Gender transition

A gender transition is the multifaceted process when individuals change their sex characteristics and/or gender presentation to reflect their gender identity, not due to social pressures or mental disorders, but due to an acute feeling of fundamental discontent with the sex to which they have been assigned (gender dysphoria). In the past, individuals who transitioned (or wished to transition) from one major sex to another were termed transsexual and were often divided into pre-op and post-op, but this terminology is now considered out-of-date and potentially offensive unless the individual identifies that way. Far more common today among all types of trans people is the more general term transgender or even simply "trans"; some trans people, of course, prefer even more general terms like queer, but like transsexual, this term should not be applied to people who do not themselves identify as such. Transitioning is a complex process consisting of social, medical, and legal aspects, and not all trans people may desire to go through all elements.

Initial results support transition as an effective treatment. Major medical associations have made statements in support of gender transition. The latest DSM, the APA's comprehensive list of psychological conditions, depathologized "gender identity disorder" by declassifying it as a disorder. The condition was replaced with gender dysphoria, which refers only to the distress and discomfort that trans people may have, and not the identity itself.

Definitions

 * Although definitions of "transsexual" and related terms like "transgender" are currently in something of a state of flux, the general tendency is for "transgender" to refer to all gender-variant people, and for "transsexual" to refer to the more specific cases of women who were assigned male at birth (transsexual women) and men who were assigned female at birth (transsexual men). "Transsexual" has largely fallen out of favor, mainly because the "sexual" part implies sex and sexuality. It is also often used in the context of trying to exclude nonbinary people or transgender people who do not necessarily want certain surgeries even if they would be effective in a physical sense (see: truscum).  The shortened form "trans" can be short for either "transgender" or "transsexual."  These terms are also preferably used as adjectives (i.e., transgender people) rather than as nouns (i.e. transgenders).


 * "Transition" can be used as either a verb ("She has been transitioning since last month") or a noun ("I will begin my transition"). There is no fixed definition of when a transition is over, since not all trans folks desire to do everything.  Transition is often an ongoing process that can take years of adjustments.  Never ask a trans person "Is your transition complete?"


 * Being trans is not an acquired state. There is no such thing as "becoming trans."  One does not become trans when one gets a certain surgery, starts hormones, or changes one's name.  Many transgender people describe being trans from birth.  However, one does begin transitioning.


 * The terms "Trans(gender) man/woman" are used with respect to a person's gender identity; a trans woman is someone who was assigned male at birth but identifies as a woman.


 * Gender and sexuality are separate concepts; transgender people can have any sexuality that cisgender (non-trans) people can. Also, sexuality is defined in terms of a trans person's gender identity, not the gender they were assigned at birth; a trans man attracted to women is straight, and a trans woman attracted to women is a lesbian.


 * A social transition is a gender transition that doesn't involve any medical or surgical interventions. It is common among people who are waiting for hormones, who are younger, or who are not sure if they want to medically transition, or who just don't feel significant physical dysphoria. Social transition can also refer to parts of someone's transition that involve interacting with other people, such as using a new name or different pronouns.

Misconceptions

 * Trans women are simply men who are so enamored with femininity that they go so far as surgery to emulate it ("autogynephilia") This is a recent point of view floated most notably by weirdos and trolls such as Ray Blanchard, Ann Lawrence and J. Michael Bailey, based largely on junk science and speculation. Aside from a great many criticisms of the concept that this is simply a love of women taken too far, it utterly ignores the existence of female-assigned-at-birth transgender individuals. Although autogynephilia is widely rejected for rational reasons, some people do openly identify as autogynephiliacs as it describes their personal experience quite well.  The more important thing is to remember that theories advancing this idea assert that all transgender people are either homosexuals or autogynephiles. Also of note is that some radical feminists assert this same idea, and feel that transgender women are the male 5th column coming in to literally rape the last sacrament of femininity, their very bodies.
 * Trans men are really butch lesbians. A claim frequently repeated by trans exclusionary radical feminists, who also claim trans men are simply deluded, brainwashed women who don't know their own minds. Poet Jay Hulme ably breaks down the misogyny in this world view in his essay "Transphobes and Trans Men" . This myth also completely ignores transgender men who aren't attracted to women at all.
 * Trans men are simply women who want to profit from male privilege. While trans men who "pass" (that is, having your gender perceived correctly when interacting with other people) do benefit from male privilege, this is a by-product of transition and not its primary aim. Similar to the myth about immigrants coming here to live off benefits (wherever "here" is), it paints people as parasites and erases their contribution to society.
 * Trans people are really homosexuals who wish to avoid social stigma by actually becoming the "opposite" sex This is often presented together with the above AGP concept, and is no more well founded. Proponents tend to note though that "homosexual transsexual people" are so effeminate that they are unable to function in life as men, and are typically able to pass so well, that they can live in "stealth" afterwards. Again, it does not recognize the existence of trans men, but further suggests that gay men would try to escape the social stigma of being gay by embracing the far greater stigma associated with being transgender. This is a bizarre concept at best. Why a person would flee a socially stigmatised identity to take up an even more stigmatised identity is a question as yet unanswered. And, again, this myth ignores the existence of transgender women who are lesbians and gay transgender men who would be perceived as straight before coming out.
 * A little therapy or a good fuck is all they need to snap out of it. This misconception ignores that the psychiatric community requires transgender people to have extensive therapy in order to receive treatment, and many who transition later in life have led a fairly successful sexual life. This view is commonly shared about cis LGB+ people too, as people believing this misconception have difficulty distinguishing the two subjects of being transgender and being gay.  Moreover, medical treatment for transgender people is typically dependent upon a course of therapy. Whilst originally introduced to hinder trans people, this now serves to prevent harm by helping transgender people through the process of transition in some countries. It should be noted that recently there is a trend for  clinics that provide hormone replacement therapy without requiring psychological evaluation. This is widely seen as a good thing among trans rights activists due to previous extensive medical gatekeeping, mistreatment, and dehumanisation.
 * Gender and physical sex are the same thing. There is a distinction between a person's identification and personality (gender), and their physical features and properties (sex). Most people perceive them to match enough that they assume they match for everyone else. Transgender people can undergo procedures to alter their sexual characteristics to bring them in line with their gender identity.
 * Transgender people may satisfy their urges with occasional role-playing or crossdressing. This is often akin to reparative therapy in cis queer people, where the individual suppresses natural urges or identification in order to appear "fine". This can be due to a number of reasons, such as fear, family pressure, or simple uncertainty about the concept or transitioning.  However, many find they cannot maintain this false front, and proceed to transition at some later date.  It is also notable that crossdressers are seldom transgender, though some crossdressers may later realize that they are better served by transitioning.
 * Transsexual and transgender are interchangeable terms. Like LGBT, transgender is an umbrella term, whose exact definition is subject to much debate, but generally covers any person whose gender expression or identity is considered "abnormal" by society.  "Transsexual", on the other hand, refers to people who have undergone medical transitions from surgeries, and does not cover gender expressions which do not involve medical transition.  Some transsexual people do not wish to be identified under the "transgender" umbrella and find it highly offensive to be referred to as "transgender" or "trans," though others accept umbrella terms for the purposes of political alliance and do not find them offensive. Today, most transgender people object to the term "transsexual," believing that it makes their identity seem sexualized and because it is often used in the context of trying to exclude nonbinary people or transgender people who do not necessarily want certain surgeries even if they would be effective in a medical sense.
 * Transgender persons are gender variant. Transgender people can prefer to conform to gender norms—or not, just like cisgender people.  Even those that have criticisms of their culture's gender norms often would prefer not to have to assert their gender to every individual they encounter 24/7, or to risk violence and street harassment for their transgressions. In the past, medical professionals actually required transgender patients to dress and act in an extremely stereotypical way for their target sex in order to qualify for treatment, though in some places such standards have been relaxed so that transgender people do not have to adopt an exaggerated presentation.
 * "Tranny" is an endearing and acceptable term for trans people. The term "tranny" is almost always used as an anti-transgender slur, and as such, most people find it highly offensive, on the level of calling a gay person a "faggot". Some trans people reclaim the term and use it for themselves, but as with other minorities that reclaim slurs in this way, it is absolutely not a polite or acceptable term for non-trans people to use.
 * It is acceptable to use "transgender" as a noun. Referring to somebody simply as "a transgender" is generally perceived as offensive (at least in the English language), just as referring to someone as merely "a cisgender" would be. Instead, we use "transgender" as an adjective; there are trans men, trans women, people who are gender fluid, etc.
 * Transitioning is purely cosmetic. Hormones can change a person's physiology beyond their appearance. Metabolism, fat and muscle distribution, strength, body odor, eyesight, sense of smell, and emotions can be affected by hormones.  Transmasculine people on testosterone will notice an increase in potential muscle mass; transfeminine people on estrogen notice the opposite. Most sex differences are caused not by chromosomes and genitals, but by hormones.  Trans people who transition early enough never go through their assigned sex's puberty, and taking hormones will induce their identified gender's puberty.
 * Transitioning is conversion therapy. First, we need to define what conversion therapy is. The Trevor Project defines it as "several dangerous and discredited practices aimed at changing an individual’s sexual orientation or gender identity" . Transitioning is changing one's gender presentation or sex characteristics to accord with one's internal sense of gender identity, none of which fits the definition of conversion therapy.

Relationship to homosexuality and bisexuality
Sexuality for trans people is usually expressed in terms of gender identity, for example, a trans woman attracted to women would be a lesbian (not straight),, and a trans woman attracted to men would be straight (not gay). Similar standards apply for trans men. Of course, a bisexual is a bisexual no matter what,. It is thus possible for an individual to have multiple "letters" on the LGBT spectrum.

Due to oppression, violence, lack of legal protections and misunderstanding, most people in these rarer sexual sub-categories tend to try to work together for legal rights and social acceptance, hence the LGBT (etc.) umbrella "label". The symbol of the Rainbow Flag indicates the range of healthy expression of sexuality in humans, and the political need for us to accept each other equally.

However, despite the symbolism of the Rainbow Flag, transgender people are often not afforded the same inclusion as other groups under the umbrella.

Also, Washington HB 2661 which granted discrimination protection to the LGBT community, only added protection for "sexual orientation", which was defined to include "gender identity and expression." While whatever argument can be made to justify this action, it still shows an ignorance of the gay and lesbian community about what motivates transgender people to consider themselves as such.

Medical aspects of transition
Sex reassignment therapy, or medical transition, traditionally involves three stages: therapy, hormones, and then surgery. This three tier approach is ordered such that a person can avoid going further than they're comfortable with.

Psychotherapy and gatekeeping
In some countries, a psychiatrist has to certify that the patient suffers from gender dysphoria and has no other mental health problems before hormone therapy can be started.

In the past, psychologists would require "Real-Life Experience", i.e., living "full-time" as their identified gender, before starting hormones. This could include getting one's name legally changed, changing one's wardrobe completely, and often presenting as one's desired sex to every friend and stranger for up to a year. Proponents for this step often point out that it could show whether or not a person is serious about transition. However, there are a few problems. First, it can be humiliating. Trans people often need hormones to "pass." Being perceived as a cross-dresser is different than being perceived as a woman or man, and hormones often make that difference. Second, it plays on gender stereotypes and ignores the fact that gender dysphoria often goes back to the body, not social roles. Third, it can be seen as a form of hazing ritual. Fourth, it can be extremely dangerous to be visibly trans. As such, the WPATH no longer requires real-life experience for hormones, just therapy. Still, some psychologists (particularly in Europe) still require it.

Within the transgender community there's a considerable amount of debate over the value of gatekeeping protocols; self-medicating with hormones is surprisingly common for those who feel that they're being forced to jump through hoops, and quite a few transgender people have felt forced to overpresent as their target gender -- to express what to them seems to be unacceptable levels of bimbosity or machismo, frequently -- in order to be taken seriously as transgender by their doctors and to continue receiving hormone therapy. Such gatekeeping is also extremely hostile to nonbinary people in most cases, and hence most advocacy for it from within the trans community is done by truscum.

As a result of said gatekeeping, there's a number of clinics that will provide hormones to those who ask for them, given a statement of informed consent and medical clearance. There is also a trend for affirmative talk therapy, where the point is to simply make sure the person has gender dysphoria as well as help them cope with society.

Past and current gatekeeping methods
There are many ways in which access to medical transition is gatekept from transgender individuals, most prominently the conservative parts of psychiatry. In both past and current eras, psychiatrists and therapists are normally how transgender people get access to medical transition.

Beyond the typical gay conversion therapy types, there are many other forms of gatekeeping individuals. For instance, therapists who in effect try to convince trans people they are not trans - this is "reparative therapy", known by most people as "gaslighting and/or torture". Of course there is no evidence this actually works, and the current scientific research suggests gender identity is an emergent property of neurobiological structures. Hence, such "reparative therapy" is the scientific equivalent of screaming and kicking at a block of wood to convince it it is metal, except that block of wood is a real human being with emotions and the capacity for autonomy, most probably terrified and depressed from abuse.

Another group of people (who are far more common than those that literally try to tell transgender people they are not who they are) are the doctors that spread misinformation about transition, either unintentionally or to convince trans people not to transition in the unscientific belief that transition is ineffective, or for purely religious reasons.

Furthermore, the common kind of "are you really trans/needing transition?" persistent questioning over years is directly responsible for long waiting lists in various health services. The actual production and access for hormone replacement therapy is extremely cheap to do - the cost is solely there to gatekeep trans people, and the long waiting times are responsible for extreme amounts of harm. "Of all trans respondents who had accessed or tried to access, 80% said that access had not been easy (rating 1, 2 or 3 out of 5 for ease of access), and 68% said that the waiting lists had been too long... ... a picture was painted of hard-to-access services, a lack of knowledge among GPs about what services are available and how to access them, and the serious consequences of having to wait. We know from other research that trans people have very high rates of self-harm (for example, a trans mental health study found that around 53% of trans survey respondents have attempted it at least once)" -- to quote the survey. This specific survey is UK-specific, however many of the same problems can be found across Europe.

The myth of high detransition rates
Many people will claim transgender people experience regret over transition and detransition at a very high rate, and that they do so because they realise they are not transgender. However, looking at the scientific literature would indicate otherwise:

For instance, looking at a 1998 meta-study we see that they found 20 MTF transitioning people and 5 FTM transitioning people who regretted transitioning due to gender identity. The number of people in the metastudy is estimated at 1000-1600 MTF transitioning people and 400-550 FTM transitioning people, which puts detransitioning due to realisation of non-transness at 1-1.5%, however the study notes that the numbers are so small for detransitioners that any such percentages would be inaccurate. This study does not include intersex or nonbinary people.

Many more recent studies come to similar conclusions. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015) reported "0.6% of transwomen and 0.3% of transmen who underwent gonadectomy were identified as experiencing regret".

Looking specifically at the US National Transgender Discrimination Survey we see that only 5% of those who detransitioned (themselves 8% of the sample) did so because "They realised gender transition was not for them" - which is around 0.4% of the overall sample. 35% had an unlisted reason for detransitioning at some point, however based on the other studies this probably has little to do with realising they weren't trans. The other reasons for detransitioning were due to social hostility (the largest cause being parental pressure at about 36% of detransitioners and the next highest were difficulty in transition, harassment, and the risk to job access). Note that participants could list more than one reason (hence why the percentages don't add to 100%).

It's important to note that these studies do measure regret rates at different parts of a traditional medical transition. Many of the earlier studies are based solely on gender-affirming operations. In those studies that measure it, it is usually found that access to is more important to transgender people. However, some of these studies also rate detransition after HRT, with similar detransition rates due to realisation of non-transness to those measuring detransitions after gender-affirming operations.

Fundamentally, this shows that long periods of medical gatekeeping for trans people have almost no benefit - because such long periods of delay are extremely harmful to trans people and almost no cisgender person will end up accidentally transitioning. Should they try and start HRT, they'd almost certainly experience gender dysphoria rapidly and stop before anything irreversible occurs - though studies on this are extremely thin on the ground because they are highly unethical.

Gatekeeping in many cases is an attempt to have someone prove an internal gender identity to another person, a nigh-impossible task. Furthermore, fretting about the extremely rare theoretical harm to a cis person as more important than helping a much larger number of trans people who could be harmed or killed from delayed transition due to gatekeeping is an indication of some pretty questionable opinions.

Naturally, some detransition cults doubt that and instead they use their "research" in order to instill fear in transgender people. However, their own sources are often either unreliable or they themselves prove them wrong. In this case, only 2 out of 222 people have regretted transitioning. We don't know whether they have completed or dropped out of treatment. Even if detransition rates are high, let's say 15%, it's still better than most other medical treatments. The large amount of data debunking this was compiled on Reddit.

Claims about suicide risk
It is sometimes claimed that there is a high rate of suicide among post-transitioning people, indicating regret at the transformation or the failure of gender transition to solve their problems or make them happy. Usually cited as evidence is a long-term Swedish study published in 2011. This concluded:"Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."

However for assessing the success of transitioning, a more relevant comparison would be with gender-non-conforming people who do not transition. Studies show that suicide rates pre-transition are also very high, indicating that non-transitioning individuals are also at risk. A meta-analysis by researchers at Cornell University said: "We identified 56 studies that consist of primary research on this topic, of which 52 (93%) found that gender transition improves the overall well-being of transgender people, while 4 (7%) report mixed or null findings."

Assessing suicide or mental illness rates is complex because of the many stressors that transitioning people may face, including a worsening relationship with their family, discrimination at work, losing their home, bullying and harassment, the end of a relationship with spouse or partner, loss of contact with children, domestic violence, poverty, harassment from law enforcement, and inability to access medical care. The researchers at Cornell concluded, unsurprisingly, "The literature also indicates that greater availability of medical and social support for gender transition contributes to better quality of life for those who identify as transgender."

Hormone replacement
In cases where psychiatric therapy leads to the conclusion that a person genuinely suffers dysphoria and should undergo physical gender transition, the Standards of Care used internationally suggest hormone therapy be given. Some people undergoing the therapy seek maximum feminization/masculinization, while others will experience relief with an androgynous presentation resulting from hormonal minimization of existing secondary sex characteristics (Factor & Rothblum, 2008). Hormones can be prescribed either by an endocrinologist or a general practitioner, and users have the option of pills, injections, gel, and patches.

Hormone therapy can provide significant comfort to patients who do not wish to make a social gender role transition or undergo surgery, or who are unable to do so (Meyer, 2009). Hormone therapy is a recommended criterion for some, but not all, surgical treatments for gender dysphoria.

Physical effects of hormone therapy
Feminizing/masculinizing hormone therapy will induce physical changes that are more congruent with a patient’s gender identity.

In transmasculine patients, treatment usually consists of testosterone taken by itself. The effects include, but are not limited to:
 * Deepened voice
 * Clitoral enlargement (variable)
 * Growth of facial and body hair
 * Cessation of menstruation
 * Atrophy of breast tissue
 * Decreased percentage of body fat compared to muscle mass
 * In some individuals, male pattern baldness
 * Becoming hungry and horny Increased appetite and libido

In transfeminine patients, treatment often includes both estrogen and an anti-androgen (testosterone blocker). Effects include, but are not limited to:
 * Breast growth (variable)
 * Decreased erectile function
 * Decreased testicular size
 * Increased percentage of body fat compared to muscle mass
 * Redistribution of fat in a more feminine pattern
 * Reduction of brain volume toward female proportions.
 * Softening of skin
 * Thinning of body hair
 * Change in body odor
 * Changes of one's face
 * In some people under 25, widening of the pelvis

Though it is generally impossible for transfeminine people to reverse all of the effects of their original puberty, such as male pattern baldness, deepened voices, and facial hair, testosterone blockers can prevent said features from becoming worse. Many transfeminine people do report these features reversing to some degree, however.

As with puberty, most physical changes, whether feminizing or masculinizing, occur over the course of two to six years. The amount of physical change and the exact timeline of effects can be highly variable. In transmasculine people, the effects of testosterone on menstruation and fat distribution will generally revert if stopped within a few weeks. For transfeminine people, the effects of hormone treatments become irreversible only after about 3 months.

Surgery and other procedures
Reassignment surgery changes aspects of a transgender person's body to make them physically resemble what is more typical for their identified gender or sex. It is usually divided between "top" surgery (breasts) and "bottom" surgery (genitals). In transmasculine people, this is usually limited to a breast reduction, as the results of creating genitalia for them are typically poor. However, significant work has been done in creating realistic genitalia for transfeminine people. This procedure is referred to as a vaginoplasty. Transfeminine people may also receive a breast enlargement if hormone therapy has not led to the growth of full breasts. Both forms of genital surgery are generally irreversible; reversing surgeries for transmasculine people may find some success, but reversing transfeminine surgeries is impossible.

Another popular surgery among transfeminine people is facial feminization surgery, which sculpts facial features such as the jaw, chin, brow bone, nose, forehead, and Adam's apple into a more feminine configuration. A less common procedure is voice feminization surgery, which modifies the voice box or vocal cords. The surgery may produce favorable results for some people, but it can leave others with a raspy voice, a "Mickey Mouse" voice, or no voice at all! Most transfeminine people simply "train" their voices instead.

Contrary to popular belief, genital reconstruction surgery (GRS/bottom surgery) is usually not the be-all-end-all goal of transitioning, nor is receiving GRS synonymous with transitioning. Some GRS recipients often report that the only changes in quality of life are related to one's sex life. Though it was helpful for them, hormones and other surgeries played a bigger role in alleviating their dysphoria. Some transgender people are "non-op", meaning they do not wish to receive GRS, but do wish to transition.

One common GRS alternative for transfeminine people is the orchiectomy, or removal of the testicles. Likewise, transmasculine people often get full hysterectomies.

Transfeminine people may also seek out permanent hair reduction and removal techniques, including laser, electrolysis, and IPL, to remove their five o'clock shadows.

Social and legal aspects of transition
In addition to hormones and surgery, many transgender people change their social presentation, aesthetics, and legal status. Common aspects of this include:


 * Legally changing one's name
 * Legally changing one's sex marker
 * Updating one's wardrobe
 * Asking others to use one's preferred pronouns, name, and title
 * Adopting new techniques of grooming, such as makeup
 * For pre-op trans men, using a breast binder
 * For pre-op trans women, tucking.

Changing of name and legal sex/gender
Name choice for transgender people is a personal matter that can involve much thought. (Stereo)typically, trans people often pick a name that sounds like their old name, sometimes even a direct equivalent. However, many trans people pick different names, often ones that have personal meaning to them. Some may pick the name they would have been given had they been born as their preferred sex. Not all trans people choose their new name on their own. Trans people with supportive parents may consult their parents in helping them choose a new name; those without parents might have friends, partners, or relatives do it.

Some countries, like France, make undergoing reassignment surgery mandatory before being able to petition for an official identity change, so before being able to insert in society (good luck finding a mainstream job presenting as female while your ID says you're a man). That is often viewed by LGBT activists as an effort to "punish" fully committed trans individuals by making sure they will be sterile; some of these are almost certainly remnants of eugenics programs. Other countries and US states require time spent on hormones, and still others simply require a note from a therapist. The requirements often depend on what document needs to be updated. Most US states allow driver's license changes without surgery, but fewer allow people to change their birth certificates without surgery. Some areas don't allow birth certificates to be changed at all, since they are treated as historical documents that were correct at the time they were written.

Federally, sex can be changed on US passports and in the Social Security database, and no surgery is required. If one's sex status is "transitional", the new passport will last for 2 years, but if it is "complete", it will last for 10 years; the definition of "complete" is up to the doctor signing the form.

The UK offers a "gender recognition certificate" (GRC) that does not require reassignment surgery, but does require two years of living as one's identified gender, however, most trans people find this process humiliating, invasive, and extremely difficult. Upon receiving the GRC, one will also receive a new short-form birth certificate, free of charge. Name changes in the UK are done by filling out a deed poll, having two friends sign it, and sending it in without a court order.

In some countries like the U.S., people can choose any name they want for themselves. (The bassist from The Bangles changed her name to Michael, despite not being trans.) In other countries, name changes have similar requirements to changing one's sex marker. There are no unisex names in Italy or Germany, and the process for changing someone's name can only be done at the same time as changing their sex. Some countries even require a court order before someone can begin medically transitioning.

California makes name changes simpler for trans people by waiving the newspaper publication requirement and sometimes the in-person hearing.

Argentina, the U.S. states of California, Colorado, Connecticut, Illinois, Maine, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, and Utah as well as Washington, DC, and the Northwest Territories in Canada allow people to change the sex on their birth certificates to "Sex: X" if they do not solely identify as male or female, while a number of other countries like Australia and the rest of Canada have the option for other documents such as passports.

Clothing and grooming
Trans people are often challenged when finding clothing because of average differences between AMAB and AFAB bodies. Women's clothing runs smaller than men's clothing, which can put trans women at the top of the women's clothing scale and trans men at the bottom of the men's scale. A trans women with broader shoulders might require a Size 16 dress with sleeves but only wear a Size 12 sleeveless dress. A trans man might have the shoulders of a men's small shirt, but require a medium because of his hips or breasts.

Shoes are the biggest problem item for trans people, especially trans women. Trans men with smaller feet simply buy their shoes from the young men's section of the shoe store. As for trans women, most stores do not carry women's shoes above US size 10 or 11. The average AMAB person has shoe size 10.5, which translates to 11.5-12 in women's sizes. Women's shoes also run narrower, so a wide width may be needed. Trans women often have to custom order their shoes. There are also less options available in larger sizes, and many of them are crossdresser-style. Otherwise, trans women might roll with unisex-style shoes like Converse high tops.

Tucking is the act of inserting one's testicles inside one's body, placing one's penis between one's legs, and securing it all with a gaff (a form of underwear). It can prevent unsightly bulges in clothing, especially swimwear and bodysuits. The FTM equivalent is binding the breasts with a binder, a Spandex undergarment that flattens the chest.

As with many people, trans women can use makeup to enhance the appearance of their faces. Color corrector is used under foundation to hide beard shadow, and contouring can mimic the effect of facial feminization surgery, especially when taking pictures. Contrary to popular belief, not all trans women rely heavily on makeup for passing. Hormones, laser hair removal, and facial surgery can work wonders.

Prejudice and violence
One father described the challenge of empathizing with his child’s fear this way: How would it feel if someone told him that one day soon he would start growing breasts and a vagina? “I’d try to stop that from happening,” he said. Until 2010 and the passage of the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, the FBI did not collect information to determine the prevalence of hate crimes against transgender people. So it is difficult to guess at how common they are out of the entire population, although most are certain that the violence rate is significantly higher than any other group. Combined with a substantially higher-than-normal suicide attempt rate (41%, more than 25 times the rate of the general population ), and the rarity of the condition in the first place, the number of successful transitions is often outweighed by those who do not transition.

The transgender community abounds with tragic stories of individuals killed by others simply for being transgender persons, and police or health care providers refusing to treat. Of particular note, one transgender woman involved in an accident was laughed at and mocked once the police and rescue personnel learned that she was a preoperative transgender person; the delay in her care and treatment was the primary cause of her death. Gwen Araujo is a well-known transgender woman, who was brutally murdered by bludgeoning force when some men, who committed statutory rape against her and forced her to give them oral sex, found out that she was transgender. Another heartbreaking story, is of a trans woman, who was run over repeatedly by her former boyfriend with his car immediately after their break up. The police later classified this tragedy as an accident, even when witnesses insisted that it was deliberate. Trans men also face significant discrimination by doctors when they are diagnosed with cervical, uterine, or ovarian cancer; there may be refusal by the doctors or even the insurance company to treat that cancer.

Bathroom bills
In the U.S., there have been recent controversies over "bathroom bills": laws that say transgender people must use the restroom matching their birth sex.

Proponents cite public safety and privacy. On safety, "Journalists may cite the 18 states and 200 municipalities with explicit transgender protections, none of which have shown an increase in public safety incidents". Predators, whether transgender or using it as a pretext, have not come out of the woodwork (save for a dick in Seattle, WA trying to make a point). Privacy is less of an issue in public restrooms, where people use stalls and men at urinals avoid looking at each other. Proponents also don't seem to consider that hairy, burly trans men would be using the women's restroom.

In contrast, of transgender respondents to the National Transgender Discrimination Survey, 53% reported verbal harassment and 8% physical assault in public places.

There have also been numerous incidents of cis women being harassed for being butch, gay, androgynous, or simply having short hair as a result of these laws.

Despite the fact that the bathroom predator is a myth that has been repeatedly debunked; despite the fact that "bathroom bills" have been proven to expose adult trans people to violence and trans children to increased levels of sexual assault, and that they increase the harassment of cis women, the U.K. government is said to be introducing one in a Sunday Times report.