We’ve gathered answers to frequent questions for transgender and gender-nonconforming people; their families and allies; and others.
The OHSU Transgender Health Program is devoted to awareness and fully inclusive access to health care.
Transgender people identify with a gender other than the one they were assigned at birth. Doctors usually assign newborns a gender based on external anatomy. Some people come to realize their gender identity is different:
- Some realize they are male.
- Some realize they are female.
- Others find they are nonbinary and/or genderqueer — neither male nor female; some blend of the two; gender-fluid (shifting); or agender (without gender).
Gender-nonconforming describes anyone whose behavior, appearance or other traits (their gender expression) vary from traditional male and female norms. Some people are both transgender and gender-nonconforming.
Intersex people represent another form of gender diversity. They are born with chromosomes, hormones and/or anatomy that are not typically male or female. They can be any gender, including female, male, transgender, nonbinary, gender-fluid or agender.
Finding one’s identity: Every transgender and gender-nonconforming person follows a unique path to gender identity and expression. Some gender-diverse people have treatments such as hormone therapy or surgery to change their anatomy or appearance. Some have neither.
Gender identity versus sexual orientation: It’s important to understand that these terms are about gender identity — who a person is. They have no relation to the person’s sexual orientation — whom a person is sexually attracted to (if anyone).
It can happen in many ways and at any time. Some people become aware at an early age that they don’t match their assigned gender. Others may not realize it until later in life.
Transgender people may sense that they don’t fit in with people of their assigned gender, or they may know they want to be something other than their assigned gender, according to the American Psychological Association.
Gender dysphoria is a strong sense that the gender you experience and the gender you were assigned at birth do not match. People with gender dysphoria may be uncomfortable with, or even detest, the physical traits and societal roles of their assigned gender.
Dysphoria affects people in different ways. Some have anxiety, distress, depression and difficulty functioning in everyday life. A mental health professional can diagnose gender dysphoria, and can serve as a supportive partner as the person explores and/or finds their gender identity and expression.
Someone generally has symptoms for at least six months before being diagnosed with gender dysphoria. Children can show symptoms but may not be diagnosed until they are teens. A diagnosis may be needed for some kinds of gender-affirming surgery.
Being uncomfortable with your assigned gender can be hard to deal with on your own. These feelings are different for everyone. They can also happen at different times in life, and they don’t always lead to changes such as transitioning.
Because there is no one way to be transgender, gender nonbinary or gender nonconforming, you may consider:
- Ask yourself questions. How strong are my feelings, and how long have I had them? Is my discomfort related to my body, my gender role in society or my name? Can I imagine living with a different gender identity? What would make me comfortable?
- Be informed. Read what people say about being transgender or gender nonconforming in blogs, publications, online forums and support groups.
- Talk to someone. A mental health therapist, a trusted friend or family member, or a participant in an online forum may help you find your true self.
- Explore. You can explore your gender identity without committing to a permanent, life-changing transition. This may mean seeking hormone therapy or living in a different gender role. We recommend talking with a mental health therapist about options.
It can be hard to tell loved ones that you’re not who they think you are. But many gender-diverse people find it’s important to let family and friends know. This can be especially important for those planning to transition.
It helps to be prepared and to put yourself in their shoes. Know what you want to say. Be ready to answer their questions. Be patient and remember that it may take them time to understand and accept your true self. Try to make it an ongoing conversation, not just a one-time revelation.
Think about who you want to tell first. Choose someone you think will be supportive, who can then be an ally as you tell others. Consider seeking other help and support, such as from a mental health therapist.
Be sure you’re safe. That can mean having an ally with you, anticipating reactions and choosing a place where you can’t be overheard. Find more tips on coming out to family and friends.
Having allies, knowing your workplace’s culture and identifying potential problems can make coming out easier. You may consider these steps:
- Talk first with someone at work you trust. A colleague can help you set up a plan, anticipate how people may react and offer other support.
- Let your manager know you want to come out before spreading the word. Your manager can be a powerful ally. The person should know your company’s culture, personalities and policies. If that makes you uncomfortable, is there a higher manager you can talk with? A human resources manager may be able to help.
- Be prepared to educate your managers and co-workers. The more informed they are about what it means to be transgender or gender nonbinary, the easier it may be for you. Direct them to resources. And be patient if they misstate your name or ask a lot of questions.
- Find out if your company’s anti-discrimination policies include gender identity or expression, and find out whether your state, city or county offers protections (see the next answer for more on this topic).
The Human Rights Campaign has more information about coming out at work.
It depends on where you live and maybe whether you’re at work, at the store or at the doctor’s office.
No federal law prohibits discrimination based on gender identity or expression. Twenty-one states, including Oregon and Washington, and the District of Columbia have such laws, though. More than 200 cities and counties do, too. An additional dozen states offer limited protections.
Some laws cover jobs, housing and public places such as hospitals and restaurants, for example. Others also include access to health insurance, education and/or credit.
Basic Rights Oregon’s Know Your Rights guide has more information about Oregon protections.
There’s no foolproof way to keep yourself from being physically or verbally assaulted in restrooms, on dates or while waiting for the bus. But you can reduce the chances with some basic steps:
- Follow your instincts. If a person, place or situation makes you uncomfortable, get help or get away. When someone in a restroom makes you uncomfortable, leave and try to find another one, wait for them to leave, or ask a friend to come in with you.
- Be aware of your surroundings, whether it’s your neighborhood, your bike route to work or a day trip somewhere new. Get a sense of what may be dangerous, and know where you can get help, such as a fire station or your regular coffee shop. At night, well-lit and busy areas are safest.
- Seek safety in numbers. Take a friend if you go out at night, and stand with others while waiting for the bus. If you go out alone at any time of day, let someone know where you’re going and when you expect to be back.
- Walk, talk and act confidently. Stand tall and walk with purpose, make eye contact, and don’t make it obvious if you’re in an unfamiliar place.
- Consider carrying a whistle or a loud noisemaker, often called a personal alarm or rape alarm, to signal for help.
- There’s no consensus on whether carrying a weapon or pepper spray is a good idea. It’s a personal decision. If you decide to, know how to use it. But also ask yourself if you could use it against someone — and be aware that it could be used against you.
Every relationship is unique, so there’s no simple answer. Some couples stay together during and after a partner’s transition, and other couples end or change the nature of their relationship.
Few statistics exist on the subject, though the 2015 U.S. Transgender Survey sheds some light:
- The National Center for Transgender Equality, which conducted the survey, received responses from more than 27,000 transgender people across the U.S.
- About one-quarter (27 percent) of those who were out to their partner said a spouse or partner had ended their relationship all or in part because they are transgender. This includes 10 percent who said a spouse or partner had ended the relationship entirely because they are transgender.
- Age plays a role. Respondents who were 45 or older were twice as likely as respondents overall to have had a relationship end solely because they are transgender.
Being married when you realize you are transgender may raise legal questions. Find links to places where you can learn more.
It can be a big adjustment when someone close to you transitions. Being open-minded and talking with your friend or family member are good ways to start.
The American Psychological Association recommends other ways you can help:
- Learn about gender diversity by researching online, reading books, going to conferences or talking to experts.
- Use the person’s name and pronouns. If in doubt, ask.
- Don’t make assumptions about the person’s sexual orientation, desire for medical treatment, or other aspects of their identity or transition plans. If you have a reason to know, ask.
- Get support in processing your feelings. Mental health professionals and support groups for family, friends and significant others can help.
Visit our resources page to learn more.
Refer a patient
- Please complete our Request for Transgender Health Services referral form and fax with relevant medical records to 503-346-6854.
- Learn more on our For Health Care Professionals page.