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Answers to Your Questions
ABOUT TRANSGENDER PEOPLE, GENDER
IDENTITY, AND GENDER EXPRESSION
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What does transgender mean?
Transgender is an umbrella term for persons
whose gender identity, gender expression, or
behavior does not conform to that typically
associated with the sex to which they were
assigned at birth. Gender identity refers to a
person’s internal sense of being male, female,
or something else; gender expression refers
to the way a person communicates gender
identity to others through behavior, clothing,
hairstyles, voice, or body characteristics.
“Trans” is sometimes used as shorthand
for “transgender.” While transgender is
generally a good term to use, not everyone
whose appearance or behavior is gendernonconforming
will identify as a transgender
person. The ways in which transgender
people are talked about in popular culture,
academia, and science are constantly changing,
particularly as individuals’ awareness,
knowledge, and openness about transgender
people and their experiences grow.
What is the difference
between sex and gender?
Sex is assigned at birth, refers to one’s biological
status as either male or female, and is associated
primarily with physical attributes such as
chromosomes, hormone prevalence, and
external and internal anatomy. Gender refers
to the socially constructed roles, behaviors,
activities, and attributes that a given society
considers appropriate for boys and men or girls
and women. These influence the ways people
act, interact, and feel about themselves. While
aspects of biological sex are similar across
different cultures, aspects of gender may differ.
Various conditions that lead to atypical
development of physical sex characteristics
are collectively referred to as intersex
conditions. For information about people with
intersex conditions (also known as disorders
of sex development), see APA’s brochure
Answers to Your Questions About Individuals
With Intersex Conditions.
Have transgender people
always existed?
Transgender persons have been documented in
many indigenous, Western, and Eastern cultures
and societies from antiquity to the present day.
However, the meaning of gender nonconformity
may vary from culture to culture.
What are some categories or
types of transgender people?
Many identities fall under the transgender
umbrella. The term transsexual refers to people
whose gender identity is different from their
assigned sex. Often, transsexual people alter or
wish to alter their bodies through hormones,
surgery, and other means to make their bodies
as congruent as possible with their gender
identities. This process of transition through
medical intervention is often referred to as sex
or gender reassignment, but more recently is
also referred to as gender affirmation. People
who were assigned female but identify and live
as male and alter or wish to alter their bodies
through medical intervention to more closely
resemble their gender identity are known as
transsexual men or transmen (also known as
female-to-male or FTM). Conversely, people
who were assigned male but identify and
live as female and alter or wish to alter their
bodies through medical intervention to more
closely resemble their gender identity are
known as transsexual women or transwomen
(also known as male-to-female or MTF). Some
individuals who transition from one gender to
another prefer to be referred to as a man or a
woman rather than as transgender.
People who cross-dress wear clothing that
is traditionally or stereotypically worn by
another gender in their culture. They vary in
how completely they cross-dress, from one
article of clothing to fully cross-dressing. Those
who cross-dress are usually comfortable with
their assigned sex and do not wish to change it.
Cross-dressing is a form of gender expression
and is not necessarily tied to erotic activity.
Cross-dressing is not indicative of sexual
orientation (see Answers to Your Questions for
a Better Understanding of Sexual Orientation &
Homosexuality for more information on sexual
orientation). The degree of societal acceptance
2 for cross-dressing varies for males and
females. In some cultures, one gender may be
given more latitude than another for wearing
clothing associated with a different gender.
The term drag queens generally refers to men
who dress as women for the purpose of
entertaining others at bars, clubs, or other
events. The term drag kings refers to women who
dress as men for the purpose of entertaining
others at bars, clubs, or other events.
Genderqueer is a term that some people use
who identify their gender as falling outside
the binary constructs of “male” and “female.”
They may define their gender as falling
somewhere on a continuum between male
and female, or they may define it as wholly
different from these terms. They may also
request that pronouns be used that are neither
masculine nor feminine, such as “zie” instead
of “he” or “she,” or “hir” instead of “his”
or “her.” Some genderqueer people do not
identify as transgender.
Other categories of transgender people
include androgynous, multigendered, gender
nonconforming, third gender, and two-spirit
people. Exact definitions of these terms vary
from person to person and may change over
time but often include a sense of blending or
alternating genders. Some people who use these
terms to describe themselves see traditional,
binary concepts of gender as restrictive.
Why are some people
transgender?
There is no single explanation for why some
people are transgender. The diversity of
transgender expression and experiences argues
against any simple or unitary explanation.
Many experts believe that biological factors
such as genetic influences and prenatal
hormone levels, early experiences, and
experiences later in adolescence or adulthood
may all contribute to the development of
transgender identities.
How prevalent are
transgender people?
It is difficult to accurately estimate the number
of transgender people, mostly because there
are no population studies that accurately and
completely account for the range of gender
identity and gender expression.
What is the relationship
between gender identity and
sexual orientation?
Gender identity and sexual orientation are not the
same. Sexual orientation refers to an individual’s
enduring physical, romantic, and/or emotional
attraction to another person, whereas gender
identity refers to one’s internal sense of being
male, female, or something else. Transgender
people may be straight, lesbian, gay, bisexual,
or asexual, just as nontransgender people
may be. Some recent research has shown
that a change or a new exploration period
in partner attraction may occur during the
process of transition. However, transgender
people usually remain as attached to loved
ones after transition as they were before
transition. Transgender people usually label
their sexual orientation using their gender as a
reference. For example, a transgender woman,
or a person who is assigned male at birth and
transitions to female, who is attracted to other
women would be identified as a lesbian or
gay woman. Likewise, a transgender man, or
a person who is assigned female at birth and
transitions to male, who is attracted to other
men would be identified as a gay man.
How does someone know that
they are transgender?
Transgender people experience their
transgender identity in a variety of ways
and may become aware of their transgender
identity at any age. Some can trace their
transgender identities and feelings back
to their earliest memories. They may have
vague feelings of “not fitting in” with people
of their assigned sex or specific wishes to
be something other than their assigned sex.
Others become aware of their transgender
identities or begin to explore and experience
gender-nonconforming attitudes and behaviors
during adolescence or much later in life. Some
embrace their transgender feelings, while
others struggle with feelings of shame or
confusion. Those who transition later in life
may have struggled to fit in adequately as their
assigned sex only to later face dissatisfaction
with their lives. Some transgender people,
transsexuals in particular, experience intense
dissatisfaction with their sex assigned at birth,
physical sex characteristics, or the gender role
associated with that sex. These individuals
often seek gender-affirming treatments.
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3What should parents do if their
child appears to be transgender
or gender nonconforming?
Parents may be concerned about a child who
appears to be gender-nonconforming for a variety
of reasons. Some children express a great deal of
distress about their assigned sex at birth or the
gender roles they are expected to follow. Some
children experience difficult social interactions
with peers and adults because of their gender
expression. Parents may become concerned when
what they believed to be a “phase” does not pass.
Parents of gender-nonconforming children may
need to work with schools and other institutions
to address their children’s particular needs and
ensure their children’s safety. It is helpful to consult
with mental health and medical professionals
familiar with gender issues in children to decide
how to best address these concerns. It is not
helpful to force the child to act in a more genderconforming
way. Peer support from other parents
of gender-nonconforming children may also
be helpful.
How do transsexuals make a
gender transition?
Transitioning from one gender to another is a
complex process and may involve transition to a
gender that is neither traditionally male nor female.
People who transition often start by expressing
their preferred gender in situations where they
feel safe. They typically work up to living full time
as members of their preferred gender by making
many changes a little at a time. While there is
no “right” way to transition genders, there are
some common social changes transgender people
experience that may involve one or more of the
following: adopting the appearance of the desired
sex through changes in clothing and grooming,
adopting a new name, changing sex designation
on identity documents (if possible), using hormone
therapy treatment, and/or undergoing medical
procedures that modify their body to conform with
their gender identity.
Every transgender person’s process or transition
differs. Because of this, many factors may determine
how the individual wishes to live and express their
gender identity. Finding a qualified mental health
professional who is experienced in providing
affirmative care for transgender people is an
important first step. A qualified professional can
provide guidance and referrals to other helping
professionals. Connecting with other transgender
people through peer support groups and transgender
community organizations is also helpful.
The World Professional Association for
Transgender Health (WPATH), a professional
organization devoted to the treatment of
transgender people, publishes The Standards of Care,
which offers recommendations for the provision of
gender affirmation procedures and services.
Is being transgender a mental
disorder?
A psychological state is considered a mental
disorder only if it causes significant distress
or disability. Many transgender people do not
experience their gender as distressing or disabling,
which implies that identifying as transgender
does not constitute a mental disorder. For these
individuals, the significant problem is finding
affordable resources, such as counseling, hormone
therapy, medical procedures, and the social
support necessary to freely express their gender
identity and minimize discrimination. Many other
obstacles may lead to distress, including a lack
of acceptance within society, direct or indirect
experiences with discrimination, or assault. These
experiences may lead many transgender people to
suffer with anxiety, depression, or related disorders
at higher rates than nontransgender persons.
According to the Diagnostic and Statistical Manual
of Mental Disorders (5th ed.; American Psychiatric
Association, 2013), people who experience
intense, persistent gender incongruence can be
given the diagnosis of gender dysphoria. Some
contend that the diagnosis inappropriately
pathologizes gender noncongruence and should
be eliminated. Others argue it is essential to
retain the diagnosis to ensure access to care. The
International Classification of Diseases (ICD) is
under revision, and there may be changes to its
current classification of intense persistent gender
incongruence as gender identity disorder.
What kinds of discrimination do
transgender people face?
Anti-discrimination laws in most U.S. cities and
states do not protect transgender people from
discrimination based on gender identity or gender
expression. Consequently, transgender people in
most cities and states face discrimination in nearly
every aspect of their lives. The National Center
for Transgender Equality and the National Gay
and Lesbian Task Force released a report in 2011
entitled Injustice at Every Turn, which confirmed
the pervasive and severe discrimination faced by
transgender people. Out of a sample of nearly
6,500 transgender people, the report found that
transgender people experience high levels of
discrimination in employment, housing, health
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4 care, education, legal systems, and even in
their families. The report can be found at
http://endtransdiscrimination.org.
Transgender people may also have additional
identities that may affect the types of
discrimination they experience. Groups with
such additional identities include transgender
people of racial, ethnic, or religious minority
backgrounds; transgender people of lower
socioeconomic statuses; transgender
people with disabilities; transgender youth;
transgender elderly; and others. Experiencing
discrimination may cause significant
psychological stress, often leaving transgender
individuals to wonder whether they were
discriminated against because of their gender
identity or gender expression, another
sociocultural identity, or some combination of
all of these.
According to the study, while discrimination
is pervasive for the majority of transgender
people, the intersection of anti-transgender
bias and persistent, structural racism is
especially severe. People of color in general
fare worse than White transgender people,
with African American transgender individuals
faring far worse than all other transgender
populations examined.
Many transgender people are the targets of
hate crimes. They are also the victims of subtle
discrimination—which includes everything
from glances or glares of disapproval or
discomfort to invasive questions about their
body parts.
How can I be supportive of
transgender family members,
friends, or significant others?
Educate yourself about transgender issues
by reading books, attending conferences,
and consulting with transgender experts.
Be aware of your attitudes concerning
people with gender-nonconforming
appearance or behavior.
Know that transgender people have
membership in various sociocultural
identity groups (e.g., race, social class,
religion, age, disability, etc.) and there
is not one universal way to look or be
transgender.
Use names and pronouns that are
appropriate to the person’s gender
presentation and identity; if in doubt, ask.
Don’t make assumptions about
transgender people’s sexual orientation,
desire for hormonal or medical treatment,
or other aspects of their identity or
transition plans. If you have a reason to
know (e.g., you are a physician conducting
a necessary physical exam or you are a
person who is interested in dating someone
you’ve learned is transgender), ask.
Don’t confuse gender nonconformity
with being transgender. Not all people
who appear androgynous or gender
nonconforming identify as transgender or
desire gender affirmation treatment.
Keep the lines of communication open with
the transgender person in your life.
Get support in processing your own
reactions. It can take some time to adjust
to seeing someone you know well
transitioning. Having someone close to
you transition will be an adjustment and
can be challenging, especially for partners,
parents, and children.
Seek support in dealing with your
feelings. You are not alone. Mental health
professionals and support groups for
family, friends, and significant others of
transgender people can be useful resources.
Advocate for transgender rights,
including social and economic justice and
appropriate psychological care.
Familiarize yourself with the local and state
or provincial laws that protect transgender
people from discrimination.
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WHERE CAN I FIND MORE INFORMATION ABOUT TRANSGENDER
HEALTH, ADVOCACY, AND HUMAN RIGHTS?
American Psychological
Association
750 First Street, NE
Washington, DC 20002
202-336-6041
lgbc@apa.org
www.apa.org/pi/lgbt/index.aspx
www.apa.org/pi/lgbt/programs/transgender/
index.aspx
Children’s National Health
	System
Gender and Sexuality Advocacy and Education
111 Michigan Ave., NW
Washington, DC 20010
202-476-4172
http://childrensnational.org/gendervariance
Family Acceptance Project
San Francisco State University
3004 16th Street, #301
San Francisco, CA 94103
fap@sfsu.edu
http://familyproject.sfsu.edu
FTMInternational
	 (FTM means Female-to-Male)
601 Van Ness Ave., Suite E327
San Francisco, CA 94102-3200
877-267-1440
info@ftmi.org
www.ftmi.org
Gender Education & Advocacy
http://gender.org
Gender Spectrum
510-788-4412
info@genderspectrum.org
www.genderspectrum.org
National Center for
	 Transgender Equality
1325 Massachusetts Ave., NW, Suite 700
Washington, DC 20005
202-903-0112
202-393-2241 (fax)
NCTE@NCTEquality.org
http://transequality.org
Parents, Families, and
	 Friends of Lesbians and Gays
	 (PFLAG) Transgender
	 Network (TNET)
PFLAG National Office
1828 L Street, NW, Suite 660
Washington, DC 20036
202-467-8180
info@pflag.org
http://community.pflag.org
Sylvia Rivera Law Project
147 W. 24th Street, 5th Floor
New York, NY 10011
212-337-8550
212-337-1972 (fax)
info@srlp.org
http://srlp.org
Transgender Law Center
1800 Market Street
San Francisco, CA 94102
415-865-0176
info@transgenderlawcenter.org
http://transgenderlawcenter.org
TransYouth Family Allies
P.O. Box 1471
Holland, MI 49422-1471
888-462-8932
info@imatyfa.org
http://www.imatyfa.org
World Professional
	 Association for Transgender
	 Health (WPATH)
wpath@wpath.org
www.wpath.org
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References:
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author.
American Psychological Association. (2006). Answers to your
questions about individuals with intersex conditions. Retrieved
from http://www.apa.org/topics/lgbt/intersex.aspx
American Psychological Association. (2008). Answers to
your questions for a better understanding of sexual orientation &
homosexuality. Retrieved from http://www.apa.org/topics/
lgbt/orientation.aspx
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P.,
DeCuypere, G., Feldman, J., … Zucker, K. (2012). Standards
of care for the health of transsexual, transgender, and gender
nonconforming people (7th version). International Journal of
Transgenderism, 13, 165–232. doi:10.1080/15532739.2011.700873
National Center for Transgender Equality and the National
Gay and Lesbian Task Force. (2011). Injustice at every turn.
Retrieved from http://endtransdiscrimination.org
World Health Organization. (1990). International statistical
classification of diseases and related health problems (10th ed.).
Retrieved from http://apps.who.int/classifications/icd10/
browse/2010/en
Suggested Bibliographic Citation (modified
accordingly for different titles):
American Psychological Association. (2011). Answers to your
questions about transgender people, gender identity, and gender
expression. Retrieved from http://www.apa.org/topics/
lgbt/transgender.aspx
This material may be reproduced in whole or in part
without permission provided that the reproduced content
includes the original bibliographic citation and the following
statement: Copyright © 2011 American Psychological
Association. Updated in 2014.
This is the third edition of this brochure. The first was written
by the APA Task Force on Gender Identity and Gender
Variance and published in 2006. The second edition was
revised and updated by members of the APA Committee on
Lesbian, Gay, Bisexual, and Transgender Concerns (CLGBTC),
Vic Muñoz, EdD, and Kevin Nadal, PhD; and APA Division
44 liaison to the CLGBTC Michael L. Hendricks, PhD,
ABPP; with the assistance of the Division 44 Committee
on Transgender & Gender Variance Issues; Jill Davidson,
PhD, NCSP; J. Rhodes Perry, Associate Director of Policy &
Programs, Parents, Families, and Friends of Lesbians and
Gays (PFLAG); and Anneliese Singh, PhD, LPC, NCC.
The American Psychological Association
750 First Street, NE
Washington, DC 20002
Public and Member Communications
202.336.5700
Produced by the APA Lesbian, Gay, Bisexual, and Transgender Concerns Office and APA Public and Member Communications