Even though the term ‘transgender’ is a bigger part of our lexicon than ever and we’re being introduced to more trans people through media and entertainment, there are still a lot of questions out there. If you’re trying be respectful of a friend who just came out or you have questions about your own identity, don’t worry.
Well, at Syrup, we gotcha covered. As part of our series on LGBTQIA+ identities, which we hope will help people explore their own identity with more confidence and knowledge, we spoke to The Gender Centre psychologist Dr. James Mordani, GP Dr. Elspeth Mann and Syrup pal and transwoman Zelda Thomas to help explain exactly what it means to be trans, to transition and all the steps you should take if you’re questioning your gender identity or identify as transgender.
So, uhh, what does it mean to be transgender?
As ACON puts it, transgender “describes the population of people whose gender is different from what was presumed for them at birth.”
The trans and gender-diverse community is varied and come in various shapes and sizes, so terms like “trans” and “transgender” can represent people who doesn’t identify as cisgendered.
FYI, based on the Latin word “cis,” meaning “on the same side as,” cisgender is a term used for people whose gender identity matches the sex that they were assigned at birth.
And, people’s experiences with their gender and gender discovery differ between each person. For Zelda Thomas, she describes the process of connecting with her transgender identity as “lengthy.”
“There are things I remember from childhood that make me think I should have picked up on it much earlier, [but] things got suppressed in high school,” she told Syrup. “I went to a sex-segregated, academically-selective high school which was very big on the ‘young man’ ideal.”
“It wasn’t until I got to uni that I started to work out that that wasn’t really right, especially after meeting out trans and genderqueer people (non-binary as a term hadn’t emerged yet).”
According to The Gender Centre’s senior case manager Elizabeth Ceissman, not all people who undergo a transition associate themselves as queer, transgender or even under the LGBTQIA+ umbrella, either. Rather, they see their process of transitioning is simply a means of becoming their most authentic selves. People who fit this interpretation of transgender see their identify not as of a transgendered person, but as male or female.
“[People] pay $80k to be [their] most authentic self, not to be a transgendered person,” Ceissman explained to Syrup.
What does it mean to transition?
According to Dr. James Morandini, clinical psychologist at The Gender Centre, “transitioning can be broadly split into social or medical transition.”
“Social transition refers to aligning one’s social gender markers (e.g., name, pronouns, clothing, hairstyle, make-up/cosmetics, speech, and mannerisms) with one’s felt gender identity. So for instance, an assigned-at-birth male who is transitioning to live as a trans woman may choose a feminine name and pronouns (she/her) and request those in her life including family, friends, school peers and work colleagues refer to her accordingly. She may change her legal documents like birth certificate and driver’s license to reflect her gender identity. She may also choose to dress in a manner that reflects her gender identity, for instance wearing nail polish, female-coded clothing like skirts or blouses, wearing cosmetics lipstick and foundation, and growing her hair out. She may undertake voice training so that her speech also signals her feminine identity. This would be her social gender transition.”
“It is critical to appreciate two things. First, social transition can come in many forms. Whereas some trans people socially transition in order to pass as the gender they identify with (will change name, pronouns, and appearance in order that they not be known to have a transgender history), others are comfortable for people to know of their transgender history, and may or may not change all of their gender markers.”
“Social transition can also mean different things for binary trans and non-transgender folk. For some non-binary folk (those individuals whose gender identity does not fit within the gender binary) social transition might involve adopting a mix of feminine and masculine gender-markers, or might involve wishing to present in a gender-less or androgynous manner. Others might lean heavily masculine or feminine in their presentation.”
“Medical transition refers to hormonal or surgical interventions that help reduce feelings of gender dysphoria and bring one’s body in line with one’s felt gender. Hormone therapy often involves taking estrogen and a testosterone-blocker for trans feminine folk and testosterone for trans masculine folk. Hormones have really powerful effects on the brain and body. For instance, trans men on testosterone will go through male puberty, developing male-typical body and facial hair, more muscular male figures, enlarged genitals, and get a deeper voice. Trans women on estrogens will often develop breasts, fat will distribute to their hips, they’ll become less muscular, and skin and hair will become more feminine.”
“Some of these changes are irreversible. Although many trans folk will just take hormones, some will pursue top surgery (breast removal or breast augmentation), bottom surgery (genital reassignment surgery), facial feminisation surgery, thyrochondroplasty (shaving Adam’s apple), or voice feminisation surgery. People usually get the medical interventions they need to reduce gender dysphoria, which might be any (or none) of those described above.”
“There is no single right way to affirm, so an individual may want any combination of the above options” adds gender-affirming GP Dr. Elspeth Mann, who uses affirm as an alternative to the term transition. “Sometimes people worry that they aren’t ‘trans enough,’ but a person is not any more Transgender, Gender Diverse or Non Binary (TDGNB) because of how much medical or surgical affirmation they’ve had.”
“Affirmation is not a sprint. The body changes you want won’t occur overnight. And remember, if you’re going to bind or tuck, please do it safely.”
What are some of the changes I might experience during the process of transitioning?
According to Mann, “someone on hormone therapy may notice a change in their face and body shape, skin texture, facial and bodily hair and changes in their voice. Muscles may tone or bulk differently with exercise. There may be changes to sweat, body odour and acne.”
“Hormones can also affect our mental health,” adds Morandini. “For some people, taking estrogen, testosterone blockers, or testosterone can have a big effect on emotions, sometimes leading to mood swings or just feeling different (e.g., trans woman reporting feeling more emotional and crying a lot more).”
“Because of this, it is recommended that you commence Hormone Replacement Therapy when you are in a stable mental health space, and make sure you have people and skills in place to help if things get hard. Sometimes people will report that hormones help them feel or think more like a woman (for trans women) or more like a man (for trans men). This can often be a welcomed experience and reduce feelings of dysphoria.”
“One big mental change is becoming used to moving through the world as your felt gender. Some trans men notice gaining some male privilege, for instance being taken more seriously for their opinions at work. On the other hand, trans women might experience for the first time feeling sexually objectified and unsafe in certain male-dominated spaces.”
“Presenting as one’s felt gender might be quite effortful early on in transition. For instance, some trans women will be consciously practicing raising their pitch and changing their intonation to speak in a more female-typical manner. They are getting used to how to walk or gesture in a female-typical manner. They may be getting used to applying make-up and wearing feminine clothes. Over time this becomes well-practiced and your default.”
Ultimately, however, as Mann concludes, “how much of this occurs and how long this takes is a bit different for everyone.” As Morandini adds, “people can start to feel more authentic, congruent, less dysphoric, and find they are functioning better in their lives as their transition continues.”
What does it mean to undergo gender-reassignment surgery?
“Gender-reassignment surgery refers to a range of surgical procedures where the appearance or function of a trans person’s sex characteristics are altered to resemble those typically associated with their identified gender,” explains Morandini.
“Often people immediately think about genital reassignment surgery or “bottom surgery”, i.e., vaginoplasty which refers to the construction of a vagina via some type of penile inversion in a trans woman, or phalloplasty, which is the construction of a penis, in a trans man. More common however is “top surgery”; mastectomy to remove breasts in trans men, and breast augmentation in trans women.”
“There are lots of surgery options that are involved in affirmation,” says Mann. “These include but are not limited to facial surgery, tracheal shaves, voice surgery and implants, but the ones everyone always talk about are top and bottom surgery.”
In Australia, in order to qualify for gender assignment surgeries, you need well-documented and long-standing anatomic gender dysphoria, so it’s strongly recommended that you see a gender-affirming GP or psychologist as soon as possible and safe to do so. From there, to undergo gender-reassignment surgery, you need to be over 18 years of age, been on hormones for at least 12 months and have two independent letters of support from mental health professionals.”
“Top surgery can occasionally be completed before the age of 18 and requires at least one letter of support from a treating mental health professional,” adds Morandini. “Gender reassignment surgeries can reduce distress and improve the quality of life for people with unremitting and severe anatomic gender dysphoria.”
“While it is obvious that surgeries can help a trans person feel more comfortable with their body, they may benefit the trans person in functional and social ways. For instance, for a trans man who has had phalloplasty being able to stand up to urinate can have a huge impact on one’s dysphoria and ability to live in the world comfortably as a man. Likewise, for trans women, a vaginoplasty may remove genital dysphoria, but also enable one to engage in sex in a way that isn’t dysphoria inducing.”
Some key things to keep in mind to make this process of transitioning more comfortable for you
For Thomas, during her period of transitioning, she found that “having good people around you,” and “playing around with [her] name and appearance when it was safe to do so” helped a lot.
“I’d mention a few things to key people but when I did the big reveal in a big Facebook post I was met with an excellent response. Similarly, TAFE was really great. I sent an email to my teacher about my new name, she shared that with my permission to other staff, and never looked back.”
“Like, yeah, there’s the medical and legal side of things but if you don’t have good people in your social life then that’s a key issue.”
“Another thing I found really useful and validating was actually looking at what people’s bodies are like. Not just the idealised magazines and Hollywood depictions but ordinary people.”
“There are heaps of women with wide shoulders, men without prominent Adam’s apples, body shapes like rectangles and balls and hourglasses and pears… Knowing that bodies come in all sorts of ways can take the pressure off to ‘conform’ to something that doesn’t actually exist.”
At the end of the day, Thomas stresses that when it comes to transitioning, remember to “have fun” and know that it’s not one single act but a period that can last an undetermined amount of time if not constantly evolving.
“Be aware that ‘transitioning’ isn’t one single act or thing,” she says. “It doesn’t necessarily have a clear starting or ending point. It’s about making yourself comfortable.”
“Changing the name you call yourself in your head may be more important for you than getting it legally changed with [your state Registry of Births, Deaths and Marriages.] There’s no one-size-fits-all, no-one starts too late or too early. Everyone can get how they want, but also find that what they want changes over time.”
If You’re Questioning Or Identify As Transgender, Visiting A Gender-affirming GP And Psychologist For Advice Can Be Helpful
No matter what stage of your transitioning or gender identity and expression you are at, speaking to a gender-affirming GP or psychologist can help you.
Psychologists can provide education on gender dysphoria, the role of societal stigma in trans mental health and information on medical and psychological risks and benefits of transition, and the different realms of it. From there, they can also help link you to transgender support groups and can advocate on your behalf when you are pursuing gender-affirming therapies.
A GP can help you access resources to assist your affirmation. This may include referrals to other health providers such as speech pathologists or surgeons. They can write letters to your place of study or work to assist you with pronouns and name changes in the workplace and at school. And, as Mann stresses, “it is a good idea to have a regular GP so that your medical care isn’t fragmented.”
“It is important to be as mentally healthy as possible while navigating your gender and affirmation,” reminds Mann. “If you have any mental health conditions, like anxiety, depression, eating disorders, past trauma, etc, a GP can refer to a psychologist to help manage these.”
“If you feel as though your GP isn’t respectful, find a different GP,” they stress. “They’re a bit like shoes: you have to find the right fit.”
Mann also says that if you’re considering undergoing a medical transition or affirmation, know that “it’s never too late.” The most important thing you can do is find a GP who is going to be respectful and support you as you navigate your gender. If you’re in NSW, ACON has a list of gender-affirming medical practitioners and institutions in the state.
“Puberty blockers are only available through specialised hospital clinics that have teams of paediatricians and psychologists,” says Mann. “Hormone therapy is available through endocrinologists or GPs that use the Informed Consent Model.”
“There are lots of things to think about, including future fertility, contraception, degree of physical change wanted, and effect on pre-existing medical conditions and medications. Your GP may need to send you to a specialist once for approval for some medications (e.g. to get approval for testosterone therapy on the PBS.) There are also compounded forms of hormone therapy (made up specially by specific pharmacists) that are a good option too if you do not want to see a specialist.”
Unfortunately, doctors don’t necessarily get in-depth training when it comes to gender incongruence, but, Mann says that this is something that “is hopefully changing with better TGDNB education in medical schools.”
“There are also different models of hormone care used around the world, some of which are more researched than others. This is an area that needs ongoing research, and the good news is that some of that is happening in Australia.”
“Getting believed by my medical support—GP, counsellor and psychiatrist was really great,” acknowledges Thomas, “particularly my GP, it was the same one I had been seeing since early childhood and he didn’t doubt me at all.”
“This is just one GP’s opinion. If you spoke to a bunch of different GPs you’d probably get a bunch of different answers.”
Frequently asked questions about being transgender
Can I be trans and still straight?
Yes. Transgender refers to your gender identity and not your sexuality. You may experience or discover your sexuality through your gender identity or gender expression (or viceversa or not at all), and can be any gender and any sexuality. They are not mutually exclusive of each other.
Do I have to have surgery to be considered transgender?
No. You can be considered transgender simply by your own accord. If you identify as transgender, that is, identify as a gender that is not what you were assigned at birth, no one can take that away from you.
At the end of the day, it’s your decision and no external opinion can decide whether you are trans, are ‘trans enough,’ or straight passing.
If I’m cisgendered, how can I be a good ally for my friend who is questioning or identifies as trans?
In much the same way as someone’s pronouns, the best way to be a good ally for your friend who identifies as transgender or is questioning is to wholeheartedly support them and listen. Educate yourself with information about what it means to be transgender (like this handy article by yours truly) and let them go at their own pace.
Someone who is questioning or identifies as transgender may undergo a number of different mental, social and psychological changes. So, the best thing you can do is offer your support, be patient and let them know you’re there for them whenever they need it.