Trans 101: FAQ
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Q: Why can’t transgender people just be gay? / Isn’t transition homophobic because it forces gay men and lesbians to become straight women and straight men?
Being gay is about who you love. Being transgender is about who you are. Many trans people first experience gender dysphoria in childhood, long before puberty or any sexual feelings.
It’s a common misconception that transgender people are simply extremely feminine gay men or extremely butch lesbians who think life would be easier as a straight woman or man, or to make it easier to attract partners.
However, like everyone else, transgender people can be straight, gay, bisexual, asexual or any other sexual orientation. For example, some transgender men are attracted to men, and being told to “just be lesbian” would not address their discomfort with their sex.
Q: Why can’t transgender people just be feminine men or masculine women? / Doesn’t this reinforce sexist stereotypes about what men and women ‘should’ be like?
Another common misconception conflates gender expression (being masculine or feminine) with gender identity (being a man or woman). People point out that just because a girl might enjoy stereotypically male activities like sports, it doesn’t mean she’s really a boy.
This is true. Many women are not feminine, and enjoy and excel in many things that society typically labels ‘male’. However, they still see themselves as women and wish to be perceived by others as such. When people refer to women, they feel included in that reference. When they think of the opposite sex, they think of men. When they are attracted to someone, they think about being their wife or girlfriend, not husband or boyfriend. When they think of their future, they see themselves as old women, not old men.
The same is true for transgender women. The desire is to be seen as a woman and/or have a typical female body, not to be feminine. Being a feminine man would thus do nothing to address the problem – all the more so if they would feel most right as a masculine woman.
Even if it were the case that all trans women were feminine and all trans men masculine, it would still not be fair to place more blame on trans people for asserting their gender identity. For instance, it would be a double standard to criticise a trans woman for wearing a dress and thus playing into female stereotypes, while not criticising a cisgender woman for doing the same.
Q: Is being transgender a mental illness?
No. While gender dysphoria is considered a mental illness, this refers to the distress experienced from being transgender, and not the state of being transgender itself. Medical authorities recommend transitioning as the appropriate treatment for gender dysphoria. Right now, it is the only solution that has proven to be effective in resolving (rather than suppressing) the condition.
Prolonged untreated gender dysphoria does correlate highly with increased mental health problems that may not fully resolve even after transition, such that many transgender people do suffer from mental illness.
However, many transitioned trans people are as mentally healthy as non-trans people of the same gender, with outcomes strongly affected by factors such as poverty, employment, abuse, and level of social acceptance. Other transgender people experience mild or negligible gender dysphoria and may be mentally healthy regardless of whether or not they decide to transition; for them, transition would make them happier, but they are fine without.
Mental health outcomes have been very positive – sometimes outstripping the general population – in transgender people who transition early in supportive environments. Significant positive effects on mental health are associated with transition in general, especially the start of hormone therapy.
Q: How is being transgender different from believing you’re a duck or attack helicopter?
Someone who truly believes that they are a duck (and isn’t, in fact, a duck) would often fit the criteria of a diagnosable mental illness such as schizophrenia. They would experience other observable symptoms of the illness such as hallucinations or hearing voices. They would likely find it difficult to function on a day-to-day basis. Their delusions involve things that are provably false – for instance, that they have feathers and a beak.
There are also cases where schizophrenic patients experience delusions of being the other sex. However, this manifests in the same way they may believe themselves to be a duck, and does not resemble gender dysphoria in transgender people. For instance, a schizophrenic man may be convinced that he is the Queen of England with the body to match, and remain oblivious to all evidence otherwise.
Whereas a transgender woman is perfectly aware that her body is what’s typical for men, not women. When she says that she’s a woman, she is speaking about her internal sense of self, not what body parts she has. She is not deluded about her physical state or how other people view her (as male), and it’s precisely that awareness and lack of delusion that leads to her distress and desire to transition.
While rare, delusions can sometimes manifest in an otherwise sane individual. As such, it is theoretically possible for a cisgender person to be genuinely deluded into believing they are transgender when they are not, and vice versa. However, given that it is not currently possible to distinguish such cases, and that their experience of dysphoria may be identical to that experienced by transgender people, transition would be the practical course of action if they meet the guidelines for requiring it. If treatment produces negative effects (such as inducing gender dysphoria in the other direction), it can easily be halted; whereas if this alleviates their distress and improves their daily function and well-being, it would arguably be in their best interests to continue.
The same would hold true if in fact all transgender people were deluded about being trans. Regardless of the cause, transition has proven to be the only effective cure for gender dysphoria. The emphasis should always be on acknowledging a person’s pain and seeking the best way to address it, rather than to dismiss their pain or assume it’s not true.
Q: How can I know if I am transgender?
There is no objective test that can tell you if you are transgender. The desire to be another sex may sometimes have other explanations. In those scenarios, transitioning is likely to worsen rather than improve the situation.
However, if you are feeling uncomfortable with your sex, here are some questions that might help guide you along in determining what’s behind these feelings, and to figure out your identity and what steps (if any) you should take to transition.
(Do note that these are just guidelines. There are no right answers, and transgender people may not always give the same answers, but these can act as a starting point.)
- Do you feel pressured to do certain things or behave a certain way because of your sex? If you were given complete freedom to live life the way you want, as a member of your sex, would the discomfort go away? Say you’re often bullied for acting too feminine for a man and made to feel like you can never be good enough. In a world where feminine men were celebrated and you were allowed to be as feminine as you liked, and your parents were proud of you just the way you are, would you still be uncomfortable being seen as a man? What about in a world where the majority of men were stereotypically feminine, and being masculine was a rarity?
If you think you may be transgender solely because you enjoy things that are atypical for your sex, you are probably not transgender, but a masculine woman or feminine man. Focus instead on finding ways to explore that side of yourself, or ways to gain the freedom to do so if you find yourself restricted in that area, and see if that solves your discomfort.
- Does the thought that you may not be transgender upset you or provide relief? Why, or why not?
- If you feel restricted and frustrated by female gender roles and having to deal with sexism, being talked down to, sexualised, considered inferior or otherwise mistreated due to your sex, does your pain stem primarily from that sexism or also from being female?
If there was full gender equality and you no longer had to deal with any sexism, would you then be content living as a woman? What about in a world where gender roles and stereotypes were flipped and it is men who suffer through all that? In such a scenario, would you still wish to be male? Would you merely tolerate being female for the benefits? Or would you then fully enjoy being female?
Some girls and women who have experienced sexual abuse may view transitioning to a male (or neutered) body as one way to escape further abuse, or to separate themselves from their past. They associate being male with being safe, strong and protected from further harm, and it is this need for safety that drives their desire to transition. Some trans men may also harbour similar feelings, the difference being that the desire to be male exists independent of this fear (in as much as it is possible to discern).
Consider that transgender people as a whole are much more at risk of sexual assault than the general population, and while transitioning may reduce the risk for trans men, it will not wholly eliminate it. In certain situations, it may even make it worse. If you are someone in this situation, you may want to consider your reactions to having to choose between two options: one in which you are female but assured a safe life free from sexual or emotional abuse, and one in which you are male but subject to sexual abuse.
If this causes your desire to be male to disappear completely, trauma is likely to be a major component of your dysphoria, and transition may not solve your distress. (It may in fact worsen it, if you start recognising your body as male and fearing it as well, while losing access to female spaces and being put in more situations where you need to be around strange men.) Whereas if it reduces but does not eliminate that desire, there may be more going on. As always, there are exceptions – such as a trans man with a history of sexual trauma whose aversion to additional abuse overrides any dysphoria he feels.
- All teenagers go through a period of identity formation and trying to work out their place in the world. This may sometimes extend to gender. If you are a pre-teen or teenager whose feelings about your gender are more questioning in nature than distressing, consider giving yourself time to mature and figure out who you are before making any big decisions.
Teenagers may grapple with what it means to have a female body in a society that often sexualises, infantilises and demeans such bodies, or a male body in a society that places certain expectations (sex, violence, NS, emotional repression, disposability) upon such bodies. If, however, you experience distress about your sex that seems unusual in scope and degree compared to what your peers are going through, you may wish to look further into this with a trusted counsellor.
- As a thought experiment, invent a attractive fictional character of your assigned sex with the personality traits, interests, talents, relationships and social reputation that you would personally love to have. How would you feel if you were that person? Would everything be perfect, or would your sex still bother you?
- If you are uncomfortable with the sexed characteristics of your body (chest, genitals, etc), does this discomfort stem from how people react to them, what they symbolise, and how they indicate your belonging to a particular sex, or from the material fact of their existence? If people no longer reacted that way, and the symbolism changed, or even if they were instead an indication that you were of the other sex, would you still be uncomfortable with those characteristics? e.g. if most women had penises and it was known as a female rather than male organ, would yours still feel wrong? (Or, would you still want to obtain one?)
- If you are dealing with homophobia, either from others or yourself, and you feel that you cannot freely love the people you love, or have your relationships deemed as valued and legitimate as that of straight people, would your pain still exist in a world where homosexual relationships were valued and celebrated as much as heterosexual ones? If you could freely find a partner and love them, with the full blessings and support of your religion, family and society, would you still be uncomfortable with your sex?
- If you desire to transition just so that somebody will love you, please don’t. This may take the form of wishing to please a parent who wanted a son or daughter and scorns you for being the ‘wrong’ gender, or a crush who isn’t attracted to people of your sex, or a partner whose family will never accept their child in a homosexual relationship. People change, and attitudes change, but transition is a very personal thing that will have major and permanent impacts on the rest of your life. If you were not transgender to begin with, doing so would also induce the same gender dysphoria that causes transgender people so much distress. Never transition for somebody else.
- In rare cases, people with OCD may fixate on the (false) idea that they are transgender and should transition. If you have a history of OCD (diagnosed or suspected) and the thought of transitioning fills you with immense fear because you like your body and gender and don’t want to be another sex (but are afraid you secretly want to), and these thoughts persistently intrude and interrupt your daily functioning, you are unlikely to be transgender. Please seek help from a professional counsellor or psychiatrist trained to deal with OCD.
(Likewise if you are a trans person with OCD who is plagued with paranoid thoughts and the immense fear that you might not be trans after all and might be making a big mistake, even if you’re wrecked with dysphoria and desperately want to be the other sex.)
- If you were given a magic button that could instantly and painlessly change your body to the one of your desired sex, and nobody would judge you for it and there would be no awkwardness to deal with, would you press that button? Would you stay that way?
- When you hear the phrase ‘opposite sex’, do you think of men or women? How do you feel about your answer? Does it feel normal, or does it feel wrong?
- If you were all alone on a desert island with nobody to see or judge you, would you still be uncomfortable with your sex?
- If you were given the chance to create an ideal, permanent human body for yourself, what sex would it be?
- When you imagine yourself in your ideal romantic relationship, what sex are you? Are you a straight or gay couple? Or something else altogether?
- When you imagine yourself as an old person having lived a long and contented life, what sex is that person?
While gender dysphoria and body dysphoria often come together, this is not always the case for everyone. Some people may be happy socially transitioning, but experience no dysphoria with their body and thus not seek to medically transition. They might be happy living their lives as a woman with a typically male body or vice versa, where any distress comes only from how society reacts, rather than their bodies.
Others may be relatively content living as their assigned gender but experience a great sense of wrongness over the sexed characteristics of their body. They might thus seek medical transition, where social transition then naturally occurs as they start looking more like and being recognised as that sex. (In rare cases, this may induce gender dysphoria, and lead to, say, somebody born male realising that he feels most at ease living as a man but with a typically female body.)
Yet other people are non-binary, and are most comfortable with a body and/or gender expression that is not strictly male nor female but both, neither, or that changes over time.
Yet others come to realise that their gender dysphoria was a by-product of other issues (such as those laid out in the list above), and that transitioning would not be appropriate for them.
Some people who do experience body dysphoria may also find it to be manageable, and decide not to seek medical intervention. They may also choose to pursue some treatment (e.g. hormone therapy) but not others.
Ultimately, what you should be asking is not “am I transgender?” but:
- In an ideal world, which gender would I want to be seen as?
- Which sex do I want my body to look like?
- Am I willing to make permanent changes to achieve those goals?
Your answers can help you determine your course of action.
Q: If I experience gender dysphoria, does that mean I have to transition?
No. Whether or not you transition is ultimately a very personal decision that should not be made lightly, and is something you’ll have to decide for yourself. Transition may be liberating, but can also often be painful and come with a high cost – not just financially but in terms of your safety, relationships, career, and so on.
Don’t rush into anything, but give yourself time to think this through. Many transgender people spend years grappling with our identities and whether or not to transition (and to what degree) before taking any action. Some people change their minds multiple times before coming to a decision. That’s normal, because transitioning can be scary, and is often a last resort for many people.
Some transgender people find that they are eventually able to accept living as their assigned gender, and even find happiness over time. Others find this impossible after years of trying. Others find ways to compromise – such as by dressing more masculine or feminine, or by adopting male/female/unisex nicknames. Yet others find that it helps to privately affirm their identity as men, women or other but continue living outwardly as their assigned gender. For example, a transgender woman may acknowledge that she is a woman, in order to have that internal peace of mind, but also decide it is best for her to continue living as a man with a typically male body.
There is no one-size-fits-all solution. How you choose to resolve or live with your gender dysphoria will depend on your specific case.
When it comes to medical transition in particular, here are some questions you might want to ask to figure out if various treatments are right for you:
- Does my discomfort with my body stem more from social ideals of what men and women ‘should’ look like, or a more fundamental disconnect? i.e. if nobody could tell I was trans and found me conventionally attractive for my gender, just as I am now, would the discomfort still be there?
- Is my body dysphoria bad enough to significantly interfere with my day-to-day life and normal functioning?
- Am I willing and able to be on lifelong hormone therapy?
- Do I have any medical conditions that may make HRT or surgery risky? (please consult a doctor.)
- Do I want to have my own biological children in future?
Q: Do all transgender people take hormones or have surgery?
Q: How long does hormone therapy last?
Lifelong hormone replacement therapy (HRT) is needed to maintain the body’s masculinisation or feminisation. If the gonads (ovaries or testes) have been removed, it becomes medically necessary for health. However, some trans people choose to only go on HRT for a while to achieve certain permanent changes (lower voice, breast growth, etc) and cease it after, whereupon some changes will reverse.
Q: How does someone become transgender?
There is a robust collection of studies pointing towards a biological basis, in particular the role of prenatal sex hormones. Some such examples are:
- A large-scale study of 400 trans women discovered significant variants (compared to cis men) in several genes associated with sex hormone -signalling, which would possibly affect sex hormone levels in development and cause atypical sex differentiation in the brain.
- A correlation between 2D:4D finger digit ratios (the length of one’s index finger to that of one’s ring finger) – which is an indicator of prenatal testosterone levels – and gender identity. One study found that transgender men on average have significantly more masculine digit ratios compared to both control males and control females, indicating anomalously high testosterone exposure in the womb.
- In a study of women who had been exposed to a now-banned estrogenic drug (DES) during pregnancy, almost a third of their male children were gender dysphoric and identified as female or non-binary. This is a rate of a hundred times the natural occurrence of transsexualism and is too high to be coincidental.
Visit this page for several compilations of such studies.
Transgender identities may also be a natural part of human sexual diversity.
A typical man has XY chromosomes, penis and testes, a deep voice, facial and body hair, and so on. Others have less masculine bodies – low testosterone levels, higher voices, sparse facial or body hair, but still think of themselves as men. A small minority are mildly intersex: they might have micropenises, be unable to urinate standing up, have feminine skeletal structures – but still see themselves as men. A smaller minority are severely intersex, including those with XXY chromosomes (Klinefelter’s Syndrome), those born without penises, those who have uteruses, ovaries or vaginas (sometimes in addition to male organs), but also still consider themselves men, even though some of these might have been raised as girls and been unaware of their intersex status until adulthood.
Even further along that spectrum, an even smaller minority of men have XX chromosomes, uteruses, ovaries, vaginas, and all those other typically-female sexual characteristics, but, like all those before them on that spectrum, also consider themselves men and might desire more masculine bodies. These are transgender men.
It would be stranger if that group did not exist and the spectrum ended abruptly. Biology would thus seem to predict the existence of transgender people – people who have most or all the physical characteristics typical of the other sex – given that human bodies have been discovered to exist everywhere else on the sexual continuum in huge variation.
Another theory has to do with how humans form in-group / out-group associations when very young. A few people may for some reason form the ‘wrong’ associations and be psychologically imprinted with a cross-sex gender identity – i.e. whatever neuropsychological process happens to make a cisgender girl ‘feel’ like a girl is set in motion in the brain of a male child, resulting in a transgender girl who ‘feels’ like a girl in the exact same way other girls do, despite her body. This is also likely influenced by biological factors that may predispose some people towards being transgender.
Ultimately, what makes somebody transgender is likely to be complex and not easily ascribed solely to biological, psychological or social influence. Within the trans community itself, there is a lot of variation in how those identities manifest, suggesting that different combinations of causes may be at play in each individual. One trans person may have a strong sense of their body being the wrong sex, another may be fine with their body but have a strong sense of being another gender, and yet another may not feel right as either a man or woman.
About 0.3% of the population or more is transgender. Transgender people have existed across all cultures throughout history. Estimated numbers have increased of late as greater information has led to better awareness and acceptance, causing more trans people find it safe to come out and transition.
Q: Why are so many transgender people over-the-top feminine or masculine?
Many transgender people, especially women, are often accused of portraying caricatures of womanhood or manhood in their mannerisms, interests and appearance.
There are a few reasons for this. Firstly, for those who have not undergone any medical transition, dress and behaviour are the only ways they have to express their gender identities. If a trans woman who has not medically transitioned goes around with short hair and in unisex clothes, acting in a neutral or masculine manner, everyone would naturally perceive her as a man. Dressing up and being exaggeratedly feminine is thus one major way of correcting that assumption. This is most prevalent right after coming out. As they progress in transition and start to be consistently known or read as their gender no matter how they dress, most eventually tone it down to what feels more natural.
Secondly, trans people are under immense pressure from society and healthcare providers to ‘prove’ that they are their gender. A trans woman who doesn’t present herself in an overtly feminine manner thus runs the risk of not being taken seriously. There are multiple stories of trans women being denied transition by doctors because they turned up for an appointment in jeans and T-shirt, and were accused of not being serious about transition until they turned up in heavy makeup and flowy dresses.
Thirdly, there’s the freedom that comes with finally being able to express a long-repressed identity. A trans woman who has had to repress her feminine side for years will naturally go slightly wild when she finally has the freedom to do all the feminine things she always wanted. Early transition is a time of discovering oneself and figuring out the kind of woman, man or non-binary person you are going to be, which may mean lots of experimenting with different clothing styles and mannerisms. A similar process happens to all teenagers, but stands out more in transgender people who transition in adulthood, as most other people would have outgrown that phase by then and have settled in their identities.
Q: What about transracial people who identify as another race?
The term ‘transracial’ originally applied to children adopted by parents of a different race, which may affect their sense of racial identity and belonging. The term has since come to refer also to people like Rachel Dolezal who claim to identify as a different race than that they were born. People then ask why such identities are invalid if transgender identities are considered valid.
Most of the time, people who claim to be transracial are unable to explain what it means to ‘be’ that race without resorting to stereotypes that are often racist and closely associated with class status. e.g. people in the West tend to describe being rich, educated and articulate as ‘acting white’, which implies pretty bad things about what non-white people are supposed to be. Or a non-Asian person may talk about how they love Asian culture and thus consider themselves Asian.
But racial identity is not as much about culture or interests, or even biology, as how you are perceived and treated by the world because of how you look. For example, there are rare cases of biracial twins who look like different races, and effectively are different races, despite having near-identical genetics and upbringing. How they interact with the world, how they see themselves, and how the world responds to each of them would be very different, and is what forms their racial identity.
Race itself is a social construct that changes over time. Indians are technically Caucasian, but are presently categorised as Asian; Irish and Italians were once not considered white, but now they are; America used to consider anyone black if they had just 1/16th African ancestry; and so on. The ways we group people into races is ultimately arbitrary, with no strict definitions.
This further muddies what it means to identify as a different race. If you had been born in a different time or different country, you might very well have been considered another race. Within each race there is also so much physical variation in features and skin colour, where in fact intra-racial populations exhibit a much greater genetic diversity among themselves than between different races.
Likewise with gender, simply having masculine or feminine traits isn’t what makes someone a man or woman. Being transgender isn’t about being a masculine woman or feminine man who might as well be the other sex. It’s about having a core gender identity that somehow formed at odds with what’s expected for someone’s body, often very early in life (though it may not be recognised till much later) and which affects every part of how that person views, relates and interacts to the world, as well as the socialisation they absorb.
This indelibly shapes who they are, as it does with children adopted by different-race parents. That is not the case for people who decide they are a particular race merely because they share stereotypical traits with that race (that may not even apply in a different country).
People sometimes do develop a genuine transracial identity, in the sense of genuinely seeing themselves as part of that race. This happens most commonly for those who are racially-mixed but identify wholly as just one of those races; in rare circumstances, it could conceivably happen with people who have no biological links to that race, but who were perhaps raised among them and treated as one of them. This would however be a psychological identity-formation process, rather than a biological one.
Q: People with Body Dysmorphic Disorder (or anorexia) are treated with psychiatric help, not surgery. Shouldn’t transgender people also be treated with therapy instead of allowed to change their bodies?
While the two conditions may seem similar on the surface, they have different causes, different manifestations, and more importantly different treatments that have been reliably proven to work.
Body Dysmorphic Disorder (BDD) is a condition in which a person becomes obsessed with imagined defects in their body. Someone with BDD might wrongly perceive their normal-sized nose as gigantic, for example. After they’ve undergone surgery to make it tiny, they may still be distressed at the misperception that it is huge. This is a psychiatric issue, and more surgery would not fix the problem. Anorexia is a similar condition where a thin or average-sized person may wrongly believe they are fat, and losing weight does not ease the distress.
Whereas a transgender man might want to remove his breasts, and after surgery successfully gives him a flat chest, he doesn’t continue thinking he has huge breasts. If he did, that would be a manifestation of BDD.
Individuals with BDD respond successfully to psychiatric treatment and medication. Whereas when psychiatric treatment is attempted for transgender individuals, the distress often increases and does not go away. Instead, allowing hormonal therapy and surgery as desired does successfully provide that relief.
Q: Is it true that transitioning and surgery increase suicide risk in transgender people?
No. It greatly reduces it. The misconception arises from comparisons between transgender people and the general population, not between transgender people who have transitioned and those who have not.
See this page for more information.
Q: Do people regret transitioning?
Only a small minority do, about 1 to 2%. Sometimes it is because they were not transgender to begin with.
See this page for more information.
(Chinese translation by Shou Chenyan from the University Scholars Programme, NUS)
- 问：跨性别者和女性化的男人/男性化的女人有何不同？ 性别转换不会加
- 问：对于身体畸形恐惧症、厌食症患者来说，医生会让他们接受精神科治疗，而不是让他们通过手术改变自己的身体。 难道跨性别者不应该也接受精神科治疗，而不是允许他们改变自己的身体吗？
同性恋在于你爱的是谁，而跨性别在于你是谁。 很多人错误地认为，跨性别女人就是女性化的同性恋男人，他们进行性别 转换或因为他们觉得自己是女人，或因为他们憎恶自己的同性恋身份，又 或因为他们想变成女人以此来吸引直男。这种想法反过来也存在于人们对 跨性别男人的认知上。然而，这些观点和事实是有出入的。就最基本的来 说，跨性别者事实上从直男直女到同性恋男女都有。很多跨性别者最早在 孩童时期，还远未经历青春期或性觉醒的时候，就已经有了性别焦虑症。
像其他任何人一样，跨性别者可以是异性恋、同性恋、双性恋、无性恋， 或其他的性向。调查显示，四分之一至三分之一的跨性别者是同性恋（相 对于他们自我认同的性别来说，而不是出生时被赋予的性别）；相似数量 的人是异性恋，还有三分之一是双性恋或者其他性向。
事实的确是这样。许多女人外表看起来并不女性化，她们在许多社会通常 划分为“男性”的领域里享受其中，并取得杰出成就。 尽管如此，她们仍 视自己为女人，也希望他人视自己为女人。当人们提到女人时，她们会认 为自己是包含在这个被提及的群体里的。而对她们来说的“异性”，是指 男性。当她们被某人吸引时，她们会想象自己成为对方的妻子或女友，而 不是丈夫或男友。 当她们想象自己的未来时，她们会想象自己成为老妇人，而不是老年男人。
不是。虽然性别焦虑症被认为是一种精神疾病，但这种疾病指向的是由于跨性别的状态而感受到的焦虑，而不是指向跨性别这个状态本身。 医疗权 威将性别转换推荐为性别焦虑症的合适治疗手段。 目前，性别转换是唯一被证明有用的解决（而不是压制）性别焦虑症的方法。 拖延不治疗的性别 焦虑症和心理健康问题的增加高度成正比，这些心理问题可能在转换后也 没法得到解决，导致许多跨性别人士承受精神疾病的折磨。
对于在支持性的环境里很早就进行性别转换的跨性别人士，他们的心理健 康水平是高出平均水平的。 一般来说，性别转换和对心理健康的显著积极效果是相联系的。
有些人真的相信自己是一只鸭子（实际上不是），这样的人基本上会被诊 断为有精神疾病，比如精神分裂症。 他们还会有其他的可察症状，比如幻视、幻听等脱离现实的表现。 这样的人很可能进行日常生活都有困难。 他们的幻想包括一些很明显是不真实的事情，比如他们身上长了翅膀或动物 的喙。
有些精神分裂症患者的确有自己是相反的性别的幻想。 然而，他们的这种 幻想，与他们认为自己是鸭子一类的幻想是以同样的方式体现出来的，这和跨性别者的性别不安症是不同的。比方说，一位精神分裂症患者可能幻想自己是英国女王，在他的这种幻想里，自己的身体也是女人，他自己是 看不到与他幻想相反的事实的。
而相反，对于一个跨性别女人来说，她完全能认识到，她的身体是一般情况下男人而不是女人会拥有的身体。 她说自己是女人，是在说她内在的自我认识，而不是她的身体性器官是女性的。 她不会幻想自己的身体是女性的，也不会幻想别人把自己的身体看成是女性的，而这种认知正是她痛苦和焦虑的来源，因为她内心认为自己是女性，却又清楚地知道自己的身体 是男性的。 这样的矛盾才导致她渴望性别转换。
没有任何一项足够客观的测试能证明你的性别认同到底是什么，然而，如 果你对自己的性别感到不舒服、不满意，以下问题或许可以帮你认识到你这种不舒服的原因，从而了解你的性别认同，并帮你了解如果要进行性格 转换，你应该采取什么措施。
有时，想成为和自己生理性别相反的性别并不一定是因为跨性别，而是另 有原因。如果是这种情况，进行性别转换会使情况恶化，而不是得到改善。 请注意，以下的信息只做引导之用，不是硬性规定。 这个问题没有完全正 确的答案，就连跨性别人士自己也不一定总会给出相同的答案。然而，你可以用这些引导性的问题作为你的起点。
- 你会觉得你的生理性别导致了你的行为受限吗？如果你有绝对的自由按你想要的方式以你的生理性别生活，这种对于你生理性别的不舒服感会消失吗？假设你是一个经常因为不够阳刚而被欺负的男生，身边的人让你感觉你永远不够好。如果这样的你生活在一个完全接纳女性化男人的世界，你可以想多女性化就多女性化，你的父母也会支持你做自己本来的样子，那你还会对自己的男性身份感到不舒服吗？如果你认为自己是跨性别的理由仅仅是你喜欢通常属于异性的事物，那很可能你不是跨性别，而是女性化男人/男性化女人。 你可以试着寻找其他方法，给自己带来做喜欢的事的自由，看看你对你生理性别的不适感会不会由此减轻。
- 如果你由于女性的身份受到性别歧视、物化，遭受不公对待，那你对自己女性身份的痛苦主要来源于性别歧视，还是真的对自己的女性身份的不认同？ 如果你生活在一个男女完全平等、没有性别歧视的时代，你会愿意以女人的身份生活吗？ 再假设世界上的两性地位是反过来的，女人占主导地位而男人受压迫，你还是会希望成为男人吗？ 在这种情况下，你会因为女人的地位优势而选择做女人吗？ 你会完全接受并享受自己的女性身份吗？
一些遭受过性虐待的女孩/女人把性别转换当成一种逃避更多虐待的方式 或摆脱自己的过去的方法。对她们来说，男性身份意味着安全和免受伤害， 而她们对性别转变的渴望也是出于这种对安全感的需要。而对于真正的跨性别男人来说，尽管他们中也有人有相似的恐惧和对安全感的需要，但他们对男性身份的渴望在这种恐惧之外也是独立存在的。
跨性别人群总体来说会比一般人承受更大的遭受性暴力的风险，而尽管手 术变性可能会让这种风险变小，但没法消除这种风险，而在特定的情况下 还可能使风险更大。 试想一下你自己在这两种身份之间选择：作为女人，有安全保障地生活，不用担心会遭受性暴力或精神虐待，还是作为男人生活，但要承受会遭受性暴力的风险。 如果这样的选项让你成为男人的渴望 完全消失，那你对自己性别的不安应该主要来源于创伤，而不是跨性别。 这种情况下，性别转换不会减轻你的痛苦和焦虑（相反，如果你开始害怕自己的男性身体，且因为生理上的转换加入了男人的社会群体，身边出现 更多的男人，你的痛苦和焦虑可能会加重）。 然而，如果面临这样的选项，你想成为男人的渴望还是没有完全消失，那你更有可能是真正的跨性别。 不过事情总有例外，对于一个经历过性创伤的跨性别男人，他对于更多虐待的逃避可能强烈过了任何其它他感觉到的对自己性别的不安。
- 所有的青少年都会经历一个自我身份的建立过程，找到自己的位置 这个过程有时也发生在性别身份的建立上。如果你是正处于发育期 的青少年，而你对你的性别的感觉更多是疑惑、探寻，而不是焦虑、痛苦，那我们建议，给你自己一点时间，让自己先成熟起来，在做重大决定之前先完全了解自己，找到自己的位置。 青少年对自己身体的不满有可能是出于社会对于不同性别所强加的价值，比如女性身体总是被物化、贬低，而拥有男性身体意味着特定的责任或负担（性能力上的要求、暴力、服兵役等）。 然而，如果你承受着在范围和程度上都超出同龄人的对自己性别的焦虑、痛苦，我们建议你 找一位专业咨询人士更深入地去了解这个问题。
- 如果你对自己的性征（胸部、性器官等）感到不舒服，这种不适感的来源是人们对于你的性征的反应，它们象征的影响，它们所代表 的你的性别从属，还是仅仅是它们的存在？ 假如，这些性征带来的人们的反应、它们象征的影响和代表的性别从属都发生转变，你还会对这些性征产生不适感吗？ 比如，如果阴茎变成了女性的性器官，大部分女性都拥有阴茎，你还会对自己拥有阴茎感到不舒服吗？
- 如果你面临着来自于自己或他人的恐同情绪，觉得因为你的性别你无法自由地去爱自己想爱的人，或者你的恋爱关系因此被认为是不正当的，假设你生活在一个同性恋和异性恋同样正常的世界，你还会对自己的性别感到痛苦吗？ 如果你的宗教、家庭、社会支持并祝 福你去爱任何你想爱的人，你还会对自己的性别感到不舒服吗？
- 如果你想性别转换只是为了有人爱你，请不要这样做。 此类性别转换的动机可能以以下的形式显现：希望取悦想生男孩/女孩，认为你的性别是错误的父母、喜欢上一个在性向上不被你的性别吸引的人，或者想要被一个反对同性恋关系的家庭接受。 人是会变的，你的想法也可能改变，但性别转换一旦进行就会对你产生终生影响。 如果你本身不是跨性别，性别转换可能反而会给你带来性别不安症等负 面影响。 性别转换是一个个人的选择，永远不要为了别人转换。
- 在很罕见的情况下，有强迫症（OCD）的人可能会（错误地）产生 他们是跨性别的想法，认为自己应该进行性别转换。 如果你有强迫症的病史（包括被诊断和怀疑为强迫症），而你有性别转换的想法会给你带来很大的恐惧和不安（因为你喜欢你的性别，并不想转换，然而同时又担心自己潜意识里想转换）,影响你的正常生活，那你很可能不是跨性别。 这种情况请咨询专业人士或治疗强迫症的精神病医生。 同样，如果你是有强迫症的跨性别者，承受着偏执的妄想，即使你有强烈的性别不安症，想进行性别转换，你还是担心自己不是跨性别并会做出错误的决定，也请咨询医生。
- 如果按一个按钮就可以让你瞬间无痛苦转变为你想要的生理性别，并没有人会因此评判你，你会按下这个按钮吗？ 你会想要一直保持这样的身体吗？
- 当你听到“异性“这个词的时候，你脑中出现的是男人还是女人？ 你对自己的反应有什么感觉？你觉得你的反应正常吗？ 还是错误的？
- 如果你有机会可以为自己创造一个理想的、永久性的身体，你会想 要什么性别？
- 你想象中的理想恋爱对象是异性还是同性？ 还是其他性别？
虽然性别焦虑症与对身体的不满和焦虑经常同时出现，但也不是所有人都两者兼有。 有些人对自己的身体没有不满，所以只需要接受社会角色上的性别转换，而不需要用医疗手段在生理上变性。 他们可能觉得有一个男性 身体的同时以女人的身份生活下去（或者相反）是完全可以接受的，他们的焦虑和痛苦只来源于社会对他们性别身份的看法，不来源于自己对自身身体的看法。 还有些人可能对自己的性别身份没有不满，但强烈地觉得自己的性征是错误的。 这样的人可能会去接受手术变性，同时社会性别角色也会随着身体的改变自然而然地转换。 （在罕见情况中，这反而可能带来性别不安症，比如一个生理上是男性的人发现他最适合作为男人生活，但同时拥有女性的身体。）
不是的。 转换与否最终还是一个个人选择的问题，在这件事上，你只能自己做决定，而且，不应该轻率决定。 性别转换也许可以解放自我，但同时也经常伴随着痛苦，和经济、人身健康、人际关系、职业等多方面的高昂 的代价。
在自己想清楚之前，不要过于急切地去做任何事情。许多跨性别者在采取行动之前经历了很多年的挣扎，才能想清楚要如何看待自己的性别认同，要不要转换，以及转换到什么程度。 有些人在做决定之前会改变很多次想法。 这都是正常的，因为转换的确可以是一个可怕的过程，对很多人来说 也是万不得己才会采取的最后办法。 有些跨性别者发现自己最终可以接受以被赋予的性别生活下去，并找到快乐，另一些人在多年的尝试后，还是觉得自己没法办到，而有些人会采取折中办法，比如在衣着上打扮得更接近于自己认同的性别，或者给自己取 更接近自己认同的性别的或者中性的别名。 还有一些人发现，对外以他们 被赋予的性别生活，但在私下里确认自己认同的性别，对他们来说可以起 到帮助。 比如说，一个跨性别女人可能会私下里对自己和亲近的家人朋友确认自己跨性别的身份，以此给自己一个内在空间，并让家人朋友把她当做女人。 但是，拥有男性身体的她还是照常像男人一样生活。 每个人的情况不一样，对她来说，可能这就是最好的处理方法。
没有一种方法是适合所有人的，是化解你对自己性别的焦虑，还是带着它生活下去，都取决于你具体的情况。 如果你想通过医疗手段进行转换，你可以先问问自己以下几个问题，来确 认自己是否适合这样的转换：
- 我对自己身体的不满，是真的来自于根本上的身体与性别认同的不 一致，还是仅仅来自于社会对于男人和女人理想外表的要求呢？比方说，如果没有人跟我说我是跨性别者，反而觉得我的身体很有异 性吸引力，我还会对自己的身体感到不舒服、不满意吗？
如果想要维持身体的男性/女性特征的话，需要进行终生的荷尔蒙替代治疗（HRT）。 如果摘除了性器官（睾丸/卵巢），由于健康需要，这样的治疗就更是必须的。 但也有一些跨性别人士只进行一段时间的荷尔蒙代替治疗，以此达到一些身体特征的永久改变（比如更低沉的嗓音，胸部的发育等等），在此之后就会停止疗程。 但是，停止治疗之后，之前完成的转变可能会反弹。
- 研究发现，食指与无名指指长比例（这个比例显示了一个人的产前睾酮水平）和性别认同有关联。 平均来说，跨性别男人比非跨性别男人和女人的食指与无名指指长比例都要高很多，这显示出他们在母胎里接触到异常高含量的睾酮。
- 一项针对孕期接触过己烯雌酚（雌激素药物，现已被禁）的妇女的研究发现，她们生下的男婴里，接近三分之一都有性别焦虑症，并在性别上认同自己为女人或非二元（类似于非常规性别）。 这样的 几率比平均上跨性别者出现的几率要高一百倍，很难是巧合。
一个典型的男人有 XY 染色体、阴茎、睾丸、低沉的嗓音、面部和身体的毛发等等。 而还有其他男人，他们的男性特征并没有那么明显 – 他们可能有更低的睾酮水平、更高的嗓音、更稀疏的毛发，但他们仍视自己为男人。 也有很小一部分人有轻微的双性人特征：他们可能有（比正常尺寸小很多的）小阴茎、无法站立着小便、拥有偏女性化的较为纤细的骨架，但他们也还是视自己为男人。 还有更小的一部分人有很严重的双性人特征，比如 有些人有 XXY 的染色体组合（克氏综合征），有些人出生时没有阴茎，有些人长有子宫、卵巢、阴道（这其中有一部分人是在有男性性器官的同时还长有这些女性性器官），但他们也还是视自己为男人，即使他们中有些人是作为女孩被抚养大的，还有一些人甚至在成年之前都不知道自己具有双性人特征。
更少数的一些男人有 XX 染色体、子宫、卵巢、阴道等所有通常长在女性身上的性器官，但是他们也像之前列举的人一样，视自己为男人。 他们可能会渴望拥有更男性化的身体。 这些人就是跨性别者。
还有一种理论说，跨性别和人在幼年时与内团体/外团体建立的联系有关。 有些人会建立“错误”的联系，在心理上形成和自己的生理性别相反的性别身份，换句话说，让生理上是女性的孩子认同自己是女人的这样一个心理神经学过程在一个生理上是男性的孩子身上发生了。 这样的一个跨性别女孩与其他非跨性别女孩一样，都“感觉“自己是个女孩，尽管她的身体不同于一般的女孩。 这种联系的建立有可能是受了带有跨性别倾向的基因影响。
不管跨性别的成因是什么，这种成因绝大多时候都很复杂，没法单纯地用生物学、心理学或社会因素的影响去解释。 在跨性别社群内，人们的性别表达也各有不同，这显示了不同的人成为跨性别者可能是出于不同的原因。 有些跨性别者可能会强烈地觉得他们的身体对于他们认同的性别来说是错误的，有些人可能对自己的身体没有不满，但对相反的生理性别的认同格外强烈，还有些人对自己作为男人和女人都感到舒适、满意。
总人口中，大约 0.3% 是跨性别者，他们在各个历史阶段和不同的文化里都有出现。 随着更多人开始觉得承认自己的跨性别身份和进行性别转换是安全的，跨性别者人口的估计最近几年有所上升。
这样的现象有几种原因。 首先，对于那些没有通过医疗手段变性的人来说，穿着打扮和行为举止是她们表达自己性别的唯一方式。 一个没有通过医疗 变性的跨性别女人如果不打扮得女性化，而是外表和举止都很中性化（比 如留短发、穿中性的衣服、举止很男子气概，等等），那大家自然而然会 把她当成男人对待。 所以她们女性化的打扮，一方面是为了纠正周围人对 她们性别的臆断。 因为此类原因而作非常女性化的打扮，通常发生在跨性 别女人刚向周围人表明自己性别身份的初始阶段。 当她们进展到采用医疗 手段变性，或不论怎样穿着都始终被视作女人的时候，大部分人最终都会 愿意将自己过于女性化的风格降低到一个更自然的程度。
其次，跨性别女人承受着来自社会和医疗服务提供者的巨大压力，需要“证明”自己是女人。 如果一个跨性别女人不把自己展示得过于女性化，她可能就会遭受不被认真对待的风险。 跨性别女人在见医生的时候因为打 扮中性而被拒绝性别转换要求的例子司空见惯，她们只有在化上大浓妆、穿上优雅的衣裙之后，人们才会觉得她们想进行性别转换的要求是认真的。
再说了，许多时候，跨性别者的自我都是经过多年压抑之后才得以释放。 一个压抑自己性别身份多年的跨性别女人在终于得到表达的自由，可以没有顾忌地去做她长久以来想做的女性化的事时，自我表达得夸张、狂热一些也是一件自然且很能理解的事。 性别转换的早期也是一个自我发现的阶段。 在这个探索自己风格和定位的阶段，去尝试多种不同的衣着和举止风 格是很正常的，就像每个青少年都会经历一个自我探索期一样。 只不过由于有些跨性别者在成年之后才进行转换，而这时大部分其他人已经过了青春期的探索阶段，找到了自己的风格和定位，所以他们的尝试和探索在人群里会更显得尤为突出。
“跨种族”一词最早用在被不同种族的家长收养的小孩身上，因为他们这种被收养的经历可能会影响他们的种族身份认同感和归属感。 这个词后来逐渐演变为用来指代那些声称自己的种族认同和自己出生的种族不同的人，例如瑞秋•多利兹，有着美国白人血统，却认为自己是个美国黑人。 有些人可能会问，如果“跨性别”可以成立，那为什么“跨种族”是不成立的呢？
大多时候，当被问起什么是种族身份的核心，声称自己是跨种族的人都没 法给出很好的解释，只会诉诸于一些带有种族歧视意味的、和社会阶级紧密相关的刻板印象。 比如说，在西方，如果一个人富有、教育水平高、善于表达，他通常会被认为表现得像白人。 而人们对于非白人的刻板印象，就是与这些形容词截然相反的。 又比如说，一个种族血统不是亚洲人的人声称自己是亚洲人，而他有这种种族身份认同的原因是他特别喜欢亚洲文化。
种族作为一个社会建构概念，在政治影响下，在不同时期有不同的定义。 例如，爱尔兰人和意大利人曾经不被当做白人，但现在是。 曾经在美国，任何有十六分之一的黑人血统的人就会被视作黑人，但是现在我们会将这 样的人看作白人。 印度人其实在血统上属于高加索人（白种人的一种），但现在却被划分为亚洲人。 这样的例子还有很多。 在不同的时期，一个人可能会被划分为不同的种族，这样的流动性让跨种族身份认同更难以定义。 而且，同属一个种族的人在身体特征上也会有很大的不同。 事实上，一个种族内的基因多样性甚至超过了不同种族之间。 同样的，对于性别来说，仅仅拥有男性/女性的外貌特征并不足以让人成为男人/女人，因为外貌特征并不是性别的本质。 许多人错误地认为这就是跨性别。 跨性别并不在于成为一个男性化的女人/女性化的男人，而在 于一个人核心的性别身份认同与他的生理性别不相符。 这种性别身份认同和生理的偏差常常在人生早期就已出现（尽管有些人可能很久之后才会发 现），影响着一个人如何看待这个世界、与他人交往、以及社会化的过程
在有些情况下，一些声称自己是跨种族者的人是真的认为他们属于自己认同的那个种族。 最常见的是混血儿，他们身上带有多种族的血统，但他们 可能只对其中一种种族产生认同。还有很少的一部分跨种族者和他们认同 的种族没有血统上的联系，但这种种族认同就是一个心理上的身份认同构 建的结果了。
身体畸形恐惧症是一种精神病，患者会过度的关注自己臆想出来的，不存 在的身体缺陷。 比方说，一个身体畸形恐惧症患者可能会错误的认为自己正常大小的鼻子过于巨大。 就算通过手术让鼻子变得已经很小，他们可能还是会错误地觉得自己的鼻子很巨大，并仍然因此焦虑痛苦。 这样的问题属于精神科的范围，就算接受更多的手术也没办法解决。 厌食症与身体畸形恐惧症相似，也是一种精神病，是指一个很瘦的或正常身材的人错误地认为自己很胖。 在这种情况下，就算他们瘦下来，这种对身材的焦虑和痛 苦也不会减轻。
而跨性别的状态是不一样的。 一个跨性别男人可能会想移除自己属于女性特征的乳房，但是他不会在做完手术，拥有了平坦的胸部之后，还认为自己有很大的乳房。 如果他有这样的错误认知的话，这就是身体畸形恐惧症的体现了。
不会。 恰恰相反，性别转换和手术极大地降低了跨性别者的自杀倾向。 这个误解来源于把跨性别者的自杀率和人口平均自杀率作比较，因为跨性别人群的平均自杀率是要高出人口平均水平的。 但这并不是进行了性别转换的跨性别群体和没有转换的跨性别群体之间的比较，所以不能用来说明性 别转换会提升自杀的风险。
只有很小一部分人（大约 1-2%）会。 在有些这样的情况里，这些人其实本来就不是跨性别者，所以他们转换之后才会后悔这个决定。