Terminology
Affirmed gender: ‘Affirmed’ gender is sometimes used to describe the post-transition gender role. Some people prefer it to the idea of ‘acquired’ gender. Transgender people are not acquiring a new gender identity, but they are affirming their inner, and until transition, hidden, core gender identity.
Androgyne: A person who identifies as not conforming to the traditional western model of gender as binary i.e man OR woman, and/or who presents a gender that is mixed or androgynous. The terms polygender or genderqueer are also used.
Anti-androgens: These are the drugs that are used to block the production of, and interfere with the action of the male sex hormones. Used by transgender women in combination with oestrogen. Please see ‘oestrogen’ for further detail.
Binding: Prior to top surgery, many transgender men use binders to flatten the breast tissue to create a more male-looking chest. Some bind on occasion, others all the time, depending on personal choice, comfort, or the level of success the binding achieves. Outcomes vary depending on the individual, chest size, build, type and material of binder used etc. Some bind successfully, for others it is less beneficial. Health problems can be associated with long-term binding and binding too tightly.
Bisexual: A person who is attracted to both males and females.
Chest surgery, chest reconstruction surgery: Can also be referred to as ‘top surgery’. This refers to surgical reconstruction to create a more male or more female appearing chest.
For transgender women, this may involve breast implants to supplement the breast development that may have already been achieved through hormone therapy.
For transgender men, there are two basic procedures; the double incision method or the keyhole/peri-areolar methods. These are described under their own entries.
Cisgender, cissexual: Refers to individuals whose gender identity and gender expression align with their assigned physical sex at birth. Cisgender is a more modern term, sometimes preferred when discussing transgender and non-transgender people, instead using the terms transgender and cisgender. This can help remove any stigma of singling out the transgender individual as being different.
Cissexism: Refers to the assumption that all men and women are biologically male or female therefore transgender people are inferior to cis-people and/or invalid.
See also ‘transphobia’.
Clitoroplasty: Term used for the surgical creation of a clitoris as part of gender reassignment surgery for transgender women. Ciswomen undertake this procedure in certain circumstances, such as Congenital Adrenal Hyperplasia or reconstruction after female circumcision. For transgender women, there are several ways in which this procedure may be done, and the success rate varies.
Cross-dresser: Refers to someone who wears clothes of another gender/sex. It is used most often to describe a heterosexual male who cross dresses as a female some or all of the time, but who does not usually have gender dysphoria or a wish to transition. See also: ‘transvestite’.
Drag queen: Refers to an anatomical male who cross-dressers as a woman, usually for performance or show. They typically, but not always identify as male and do not wish to change their anatomical sex.
Double incision method: This refers to a type of top surgery for transgender men. The type of procedure used will vary dependant on breast tissue; this method is most effective for individuals with a medium to large amount of breast tissue. Using this method, the surgeon makes large incisions horizontally across each breast, usually below the nipple. The skin is then peeled back in order to remove the mammary glands and fatty tissue with a scalpel. The chest muscles are not touched. Should there be hard-to-reach areas of fatty tissue, such as near the armpits, this tissue may be removed via liposuction. Once the breast tissue is removed the excess chest skin is trimmed, the incisions closed, and nipples are resized then grafted into place. Two seams/scars are usually left just below the line of the pectoral muscles.
Electrolysis: This is the painful and expensive procedure used by transgender women to permanently remove hair from the face and body. It is very important to the process of transition and to the well-being of the individual, and whether carried out by the NHS or privately the recipient should expect the usual standards of good practice, such as sensitivity and confidentiality.
Electrolysis is sometimes used by transgender men prior to certain types of phalloplasty.
Facial feminisation surgery (FFS): this is the term given to a range of reconstructive surgical procedures that are designed to alter a typically masculine face to bring them closer to the shape and size of typically female facial features. It is important to note this surgery is not exclusively used by transgender women, but by cisgender women too. Procedures involved could include, brow lift, rhinoplasty, cheek implantation, and lip augmentation. For a number of transgender women, FFS is medically important to their treatment, and as important, and sometimes even more important than GRS, as it reduces the gender dysphoria and assists in their integration during and after transition.
FtM: This refers to a female-to-male transgender individual, or transgender man. This is someone who was born in a female body but whose gender identity is male. Many transgender men will undergo hormonal and/or surgical treatment in order to live successfully as men in society.
Gay: Refers to a person attracted to the same gender.
Gender binary: The idea that there are only two genders or sexes—male/female or man/woman, and that a person must be strictly either/or.
Gender confirmation: a term often preferred by the transgender cohort of society to describe the treatments they undertake during transition because the process is NOT about the individual ‘changing’ in any way, they are simply realigning their bodies to match their inner or core gender identity.
Gender confirmation treatment/surgery or gender reassignment surgery: This can also be referred to as gender reassignment surgery. It refers to the treatments that individuals take to permanently transition, such as hormone therapy, surgery etc and which bring the sex characteristics of the body more into line with the core gender identity.
For transgender women, this usually involves vaginoplasty and/or orchidectomy. Breast augmentation/implants may or may not be needed or wanted. For transgender men, there are several surgical procedures involved, including chest reconstruction surgery, hysterectomy/oophorectomy, and different types of genital reconstruction surgery (GRS). Many transgender men undergo chest surgery, but not GRS, whereas some have all procedures (which may total more than three surgeries, as GRS can often involve several procedures).
Most transgender individuals view their ‘transition’ as an affirmation of the gender identity they have always had, rather than an actual transition from one gender identity to another. Many prefer simply to call themselves females or males rather than ‘transgender’ or ‘transsexuals’ because the ‘trans’ prefix suggests they have changed, rather than simply accepted, their true gender identity. This is consistent with the important concept that people do not need to have any surgery in order to affirm their gender identity.
Gender dysphoria: This is the clinical term and recognised medical condition which describes the extreme discomfort felt by transgender people owing to the contradiction between their physical sex and their gender identity. Dysphoria means unhappiness, which is frequently the outcome when you feel this ‘mismatch’ between your feelings and your body. This unhappiness is increased by having to live as ‘men’ or ‘women’ where the norms associated with being ‘men’ or ‘women’ are alien to their inner identity. Although transgender individuals do not all necessarily experience depression, it is the leading mental health issue they face, and the 41% attempted suicide rate among transgender people is more than 25 times the rate of the general population, which is 1.6 percent. The term can also refer to body dysphoria, as transgender individuals often feel intense disgust with their physical bodies prior to transition.
Gender expression: This refers to the external manifestation of a person’s gender identity. It may or may not conform to the socially-defined norms commonly thought of as either masculine or feminine. This could refer to the way you move, dress, have your hair, mannerisms, physical characteristics, voice etc.
Gender identity: Your gender Identity is your own psychological identification or inner feeling of yourself as male or female. It may also be referred to as your ‘core’ identity. Whilst for most people their gender identity and sex broadly correspond, for transgender individuals their gender identity and sex (physical sex) do not match.
The concept that gender only exists along binary lines (male or female) is a questionable presumption, but still one mostly accepted until gender variant understanding and knowledge improves.
Also, ‘sexual identity’ is not the same as ‘gender identity’.
Gender identity disorder (GID): A condition identified by psychologists and medical doctors wherein a person who has been assigned one gender at birth identifies as belonging to another gender. This is the clinical diagnosis. Many now prefer to use the terms ‘gender dysphoria’ or ‘gender incongruence’, removing the negative idea often associated with the term GID, where the word ‘disorder’ can sometimes be wrongly seen to imply the condition is a mental illness, which it is not.
Gender variance, gender dysphoria, and gender identity disorder (GID) are natural parts of human development, just not part of that ‘norm’ experienced by the majority. According to DSM-IV-TR, Gender Identity Disorder is the diagnosis used when a person has (1) a strong and persistent cross-gender identification and (2) persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex, and the disturbance (3) is not concurrent with physical intersex condition and (4) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Genderqueer: A person who identifies their gender as not conforming to the traditional western model of gender as binary i.e man OR woman, and/or who presents a gender that is mixed or androgynous. The terms androgyne or polygender are also used.
Gender reassignment surgery: This refers to the treatments that individuals take to permanently transition, such as hormone therapy, different surgeries etc and which bring the sex characteristics of the body more into line with their core gender identity. See also ‘gender confirmation treatment/surgery’.
Gender role: This is our social role, how we behave in society, or how we interact with others and how we express our gender identity. Typically, these ‘roles’ are conditioned by norms expected by society from what is appropriate or expected from men and from women; e.g. type of subjects studied, choice of employment, manner of dress, familial duties, leisure pursuits, appearance etc.
Society still presumes conformity to its ‘rules’ regarding adapting a gender role appropriate to your sex rather than your inner gender identity. I.e. if you are physically male you must act in a masculine way. Operating outside these expectations can cause anxiety, even personal danger.
Gender variance: Gender identity is not determined by physical sex i.e. genitalia. When someone behaves or dresses in ways outside of societal norms for their perceived gender, their actions can be described as gender variant.
Genital reconstruction surgery (GRS): May also be referred to as ‘genital reassignment surgery.’ These are the surgical treatments undertaken by transgender individuals to better align their physical bodies with their core gender identity.
For transgender women this is usually the process of orchidectomy, or removal of the testes, and vaginoplasty, where the outer skin of the penis is surgically inverted to create a clitoris and vagina.
For transgender men this is usually the process of constructing a phallus/penis from an individual’s own donor tissue (phalloplasty), or the process of ‘freeing up’ the enlarged clitoris so that it is presented on the body in a more phallic/penis-like manner (metoidioplasty). Scrotal implants may or may not be added during these procedures.
Hate crime: Refers to any incident, which constitutes a criminal offerce, perceived by the victim or any other person as being motivated by hate or prejudice. Transphobia is a hate crime.
Heterosexual: A person attracted to those of the other traditional gender.
Hormone therapy: This is the administering of the sex hormones of the non-birth sex to affect the development of feminine or masculine secondary sex characteristics. For most this is effective, therapeutic, and safe and it continues for life. Androgens (testosterone) are used for transgender men; estrogens and anti-androgens for transgender women. The goals of the therapy are to help the individual achieve a more feminine or masculine appearance. The benefits are not just from the changes which improve passing and reduce social stigma, but also derive from the psychological affect of the individuals’ knowing they now have the ‘correct’ hormones.
Hysterectomy: This is the surgical removal of the uterus. This surgery is often undertaken by transgender men as part of their transition, but is not compulsory.
Intersex: The usual definition of intersex refers to individuals born with both male and female genitalia, or genitalia that are not clearly male or female. This condition is sometimes not identified until puberty, when the person either fails to develop certain expected secondary sex characteristics, or develops characteristics that were not expected. The issues of intersex individuals face can be similar to those faced by transgender people, but there can be important differences; one example of such differences could be that an intersex individual might undergo gender assignment surgery whereas a transgender individual would undergo gender reassignment surgery. There are also many different intersex conditions. So while many people born with some intersex conditions are more likely to feel their gender assignment at birth was incorrect and identify as transgender, some do not and will identify male, female, intersex etc.
Keyhole or peri-areolar surgery: This refers to a type of top surgery for transgender men. The type of procedure used will vary dependant on breast tissue; this method is most effective for individuals with very small breasts who have little breast tissue, whose breasts do not sag, or whose breast skin is too tight to perform the double incision method. Using this method, a small incision is made along the circumference of the areola, and the breast tissue is removed via a scalpel or liposuction needle through the incision. The nipple is left attached to the body via a pedicle (a stalk of tissue) in an attempt to maintain sensation. Once the breast tissue has been removed, the skin is pulled tight, and the incision is closed. The nipple may be resized or repositioned.
Lower surgery: see ‘genital reconstruction surgery’.
Mammoplasty: This refers to breast enlargement/augmentation surgery that may or may not take place as part of gender reassignment surgery for transgender women. It would depend on the individual’s need or preference.
Metoidioplasty: Sometimes spelled “metaoidioplasty;”. This is the surgical process of “freeing up” the enlarged clitoris from its connective tissue (the clitoris is typically elongated and changed somewhat in appearance from testosterone therapy) so that it is presented on the body in a more phallic or penis-like manner (or micro-penis). Scrotal implants may or may not be added. See also ‘genital reconstruction surgery’.
MtF: Refers to a male-to-female transgender individual or transgender woman. This is someone who was born in a male body but whose gender identity is female. Usually, male-to-female individuals will seek hormonal and/or surgical treatment in order to live successfully as women in society.
Oestrogen: Drug used as part of the hormone therapy for transgender women along with anti-androgens. May be given through a pill, transdermal patch, or injection; each form of oestrogen has its advantages and treatment must be tailored to the patient. Therapeutic effects generally include breast development (after two years of therapy, no further growth is expected; patients with large-breasted female relatives and younger patients typically have the most development), expansion of the nipple-areolar area, redistribution of body fat from the abdomen to hips and thighs, testicular, prostate atrophy (lowering the risk of prostate cancer, especially in persons
Oophorectomy: Refers to the surgical removal of one or both ovaries. This surgery is often undertaken by transgender men, usually in combination with a hysterectomy, as part of the transition.
Orchidectomy (or “orchiectomy”): Refers to the surgical removal of the testicles. This causes sterilization and greatly reduces the production of testosterone. It should not be confused with penectomy, which is the removal of the penis. Some transgender women undergo orchidectomy as an initial stage before vaginoplasty, while others may choose it as their only genital surgery. The term ‘orchidectomy’ is more usual in Europe, with ‘orchiectomy’ more common in the US.
Packing: The process whereby transgender men create a male-looking bulge in their crotch, usually achieved through a home-made or store-bought packer or prosthetic device. Some transgender men do not pack; some find it too hot, others find it uncomfortable and/or inconvenient, and still others find it personally unnecessary. Some pack for the sake of creating a realistic-looking bulge in their pants in order to pass, and some find it an important part of their transitioning process. It depends on the individual. For some, the term ‘packing’ is not an accurate description for the wearing of a prosthetic device as it may be considered more an extension of the body rather than merely a packer.
Passing: This is very important for a transgender person and refers to successfully being perceived as a member of your preferred gender, regardless of actual birth sex.
Penectomy: The surgical removal of the penis.
Peri-areolar or keyhole surgery: This refers to a type of top surgery for transgender men. The type of procedure used will vary dependant on breast tissue; this method is most effective for individuals with very small breasts who have little breast tissue, whose breasts do not sag, or whose breast skin is too tight to perform the double incision method. Using this method, a small incision is made along the circumference of the areola, and the breast tissue is removed via a scalpel or liposuction needle through the incision. The nipple is left attached to the body via a pedicle (a stalk of tissue) in an attempt to maintain sensation. Once the breast tissue has been removed, the skin is pulled tight, and the incision is closed. The nipple may be resized or repositioned.
Phalloplasty: This is the creation of penis, with or without urethra and is a type of genital reconstruction surgery for transgender men. The phallus/penis is constructed from an individual’s own donor tissue (usually taken from the forearm, leg, and/or abdomen) that has been shaped and grafted into place. Phalloplasty operations are usually done in stages requiring multiple surgeries. Scrotal implants may or may not be added. See also ‘genital reconstruction surgery’.
Phenotype: The set of physical characteristics of an individual resulting from genetic make-up.
Polygender: A person who identifies their gender as not conforming to the traditional western model of gender as binary i.e man OR woman, and/or who presents a gender that is mixed or androgynous. The terms androgyne or genderqueer are also used.
Post-op (also post-operative): Transgender individuals who have undergone one or more gender reassignment surgery procedures.
Pre-op (also pre-operative): Transgender individuals who have not or not yet undergone gender reassignment surgery, but who are intending to complete same. They may or may not take hormone therapy. Remember, transgender people do not need to have any surgery in order to affirm their gender identity
Prosthetic device: This is a packing device (or ‘packer’) used by transgender men. It may also double as an ‘STP packer’ if it can also be used to urinate through while standing up (STP = Stand To Pee).
Real life experience (RLE): This refers to the period of time in which a transgender person is required to live full time in the role of the gender with which they identify before the medical community will begin the medical gender reassignment process. (i.e., a transgender woman born physically male but with a female gender would in RLE be living full time as female)
Secondary sex characteristics: These are the physical traits that characterise a body as more ‘male’ or ‘female’ in appearance, but that are not directly part of the reproductive system. They include facial and body hair growth, muscle development, fat pattern distribution, voice changes, and breast development, etc.
Sex: The medical term which refers to our genital appearance at birth and then to our male/female biological development (phenotype); our physical build, external appearance, internal organs and our brain, all of which differ between men and women. Telling someone’s sex is usually medically very simple. In an infant, the sex is judged entirely on the genital appearance at birth. Other phenotypic factors such as karyotype (chromosomal configuration) are seldom tested unless a genital anomaly is present. The gender of an individual is a key matter of personal identity which may not be determined by physical characteristics present at birth.
Sex change operation: This term is now rarely used as it is a distortion of what actually happens. When undergoing surgery the individual is not changing their sex, just realigning their bodily sex characteristics to better match their core gender identity, which has never changed. E.g. a transgender man is not changing sex to become a man, but is already a man and now undergoing treatment to realign bodily characteristics. See ‘gender reassignment surgery’.
The term ‘sex change’ is often used in a derogatory manner and should be avoided.
Sexual orientation: Sexual orientation is an entirely separate issue from gender identity. Many people confuse the issues of sexuality and gender. But transgender people, just like everyone else, may be orientated towards men, women, both, or neither. Therefore the sexual orientation of transgender people can be straight, gay, lesbian, bi or asexual. Their sexual relationships may remain the same through the transition process, or they may change.
Stealth: Refers to the position when a man or woman who has already transitioned into a different gender has not disclosed this to others. Term often used in a derogatory or accusatory manner.
Stereotype: A stereotype is a commonly held, but oversimplified and often inaccurate, belief about the characteristics of a group of people. Transgender individuals are often negatively stereotyped.
STP device: This is short for ‘Stand to Pee’ device used by transgender men, which is a device designed to aid the user in standing to pee at a urinal or toilet.
Surgery: Individuals with gender dysphoria may or may not have surgery and, if they do, they may have one or more types of surgery, depending upon their circumstances and/or preferences. For some, surgery is not essential to resolve their gender dysphoria.
Numerous terms are used to describe the genital surgeries that some people may undergo, including ‘gender affirmation surgery’ (GAS), ‘gender reassignment surgery’ (GRS), ‘genital reassignment surgery’ (GRS), or ‘genital reconstruction surgery’ (GRS), amongst many others. Occasionally, ‘realignment’ is used instead of ‘reassignment’ or ‘reconstruction’. Many people also now consider ‘sex change’, ‘sex change operation’, ‘sex change surgery’, ‘pre-op’, and ‘post-op’ as derogatory terms so these should be avoided.
Sometimes individuals have very strong feelings over which term they prefer; clinicians should listen and bear this in mind, though usually ‘genital surgery’ will cover all bases. For example, ‘lower surgery’ is generally preferred instead of ‘bottom surgery’.
- Some may have an orchidectomy.
- Some may have a hysterectomy and a bilateral oophorectomy.
- Some may have breast augmentation.
- Some may have ‘top surgery’.
- Some may have “facial feminization surgery” (FFS).
- Some may have a tracheal shave (chondrolaryngoplasty) to reduce the Adam’s apple.
- Some may have surgeries to alter the pitch of their voice.
Testosterone: This is often shortened to ‘T’ and is the drug used in hormone therapy for transgender men, usually given by injection. It is an androgenic hormone responsible for producing masculine secondary sex characteristics and the therapeutic effects generally include deepening of the voice, redistribution of body fat from hips and thighs to abdomen, increased lean body/muscle mass, increased libido, increased facial and body hair, coarsening of the skin, urine and body odour changes, thickening of the laryngeal prominence, thickening of bones in the face, increased energy, decreased or absent periods, and positive mood. What doesn’t change: breast size, pelvic structure, and height.
Top surgery: see ‘chest surgery’. This is a term most often used by transgender men to refer to the removal of breast tissue, relocation and resizing of nipple complexes, and chest reconstruction to a male chest structure.
Tracheal shave: a surgery sometimes obtained by transgender women to greatly reduce the appearance of an Adam’s apple.
Trans: an ‘umbrella’ term that may cover the whole range and diversity of gender identity and expression which falls outside usual norms.
Transgender:
Transgender is a term that has come to replace ‘transsexual’ in everyday speech. It is sometimes confusingly used as an ‘umbrella’ term covering a very wide range of conditions. Focus: the Identity Trust does not endorse or encourage the use of ‘transgender’ in this way and reserves it for people who have transitioned on a permanent basis from one gender to another. The important aspect of this transition is that it is permanent. For a variety of reasons, it may or may not involve surgical or pharmaceutical intervention. Not all individuals who have transitioned on a permanent basis have surgery or treatment with hormones. Most importantly, the condition of being transgender should not be confused with being a cross-dresser, a transvestite, or a drag queen/king.
Transition: Refers to that period of time when transgender individuals change their gender expression and/or physical appearance to align the above with their gender identity. They transition from their birth assigned sex to that of the gender they really are. They may do this through hormones and/or surgery but the nature of their transition varies depending on the needs and desires of that individual. They may choose any combination of social, medical, or legal steps to enable them to be comfortable with their body or gender role. It involves a permanent change of gender role in all spheres of life, with family, friends, co-workers, and society in general, along with the changing of name and/or gender on various legal documents.
Some transgender individuals make this change overnight, but for many it is a gradual set of changes over time. Because of this, it can be difficult to determine when transition begins or ends. For some, transition begins when they begin hormones, for others it may be when they tell their families. Some might feel it begins when they change their name. Likewise, how long transition lasts can depend on the individual. For some, they may feel in transition for a few years while the hormonal changes take effect and/or the surgeries take place, after which their transition is complete. For others who elect not to undertake surgery, some may feel forever in transition, while, alternatively others feel that they have reached the point to which they are happy to go and so have finished transition for them.
In short, transition means different things to different individuals and it is best to take your lead from the feelings of the transgender individual involved. In the same way, some transgender individuals find the term ‘transition’ offensive and prefer the terms ‘gender affirmation’ or ‘process of gender affirmation’. It is again; best to follow the lead of the transgender person in question as to what they prefer.
Transphobia: Term to describe the irrational fear, hatred, dislike of and discrimination towards those whose gender identity and/or gender expression do not conform to traditional or stereotypical gender norms. It also covers an associated range of negative attitudes and feelings towards transgender people, usually based on ignorance, misconceptions, and negative stereotypes. It can lead to either accidental or deliberate prejudice, discrimination and harassment which can be subtle or obvious, and also to verbal and physical attacks on transgender people.
Alternate terms; cissexism, transprejudice, trans-misogyny (against transgender women), trans-misandry (against transgender men).
Transphobic: Refers to a person, words, or actions perceived to derive from feelings of transphobia.
Transsexual: Term used to describe an individual whose gender identity does not match the sex assigned to them at birth. Usually, transsexual individuals will seek medical help through hormones and/or surgery to align their bodies with their gender identity, though neither is necessary to be transsexual.
It can be regarded as safer for clinicians not to use this term unless the transgender individual requests that they do, because though the term transsexual remains strong in the medical community owing to DSM’s prior use of the diagnosis, ‘Transsexualism’, it is now regarded as an out-of-date, misleading, sometimes even pejorative term. It implies a focus on sexual identity, whereas the issues are of gender, not sexuality.
For that reason, transgender individuals often prefer the term ‘transgender’ to that of ‘transsexual’ because it places the focus correctly on gender identity rather than sexual identity. So while the terms ‘transgender’ and ‘transsexual’ are frequently, and erroneously, thrown into the gay, lesbian and bisexual forum they refer to an entirely separate aspect of identity.
Transsexualism: Term referring to being transsexual..
Transvestites: Refers to individuals who wear clothes of another gender/sex. Transvestites can fall under the same umbrella as transgender, but they are not transgender. They may cross-dress for reasons such as sexual gratification or fetishism, but usually have no desire to change themselves or their bodies, and no dysphoria regarding their sex, gender identity and gender role. This means that there is a huge deal of difference between on one side transvestites, cross-dressers, drag artists etc. and on the other, transgender people. As the word ‘transvestite’ is often, unfortunately used in a derogatory sense, the term, ‘cross-dresser’ is often preferred. See also: ‘cross-dresser’.
Vaginoplasty: Refers to the surgical creation of a vagina whereby the skin of the foreskin and penis is typically inverted to form a fully sensate vagina. A clitoris supplied with nerve endings can also be formed from part of the glans of the penis. It is usually started with bilateral orchidectomy. See also, ‘genital reconstruction surgery’.
Variation of sex development (VSD): This is another term for ‘intersex’ and is preferred by some medical practitioners and intersex people in place of DSD (Disorder of Sex Development) as it removes any stigma from inclusion of the word ‘disorder’. See ‘intersex’.
