Transitioning (transgender)

Transitioning is the process of changing one's gender presentation to accord with one's internal sense of one's gender - the idea of what it means to be a man or woman. For transsexuals, this usually includes sexual reassignment surgery, and their new sex is "opposite" that of birth sex; for intersex people it is different from how they were raised; for genderqueer people it is neither solely female nor male. Cross-dressers and drag queens and drag kings tend not to transition, since their variant gender presentations are (usually) only adopted temporarily.

Transition must begin with a personal decision to transition, prompted by the feeling that one's gender identity does not match the gender that one was assigned at birth. One of the most significant parts of transitioning for many transgender people is coming out for the first time. Transitioning is a process, not an event, that takes anywhere between several months and several years. Some people, especially genderqueer people, may spend their whole life transitioning as they redefine and re-interpret their gender as time passes. Transitioning generally begins where the person feels comfortable: for some, this begins with their family with whom they are intimate and reaches to friends later or may begin with friends first and family later. Sometimes transitioning is at different levels between different spheres of life. For example, someone may transition far with family and friends before even coming out at work.

Terminology

Transitioning is sometimes confused with sexual reassignment surgery (SRS), but that is only one possible element of transitioning. Many people who transition choose not to have SRS, or do not have the means to do so. Whereas SRS is a surgical procedure, transitioning is more holistic and usually includes physical, psychological, social, and emotional changes. Some genderqueer and intersex people have little or no desire to undergo surgery to change their body but will transition in other ways.

Passing refers to being perceived and accepted by other people as a desired gender identity. This can be one aspect of transitioning, though genderqueer people may choose to purposely not pass. Someone observing, for example, a trans woman passing may know of her trans status but still considers her a woman. Drag queens generally present with exaggerated female and feminine characteristics (e.g. heavy make-up, suggestive clothing, excessive jewellery) whereas drag kings present exaggerated male attributes and hyper-masculine personas.

The real life experience, "RLE", or Going fulltime refers to a person living one's everyday life as one's chosen gender identity. One's passing can be limited by safety, legal or bodily restraints. For instance, someone who has worked at a job as female may feel one cannot safely present as male and may switch jobs instead. Psychiatrists and psychologists using the WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People will normally require an RLE of a year's duration before recommending surgery.

Going stealth means to live as a gender without other people realising a person is transgender. Trans people often go stealth in public but not with family, partners, or intimate friends. There have been many cases of people who have lived and worked as a gender identity opposite of their birth gender. See Category:Transgender and transsexual people for some examples.

Various aspects

Transitioning is a complicated process that involves any or all of the gendered aspects of a person's life. Below are some common parts of transitioning. People may choose elements based on their own gender identity, body image, personality, finances, and sometimes the attitudes of others. A degree of experimentation is used to know what changes best fit them. Transitioning also varies between cultures and subcultures according to differences in the societies' views of gender.

• Coming out
• Gender role changes
• Legally and/or socially changing their name to something consistent with their gender identity
• Asking others to use a set of pronouns different from before
• Having one's legal gender changed on their driver's license, ID, birth certificate, etc.
• Personal relationships take on different dynamics in accordance with gender
• Altering objects worn to better represent gender identity
• Adopting mannerisms consistent with the new gender role
• Any surgery and/or hormone therapy
• Changing their voice's pitch and/or vocal resonance
• Sexual acts, especially if the body's sex organs have changed
• A person's ideas about gender in general may change which may affect their religious, philosophical and/or political beliefs
• Passing or going stealth

Real-Life Experience

Real-life experience (RLE) is a process where transsexual and transgender people live full-time in their preferred gender identity for a period of time, in order to demonstrate that they can function as a member of said gender. Functioning in their preferred gender includes some or all of the following abilities, as reviewed by the person's clinician:

• To maintain full or part-time employment
• To function as a student
• To function in community-based volunteer activity
• To acquire a (legal) gender-identity-appropriate first name
• To provide documentation that persons other than the therapist know that the patient functions in the desired gender role.

Historically, this process was a prerequisite to receive permission for hormonal treatment and sex reassignment surgery.

A minimum requirement of RLE is no longer part of the World Professional Association for Transgender Health standards of care (SOC) requirements for hormonal therapy. Either three months of RLE or a specified time in psychotherapy (usually at least three months) now suffices. The current SOC states: "Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person's responsibility."

With respect to genital surgery, a continuous 12 months of RLE is a requirement. A year containing intermittent periods of returning to the original gender are not considered to fulfill the RLE criteria for surgery. The SOC states: "Individuals cannot receive genital surgery without meeting the eligibility criteria.... The SOC provide for an individual approach for every patient; but this does not mean that the general guidelines, which specify treatment consisting of diagnostic evaluation, possible psychotherapy, hormones, and real-life experience, can be ignored."

However, clinical practice in many places may be more or less stringent. In the United Kingdom, most National Health Service trusts will require 24 months before surgery, whereas in Thailand, some surgeons do not require the completion of the RLE.

See also

• List of transgender-related topics