgrown that phase by then.

The term ‘transracial’ originally applied to children adopted by parents of a different race, which may affect their sense of racial identity and belonging. The term has since come to refer also to people like Rachel Dolezal who claim to identify as a different race than that they were born. People then ask why such identities are invalid if transgender identities are considered valid.

Most of the time, people who claim to be transracial are unable to explain what it means to ‘be’ that race without resorting to stereotypes that are often racist and closely associated with class status. e.g. people in the West tend to describe being rich, educated and articulate as ‘acting white’, suggesting that non-white people cannot be those things. Or a non-Asian person may talk about how they love Asian culture and thus consider themselves Asian.

But racial identity is not as much about culture or interests, or even biology, as how you are perceived and treated by the world because of how you look. For example, there are rare cases of biracial twins who look like different races, and effectively are different races, despite having near-identical genetics and upbringing. How they interact with the world, how they see themselves, and how the world responds to each of them would be very different, and is what forms their racial identity.

Race itself is a social construct that changes over time. Indians are technically Caucasian, but are presently categorised as Asian; Irish and Italians were once not considered white, but now they are; America used to consider anyone black if they had just 1/16th African ancestry; and so on. The ways we group people into races is ultimately arbitrary, with no strict definitions.

This further muddies what it means to identify as a different race. If you had been born in a different time or different country, you might very well have been considered another race. Within each race there is also so much physical variation in features and skin colour, where in fact intra-racial populations exhibit a much greater genetic diversity among themselves than between different races.

Likewise with gender, simply having masculine or feminine traits isn’t what makes someone a man or woman. Being transgender isn’t about being a masculine woman or feminine man who might as well be the other sex. It’s about having a gender identity that is at odds with what’s expected for someone’s body, often starting early in life (though it may not be recognised till much later) and which affects every part of how that person views, relates and interacts to the world, as well as the socialisation they absorb.

This indelibly shapes who they are, as it does with children adopted by different-race parents. That is not the case for people who decide they are a particular race merely because they share stereotypical traits with that race (that may not even apply in a different country).

People sometimes do develop a genuine transracial identity, in the sense of truly seeing themselves as part of that race. This happens most commonly for those who are racially-mixed but identify wholly as just one of those races; in rare circumstances, it could conceivably happen with people who have no biological links to that race, but who were perhaps raised among them and treated as one of them. This would however be a psychological identity-formation process, rather than a biological one.

While the two conditions may seem similar on the surface, they have different causes, different manifestations, and more importantly different treatments that have been reliably proven to work.

Body Dysmorphic Disorder (BDD) is a condition in which a person becomes obsessed with imagined defects in their body. Someone with BDD might wrongly perceive their normal-sized nose as gigantic, for example. After they’ve undergone surgery to make it tiny, they may still be distressed at the misperception that it is huge. This is a psychiatric issue, and more surgery would not fix the problem. Anorexia is a similar condition where a thin or average-sized person may wrongly believe they are fat, and losing weight does not ease the distress.

Whereas a transgender man might want to remove his breasts, and after surgery successfully gives him a flat chest, he doesn’t continue thinking he has huge breasts. If he did, that would be a manifestation of BDD.

Individuals with BDD respond successfully to psychiatric treatment and medication. Whereas when psychiatric treatment is attempted for transgender individuals, the distress often increases and does not go away. Instead, allowing hormonal therapy and surgery as desired does successfully provide that relief.

No. It greatly reduces it. The misconception arises from comparisons between transgender people and the general population, not between transgender people who have transitioned and those who have not.

See this page for more information.

Yes, but it is rare, and especially rare when it comes to surgery – regret rates for trans surgeries (including non-genital surgeries) have consistently remained under 1% since the 1960s, with similar numbers in this newer review of 27 studies. A January 2023 study of 1,989 trans patients found that 0.3% regretted surgery and requested a reversal or detransitioned. The majority of regret was due to medical complications and dissatisfaction with surgical outcomes, or social factors such as rejection from family, rather than a change in gender identity.

(For comparison, the regret rate for cosmetic surgery in the UK is around 65%, while regret for knee replacement surgery is around 6-30%.)

Regret for hormone therapy is higher, but difficult to quantify. A confounding factor is the increasing number of non-binary individuals seeking to obtain an androgynous appearance through temporary hormone therapy. Available studies have a wide range of figures as a result – from as low as 0.47% to a possible high of 12.2% patients at one UK clinic who detransitioned or expressed regret.

(Note: a different study had 29.8% of patients ceasing HRT with the US Military Healthcare System, but this included those who no longer qualified for military healthcare and transferred to other clinics.)

Among youths on puberty blockers, 98% persist in their trans identity and continue with transition. The 2% include those who decided to postpone or not pursue medical transition and those who no longer consider themselves trans. They go off the blockers and proceed with regular puberty.

Among youths who presented themselves to gender clinics with gender dysphoria, 9.4% chose not to pursue medical treatment or ceased to identify as trans. None had started on any medical treatment.

It is important not to conflate detransition with regret. A comprehensive study of 28,000 trans respondents in the US found that 8% had detransitioned at some point due to pressures from family or workplaces, or being unable to cope with discrimination. 62% of those had since managed to retransition. Separately, out of 3,398 patients who attended a UK gender clinic, 3 (0.09%) had detransitioned permanently, while 10 (0.29%) did so temporarily.

Many people have the false impression that a large number of trans people regret transition. This is due to the disproportionate media coverage that such people receive, often amplified by organisations with explicitly anti-trans stances. In some cases, they seem to fall into the category of those whose regret had more to do with the difficulties of living as a trans person in society, rather than a change in identity, but where this is glossed over to push a narrative that people are being carelessly rushed into transition.

Here are some reasons given by people who did regret surgery or transition, both from anecdotal online accounts from detransitioners as well as from the studies previously linked:

• Inability to cope with the abuse from family, friends and society that they experienced as a result of transitioning; being subject to homelessness, poverty, unemployment, physical or sexual assault
• Rejection from family, especially their parents, partners or children
• Loneliness, especially the difficulty in developing romantic relationships
• Mourning their loss of fertility and how they can no longer have biological children
• Changing political or religious views on gender, particularly regarding the validity or morality of transgender identities and transitioning
• Realising their gender dysphoria was due to past trauma (especially sexual abuse or the fear of such) or internalised misogyny, rather than a genuine identification with or desire to be another sex; in some cases, trauma counselling solved the dysphoria
• Internalised transphobia (e.g “I’ll never be a real woman”) and finding it preferable or more honest to struggle with dysphoria than live as a transitioned transgender person
• Mistaking the desire not to be their assigned sex for a desire to be the other sex
• Misdiagnosis – either due to a mental illness which confounded the results, or a case where gender non-conformity was mistaken for a transgender identity
• Realising they were actually non-binary, and/or just as uncomfortable with a body more typical of the ‘other’ sex
• Feeling pressured into taking steps they did not want – like surgery. Some reported feeling pressured into sex reassignment surgery by romantic/sexual partners, gendered body ideals, doctors, or because of bureaucratic requirements to be legally recognised as their gender (as is the case in Singapore).
• Poor or dissatisfactory surgical outcomes (which is becoming less common as technology continues to improve; the risk of complications for MTF genital surgery is now down to 1%)
• Inability to ‘pass’ as cisgender, leading to diminished quality of life and fears for safety, or thinking that their transition was a failure.

As with all healthcare, doctors and researchers should do their best to ensure that patients receive the highest level of evidence-based care. This will still never be perfect, and unfortunately there will still be cases when the wrong call was made. However, when those treatments are necessary and life-saving for close to 99% of surgical patients – or around 90% for hormone therapy – the suffering of the 1% who make a mistake should not be a reason for the 99% should suffer instead.

The response should instead be to look at how to further reduce regret, and how to ensure that those who do end up regretting treatment likewise have access to high-quality care to undo its effects.

In the worst case scenario, those who regret transition would end up with gender dysphoria and be in a similar but much better state than even the average trans person who transitions. In most cases, they can have children, their bodies produce their own hormones, and most importantly they are not constantly bombarded by societal messages challenging the validity of their gender identity and painting them as deceptive, deluded and dangerous.

The things they despair over and that the public sympathises with – having a body with sexual characteristics that don’t match their gender identity, feeling like freaks, getting rejected by friends, family and potential romantic partners – are the exact same things that many trans people suffer to a much greater degree, but which is instead often met not with sympathy but ridicule.

So if people can empathise with a cisgender woman’s despair at having mistakenly transitioned and developed a deep voice, facial hair and flat chest that make people see her as a man instead of a woman, they should be equally able to empathise with a transgender woman who has been grappling with a far more intense version of the same thing all her life, and be just as fired up on her behalf to ensure she gets the care she needs.

The pain of those who transitioned and regretted it – and the empathy from those who hear their stories – shows that gendered embodiments and perceptions do matter. It also shows that most people do, instinctively, understand what it means to be trans, and understand why someone might be desperate to transition away from a self that does not feel like them.

The goal of transition healthcare is ultimately to ensure that no one needs to be stuck looking like a sex that does not match their sense of self and causes them distress. This includes helping those who wrongfully transitioned transition back to a body that is more aligned with who they are. Eradicating or restricting trans healthcare will trap them too; making exceptions for them would be hypocritical, and indefensibly imply that their gender dysphoria is real while that of trans people is not.

If people are moved by the pain of those who made a mistake and are now trapped looking like a sex they do not feel like, the response should be to do all they can to ensure that as few people as possible ever feel trapped that way. Banning transition healthcare will achieve the complete opposite effect.