The term transgender has varying definitions across cultures and communities. Most describe transgender people as those who have a gender identity that is different from their sex assigned at birth. Sex assignment at birth is based on external genitalia, whereas gender identity refers to the internal sense of one’s gender. Although people use many different terms to describe themselves, in general, a transgender woman is someone who was listed as male on their birth certificate and whose gender identity is female, and a transgender man is someone who was listed as female on their birth certificate and whose gender identity is male. Other people may have a gender identity that is fluid or non-binary; their gender is neither male nor female, or it is a mix of male and female. Sexual orientation, which relates to emotional and sexual attraction to others, is distinct from gender identity; transgender people may have any sexual orientation regardless of their gender identity. For transgender people, the discordance between their gender identity and their assigned sex at birth can cause a great deal of distress. That is why it is important for transgender people to be able to access health care that is patient-centered.

Many—but not all—transgender people make changes to their physical appearance. This is sometimes called gender affirmation. These changes can include modifications to clothing, hairstyles, and mannerisms. Many will change their first name, and they may want others to refer to them by pronouns that correspond to their gender identity. It is estimated that about 60% to 70% of transgender people take hormones and that about 20% to 40% have had one or more gender-affirming surgeries to alter their physical characteristics. Decisions about medical or surgical treatments depend on personal choice and cost.

How many people identify as transgender?

There are two recent estimates of population size ranging from 0.4% to 0.6%. The new estimates are larger than the previous estimate from roughly a decade ago. The analyses note several reasons that may account for this difference, including a perceived increase in visibility and social acceptance of transgender people, which may increase the number of individuals willing to identify as transgender on a government survey. It is also noted that younger adults aged 18 to 24 are more likely than older adults to say they are transgender.

Sex is a biological construct based on chromosomes and anatomy.

Gender is a social construct (an idea or concept) and refers to attitudes, feelings, and behaviors often associated with a person’s assigned sex.

Gender identity refers to an individual’s personal sense of self and gender.

Gender dysphoria refers to clinically significant distress experienced due to discordance (conflict) between gender identity and assigned gender. Gender dysphoria may show itself in a variety of ways, including desires to be treated consistently with one’s gender identity—not assigned gender—and/or to have physical sex characteristics aligned with one’s gender identity. Not all transgender or gender-diverse people experience gender dysphoria.

Gender diverse refers to individual people or the community of people with gender identities outside of the traditional gender binary of female and male.

Transgender is a term used to describe people whose gender identity and assigned sex do not align.

The origin of the word gender came from the Old French "gendre" (now termed "genre"), which meant "kind, sort, genus." Generally, children are assigned to their gender at birth based on their anatomy and chromosomes. For most children, this gender assignment corresponds to their gender identity, an innate sense of identifying oneself as male or female. Some children might experience incongruity and grow into transgender adults.

Gender dysphoria (GD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), is defined as a "marked incongruence between their experienced or expressed gender and the one they were assigned at birth." It was previously termed "gender identity disorder."

Children or adolescents who experience this turmoil cannot correlate to their gender expression when identifying themselves within traditional societal binary male or female roles, which may cause cultural stigmatization.

This can further lead to relationship conflicts with family, peers, and friends in various aspects of their daily lives and lead to rejection from society, interpersonal conflicts, symptoms of depression and anxiety, substance use disorders, a negative sense of well-being, and poor self-esteem, and increased risk of self-harm and suicidality.

More awareness must be created to perceive gender expression as a continuum from male to female rather than fixed binary norms. This might help society to understand the population and reduce the burden of mental health problems created by the associated stigma.

The term gender should not be confused with sexual orientation. A transgender man (biological female) may identify himself as heterosexual and still be sexually attracted to women and vice versa.

Gender-affirming treatments frequently are not single procedures. They may be part of a multidisciplinary treatment plan that may involve medical, surgical, and behavioral health interventions.

Gender-affirming treatments include the following:

• gender-affirming surgery (GAS)
• gender-affirming facial hair removal
• gender-affirming speech therapy
• gender-affirming hormone therapy
• gender-affirming behavioral health services

If you’re looking for gender-affirming care and treatment, it may be helpful to start by speaking to your primary care provider (PCP) or other trusted provider, or by speaking to a representative from your health plan.

• Transgender person: A person whose gender identity or expression is different from their sex assigned at birth.
• Transgender man: A person assigned female at birth who identifies as male.
• Transgender woman: A person assigned male at birth who identifies as female.
• Cisgender person: A person whose sex assigned at birth is the same as their gender identity or expression.
• Gender expression: A person’s outward presentation of their gender (for example, how they act or dress).
• Gender identity: A person’s internal understanding of their own gender.

Cisgender is a term used to describe people whose gender identity aligns with the gender associated with their assigned sex.

Gender expression refers to the way someone communicates their gender to the world through clothing, behavior, speech, and more. Gender expression varies based on culture, context, and history.

​Intersex describes a group of congenital conditions in which genitals, reproductive organs, and/or other sexual anatomy do not develop or align with traditional expectations for the female sex or the male sex. Being intersex is different from being transgender.

Non-binary describes someone whose gender identity does not fit into the traditional binary structure of girl/woman and boy/man.