{{Short description|Changing gender presentation to accord with gender identity}} {{Redirect|Gender change|sex change|Sex change (disambiguation){{!}}Sex change}} {{Transgender sidebar}} '''Gender transition''' is the process of affirming and expressing internal sense of gender, rather than the sex assigned at birth. It is a recommended course of treatment for persons experiencing gender dysphoria,<ref>{{Cite web |last=World Medical Association |date=October 2015 |title=WMA Statement on Transgender People |url=https://www.wma.net/policies-post/wma-statement-on-transgender-people/ |access-date=2025-03-22 |language=en-US}}</ref><ref>{{Cite web |date=February 28, 2024 |title=APA adopts groundbreaking policy supporting transgender, gender diverse, nonbinary individuals |url=https://www.apa.org/news/press/releases/2024/02/policy-supporting-transgender-nonbinary |access-date=2025-03-22 |website=American Psychological Association}}</ref> providing improved mental health outcomes in the majority of people.<ref>{{Cite journal |last1=Baker |first1=Kellan E |last2=Wilson |first2=Lisa M |last3=Sharma |first3=Ritu |last4=Dukhanin |first4=Vadim |last5=McArthur |first5=Kristen |last6=Robinson |first6=Karen A |date=April 2021 |title=Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review |journal=Journal of the Endocrine Society |publication-date=2 February 2021 |volume=5 |issue=4|article-number=bvab011 |doi=10.1210/jendso/bvab011 |doi-access=free |pmid=33644622 |pmc=7894249 }}</ref><ref>{{Cite journal |last1=Shelemy |first1=Lucas |last2=Cotton |first2=Sue |last3=Crane |first3=Catherine |last4=Knight |first4=Matthew |date=2024 |title=Systematic review of prospective adult mental health outcomes following affirmative interventions for gender dysphoria |journal=International Journal of Transgender Health |issue=3 |volume=26 |pages=480–500 |doi=10.1080/26895269.2024.2333525 |pmid=40756726 |issn=2689-5269|doi-access=free |pmc=12312132 }}</ref><ref>{{Cite journal |last1=Dhejne |first1=Cecilia |last2=Van Vlerken |first2=Roy |last3=Heylens |first3=Gunter |last4=Arcelus |first4=Jon |date=2016 |title=Mental health and gender dysphoria: A review of the literature |journal=International Review of Psychiatry |volume=28 |issue=1 |pages=44–57 |doi=10.3109/09540261.2015.1115753 |issn=1369-1627 |pmid=26835611 |url=https://pure.amsterdamumc.nl/en/publications/b38b3d06-3e77-4e78-90af-abb221f01403 }}</ref><ref>{{Cite web |last=Cornell University |date=2018 |title=What does the scholarly research say about the effect of gender transition on transgender well-being? |url=https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/ |access-date=2025-03-22 |website=What We Know Project |language=en-US}}</ref>
A ''social transition'' may include coming out as transgender,{{Efn|While the label Transgender is used here, people of diverse gender identities may socially or medically transition.|name=a|group=lower-alpha}} using a new name and pronouns, and changing one's public gender expression.<ref name="Brown&Rounsley">Brown, M. L. & Rounsley, C. A. (1996) ''True Selves: Understanding Transsexualism – For Families, Friends, Coworkers, and Helping Professionals'' Jossey-Bass: San Francisco {{ISBN|0-7879-6702-5}}</ref> This is usually the first step in a gender transition. People socially transition at almost any age,<ref name=":3"/><ref name=":4"/> as a social transition does not involve medical procedures. It can, however, be a prerequisite to accessing transgender healthcare in many places.<ref name=":5" /><ref name=":6" />
In transgender youth, puberty blockers are sometimes offered at the onset of puberty to allow the exploration of their gender identity without the distress<ref name=":7">{{Cite journal |last1=Turban |first1=Jack L. |last2=King |first2=Dana |last3=Carswell |first3=Jeremi M. |last4=Keuroghlian |first4=Alex S. |date=1 February 2020 |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |pmid=31974216 |journal=Pediatrics|volume=145 |issue=2 |article-number=e20191725 |doi=10.1542/peds.2019-1725 |pmc=7073269 }}</ref><ref name=":8">{{Cite journal |last=Lambrese |first=Jason |date=2010-08-01 |title=Suppression of Puberty in Transgender Children |url=https://journalofethics.ama-assn.org/article/suppression-puberty-transgender-children/2010-08 |journal=AMA Journal of Ethics |language=en |volume=12 |issue=8 |pages=645–649 |doi=10.1001/virtualmentor.2010.12.8.jdsc1-1008 |issn=2376-6980 |pmid=23186849|url-access=subscription }}</ref> of irreversible pubertal changes. Upon reaching the age of consent, they become eligible to pursue a medical transition if it is still desired.
A ''medical transition'' may include hormone replacement therapy (HRT), transgender voice therapy, and gender-affirming surgery. The ability to start a medical transition is typically offered after a diagnosis of gender dysphoria,<ref name="j624">{{cite journal |last=Johnson |first=Austin H. |date=2019 |title=Rejecting, reframing, and reintroducing: trans people's strategic engagement with the medicalisation of gender dysphoria |journal=Sociology of Health & Illness |volume=41 |issue=3 |pages=517–532 |doi=10.1111/1467-9566.12829 |pmid=30484870 |issn=0141-9889}}</ref> a form of medicalization. In recent years, there has been a push for an informed consent model of transgender healthcare which allows adults to access HRT without a formal diagnosis.<ref name="c152">{{cite journal |last=Schulz |first=Sarah L. |date=2017-12-13 |title=The Informed Consent Model of Transgender Care: An Alternative to the Diagnosis of Gender Dysphoria |journal=Journal of Humanistic Psychology |publisher=SAGE Publications |volume=58 |issue=1 |pages=72–92 |doi=10.1177/0022167817745217 |issn=0022-1678}}</ref>
Transitioning is a process that can take anywhere from several months to several years, and may affect any or all of the gendered aspects of a person's life, which include aesthetics, social roles, legal status, and biological aspects of the body. Details of an individual's transition may vary based on gender identity, body image, personality, finances, the attitudes of others and culturally specific views of gender.<ref>{{cite journal|title=Book Review: Sally Hines, Transforming Gender: Transgender Practices of Identity, Intimacy and Care. Bristol: The Policy Press,2007.227 pp.ISBN 978-1-86134-9170 £24.99 (pbk).ISBN 978-1-86134-9163 £60.00 (hbk)|first=Patricia|last=Elliot|date=1 October 2008|journal=Sexualities|volume=11|issue=5|pages=646–648|doi=10.1177/13634607080110050603|s2cid=145654831}}</ref>
==Terminology== This page uses topic-specific vocabulary, defined below: * '''Gender identity''' is a person's internal sense of their own gender. It may correlate with the gender assigned at birth or differ from it. In most individuals, gender identity is congruent with their assigned gender - these individuals are ''cisgender''. Those who do not identify with their birth gender may identify as ''transgender.'' * '''Cisgender''' is an adjective that refers to people who identify the gender assigned to them at birth. Cisgender people may have any sexual orientation or gender expression. * '''Transgender''' is an adjective that refers to people who identify with a gender that differs from the one assigned to them at birth. Transgender people may have any sexual orientation or gender expression. * '''Assigned gender at birth''' ('''AGAB''') is a term that refers to the sex or gender assigned to people when they are born. Assigned a gender at birth is based on physical characteristics, and does not account for internal gender identity. * '''Gender expression''' refers to the external presentation of gender identity. Typically, a person's gender expression is thought of in terms of masculinity (a tomboy, a butch lesbian, a drag king) or femininity (an effeminate male, a 'femboy', a drag queen), but an individual's gender expression may incorporate both feminine and masculine traits, or neither. One may express their gender through clothing, behavior, hair styling, voice, etc.<ref>{{Citation |last=Edelman |first=Elijah Adiv |title=Gender Identity and Transgender Rights in Global Perspective |date=6 November 2019 |work=The Oxford Handbook of Global LGBT and Sexual Diversity Politics |pages=61–74 |editor-last1=Bosia |editor-first1=Michael J. |editor-last2=McEvoy |editor-first2=Sandra M. |editor-last3=Rahman |editor-first3=Momin |publisher=Oxford University Press |doi=10.1093/oxfordhb/9780190673741.013.24 |isbn=978-0-19-067374-1}}</ref><ref>{{Cite journal |last1=Carabez |first1=Rebecca |last2=Pellegrini |first2=Marion |last3=Mankovitz |first3=Andrea |last4=Eliason |first4=Mickey |last5=Scott |first5=Megan |date=12 August 2015 |title=Does your organization use gender inclusive forms? Nurses' confusion about trans* terminology |journal=Journal of Clinical Nursing |volume=24 |issue=21–22 |pages=3306–3317 |doi=10.1111/jocn.12942 |issn=0962-1067 |pmid=26263919 |doi-access=free}}</ref> It is not necessarily related to one's gender identity. * Gender Euphoria is the positive feeling experienced when one's gender is affirmed. It is often considered the opposite of gender dysphoria<ref name=":12">{{Cite web |date=2026-03-31 |title=What is gender euphoria? |url=https://www.thetrevorproject.org/blog/what-is-gender-euphoria/ |access-date=2026-05-05 |website=The Trevor Project |language=en-US}}</ref>. * '''Gender dysphoria''' is the distress a person experiences from a mismatch between their internal gender identity and their gender assigned at birth.<ref>{{cite web |author=Human Rights Campaign |author-link=Human Rights Campaign |title=Sexual Orientation and Gender Identity Definitions |url=http://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions |url-status=live |archive-url=https://web.archive.org/web/20151125033133/http://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions |archive-date=November 25, 2015 |access-date=June 13, 2021}}</ref><ref name="MorrowMessinger">{{cite book |title=Sexual Orientation and Gender Expression in Social Work Practice: working with gay, lesbian, bisexual, and transgender people |date=2006 |publisher=Columbia University Press |isbn=978-0-231-50186-6 |veditors=Morrow DF, Messinger L |location=New York |page=8 |quote=Gender identity refers to an individual's personal sense of identity as masculine or feminine, or some combination thereof.}}</ref> People who suffer from gender dysphoria may ''transition'' in order to alleviate this distress. * '''Non-binary''' is a gender identity described as neither entirely male nor female (not one of the two binary sexes). Non-binary people may suffer from gender dysphoria, and may consider themselves transgender. Non-binary people may have any sexual orientation or gender expression. * '''Transitioning''' refers to the process of affirming and expressing one's internal sense of gender, as opposed to the gender assigned to them at birth. There are two major facets of gender transitioning: a social transition, and a medical transition; almost all transgender people will socially transition, and many will undergo some degree of medical transition.{{Citation needed|date=September 2024}} * '''Detransitioning''' (sometimes also known as '''re-transitioning''') is the cessation of transgender identity, a transition to a different gender or both, often to the natal gender.<ref>{{cite web |date=7 August 2013 |title=Transitioning Back To One's Assigned Sex At Birth |url=http://transadvocate.com/transitioning-back-to-ones-assigned-sex-at-birth_n_9946.htm |archive-url=https://web.archive.org/web/20170920093038/http://transadvocate.com/transitioning-back-to-ones-assigned-sex-at-birth_n_9946.htm |archive-date=2017-09-20 |access-date=1 September 2017 |website=The TransAdvocate}}</ref>
== Social transition == {{redirect|Social transitioning|social changes on a societal level|Social change}} Social transitioning is the process of changing the way one presents their gender to others<ref name=":11">{{Cite web |date=2023-10-03 |title=Social transitioning for trans people: What it involves |url=https://www.medicalnewstoday.com/articles/social-transitioning |access-date=2026-05-05 |website=www.medicalnewstoday.com |language=en}}</ref>.The social process of transitioning can begin with 'coming out', where others are told that one does not identify with their birth sex. The newly out trans person may adopt a new name, ask to be referred to with a new set of pronouns, and change their presentation to better reflect their identity.<ref>{{Cite journal |last1=Olson |first1=Kristina R. |last2=Durwood |first2=Lily |last3=Horton |first3=Rachel |last4=Gallagher |first4=Natalie M. |last5=Devor |first5=Aaron |date=13 July 2022 |title=Gender Identity 5 Years After Social Transition |journal=Pediatrics|volume=150 |issue=2 |article-number=e2021056082 |doi=10.1542/peds.2021-056082 |pmid=35505568 |pmc=9936352 }}</ref><ref name="Bigner" /> There is no "one way" to socially transition, it can look very different depending on the lifestyle and preferences of the individual. It is usually reversible.Socially transitioning does not involve medical intervention or gender affirming surgery, but it may be a prerequisite to access transgender healthcare in some regions.<ref name=":5">{{Cite journal |last1=Evans |first1=Shelley |last2=Crawley |first2=Jamie |last3=Kane |first3=Debbie |last4=Edmunds |first4=Kathryn |date=December 2021 |title=The process of transitioning for the transgender individual and the nursing imperative: A narrative review |url=https://onlinelibrary.wiley.com/doi/10.1111/jan.14943 |journal=Journal of Advanced Nursing |language=en |volume=77 |issue=12 |pages=4646–4660 |doi=10.1111/jan.14943 |pmid=34252206 |issn=0309-2402|url-access=subscription }}</ref><ref name=":6">{{Cite journal |last=Rachlin |first=Katherine |title=Medical Transition without Social Transition: Expanding Options for Privately Gendered Bodies |url=https://read.dukeupress.edu/tsq/article-abstract/5/2/228/134507/Medical-Transition-without-Social |access-date=2024-07-21 |website=read.dukeupress.edu|date=May 2018 |volume=5 |issue=2 |pages=228–244 |doi=10.1215/23289252-4348660 |url-access=subscription }}</ref>
People may socially transition at any age, with documented cases of children as young as 5,<ref name=":3">{{Cite journal |last1=Kennedy |first1=Natacha |last2=Hellen |first2=Mark |date=2010 |title=Transgender Children: more than a theoretical challenge |url=https://www.gjss.org/sites/default/files/issues/chapters/papers/Journal-07-02--02-Kennedy-Hellen.pdf |journal=Graduate Journal of Social Science}}</ref><ref>{{Cite journal |last1=Olson |first1=Kristina R. |last2=Gülgöz |first2=Selin |date=June 2018 |title=Early Findings From the TransYouth Project: Gender Development in Transgender Children |url=https://srcd.onlinelibrary.wiley.com/doi/10.1111/cdep.12268 |journal=Child Development Perspectives |language=en |volume=12 |issue=2 |pages=93–97 |doi=10.1111/cdep.12268 |issn=1750-8592|url-access=subscription }}</ref><ref>{{Cite journal |last1=Olson |first1=Kristina R. |last2=Key |first2=Aidan C. |last3=Eaton |first3=Nicholas R. |date=April 2015 |title=Gender Cognition in Transgender Children |url=http://journals.sagepub.com/doi/10.1177/0956797614568156 |journal=Psychological Science |language=en |volume=26 |issue=4 |pages=467–474 |doi=10.1177/0956797614568156 |pmid=25749700 |issn=0956-7976|url-access=subscription }}</ref> or adults as old as 75.<ref name=":4">{{Cite book |last=Fabbre |first=Vanessa D. |url=https://www.taylorfrancis.com/chapters/edit/10.4324/9781315731803-5/gender-transitions-later-life-significance-time-queer-aging-vanessa-fabbre |title=Gender Transitions in Later Life: The Significance of Time in Queer Aging |date=2015 |isbn=978-1-315-73180-3 |doi=10.4324/9781315731803-5|doi-broken-date=23 March 2026 }}</ref> While many of those who socially transition will pursue a medical transition, not everyone can access gender affirming care, and not all may wish to pursue it.
Passing refers to the perception and recognition of trans people as their desired gender identity by outsiders who may not know they are transgender. For many trans people, passing is a very important aspect of their transition often seen as an 'end goal'. Passing can greatly alleviate gender dysphoria. Failure to pass can cause serious repercussions for trans people's psychological well-being and safety, including but not limited to: poor mental health, discrimination, increased barriers to medical care{{Citation needed|date=July 2024}}, harassment, fetishization, ostracization, increased risk of homelessness, and targeted violence due to increased visibility of one's transgender status.<ref>{{Cite web |title=Transgender-Specific Issues: Passing {{!}} Responding to Transgender Victims of Sexual Assault |url=https://www.ovc.gov/pubs/forge/transgender_passing.html |url-status=live |archive-url=https://web.archive.org/web/20191007191104/https://www.ovc.gov/pubs/forge/transgender_passing.html |archive-date=2019-10-07 |access-date=2019-10-07 |website=www.ovc.gov}}</ref> Going 'full-time' refers to the act of living everyday life as one's identified gender.<ref name="social transition">{{cite web |title=TransWhat? • Social transition |url=https://transwhat.org/transition/socialtrans.html |url-status=live |archive-url=https://web.archive.org/web/20171108001521/http://transwhat.org/transition/socialtrans.html |archive-date=2017-11-08 |access-date=2017-10-29 |website=transwhat.org}}</ref> People who go full-time may or may not fully pass, and may or may not keep their transgender identity a secret.
Going 'stealth' refers to the act of living as one's identified gender without revealing oneself to be transgender.<ref>{{cite web |last1=Urquhart |first1=Evan |title=For Many Trans Men in the South, Going "Stealth" Makes the Most Sense |url=https://slate.com/human-interest/2018/06/why-trans-men-in-the-south-go-stealth.html |website=Slate Magazine |access-date=February 25, 2022 |language=en |date=June 29, 2018 |archive-date=February 25, 2022 |archive-url=https://web.archive.org/web/20220225041747/https://slate.com/human-interest/2018/06/why-trans-men-in-the-south-go-stealth.html |url-status=live }}</ref> In some countries, being stealth may be a safety necessity, due to health, safety, and wellbeing risks of being openly transgender.
=== Legal aspects === {{main|Transgender rights|Legal recognition of non-binary gender}}
Transgender people in many parts of the world can legally change their name to something consistent with their gender identity.<ref name="Bigner">Jerry J. Bigner, Joseph L. Wetchler, ''Handbook of LGBT-affirmative Couple and Family Therapy'' (2012, {{ISBN|0415883598}}), page 207: "gender transition can be achieved through the use of clothing, hairstyle, preferred name and pronouns,..."</ref> Some regions also allow one's legal sex marker changed on documents such as driver licenses, birth certificates, and passports. The exact requirements vary from jurisdiction to jurisdiction; some require sex reassignment surgery, while many do not. In addition, some states that require sex reassignment surgery will only accept 'bottom surgery', or a genital reconstruction surgery, as a valid form of sex reassignment surgery, while other states allow other forms of gender confirmation surgery to qualify individuals for changing information on their birth certificates.<ref name=":1">{{Cite web|url=http://www.lgbtmap.org/equality-maps|title=Movement Advancement Project {{!}} Snapshot: LGBT Equality by State|website=www.lgbtmap.org|access-date=2019-10-07|archive-date=2019-04-22|archive-url=https://web.archive.org/web/20190422164047/http://www.lgbtmap.org/equality-maps|url-status=live}}</ref> In some U.S. states, it is also possible for transgender individuals to legally change their gender on their drivers license without having had any form of qualifying gender confirmation surgery.<ref name=":1" /> Also, some U.S. states are beginning to add the option of legally changing one's gender marker to X on legal documents, an option used by some non-binary people.<ref>{{Cite web| url=https://loveisarainbow.com/2018/04/gender-neutral-choice/| title=Gender Neutral Choice in Legal Documents - Love is a Rainbow Article| date=2018-04-14| website=Love is a Rainbow| access-date=2019-10-07| archive-date=2023-02-13| archive-url=https://web.archive.org/web/20230213092513/https://loveisarainbow.com/2018/04/gender-neutral-choice/| url-status=dead}}</ref>
=== Social repercussions === A person's ideas about gender in general may change as part of their transition, which may affect their religious, philosophical or political beliefs. In addition, personal relationships can take on different dynamics after coming out. For instance, what was originally a lesbian couple may become a heterosexual one as a partner comes out as a trans man - or parents of a boy may become parents of a girl after their child comes out as a trans woman.{{Citation needed|date=April 2026}}
Over the course of a gender transition, people who are close to the transitioning individual may experience a sense of loss and work through a grieving process.<ref name=":0">{{Cite journal|last=Norwood|first=Kristen|date=March 2013|title=Grieving Gender: Trans-identities, Transition, and Ambiguous Loss|journal=Communication Monographs|volume=80|issue=1|pages=24–45|doi=10.1080/03637751.2012.739705|s2cid=35092546|issn=0363-7751}}</ref> This type of loss is an ambiguous loss, characterized by feelings of grief where the item of loss is obscure. Family members may grieve for the gendered expectations that their loved one will no longer follow, whereas the transgender person themself may feel rejected by their relatives' need to grieve.<ref>{{cite journal |last1=McGuire |first1=Jenifer K. |last2=Catalpa |first2=Jory M. |last3=Lacey |first3=Vanessa |last4=Kuvalanka |first4=Katherine A. |title=Ambiguous Loss as a Framework for Interpreting Gender Transitions in Families: Ambiguous Loss in Gender Transition |journal=Journal of Family Theory & Review |date=September 2016 |volume=8 |issue=3 |pages=373–385 |doi=10.1111/jftr.12159 |url=https://onlinelibrary.wiley.com/doi/full/10.1111/jftr.12159 |access-date=30 December 2022|url-access=subscription }}</ref> Feelings that arise are described as a way of seeing the person who is transitioning as the same, but different, or both present and absent.<ref name=":0" />
== Medical transition == {{main|Gender-affirming care}}
Physical aspects of gender transition can go along with social aspects; as well as wearing gender affirming clothing, transgender people often hide features from their natal puberty; for example, transgender men binding their breasts and transgender women shaving. Other physical aspects of transitioning require medical intervention, such as transgender hormone therapy or surgeries.
It is important to note that most transgender individuals will receive few, if any, surgeries throughout their lifetimes and some may never receive HRT. Barriers to accessing medical transitioning can include: a lack of financing, a lack of desire, or a lack of accessibility.
=== Puberty blockers === Puberty blockers / hormone blockers are medications used to block natal sex hormones. For transgender youth, hormone blockers may be offered at the onset of puberty to allow the exploration of their gender identity without the distress<ref name=":7" /><ref name=":8" /> of irreversible pubertal changes. Puberty blockers are considered reversible<ref name=":2">{{Cite journal |last1=Rölver |first1=Angela |last2=Föcker |first2=Manuel |last3=Romer |first3=Georg |date=2022 |title=Desisting from gender dysphoria after 1,5 years of puberty suppression: A case report |department=Department of Child and Adolescent Psychiatry |journal=University Hospital Münster |volume=1 |issue=2 |article-number=100049 |doi=10.1016/j.psycr.2022.100049|doi-access=free }}</ref> and their use is deemed safe and effective<ref>{{Cite journal |last1=Rew |first1=Lynn |last2=Young |first2=Cara C. |last3=Monge |first3=Maria |last4=Bogucka |first4=Roxanne |date=February 2021 |title=Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature |url=https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12437 |journal=Child and Adolescent Mental Health |language=en |volume=26 |issue=1 |pages=3–14 |doi=10.1111/camh.12437 |issn=1475-357X |pmid=33320999|url-access=subscription }}</ref> as treatment for gender dysphoria in gender-diverse children<ref>{{Cite journal |last1=Giordano |first1=Simona |last2=Holm |first2=Søren |date=2020-04-02 |title=Is puberty delaying treatment 'experimental treatment'? |journal=International Journal of Transgender Health |language=en |volume=21 |issue=2 |pages=113–121 |doi=10.1080/26895269.2020.1747768 |issn=2689-5269 |pmc=7430465 |pmid=33015663}}</ref> and for precocious puberty in cisgender children;<ref>{{Cite journal |last=Eugster |first=Erica A |date=May 2019 |title=Treatment of Central Precocious Puberty |journal=Journal of the Endocrine Society |volume=3 |issue=5 |pages=965–972 |doi=10.1210/js.2019-00036 |pmc=6486823 |pmid=31041427}}</ref> their use may be discontinued at any time if natal puberty-blocking is no longer desired, or if cross-sex hormone replacement therapy is initiated.<ref name=":2" /> For transgender adults, hormone blockers may be offered in a course with cross-sex hormone replacement therapy in order to treat gender dysphoria.
=== Hormone replacement therapy === Hormone replacement therapy (HRT) is a medical treatment that replaces the primary sex hormones in the body, in order to develop the secondary sex characteristics of the opposite sex. Typically, masculinizing HRT uses the male sex hormone testosterone, while feminizing HRT uses the female sex hormone estrogen and sometimes progesterone, as well as testosterone blockers.
=== Voice training === Voice therapy (or 'voice training') is ''non-surgical'' gender-affirming treatment for the masculinization or feminization of the voice. ''Transfeminine people'' will not experience any impact on voice pitch from feminizing hormone therapy (unless their natal puberty was sufficiently blocked), so voice training is very often undergone in order to learn how to speak in a higher and more feminine register. ''Transmasculine people'', on the other hand, will experience a marked lowering in pitch from masculinizing HRT (testosterone) to a cisgender male level, so vocal masculinization training is not as typical as vocal feminization training.{{Citation needed|date=April 2026}} Irrespectively, vocal masculinization training can help one learn to speak in a lower and more masculine register.
=== Surgery === {{Main|Gender-affirming surgery}}
Voice surgery refers to a ''surgical'' treatment that allows for the masculinization or feminization of one's vocal pitch. ''Transfeminine people'' can undergo voice surgery to surgically increase their pitch range. Transmasculine people very uncommonly undergo voice surgery, as masculinizing HRT (testosterone) often lowers voices to a cisgender male pitch. Irrespectively, vocal masculinization surgery can be underwent to surgically decrease their pitch range.
Facial surgery is gender-affirming surgery underwent on the face, usually facial masculinization or facial feminization.
Top surgery refers to gender affirming surgeries of the breasts. In transmasculine and/or nonbinary individuals, this may be a double mastectomy (removal of breast tissue), and/or a ''chest reconstruction'. In transfeminine and/or nonbinary individuals, this may be a breast augmentation.Top surgery requires the ability to give informed consent to the medical procedure. The individual getting the procedure will have to understand the legal requirements and prerequestits to get top surgery. They will also have to understand the aftercare procedure given by the doctor. The specifics of the procedure will vary depending on what the individual wants done and the specializations of the doctor doing the procedure<ref name=":9">{{Cite web |title=Top Surgery |url=https://www.transhub.org.au/clinicians/top-surgery/ |access-date=2026-05-05 |language=en-AU}}</ref>. The different types of top surgery available are listed below:
* Double incision top surgery with nipple grafts: Procedure where the nipples and breast tissue are removed, then the nipples are repositioned and re-attached. The incisions are made along the left and right side of the chest. The nipples may be reshaped and reduced before re-attachment, and lose sensation after the procedure. This procedure is typically chosen for those who want a more masculine look<ref name=":9" /><ref name=":10">{{Cite web |last=Liang |first=Fan |date=May 4, 2026 |title=Top Surgery (Chest Masculinization and Chest Feminization) |url=https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/top-surgery#masculinization |website=hopkinsmedicine.org}}</ref>. * Periareolar top surgery: Breast tissue is removed through a small incision under the nipple. Also known as 'keyhole top surgery'. This type of surgery is used to remove smaller breasts for a more masculine chest<ref name=":10" />. * Inverted-T top Surgery: Uses the same horizontal incisions as double incision surgery, but adds a verticle incision to the nipple to preserve the blood supply and sensation in the nipple. The nipple stalk is not severed, so more sensation is maintained<ref name=":9" />. * Breast Augmentation: An implant is inserted under the chest tissue to create the look of breasts<ref name=":10" />.
Bottom surgery refers to gender affirming surgeries performed on the genitalia. In transmasculine and/or nonbinary individuals, this may be a hysterectomy (removal of the uterus), a oophorectomy (removal of the ovaries), or both. A penis can be constructed through metoidioplasty or phalloplasty, and a scrotum through scrotoplasty. In transfeminine and nonbinary individuals, this may be a penectomy (removal of the penis), orchiectomy (removal of the testicles), vaginoplasty (construction of a vagina), or a vulvoplasty (construction of a vulva).
==See also== * List of transgender-related topics
==References== <references /><ref name=":9" /><ref name=":10" /><ref name=":11" /><ref name=":12" /><references group="lower-alpha" />
==Further reading== * {{cite web |title=What does the scholarly research say about the effect of gender transition on transgender well-being? |url=https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/ |website=What We Know |publisher=Center for the Study of Inequality, Cornell University}} * {{cite book |last1=Lahai |first1=John Idriss |last2=Moyo |first2=Khanyisela |title=Gender in Human Rights and Transitional Justice |date=2018 |publisher=Palgrave Macmillan |isbn=978-3-319-54202-7}}
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