Key messages
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Transgender people
Transgender people (often called trans people) experience a degree of gender incongruence;1 that is, a discordance between their personal sense of their own gender (their gender identity) and the sex assigned to them at birth.2 Panel 1 defines some key terms related to gender identity.
The terms gender identity and gender incongruence refer to a person's own experience of who they are, and are not the same as sexual orientation, which is about to whom a person is attracted. A transgender man may be attracted to women (including, perhaps, transgender women), in which case he may identify as a heterosexual transgender man. Alternatively, he may be attracted to men (including, perhaps, transgender men), in which case his sexual identity may be as a homosexual or gay man. Furthermore, being transgender is not the same as being intersex. Intersex people develop atypically in regard to some or all aspects of their biological sex, whereas transgender people identify in a way that does not match their assigned sex (panel 2).
In preparing this article we accessed academic papers and documentation published by international agencies, governments and associated institutions, and community-based organisations. We searched various databases, including Google and Google Scholar databases. We also used relevant list serves and journal email alerts to ensure that up-to-date documentation was included. The peer review process, which proceeded by way of several steps, included a consultation meeting in Beijing in November, 2013, attended by, among others, transgender community leaders from several countries.
Transgender people may seek health-care services for reasons related to their gender incongruence (and accompanying dysphoria). They may seek information and counselling support to help explore identity issues, or to consider difficult decisions about gender transition, and implications for family relationships, employment, and broader social stigma. Children and youth with gender issues, as well as their parents and teachers, may need support and information too.
Key messages Transgender people
We do not know how many transgender people there are, or how many experience a need for health care, which poses a problem for health-care planners. The first task for the researcher in this area is to decide whom to count, and by what means. Transgender people are a very diverse group. Some live with their gender incongruence, but decide not to transition. Some make a social transition only, without accessing any gender-affirming health care. Some buy hormones from non-medical providers (or on
A growing body of scientific evidence is now available to inform debate on the extent to which biological factors (especially hormonal and genetic), rather than factors such as parenting or social environment, contribute to the development of gender identity. Putative contributing factors that are not biological are not within the scope of this section. However, gender outcomes are probably influenced by interactions between underlying biology and cultural norms and mores, which generate social
There remain places (for example, the Caribbean and much of Africa and the Middle East) for which little or no information is available about transgender people, their lived experiences, and their health needs. Nevertheless, across much of the world, transgender people experience stigma on a daily basis, being viewed by others in society as sexually deviant, morally corrupt, unnatural, or mentally disordered.48 They often experience what is called “minority stress”, leading to poor health and
Transgender peoples' access to health care is complicated by the fact that, at present, their experiences are conceptualised as a mental disorder. The view that transgender people are mentally disordered has long been criticised by transgender people, clinicians, and researchers, with arguments focused on the way that such diagnoses psychopathologise diversity (turn difference into mental disorder), with consequences for health and wellbeing. In response, in 2010, WPATH issued a public
We have noted that transgender people have a gender identity that is not congruent with their assigned sex, and that they may experience discomfort or distress where opportunities to express that identity are denied them or where that identity is not respected. Some transgender people seek gender-affirming healthcare aimed at bodily changes to match their gender identity. Gender incongruence is more common than clinic-based studies suggest, and may be linked to biological factors. We have seen