define the term gender reassignment

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What is gender reassignment

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A decision to undertake gender reassignment is made when an individual feels that his or her gender at birth does not match their gender identity. This is called ‘gender dysphoria’ and is a recognised medical condition.

Gender reassignment refers to individuals, whether staff, who either:

Have undergone, intend to undergo or are currently undergoing gender reassignment (medical and surgical treatment to alter the body).
Do not intend to undergo medical treatment but wish to live permanently in a different gender from their gender at birth.

‘Transition’ refers to the process and/or the period of time during which gender reassignment occurs (with or without medical intervention).

Not all people who undertake gender reassignment decide to undergo medical or surgical treatment to alter the body. However, some do and this process may take several years. Additionally, there is a process by which a person can obtain a Gender Recognition Certificate , which changes their legal gender.

People who have undertaken gender reassignment are sometimes referred to as Transgender or Trans (see glossary ).

Transgender and sexual orientation

It should be noted that sexual orientation and transgender are not inter-related. It is incorrect to assume that someone who undertakes gender reassignment is lesbian or gay or that his or her sexual orientation will change after gender reassignment. However, historically the campaigns advocating equality for both transgender and lesbian, gay and bisexual communities have often been associated with each other. As a result, the University's staff and student support networks have established diversity networks that include both Sexual Orientation and Transgender groups.

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What does it mean for someone to have the protected characteristic of “gender reassignment” under the Equality Act 2010? The government, public bodies, many employers and even employment tribunals are often confused about this.

Having the protected characteristic of gender reassignment does not mean that someone’s sex has changed or give them the right to make other people pretend that it has.

These FAQs cover the definition of the characteristic and who it covers – and what this means for employers and service providers.

Download these gender reassignment FAQs as a PDF.

What is the protected characteristic of “gender reassignment”?

What does it mean to have this characteristic , who can have this characteristic , does having the protected characteristic of gender reassignment mean that a person must be treated as the opposite sex , does the equality act outlaw “misgendering”, is it harassment to “out” a person as transgender , can employers have policies which require people to refer to transgender people in particular situations in a particular way , what should employers and service providers do to avoid the risk of harassment claims , should schools have rules about “misgendering”.

The Equality Act 2010 at Section 7 defines the protected characteristic of “gender reassignment” as relating to a person who is:

“proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.”

The law refers to this as being “transsexual”. But the term more commonly used today is “transgender” or “trans”. This broadly relates to anyone at any stage of a personal process. For example:

A man tells his employer that he is considering “transitioning” and is seeing a therapist with the potential result of being referred for medical treatment.
A man identifies as a “transwoman” without having any surgery or treatment.
A woman identified as a “transman” for several years and took testosterone, but has now stopped and “detransitioned”.

The Equality Act protects people from direct and indirect discrimination, harassment or victimisation in situations that are covered by the Equality Act, such as in the workplace or when receiving goods or services.

Direct discrimination

Direct discrimination is when you are treated worse than another person or other people because:

you have a protected characteristic
someone thinks you have that protected characteristic (known as discrimination by perception)
you are connected to someone with that protected characteristic (known as discrimination by association).

For example: an employee tells their employer that they intend to transition. Their employer alters their role against their wishes to avoid them having contact with clients.

The comparator is a person who is materially similar in other aspects but does not have the protected characteristic (“is not trans”).

Indirect discrimination

Indirect discrimination happens when a policy applies in the same way for everybody but disadvantages a group of people who share a protected characteristic, and you are disadvantaged as part of this group. This is unlawful unless the person or organisation applying the policy can show that there is a good reason for the policy. This is known as objective justification .

For example: an airport has a general policy of searching passengers according to their sex. Everyone travelling needs to follow the same security procedures and processes, but it makes transgender travellers feel uncomfortable. This could be indirect discrimination, so the airport reviews its policy and changes it so that any passenger may ask to be searched by a staff member of either sex and have a private search, out of view of other passengers.

Harassment is unwanted behaviour connected with a protected characteristic that has the purpose or effect of violating a person’s dignity or creating a degrading, humiliating, hostile, intimidating or offensive environment.

For example: a transgender person is having a drink in a pub with friends and is referred to by the bar staff as “it” and mocked for their appearance.

Victimisation

Victimisation is when you are treated badly because you have made a complaint of gender-reassignment discrimination under the Equality Act or are supporting someone who has made a complaint of gender-reassignment discrimination. For example:

For example: a person proposing to undergo gender reassignment is being harassed by a colleague at work. He makes a complaint about the way his colleague is treating him and is sacked.

The Equality Act also provides that if a person is absent from work because of gender-reassignment treatment, their employer cannot treat them worse than they would be treated if absent for illness or injury.

Does a person have to be under medical supervision?

No. This was explicitly removed from the definition in 2010. Gender reassignment can be a personal process.

Must they have a gender-recognition certificate or be in the process of applying for one?

No. The protected characteristic is defined without reference to the Gender Recognition Act.

Do they have to have made a firm decision to transition?

No. Protection against discrimination and harassment attaches to a person who is proposing to undergo, is undergoing or has undergone a process (or part of a process).

During the passage of the Equality Act, the Solicitor General stated in Parliament:

“Gender reassignment, as defined, is a personal process, so there is no question of having to do something medical, let alone surgical, to fit the definition. “Someone who was driven by a characteristic would be in the process of gender reassignment, however intermittently it manifested itself. “At what point [proposing to undergo] amounts to ‘considering undergoing’ a gender reassignment is pretty unclear. However, proposing’ suggests a more definite decision point, at which the person’s protected characteristic would immediately come into being. There are lots of ways in which that can be manifested – for instance, by making their intention known. Even if they do not take a single further step, they will be protected straight away. Alternatively, a person might start to dress, or behave, like someone who is changing their gender or is living in an identity of the opposite sex. That too, would mean they were protected. If an employer is notified of that proposal, they will have a clear obligation not to discriminate against them.”

In the case of Taylor v Jaguar Land Rover , a male employee told his employer that he was “gender fluid” and thought of himself as “part of a spectrum, transitioning from the male to the female gender identity”. He said to his line manager: “I have no plans for surgical transition.” He started wearing women’s clothing to work, asked to be referred to by a woman’s name and raised a question about which toilets he should use. The Employment Tribunal concluded that he was covered by the protected characteristic.

Can children have the protected characteristic?

Yes. In the case of AA, AK & Ors v NHS England , NHS England argued that children who are waiting for assessment by the Tavistock Gender Identity Development Service (GIDS) do not have the protected characteristic as they have not yet reached the stage of proposing to transition. The Court of Appeal rejected this argument. It noted that the definition of “gender reassignment” does not require medical intervention and can include actions such as changing “one’s name and/or how one dresses or does one’s hair”.

The court concluded:

“There is no reason of principle why a child could not satisfy the definition in s.7 provided they have taken a settled decision to adopt some aspect of the identity of the other gender.”

It noted that the decision did not have to be permanent.

Is “Gillick competence” relevant to the protected characteristic?

No. “Gillick competence” refers to the set of criteria that are used for establishing whether a child has the capacity to provide consent for medical treatment, based on whether they have sufficient understanding and intelligence to fully understand it.

Having the protected characteristic of gender reassignment (that is, being able to bring a claim for gender-reassignment discrimination) does not depend on having any diagnosis or medical treatment. Therefore Gillick competence is not relevant to the Equality Act criteria.

No. There is nothing in the Equality Act which means that people with the protected characteristic of “gender reassignment” need to be treated in a particular way, or differently from people without the characteristic.

Article 9 and 10 of the European Convention of Human Rights protect the fundamental human rights of freedom of speech and freedom of belief.

In the case of Forstater v CGDE [2021] it was established that the belief that men are male and women are female, and that this cannot change and is important, is protected under Article 9 and in relation to belief discrimination in the Equality Act.

This means that employers and service providers must not harass or discriminate against people because they recognise that “transwomen” are men and “transmen” are women. Employers and service providers cannot require people to believe that someone has changed sex, or impose a blanket constraint on expressing their belief.

No. “Misgendering” is not defined or outlawed by the Equality Act.

In general, people who object to “misgendering” mean any reference to a person who identifies as transgender by words that relate to their sex. This can include using the words woman, female, madam, lady, daughter, wife, mother, she, her and so on about someone who identifies as a “transman”, or man, male, sir, gentleman, son, husband, father, he, him and so on about someone who identifies as a “transwoman”.

Any form of words may be harassment, but this depends on the circumstances and the purpose and effect of the behaviour. Harassment is unwanted conduct related to a relevant protected characteristic that has the purpose or effect of violating a person’s dignity, or creating an intimidating, hostile, degrading, humiliating or offensive environment for a person. An employment tribunal would also consider:

that person’s perception
the other circumstances of the case
whether it is reasonable for the conduct to have that effect.

Tribunals have emphasised that when judging harassment context is everything, and warned against a culture of hypersensitivity to the perception of alleged victims.

Employment tribunal judgments

As Lord Justice Nicholas Underhill found in Dhellwal v Richmond Pharmacology [2009], a case decided under the Race Relations Act:

“What the tribunal is required to consider is whether, if the claimant has experienced those feelings or perceptions, it was reasonable for her to do so. Thus if, for example, the tribunal believes that the claimant was unreasonably prone to take offence, then, even if she did genuinely feel her dignity to have been violated, there will have been no harassment within the meaning of the section.”

In the Forstater case, the employment appeal tribunal said that it was not proportionate to “impose a requirement on the Claimant to refer to a trans woman as a woman to avoid harassment”. It said that:

“ Whilst the Claimant’s belief, and her expression of them by refusing to refer to a trans person by their preferred pronoun, or by refusing to accept that a person is of the acquired gender stated on a GRC, could amount to unlawful harassment in some circumstances, it would not always have that effect. In our judgment, it is not open to the Tribunal to impose in effect a blanket restriction on a person not to express those views irrespective of those circumstances.”

In the case of de Souza v Primark Stores [2017] , a transgender claimant who went by the name of Alexandra, but whose legal name was Alexander, was found to have been harassed by colleagues who made a point of using the male form of name when they knew he did not want them to, but not by being issued with a “new starter” badge that showed his legal name.

In the case of Taylor v Jaguar Land Rover [2020] , a male claimant who wore women’s clothing to work was judged to have been exposed to harassment by colleagues saying “What the hell is that?”, “So what’s going on? Are you going to have your bits chopped off?”, “Is this for Halloween?” and referring to the claimant as “it”.

Not necessarily.

A person can be “outed” as transgender in two different ways:

Their sex is commonly known and recorded, but their transsexualism is not (for example a man who cross-dresses at the weekend and is considering transitioning is “outed” at work by someone who has seen them at a social event).
They are disappointed in the expectation of being treated as one sex when they are actually the other (for example a person who identifies as a “trans woman” is referred to as male by a woman in a changing room).

In Grant v HM Land Registry [2011] , which concerned the unwanted disclosure that an employee was gay, Lord Justice Elias found that this did not amount to harassment:

“Furthermore, even if in fact the disclosure was unwanted, and the claimant was upset by it, the effect cannot amount to a violation of dignity, nor can it properly be described as creating an intimidating, hostile, degrading, humiliating or offensive environment. Tribunals must not cheapen the significance of these words. They are an important control to prevent trivial acts causing minor upsets being caught by the concept of harassment.”

The perception (or hope) of transgender people that they “pass” as the opposite sex is often not realistic. Their sex is not in fact hidden, but is politely ignored by some people in some situations. It is not reasonable for them to be offended by other people recognising their sex, particularly if they are seeking access to a single-sex service. Acknowledging someone’s sex, particularly where there is a good reason, is unlikely to be harassment.

In the first-instance case of Chapman v Essex Police , a transgender police officer felt embarrassed and upset when a police control-room operator double-checked his identity over the radio because his male voice did not match the female name that the operator could see. The tribunal did not uphold a complaint of harassment, finding that the claimant was “too sensitive in the circumstances”.

Yes, but those policies must be proportionate. Employers cannot have blanket policies against “misgendering”, but can have specific policies concerning how staff should refer to transgender people in particular situations. Organisations should recognise that these policies constrain the expression of belief, and therefore they should seek to achieve their specific aims in the least intrusive way possible.

When determining whether an objection to a belief being expressed is justified, a court will undertake a balancing exercise. This test is set out in the case of Bank Mellat v HM Treasury :

Is the objective the organisation seeks to achieve sufficiently important to justify the limitation of the right in question?
Is the limitation rationally connected to that objective?
Is a less intrusive limitation possible that does not undermine the achievement of the objective in question?
Does the importance of the objective outweigh the severity of the limitation on the rights of the person concerned?

For example:

A company provides a specialist dress service to transsexual and transvestites. The men who use the service expect to be called “she” and “her” and referred to as Madam. It is justified for the employer to train and require staff to use this language when serving customers.
Staff at a full-service restaurant greet customers as “Sir” and “Madam” as they arrive. The restaurant’s policy is that staff should use the terms which appear most appropriate based on gendered appearance, and to defer to customer preference if one is expressed. This is justified by the aim of creating the service and ambience that the restaurant owners seek to provide.
A public body assesses claimants for medical benefits, including individuals with mental-health conditions. It directs its staff to refer to claimants using the terms which the claimants prefer, including using opposite-sex pronouns when requested, in order to make them feel comfortable. However, it recognises that in recording medical information, assessors must be able to be accurate about claimants’ sex. This is justified by the aim of providing a service that is accessible and effective for vulnerable clients.

The case of David Mackereth v AMP and DWP concerned a doctor who lost his job undertaking claimant health assessments for the Department for Work and Pensions because he refused to comply with its policy on using claimants’ preferred pronouns. The employer’s policy was found not to have amounted to unlawful harassment or discrimination against Dr Mackereth, in the particular circumstances of his job. However, the Employment Appeal Tribunal stated that “misgendering” would not necessarily be harassment:

“Such behaviour may well provide grounds for a complaint of discrimination or harassment but, as the EAT in Forstater made clear, that will be a fact-specific question to be determined in light of all the circumstances of the particular case.”

Relevant considerations

In Higgs v Farmor’s School [2023] Mrs Justice Eady sets out the considerations that are likely to be relevant considering whether constraining the expression of a belief (“manifestation”) in order to avoid harassment or discrimination is justified in the context of employment. These include:

the content of the manifestation
the tone used
the extent of the manifestation
the worker’s understanding of the likely audience
the extent and nature of the intrusion on the rights of others, and any consequential impact on the employer’s ability to run its business
whether the worker has made clear that the views expressed are personal, or whether they might be seen as representing the views of the employer, and whether that might present a reputational risk
whether there is a potential power imbalance given the nature of the worker’s position or role and that of those whose rights are intruded upon;
the nature of the employer’s business, in particular where there is a potential impact on vulnerable service users or clients
whether the limitation imposed is the least intrusive measure open to the employer.

Employers cannot force employees to believe that people can change sex, or prevent them expressing that lack of belief except in limited circumstances. So what should employers do to protect transgender people from harassment, and themselves from liability?

They should have ordinary policies against bullying and harassment, including jokes, name-calling, humiliation, exclusion and singling people out for different treatment.

They should seek to avoid putting people in situations they will reasonably experience as hostile or humiliating.

Ambiguous rules put people in situations where it is reasonable to feel offended. For example, an employer provides “female” toilets, showers and changing rooms, but allows some male staff in because they identify as transgender. This creates a hostile environment:

female staff are surprised, shocked, humiliated and upset to find themselves sharing with a colleague of the opposite sex
male staff members who want people to treat them as women may be challenged or face comments that are intended to intimidate, humiliate or degrade them.

This was the situation faced by the Sheffield Hospital Trust , which had a policy that transgender staff could use opposite-sex facilities. It had to deal with the fall-out when women complained about seeing a half-naked male in their changing room and the male staff member sued for harassment after being questioned about this.

Rather than putting these two groups of people together in a environment where both will reasonably feel harassed, employers should have clear rules about facilities that are single-sex, and also, where possible, provide a unisex alternative for anyone who needs it, including people who feel that they have “transitioned away from their sex” and therefore do not wish to use single-sex facilities shared with members of their own sex. The EHRC last year provided guidance on single-sex services which encouraged clear rules and policies.

It should be made clear to people who have the protected characteristic of “gender reassignment” that having this characteristic does not mean it is reasonable for them to expect others to believe or pretend to believe they have changed sex, or for them to be allowed to break (or expect to be an exception to) rules that aim to protect the dignity and privacy of others.

If a person breaks a clear rule against entering a space provided for the opposite sex, it is not reasonable for them to feel offended when this is pointed out.

No. It would not be lawful for schools to have a policy that forbids, punishes or denigrates pupils who use clear words about the sex of other people (such as pronouns, but also boy/girl, male/female and so on), nor to require pupils to refer to some classmates as if they were the opposite sex.

To do so constrains the freedom of speech of pupils in a way that is unjustified and discriminates against them on the basis of belief.
It is inconsistent with schools’ safeguarding duty of care , and with their record-keeping responsibilities, for staff to misrepresent the sex of pupils in their records or in introducing them to their peers.
In order to explain and enforce sex-based rules designed to keep children safe (such as who is allowed in which showers, toilets, dormitories or sports teams), schools must be able to use clear and unequivocal language.
It is not reasonable to expect that a child at school, or transferring between schools, can avoid being “outed” as the sex that they are .

We do not think that any policy which tells teachers or pupils to lie about the sex of pupils, constrains them from using clear sex-based language or treats them detrimentally if they do would pass the proportionality test. It is an unreasonable constraint on speech that is neither required nor justified in order to avoid discrimination on the basis of gender reassignment.

Schools form part of a system that is regulated at a national level. In England that system is the responsibility of the Secretary of State for Education. It is the responsibility of the Secretary of State to make this legal situation clear across the English school system by issuing the long-awaited DfE guidance.

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Stages of Gender Reassignment

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The idea of getting stuck in the wrong body sounds like the premise for a movie in "Freaky Friday," a mother and a daughter swap bodies, and in "Big" and "13 Going on 30," teenagers experience life in an adult's body. These movies derive their humor from the ways in which the person's attitude and thoughts don't match their appearance. A teenager trapped in her mother's body, for example, revels in breaking curfew and playing air guitar, while a teenager trapped in an adult's body is astounded by the trappings of wealth that come with a full-time job. We laugh because the dialogue and actions are so contrary to what we'd expect from someone who is a mother, or from someone who is an employed adult.

But for some people, living as an incongruous gender is anything but a joke. A transgender person is someone who has a different gender identity than their birth sex would indicate. We interchange the words sex, sexuality and gender all the time, but they don't actually refer to the same thing. Sex refers to the parts we were born with; boys, we assume, have a penis, while girls come equipped with a vagina. Sexuality generally refers to sexual orientation , or who we're attracted to in a sexual and/or romantic sense. Gender expression refers to the behavior used to communicate gender in a given culture. Little girls in the U.S., for example, would be expected express their feminine gender by playing with dolls and wearing dresses, and little boys would be assumed to express their masculinity with penchants for roughhousing and monster trucks. Another term is g ender identity, the private sense or feeling of being either a man or woman, some combination of both or neither [source: American Psychological Association ].

Sometimes, a young boy may want to wear dresses and have tea parties, yet it's nothing more than a phase that eventually subsides. Other times, however, there is a longing to identify with another gender or no gender at all that becomes so intense that the person experiencing it can't function anymore. Transgender is an umbrella term for people who identify outside of the gender they were assigned at birth and for some gender reassignment surgeries are crucial to leading a healthy, happy life.

Gender Dysphoria: Diagnosis and Psychotherapy

Real-life experience, hormone replacement therapy, surgical options: transgender women, surgical options: transgender men, gender reassignment: regrets.

Transgender people may begin identifying with a different gender, rather than the one assigned at birth, in early childhood, which means they can't remember a time they didn't feel shame or distress about their bodies. For other people, that dissatisfaction with their biological sex begins later, perhaps around puberty or early adulthood, though it can occur later in life as well.

It's estimated that about 0.3 percent of the U.S. population self-identify as transgender, but not all who are transgender will choose to undergo a gender transition [source: Gates ]. Some may choose to affirm their new gender through physically transforming their bodies from the top down, while others may prefer to make only certain cosmetic changes, such as surgeries to soften facial features or hair removal procedures, for example.

Not all who identify with a gender different than their birth sex suffer from gender dysphoria or go on to seek surgery. Transgender people who do want gender reassignment surgery, however, must follow the standards of care for gender affirmation as defined by the World Professional Association for Transgender Health (WPATH).

In 1980, when gender identity disorder (GID) was first recognized, it was considered a psychiatric disorder. In 2013, though, GID was, in part, reconsidered as biological in nature, and renamed gender dysphoria . It was reclassified as a medical condition in the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a common language and standards protocol manual for the classification of mental disorders. With this classification, transgender people must be diagnosed prior to any treatment [source: International Foundation for Gender Education ].

Gender dysphoria is diagnosed when a person has a persistent desire to become a different gender. The desire may manifest itself as disgust for one's reproductive organs, hatred for the clothing and other outward signs of one's given gender, and/or a desire to act and be recognized as another gender. This desire must be continuously present for six months in order to be recognized as a disorder [source: WPATH].

In addition to receiving the diagnosis from a mental health professional, a person seeking reassignment must also take part in psychotherapy. The point of therapy isn't to ignite a change, begin a conversion or otherwise convince a transgender person that it's wrong to want to be of a different gender (or of no specific gender at all) . Rather, counseling is required to ensure that the person is realistic about the process of gender affirmation and understands the ramifications of not only going through with social and legal changes but with permanent options such as surgery. And because feeling incongruous with your body can be traumatizing and frustrating, the mental health professional will also work to identify any underlying issues such as anxiety, depression, substance abuse or borderline personality disorder.

The mental health professional can also help to guide the person seeking gender reassignment through the next step of the process: real-life experience.

WPATH requires transgender people desiring gender reassignment surgery to live full-time as the gender that they wish to be before pursuing any permanent options as part of their gender transition. This period is a known as real-life experience (RLE) .

It's during the RLE that the transgender person often chooses a new name appropriate for the desired gender, and begins the legal name-change process. That new name often comes with a set of newly appropriate pronouns, too; for example, when Chastity Bono, biologically born as Sonny and Cher's daughter in 1969, began her transition in 2008 she renamed herself as Chaz and instructed people to use "he" rather than "she" [source: Donaldson James ].

In addition to a new name and pronouns, during this time gender-affirming men and women are expected to also adopt the clothing of their desired gender while maintaining their employment, attending school or volunteering in the community. Trans women might begin undergoing cosmetic procedures to rid themselves of body hair; trans men might take voice coaching in attempt to speak in a lower pitch. The goal of real-life experience is to expose social issues that might arise if the individual were to continue gender reassignment. How, for example, will a boss react if a male employee comes to work as a female? What about family? Or your significant other? Sometimes, during RLE people realize that living as the other gender doesn't bring the happiness they thought it would, and they may not continue to transition. Other times, a social transition is enough, and gender reassignment surgery isn't pursued. And sometimes, this test run is the confirmation people need to pursue physical changes in order to fully become another gender.

In addition to the year-long real-life experience requirement before surgical options may be pursued, WPATH recommends hormonal therapy as a critical component to transitioning before surgery. Candidates for hormone therapy may choose to complete a year-long RLE and counseling or complete six months of a RLE or three-months of a RLE/three months of psychotherapy before moving ahead with hormone therapy.

Upon successfully completing a RLE by demonstrating stable mental health and a healthy lifestyle, the transitioning individual becomes eligible for genital reconstructive surgery — but it can't begin until a mental health professional submits a letter (or letters) of recommendation indicating that the individual is ready to move forward [source: WPATH].

Hormone replacement therapy (HRT) , also called cross-sex hormones, is a way for transgender individuals to feel and look more like the gender they identify with, and so it's a major step in gender reassignment. In order to be eligible for hormone therapy, participants must be at least 18 years old (though sometimes, younger adolescents are allowed to take hormone blockers to prohibit their naturally occurring puberty) and demonstrate to a mental health professional that they have realistic expectations of what the hormones will and won't do to their bodies. A letter from that mental health professional is required, per the standards of care established by WPATH.

Hormone therapy is used to balance a person's gender identity with their body's endocrine system. Male-to-female candidates begin by taking testosterone-blocking agents (or anti-androgens ) along with female hormones such as estrogen and progesterone . This combination of hormones is designed to lead to breast growth, softer skin, less body hair and fewer erections. These hormones also change the body by redistributing body fat to areas where women tend to carry extra weight (such as around the hips) and by decreasing upper body strength. Female-to-male candidates begin taking testosterone , which will deepen the voice and may cause some hair loss or baldness. Testosterone will also cause the clitoris to enlarge and the person's sex drive to increase. Breasts may slightly shrink, while upper body strength will increase [source: WPATH].

It usually takes two continuous years of treatment to see the full results of hormone therapy. If a person were to stop taking the hormones, then some of these changes would reverse themselves. Hormone therapy is not without side effects — both men and women may experience an increased risk for cardiovascular disease, and they are also at risk for fertility problems. Some transgender people may choose to bank sperm or eggs if they wish to have children in the future.

Sometimes hormonal therapy is enough to make a person feel he or she belongs to the desired gender, so treatment stops here. Others may pursue surgical means as part of gender reassignment.

Surgical options are usually considered after at least two years of hormonal therapy, and require two letters of approval by therapists or physicians. These surgeries may or may not be covered by health insurance in the U.S. — often only those that are considered medically necessary to treat gender dysphoria are covered, and they can be expensive. Gender reassignment costs vary based on each person's needs and desires; expenses often range between $7,000 and $50,000 (in 2014), although costs may be much greater depending upon the type (gender reconstructive surgeries versus cosmetic procedures) and number of surgeries as well as where in the world they are performed [source: AP ].

Gender affirmation is done with an interdisciplinary team, which includes mental health professionals, endocrinologists, gynecologists, urologists and reconstructive cosmetic surgeons.

One of the first surgeries male-to-female candidates pursue is breast augmentation, if HRT doesn't enlarge their breasts to their satisfaction. Though breast augmentations are a common procedure for cisgender women (those who identify with the gender they were assigned at birth), care must be taken when operating on a biologically male body, as there are structural differences, like body size, that may affect the outcome.

The surgical options to change male genitalia include orchiectomy (removal of the testicles), penile inversion vaginoplasty (creation of a vagina from the penis), clitoroplasty (creation of a clitoris from the glans of the penis) and labiaplasty (creation of labia from the skin of the scrotum) [source: Nguyen ]. The new vagina, clitoris and labia are typically constructed from the existing penile tissue. Essentially, after the testicles and the inner tissue of the penis is removed and the urethra is shortened, the skin of the penis is turned inside out and fashioned into the external labia and the internal vagina. A clitoris is created from excess erectile tissue, while the glans ends up at the opposite end of the vagina; these two sensitive areas usually mean that orgasm is possible once gender reassignment is complete. Male-to-female gender reconstructive surgery typically takes about four or five hours [source: University of Michigan ]. The major complication from this surgery is collapse of the new vaginal cavity, so after surgery, patients may have to use dilating devices.

Trans women may also choose to undergo cosmetic surgeries to further enhance their femininity. Procedures commonly included with feminization are: blepharoplasty (eyelid surgery); cheek augmentation; chin augmentation; facelift; forehead and brow lift with brow bone reduction and hair line advance; liposuction; rhinoplasty; chondrolargynoplasty or tracheal shave (to reduce the appearance of the Adam's apple); and upper lip shortening [source: The Philadelphia Center for Transgender Surgery]. Trans women may pursue these surgeries with any cosmetic plastic surgeon, but as with breast augmentation, a doctor experienced with this unique situation is preferred. One last surgical option is voice modification surgery , which changes the pitch of the voice (alternatively, there is speech therapy and voice training, as well as training DVDs and audio recordings that promise the same thing).

Female-to-male surgeries are pursued less often than male-to-female surgeries, mostly because when compared to male-to-female surgeries, trans men have limited options; and, historically, successful surgical outcomes haven't been considered on par with those of trans women. Still, more than 80 percent of surgically trans men report having sexual intercourse with orgasm [source: Harrison ].

As with male-to-female transition, female-to-male candidates may begin with breast surgery, although for trans men this comes in the form of a mastectomy. This may be the only surgery that trans men undergo in their reassignment, if only because the genital surgeries available are still far from perfect. Forty percent of trans men who undergo genital reconstructive surgeries experience complications including problems with urinary function, infection and fistulas [sources: Harrison , WPATH].

Female-to-male genital reconstructive surgeries include hysterectomy (removal of the uterus) and salpingo-oophorectomy (removal of the fallopian tubes and ovaries). Patients may then elect to have a metoidioplasty , which is a surgical enlargement of the clitoris so that it can serve as a sort of penis, or, more commonly, a phalloplasty . A phalloplasty includes the creation of a neo-phallus, clitoral transposition, glansplasty and scrotoplasty with prosthetic testicles inserted to complete the appearance.

There are three types of penile implants, also called penile prostheses: The most popular is a three-piece inflatable implant, used in about 75 percent of patients. There are also two-piece inflatable penile implants, used only 15 percent of the time; and non-inflatable (including semi-rigid) implants, which are used in fewer than 10 percent of surgeries. Inflatable implants are expected to last about five to 10 years, while semi-rigid options typically have a lifespan of about 20 years (and fewer complications than inflatable types) [source: Crane ].

As with trans women, trans men may elect for cosmetic surgery that will make them appear more masculine, though the options are slightly more limited; liposuction to reduce fat in areas in which cisgender women i tend to carry it is one of the most commonly performed cosmetic procedures.

As surgical techniques improve, complication rates have fallen too. For instance, long-term complication risks for male-to-female reconstructive surgeries have fallen below 1 percent. Despite any complications, though, the overwhelming majority of people who've undergone surgical reconstruction report they're satisfied with the results [source: Jarolím ]. Other researchers have noted that people who complete their transition process show a marked improvement in mental health and a substantial decrease in substance abuse and depression. Compare these results to 2010 survey findings that revealed that 41 percent of transgender people in the U.S. attempted suicide, and you'll see that finally feeling comfortable in one's own skin can be an immensely positive experience [source: Moskowitz ].

It's difficult, though, to paint a complete picture of what life is like after people transition to a new gender, as many people move to a new place for a fresh start after their transition is complete. For that reason, many researchers, doctors and therapists have lost track of former patients. For some people, that fresh start is essential to living their new lives to the fullest, while others have found that staying in the same job, the same marriage or the same city is just as rewarding and fulfilling and vital to their sense of acceptance.

In many ways, the process of gender affirmation is ongoing. Even after the surgeries and therapies are complete, people will still have to deal with these discrimination issues. Transgender people are often at high risk for hate crimes. Regular follow-ups will be necessary to maintain both physical and mental health, and many people continue to struggle with self-acceptance and self-esteem after struggling with themselves for so long. Still, as more people learn about gender reassignment, it seems possible that that these issues of stigma and discrimination won't be so prevalent.

As many as 91 percent Americans are familiar with the term "transgender" and 76 percent can correctly define it; 89 percent agree that transgender people deserve the same rights, privileges and protections as those who are cisgender [source: Public Religion Research Institute ]. But that's not to say that everything becomes completely easy once a person transitions to his or her desired gender.

Depending upon where you live, non-discrimination laws may or may not cover transgender individuals, so it's completely possible to be fired from one's job or lose one's home due to gender expression. Some people have lost custody of their children after divorces and have been unable to get courts to recognize their parental rights. Historically, some marriages were challenged — consider, for example, what happens when a man who is married to a woman decides to become a woman; after the surgery, if the two people decide to remain married, it now appears to be a same-sex marriage, which is now legalized in the U.S. Some organizations and governments refuse to recognize a person's new gender unless genital reconstructive surgery has been performed, despite the fact that some people only pursue hormone therapy or breast surgery [sources: U.S. Office of Personnel Management , Glicksman ].

Lots More Information

Author's note: stages of gender reassignment.

It's interesting how our terminology changes throughout the years, isn't it? (And in some cases for the better.) What we used to call a sex change operation is now gender realignment surgery. Transsexual is now largely replaced with transgender. And with good reason, I think. Knowing that sex, sexuality and gender aren't interchangeable terms, updating "sex change" to "gender reassignment" or "gender affirmation" and "transsexual" to "transgender" moves the focus away from what sounds like something to do with sexual orientation to one that is a more accurate designation.

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adenoidectomy
adrenalectomy
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enterostomy
hysterectomy
pump something out
reduction mammaplasty
reimplantation

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Gender reassignment discrimination

Published: 22 December 2021

Last updated: 23 February 2023

Your rights under the Equality Act 2010
Age discrimination
Disability discrimination
Marriage and civil partnership discrimination
Pregnancy and maternity discrimination
Race discrimination
Religion or belief discrimination
Sex discrimination
Sexual orientation discrimination
Terms used in the Equality Act
Harassment and victimisation
Direct and indirect discrimination

What countries does this apply to?

On this page we have used plain English to help explain legal terms. This does not change the meaning of the law.

The Equality Act 2010 uses the term ‘transsexual’ for individuals who have the protected characteristic of gender reassignment. We recognise that some people consider this term outdated, so we have used the term ‘trans’ to refer to a person who has the protected characteristic of gender reassignment. However, we note that some people who identify as trans may not fall within the legal definition.

This page is subject to updates due to the evolving nature of some of the issues highlighted.

This is when you are treated differently because you are trans in one of the situations covered by the Equality Act . The treatment could be a one-off action or as a result of a rule or policy. It doesn’t have to be intentional to be unlawful.

There are some circumstances when being treated differently due to being trans is lawful. These are explained below.

The Equality Act 2010 says that you must not be discriminated against because of gender reassignment.

In the Equality Act, gender reassignment means proposing to undergo, undergoing or having undergone a process to reassign your sex.

To be protected from gender reassignment discrimination, you do not need to have undergone any medical treatment or surgery to change from your birth sex to your preferred gender.

You can be at any stage in the transition process, from proposing to reassign your sex, undergoing a process of reassignment, or having completed it. It does not matter whether or not you have applied for or obtained a Gender Recognition Certificate, which is the document that confirms the change of a person's legal sex.

For example, a person who was born female and decides to spend the rest of their life as a man, and a person who was born male and has been living as a woman for some time and obtained a Gender Recognition Certificate, both have the protected characteristic of gender reassignment.

There are four types of gender reassignment discrimination.

Direct discrimination

Direct discrimination happens when someone treats you worse than another person in a similar situation because you are trans.

You inform your employer that you intend to spend the rest of your life living as the opposite sex. If your employer alters your role against your wishes to avoid you having contact with clients, this would be direct gender reassignment discrimination.

The Equality Act says that you must not be directly discriminated against because:

you have the protected characteristic of gender reassignment. A wide range of people identify as trans. However, you are not protected under the Equality Act unless you have proposed, started or completed a process to change your sex.
someone thinks you have the protected characteristic of gender reassignment. For example, because you occasionally cross-dress or do not conform to gender stereotypes (this is known as discrimination by perception).
you are connected to a person who has the protected characteristic of gender reassignment, or someone wrongly thought to have this protected characteristic (this is known as discrimination by association).

Absences from work

If you are absent from work because of your gender reassignment, your employer cannot treat you worse than you would be treated if you were absent:

due to an illness or injury.

Example –

Your employer cannot pay you less than you would have received if you were off sick.

due to some other reason - however, in this case it is only discrimination if your employer is acting unreasonably.

If your employer would agree to a request for time off for someone to attend their child’s graduation ceremony, then it may be unreasonable to refuse you time off for part of a gender reassignment process. This would include, for example, time off for counselling.

Indirect discrimination

Indirect discrimination happens when an organisation has a particular policy or way of working that puts people with the protected characteristic of gender reassignment at a disadvantage. Sometimes indirect gender reassignment discrimination can be permitted if the organisation or employer is able to show that there is a good reason for the discrimination. This is known as objective justification .

An employer has a practice of starting induction sessions for new staff with an ice-breaker designed to introduce everyone in the room to each other. Each worker is required to provide a picture of themselves as a toddler. One worker is a trans woman who does not wish her colleagues to know that she was brought up as a boy, so she does not bring her photo and is criticised by the employer in front of the group for not joining in. The same approach is taken for all new staff, but it puts people with the protected characteristic of gender reassignment at a particular disadvantage. This would be unlawful indirect discrimination unless the employer could show that the practice was justified.

Harassment is when someone makes you feel humiliated, offended or degraded for reasons related to gender reassignment.

A person who has undergone male-to-female gender reassignment is having a drink in a pub with friends and the landlord keeps calling her ‘sir’ or ‘he’ when serving drinks, despite her complaining about it.

Harassment can never be justified. However, if an organisation or employer can show it did everything it could to prevent people who work for it from harassing you, you will not be able to make a claim for harassment against the organisation, only against the harasser.

Victimisation

Victimisation is when you are treated badly because you have made a complaint of gender reassignment discrimination under the Equality Act. It can also occur if you are supporting someone who has made a complaint of gender reassignment discrimination.

A person proposing to undergo gender reassignment is being harassed by a colleague at work. He makes a complaint about the way his colleague is treating him and is sacked.

A difference in treatment may sometimes be lawful. This will be the case where the circumstances fall under one of the exceptions in the Equality Act that allow organisations to provide different treatment or services on the basis of gender reassignment.

Examples –

The organisers of a women’s triathlon event decide to exclude a trans woman with a Gender Recognition Certificate as they think her strength or stamina gives her an unfair advantage. However, the organisers would need to be able to show that this was necessary to make the event fair or safe for everyone.

A service provider provides single-sex services. The Equality Act allows a lawfully established separate or single-sex service provider to prevent, limit or modify people’s access on the basis of gender reassignment in some circumstances. However, limiting or modifying access to, or excluding a trans person from, the separate or single-sex service of the gender in which they present will be unlawful if you cannot show such action is a proportionate means of achieving a legitimate aim. This applies whether or not the person has a Gender Recognition Certificate.

Updated: 23 Feb 2023

Removed paragraph on language recommendations made by Women and Equalities Committee (WEC) in 2016
Removed the term ‘transsexual’ as per WEC 2016 recommendations
Added paragraph explaining use of plain English in the guidance
Removed a paragraph on intersex people not being explicitly protected from discrimination by the Equality Act

Page updates

22 December 2021

Last updated:

23 February 2023

Advice and support

If you think you might have been treated unfairly and want further advice, you can contact the Equality Advisory and Support Service (EASS) .

The EASS is an independent advice service, not operated by the Equality and Human Rights Commission.

Phone: 0808 800 0082

Call the EASS on:

0808 800 0082

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Preparation and Procedures Involved in Gender Affirmation Surgeries

If you or a loved one are considering gender affirmation surgery , you are probably wondering what steps you must go through before the surgery can be done. Let's look at what is required to be a candidate for these surgeries, the potential positive effects and side effects of hormonal therapy, and the types of surgeries that are available.

Gender affirmation surgery, also known as gender confirmation surgery, is performed to align or transition individuals with gender dysphoria to their true gender.

A transgender woman, man, or non-binary person may choose to undergo gender affirmation surgery.

The term "transexual" was previously used by the medical community to describe people who undergo gender affirmation surgery. The term is no longer accepted by many members of the trans community as it is often weaponized as a slur. While some trans people do identify as "transexual", it is best to use the term "transgender" to describe members of this community.

Transitioning

Transitioning may involve:

Social transitioning : going by different pronouns, changing one’s style, adopting a new name, etc., to affirm one’s gender
Medical transitioning : taking hormones and/or surgically removing or modifying genitals and reproductive organs

Transgender individuals do not need to undergo medical intervention to have valid identities.

Reasons for Undergoing Surgery

Many transgender people experience a marked incongruence between their gender and their assigned sex at birth. The American Psychiatric Association (APA) has identified this as gender dysphoria.

Gender dysphoria is the distress some trans people feel when their appearance does not reflect their gender. Dysphoria can be the cause of poor mental health or trigger mental illness in transgender people.

For these individuals, social transitioning, hormone therapy, and gender confirmation surgery permit their outside appearance to match their true gender.

Steps Required Before Surgery

In addition to a comprehensive understanding of the procedures, hormones, and other risks involved in gender-affirming surgery, there are other steps that must be accomplished before surgery is performed. These steps are one way the medical community and insurance companies limit access to gender affirmative procedures.

Steps may include:

Mental health evaluation : A mental health evaluation is required to look for any mental health concerns that could influence an individual’s mental state, and to assess a person’s readiness to undergo the physical and emotional stresses of the transition.
Clear and consistent documentation of gender dysphoria
A "real life" test : The individual must take on the role of their gender in everyday activities, both socially and professionally (known as “real-life experience” or “real-life test”).

Firstly, not all transgender experience physical body dysphoria. The “real life” test is also very dangerous to execute, as trans people have to make themselves vulnerable in public to be considered for affirmative procedures. When a trans person does not pass (easily identified as their gender), they can be clocked (found out to be transgender), putting them at risk for violence and discrimination.

Requiring trans people to conduct a “real-life” test despite the ongoing violence out transgender people face is extremely dangerous, especially because some transgender people only want surgery to lower their risk of experiencing transphobic violence.

Hormone Therapy & Transitioning

Hormone therapy involves taking progesterone, estrogen, or testosterone. An individual has to have undergone hormone therapy for a year before having gender affirmation surgery.

The purpose of hormone therapy is to change the physical appearance to reflect gender identity.

Effects of Testosterone

When a trans person begins taking testosterone , changes include both a reduction in assigned female sexual characteristics and an increase in assigned male sexual characteristics.

Bodily changes can include:

Beard and mustache growth
Deepening of the voice
Enlargement of the clitoris
Increased growth of body hair
Increased muscle mass and strength
Increase in the number of red blood cells
Redistribution of fat from the breasts, hips, and thighs to the abdominal area
Development of acne, similar to male puberty
Baldness or localized hair loss, especially at the temples and crown of the head
Atrophy of the uterus and ovaries, resulting in an inability to have children

Behavioral changes include:

Aggression
Increased sex drive

Effects of Estrogen

When a trans person begins taking estrogen , changes include both a reduction in assigned male sexual characteristics and an increase in assigned female characteristics.

Changes to the body can include:

Breast development
Loss of erection
Shrinkage of testicles
Decreased acne
Decreased facial and body hair
Decreased muscle mass and strength
Softer and smoother skin
Slowing of balding
Redistribution of fat from abdomen to the hips, thighs, and buttocks
Decreased sex drive
Mood swings

When Are the Hormonal Therapy Effects Noticed?

The feminizing effects of estrogen and the masculinizing effects of testosterone may appear after the first couple of doses, although it may be several years before a person is satisfied with their transition. This is especially true for breast development.

Timeline of Surgical Process

Surgery is delayed until at least one year after the start of hormone therapy and at least two years after a mental health evaluation. Once the surgical procedures begin, the amount of time until completion is variable depending on the number of procedures desired, recovery time, and more.

Transfeminine Surgeries

Transfeminine is an umbrella term inclusive of trans women and non-binary trans people who were assigned male at birth.

Most often, surgeries involved in gender affirmation surgery are broken down into those that occur above the belt (top surgery) and those below the belt (bottom surgery). Not everyone undergoes all of these surgeries, but procedures that may be considered for transfeminine individuals are listed below.

Top surgery includes:

Breast augmentation
Facial feminization
Nose surgery: Rhinoplasty may be done to narrow the nose and refine the tip.
Eyebrows: A brow lift may be done to feminize the curvature and position of the eyebrows.
Jaw surgery: The jaw bone may be shaved down.
Chin reduction: Chin reduction may be performed to soften the chin's angles.
Cheekbones: Cheekbones may be enhanced, often via collagen injections as well as other plastic surgery techniques.
Lips: A lip lift may be done.
Alteration to hairline
Male pattern hair removal
Reduction of Adam’s apple
Voice change surgery

Bottom surgery includes:

Removal of the penis (penectomy) and scrotum (orchiectomy)
Creation of a vagina and labia

Transmasculine Surgeries

Transmasculine is an umbrella term inclusive of trans men and non-binary trans people who were assigned female at birth.

Surgery for this group involves top surgery and bottom surgery as well.

Top surgery includes :

Subcutaneous mastectomy/breast reduction surgery.
Removal of the uterus and ovaries
Creation of a penis and scrotum either through metoidioplasty and/or phalloplasty

Complications and Side Effects

Surgery is not without potential risks and complications. Estrogen therapy has been associated with an elevated risk of blood clots ( deep vein thrombosis and pulmonary emboli ) for transfeminine people. There is also the potential of increased risk of breast cancer (even without hormones, breast cancer may develop).

Testosterone use in transmasculine people has been associated with an increase in blood pressure, insulin resistance, and lipid abnormalities, though it's not certain exactly what role these changes play in the development of heart disease.

With surgery, there are surgical risks such as bleeding and infection, as well as side effects of anesthesia . Those who are considering these treatments should have a careful discussion with their doctor about potential risks related to hormone therapy as well as the surgeries.

Cost of Gender Confirmation Surgery

Surgery can be prohibitively expensive for many transgender individuals. Costs including counseling, hormones, electrolysis, and operations can amount to well over $100,000. Transfeminine procedures tend to be more expensive than transmasculine ones. Health insurance sometimes covers a portion of the expenses.

Quality of Life After Surgery

Quality of life appears to improve after gender-affirming surgery for all trans people who medically transition. One 2017 study found that surgical satisfaction ranged from 94% to 100%.

Since there are many steps and sometimes uncomfortable surgeries involved, this number supports the benefits of surgery for those who feel it is their best choice.

A Word From Verywell

Gender affirmation surgery is a lengthy process that begins with counseling and a mental health evaluation to determine if a person can be diagnosed with gender dysphoria.

After this is complete, hormonal treatment is begun with testosterone for transmasculine individuals and estrogen for transfeminine people. Some of the physical and behavioral changes associated with hormonal treatment are listed above.

After hormone therapy has been continued for at least one year, a number of surgical procedures may be considered. These are broken down into "top" procedures and "bottom" procedures.

Surgery is costly, but precise estimates are difficult due to many variables. Finding a surgeon who focuses solely on gender confirmation surgery and has performed many of these procedures is a plus. Speaking to a surgeon's past patients can be a helpful way to gain insight on the physician's practices as well.

For those who follow through with these preparation steps, hormone treatment, and surgeries, studies show quality of life appears to improve. Many people who undergo these procedures express satisfaction with their results.

Bizic MR, Jeftovic M, Pusica S, et al. Gender dysphoria: Bioethical aspects of medical treatment . Biomed Res Int . 2018;2018:9652305. doi:10.1155/2018/9652305

American Psychiatric Association. What is gender dysphoria? . 2016.

The World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender-nonconforming people . 2012.

Tomlins L. Prescribing for transgender patients . Aust Prescr . 2019;42(1): 10–13. doi:10.18773/austprescr.2019.003

T'sjoen G, Arcelus J, Gooren L, Klink DT, Tangpricha V. Endocrinology of transgender medicine . Endocr Rev . 2019;40(1):97-117. doi:10.1210/er.2018-00011

Unger CA. Hormone therapy for transgender patients . Transl Androl Urol . 2016;5(6):877-884. doi:10.21037/tau.2016.09.04

Seal LJ. A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria . Ann Clin Biochem . 2016;53(Pt 1):10-20. doi:10.1177/0004563215587763

Schechter LS. Gender confirmation surgery: An update for the primary care provider . Transgend Health . 2016;1(1):32-40. doi:10.1089/trgh.2015.0006

Altman K. Facial feminization surgery: current state of the art . Int J Oral Maxillofac Surg . 2012;41(8):885-94. doi:10.1016/j.ijom.2012.04.024

Therattil PJ, Hazim NY, Cohen WA, Keith JD. Esthetic reduction of the thyroid cartilage: A systematic review of chondrolaryngoplasty . JPRAS Open. 2019;22:27-32. doi:10.1016/j.jpra.2019.07.002

Top H, Balta S. Transsexual mastectomy: Selection of appropriate technique according to breast characteristics . Balkan Med J . 2017;34(2):147-155. doi:10.4274/balkanmedj.2016.0093

Chan W, Drummond A, Kelly M. Deep vein thrombosis in a transgender woman . CMAJ . 2017;189(13):E502-E504. doi:10.1503/cmaj.160408

Streed CG, Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular disease among transgender adults receiving hormone therapy: A narrative review . Ann Intern Med . 2017;167(4):256-267. doi:10.7326/M17-0577

Hashemi L, Weinreb J, Weimer AK, Weiss RL. Transgender care in the primary care setting: A review of guidelines and literature . Fed Pract . 2018;35(7):30-37.

Van de grift TC, Elaut E, Cerwenka SC, Cohen-kettenis PT, Kreukels BPC. Surgical satisfaction, quality of life, and their association after gender-affirming aurgery: A follow-up atudy . J Sex Marital Ther . 2018;44(2):138-148. doi:10.1080/0092623X.2017.1326190

American Society of Plastic Surgeons. Gender confirmation surgeries .

American Psychological Association. Transgender people, gender identity, and gender expression .

Colebunders B, Brondeel S, D'Arpa S, Hoebeke P, Monstrey S. An update on the surgical treatment for transgender patients . Sex Med Rev . 2017 Jan;5(1):103-109. doi:10.1016/j.sxmr.2016.08.001

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Definition of gender reassignment noun from the Oxford Advanced Learner's Dictionary

gender reassignment

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Open access
Published: 19 August 2024

Discontinuing hormonal gender reassignment: a nationwide register study

Riittakerttu Kaltiala ORCID: orcid.org/0000-0002-2783-3892 1 ,
Mika Helminen 2 ,
Timo Holttinen 3 &
Katinka Tuisku 4

BMC Psychiatry volume 24 , Article number: 566 ( 2024 ) Cite this article

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With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation.

A nationwide register-based follow-up was conducted. Data were analysed via cross-tabulations with chi-square statistics and t tests/ANOVAs. Multivariate analyses were performed via Cox regression, which accounts for differences in follow-up times.

Of the 1,359 subjects who had undergone hormonal GR in Finland from 1996 to 2019, 7.9% discontinued their established hormonal treatment during an average follow-up of 8.5 years. The risk for discontinuing hormonal GR was greater among later cohorts. The hazard ratio was 2.7 (95% confidence interval 1.1–6.1) among those who had accessed gender identity services from 2013 to 2019 compared with those who had come to contact from 1996 to 2005. Discontinuing also appeared to be emerging earlier among those who had entered the process in later years.

Conclusions

The risk of discontinuing established medical GR has increased alongside the increase in the number of patients seeking and proceeding to medical GR. The threshold to initiate medical GR may have lowered, resulting in a greater risk of unbalanced treatment decisions.

Trial registration number (TRN)

Not applicable (the paper does not present a clinical trial).

Peer Review reports

In gender medicine, transition refers to people with sex-discordant gender identities making changes in their lives to live in their experienced gender, socially (appearance, name, personal pronouns), juridically (identity documents) or medically (hormonal and surgical medical interventions that modify secondary sex characteristics ) . Detransition refers to people aborting their initiated transition and reversing it, totally or partially, to live in a sex-accordant role by reversing the abovementioned steps of transition.

Recent decades have witnessed an exponential increase in those seeking medical interventions to support their transition (medical gender reassignment, GR), with an increasing share of younger individuals of the female sex [ 1 , 2 ]. Psychiatric morbidity among people who contact specialized gender identity services (GISs) has increased simultaneously [ 2 , 3 ] and is particularly pronounced among the youngest age groups [ 4 ].

It has long been assumed that very few patients embarking on medical GR regret their choice and seek to reverse it. From the 1970s to the 2010s, estimates of those regretting their initiated GR were only in the region of 2% [ 5 , 6 ]. However, more recent research suggests that alongside the increase in the number of people accessing medical gender reassignment, reversing the initiated transition seems to be increasing [ 7 ]. In recent samples, 20–30% of those who initiated hormonal GR discontinued hormonal treatment in four to five years [ 8 , 9 ]. It is possible that some patients discontinue hormonal treatment because they have reached their transition goals. Some changes, such as lowering of the voice, can be reached with relatively short hormonal treatments and are permanent, while maintaining some other changes require permanent treatment.

People abandoning their gender transition have reported various reasons for doing so, such as coming to terms with their natal sex, concerns about medical complications, attributing gender dysphoria to reasons other than gender identity, such as trauma or mental disorders, finding that the transition did not alleviate distress, struggles with sexual orientation and discrimination [ 10 , 11 ]. More importantly, those who have detransitioned have repeatedly reported that before their embarking on medical GR, insufficient attention was given to their mental health and psychosocial problems, which, in retrospect, they believed played a major role in their desire to transition. They have expressed concerns that assessments for medical gender reassignment were too superficial, with no search for explanations for their distress beyond an assumed stable sex-discordant identity requiring transition. [ 10 , 11 ]. This contradicts calls to lower the threshold for medical gender reassignment [ 12 , 13 ]. Several recent national guidelines and recommendations [ 4 , 14 , 15 ], however, emphasize the appropriate treatment of psychiatric comorbidities and associated difficulties as well as a psychosocial intervention facilitating identity exploration as first-line interventions for gender dysphoria before considering medical interventions, particularly for young people.

In Finland, gender identity assessments potentially leading to medical GR interventions are conducted at two of the country’s five university hospitals. Services for legal adults (> 18 years) have been available since the early 1990s [ 16 ] and became available to minors in 2011 [ 17 ]. The national guidelines require minors presenting with feelings of gender dysphoria to first undergo psychosocial intervention to support identity exploration and to receive appropriate treatment for any severe mental disorders [ 14 ], after which they can proceed to the centralized GIS, where diagnostic assessments are carried out by specialized mental health teams. Both GISs have separate diagnostic teams for minors and for adults. Hormonal GR interventions are initiated at the same hospitals in gynecological outpatient clinics, and after stabilization, hormonal treatment is transferred to services in the patients’ places of residence. Genital surgeries with gender identity indication are nationally centralized to one university hospital and require recommendations from both nationally centralized diagnostic GIS units. Psychiatric treatment for any concomitant mental health condition is provided at the specialized secondary care or primary health care facility in the patient’s place of residence. Until 2022, diagnostic assessments at the nationally centralized GIS were also a prerequisite for registered sex change, but since 3 April 2023, legal adults have been granted legal GR on the basis solely of their own request. Medical GR remains nationally centralized and is available case-by-case after a comprehensive diagnostic assessment by a multidisciplinary mental health team, as outlined in the national guidelines [ 14 , 18 , 19 ].

An important ethical principle in all medicine is to not harm. A more severe or life-threatening condition may justify greater risks in its treatment. In medical gender reassignment, hormonal and surgical interventions are performed on physically healthy bodies. If the patient subsequently regrets the changes brought by the treatments, not to mention undesired side effects, this can be considered harmful. As in other Western countries, alongside the vastly increasing number of referrals to the GIS, increasing numbers of younger people with increasingly common psychiatric needs have initiated medical GR in Finland [ 2 ]. This may be followed by increasing numbers of people who later feel otherwise about their medical GR. On the other hand, the purpose of the nationally centralized and comprehensive assessment before medical GR is to ensure reasoned treatment decisions and satisfactory patient outcomes, avoiding possible regrets. This may counteract the risks related to the more complex presentations among those seeking medical GR. Those abandoning their gender transitions have repeatedly claimed that the distress accompanying their situation is not appropriately addressed [ 20 ]. It is crucial to take seriously the desire to reverse medical GR and to ascertain its likelihood and predictors to target medical GR safely and provide appropriate services for those opting out of treatment that has resulted in irreversible changes in a healthy pretreatment body. In the present study, we referred to national registry data to determine which patients are likely to discontinue hormonal GR. More specifically, we asked:

How commonly did people who proceeded to hormonal GR after assessment in the nationally centralized GIS from 1996 to 2019 discontinue their established hormonal GR?

What are the predictors of discontinuation in terms of age, age at admission to the GIS, direction of transition, surgical treatment, psychiatric treatment needs and cohort effects?

Has the risk of discontinuing hormonal GR changed over time?

Design and setting

A register-based follow-up study was conducted using information held in health care registers in Finland. These comprehensive and reliable national registers can be used to study large patient groups and collate information from different registers (on an individual level) via the unique personal identity code assigned to each permanent resident of Finland. Register data can be applied for research purposes from the Finnish Social and Health Data Permit Authority Findata and Statistics Finland. Data extraction, linkages and pseudonymization are carried out by these authorities, and researchers are allotted a special secure connection for pseudonymized data only. Analyses producing unduly precise information potentially enabling a person to be identified must be amended to ensure the anonymity of the persons included. The present study obtained ethical approval from the ethics committee of Tampere University Hospital (R20040R) and relevant permissions from Findata (THL/5188/14.02.00/2020) and Statistics Finland (TK/1016/07.03.00/2020). In accordance with Articles 6e and 9i and j of Regulation (EU) 2016/679 of the European Parliament and of the Council [ 21 ], no individual informed consent was needed.

A personal identity code is assigned at birth (or upon obtaining Finnish citizenship). This indicates sex (male or female). Legal sex change entails a new identity code. People are listed in the national registers according to their currently valid personal identity code. This code serves to retrieve data from various registers (including earlier data under the original identity code). Researchers cannot obtain information about identity code changes (changes in juridical sex). Researchers using the data never see the actual identity codes.

Data extraction

Subjects referred to either of the two nationally centralized GISs were identified from the hospital databases of Tampere and Helsinki University Hospitals. The first contact with a diagnostic team in either of the two GISs was recorded as the index date. The Finnish Social and Health Data Permit Authority Findata combined the lists from the two hospitals. A total of 3,665 individuals were identified as having contacted the nationally centralized gender identity units between 1996 and 2019. Of these, 1,359 had initialized and embarked on feminizing or masculinizing hormonal treatment (see below, next paragraph) and formed the subjects of the present study.

The register of the Social Insurance Institution of Finland (KELA), with information on prescription medications purchased and information on reimbursement, was used to obtain information on hormonal GR in the clinical GD group. Persons diagnosed with F64.0 (since 2020, also F64.8) in the nationally centralized gender identity units are entitled to special reimbursement (code 121) for their hormonal treatment, as are patients suffering from specified endocrine disorders. In the treatment of gender dysphoria, special reimbursement is available when hormonal treatment has continued for more than a year. The data on prescription medications were collected up to the end of 2021.

The Care Register for Health Care [ 22 ] was used for information on all treatment contacts to specialist-level psychiatric services from 1994 to 2022. The register, which has been in operation since 1994, includes all outpatient and inpatient contacts with specialist-level health services in Finland. For all contacts, admission and discharge dates were extracted. The Care Register for Health Care was further used to provide information on gender reassignment surgeries.

The Population Register provided information on those deceased and their dates of death.

Discontinuing hormonal GR

Subjects entitled to special reimbursement for hormonal treatments were considered to have discontinued their hormonal GR if they had purchased no hormones for more than 12 months before the end of the data collection or, if deceased, for 12 months or more before their death, or if they had been purchasing specially reimbursed feminizing hormones but had later switched to masculinizing hormones, or vice versa. To obtain reimbursements for prescription medications from the Social Insurance Institution of Finland (KELA), these medications can be purchased for only three months at a time. Thus, not purchasing them for over a year means that they are most likely not being taken. The last date of purchase of the originally prescribed hormonal GR medication was recorded. Patients who discontinue hormonal GR may require birth-sex accordant hormonal replacement to detransition after gonad removal or if their natural hormone production does not resume. For subjects whose specially reimbursed hormone treatment had changed from masculinizing to feminizing or vice versa, the last date of purchase of the originally initiated type of hormonal GR was recorded.

Types and durations of hormonal GR

In the analyses, hormonal GR was divided into feminizing and masculinizing. The duration of hormonal GR with special reimbursement was calculated in months from the dates of first and last/latest purchase of the originally initiated masculinizing/feminizing hormones.

Time variables

The subject’s year of birth was used in the analyses as a continuous variable. The year of initial contact with the GIS (index year) was categorized into intake cohorts with the first contact with the GIS in 1996–2005 vs. 2006–2012 vs. 2013‒2019. As the inclusion period did not fall into three even periods, the first period, with a clearly lower case load, was extended.

Age at first contact with the GIS (index date) was calculated from the dates of index contact and birth. Age in years was used in bivariate analyses as a continuous variable. In multivariable analyses, age was divided into adolescent (up to 22 years old) and adult (23+) at index contact.

Gender reassignment surgeries

The gender reassignment surgeries recorded were genital surgery (vaginoplasty, phalloplasty/metoidioplasty) and chest masculinization.

Specialist-level psychiatric treatment contact

Specialist-level psychiatric treatment contacts other than those related to gender identity assessment were recorded. Having received specialist-level psychiatric treatment was used in the analyses as a comprehensive dichotomous variable (yes/no). Furthermore, having specialist-level psychiatric treatment contact before entering the GIS (yes/no) was used, as was having specialist-level psychiatric treatment two or more years after entering the GIS (yes/no).

Statistical analyses.

Bivariate associations between discontinuing hormonal GR and the explanatory variables were studied via cross-tabulations with chi-square statistics (Fisher’s exact test where appropriate) and the Mantel‒Haenszel test for categorical variables and t tests and ANOVA for continuous variables. Multivariate associations were studied via Cox regression, accounting for differences in follow-up times. Discontinuing hormonal GR was entered as the dependent variable. The independent variables entered were (1) direction of hormonal treatment (masculinizing/feminizing), year of birth and index year cohort; (2) GR surgeries; (3) age at first entering the GIS (adolescent vs. adult); and (4) and, finally, having received specialist-level psychiatric treatment (yes/no). Hazard ratios (HRs) with 95% confidence intervals are given. The cut-off for statistical significance was considered p < 0.05.

There were 1,359 people who, after having been assessed in the nationally centralized GIS, had purchased masculinizing or feminizing hormones with a special reimbursement code. The mean (sd) age of the participants on admission to the GIS was 25.6 (9.3) years, and 49.1% of them were under 23 years of age. In total, 467 (34.4%) had received feminizing treatment, and 892 (65.6%) had received masculinizing treatment. At index contact with the GIS, those who subsequently initiated feminizing GR were older than those who proceeded to masculinizing GR (29.7 (11.1) vs. 23.4 (7.3) years, p < 0.001). The mean (sd) duration of hormonal GR was 62.0 (57.0) months, with a median of 44.5 months, with no difference between masculinizing and feminizing treatments. Genital surgeries were more commonly performed on those who had proceeded to feminizing treatment (46.7% vs. 14.9%, p < 0.001). Among those on masculinizing treatment, 41.5% had undergone chest masculinization. Among all patients proceeding to hormonal GR, 57.4% had ever had treatment contact with specialist-level psychiatric care.

A total of 107 subjects (7.9% of those who had started hormonal GR and obtained special reimbursement for it) had not been purchasing GR hormones for at least a year before the end of data collection (or before the subject died) or had changed from feminizing GR to masculinizing treatment, or vice versa. These were considered to have discontinued hormonal GR. Among those who had obtained feminizing GR, 10.5% had discontinued hormonal treatment, and among those who had obtained masculinizing GR, 6.5% ( p = 0.004). Those who discontinued hormonal GR were slightly older at the index contact and at their latest purchase of specially reimbursed hormones than those who continued hormonal GR. The two groups had used hormonal GR for comparable periods. Those who discontinued and those who stayed on hormonal GR had comparable specialist-level psychiatric treatment contacts. (Table 1 )

Those who discontinued and those who continued hormonal GR had equally common specialist-level psychiatric treatment contact before contacting the GIS (15.3% vs. 17.8%, p = 0.5) as well as two or more years after entering the GIS (59.9% vs. 57.0%, p = 0.2).

Changes across intake cohorts

The basic characteristics of the subjects changed across intake cohorts. The mean (sd) age among those who had contacted the GIS from 1996 to 2005 and subsequently proceeded to hormonal GR was 31.1 (7.9); from 2006 to 2012, it was 25.7 (9.3); from 2013 to 2019, it was 24.8 (9.2) years ( p < 0.001); and the proportion of adolescents (< 23-year-olds) was 13.7% vs. 48.9% vs. 53.6% ( p < 0.001). The proportion of those seeking change towards masculinity increased, and the same change was observed among those discontinuing hormonal GR. The proportion of those with specialist-level psychiatric treatment contacts fluctuated between cohorts among those continuing hormonal GR but remained unchanged among those who discontinued it (Table 1 ).

Multivariable analyses

The hazard ratio (HR) for discontinuing hormonal GR was greater among those in the latest intake cohort (2013–2019) as compared to those in the earliest cohort (1996–2005) when the type of hormonal GR (masculinizing vs. feminizing) and year of birth were accounted for (Table 2 Model 1) and when surgical GR (Table 2 Model 2), age at index admission (adolescent vs. adult) (Table 2 Model 3) and, finally, specialist-level psychiatric treatment contact (Table 2 Model 4) were added. Genital surgeries were associated with a decreased HR for the discontinuation of hormonal GR. Earlier year of birth was very slightly but statistically significantly associated with increased HR for discontinuing hormonal GR in the first models but levelled out in subsequent models.

Confirmatory analyses

Because the oldest individuals in the sample may have discontinued hormonal GR due to reaching the age of natural decline in hormonal levels, the final model was repeated among individuals younger than 60 at the end of data collection, but this did not change the findings.

A further confirmatory analysis was carried out using data from those subjects whose index contact was before 2018 because of the rather short follow-up times among those who had started their gender identity assessments in 2018 or 2019. This caused no changes to the findings presented in Table 2 .

Changes in the discontinuation of hormonal GR over time

Survival curves for the three index date cohorts suggested that the discontinuation of hormonal GR emerged in a shorter time from the earliest to the latest intake cohort (Fig. 1 ). To explore this further, discontinuation within two years of obtaining special reimbursement for hormonal GR was scrutinized among those with index dates before 2018. Among the two earlier intake cohorts (combined due to small cell frequencies in the original categories), 1.3% of those who had started hormonal GR discontinued it within two years; among the latest intake cohort, 2.9% ( p = 0.06).

Time (in years)* to discontinuing hormonal gender reassignment in the different intake cohorts (1 = 1996–2005, 2 = 2006–2012, 3 = 2013–2019). *modeled by Cox regression

In this nationally representative register study covering subjects proceeding to hormonal GR over three decades, 7.9% discontinued their established hormonal GR. The risk for discontinuing hormonal GR was greater in the latest intake cohort (2013–2019) than in the earliest cohort (1996–2005). Genital surgeries were associated with a decreased risk of discontinuing hormonal GR. Over the decades, the time to discontinuation grew shorter.

The proportion of those who discontinued treatment was smaller than that reported in the most comparable study [ 9 ] from the USA, where almost one-third of adolescents and young adults discontinued their hormonal GR within four years. The relatively low discontinuation rate in our study may be due to the comprehensive assessment in the nationally centralized GIS before initiating hormonal treatments. When severe psychiatric comorbidities are present, great care is taken in considering physical interventions [ 2 , 14 , 17 ]. The proportion of those who discontinued their established hormonal GR was nevertheless manifold compared with earlier reports of proportions regretting medical transition among samples who had initiated their treatments between the 1960s and 2010s [ 5 , 6 ]. However, both of those reports focused on actively expressed regrets, and in the latter study [ 6 ], the proportion lost to follow-up—with later development thus unknown—was high. The proportion discontinuing their established hormonal GR in the present study was comparable to the proportion defined as detransitioners (those who discontinued treatment and reverted to living in their original gender role) in a register-based study of 175 subjects initially assessed in 2017–18 in the UK [ 7 ]. However, in that UK study, a clearly greater additional share of the studied group also subsequently disengaged from the treatments or did not adhere to their treatment plan. In a study evaluating the situation of people diagnosed with GD in a specified GP practice population [ 8 ] and, as noted, in a register study in the USA [ 9 ], much greater shares discontinued their medical GR. Direct comparisons among these studies are not feasible because of their different focuses and methodologies. However, together with the most recent studies, our study suggests that discontinuing hormonal GR is a significant phenomenon in gender medicine, and studies reporting the experiences of detransitioners [ 10 , 11 ] suggest that it is often related to profound psychological distress.

In multivariate models accounting for differences in follow-up times and for changes in patient characteristics across intake cohorts, the risk of discontinuing hormonal GR was almost threefold among those patients who had contacted the GIS from 2013 to 2019 compared with those who had contacted the GIS from 1996 to 2005. Our findings also suggest that the time to discontinuation of hormonal GR may have shortened among the later patients; however, in the latest intake cohort, more discontinuations may still emerge, and this will eventually affect the final conclusions about the average time to discontinuation. The proportion of subjects who discontinued after short use, a maximum of two years of specially reimbursed medication use, nevertheless appeared to have increased. (This will mean a maximum of three years of total use, given the rules on special reimbursement). Over the whole study period, the number of people seeking GR increased manifoldly [ 2 ], as did the number of subjects proceeding to hormonal GR. Alongside with this, the risk of discontinuing established medical GR has also increased. The populations seeking medical GR may have changed in a way that limits positive treatment outcomes. It is already known that subjects currently seeking medical GR are, unlike earlier, predominantly birth-registered females, who are younger than before and present with more psychiatric comorbidities than before [ 1 , 2 , 3 , 20 ]. These observations may suggest that an increasing share of GD patients actually do not present with achieved, consolidated identity [ 20 , 23 ]. In particular, medical transition early in terms of identity development may increase the risk of unbalanced treatment decisions, and this risk appears to have increased towards the present day, with detransitioning as the next step. Greater attention to gender identity issues and GR in the media and social media as well as assertive advocacy for medical GR may play a role in these developments [ 20 , 24 , 25 ].

Somewhat unexpectedly, the need for specialist-level psychiatric care did not differentiate those who continued and those who discontinued hormonal GR. Approximately one in six of the patients who had started hormonal GR, both those who later discontinued and those who continued the treatment, had needed specialist-level psychiatric treatment before embarking on gender identity assessments. This number was clearly less than that of all patients who were in contact with the GIS [ 2 ]. It is expected that the two groups would be comparable at the time of the decision to initiate medical GR and suffer fewer psychiatric comorbidities than those who could not start medical GR. However, psychiatric treatment needs increased vastly after the index contact with the GIS in both groups who proceeded to medical GR, those who subsequently discontinued it and those who continued on hormonal GR. A more detailed analysis of the nature of psychiatric needs and subsequent identity struggles is needed to better understand the discontinuation of medical GR in the future. According to the multivariable analyses, the risk for discontinuing hormonal GR did not differ between those who had initially contacted the GIS during adolescence (< 23 years) and those who had contacted in adulthood. This may be due to assessments being particularly cautious with younger patients, whereas with middle-aged subjects, self-determination may be accorded greater significance.

Having undergone genital surgeries was predictive of a decreased risk of discontinuing hormonal treatments. This may be due to strict treatment protocols requiring psychological stability as part of eligibility for genital surgeries. A recommendation letter is required from both the nationally centralized GIS for gender surgeries to ensure both the patient’s capacity to consent and that their psychological and psychosocial resources will suffice to recover from major surgery.

Methodological considerations.

A strength of the present study is the use of nationwide registry data over three decades. The registers are comprehensive since treatment providers are required by law to report to them all the information on which this study relies. The subjects were identified in the databases of the hospitals where the nationally centralized GISs operate, thereby ensuring the reliability of sampling. The long inclusion period made it possible to analyse changes over time. A limitation is that only subjects who had obtained the special reimbursement code for their hormonal GR were included. There may be subjects who discontinued hormonal GR before their entitlement to special reimbursement (which can take place after a year), and their number is not known. Another limitation is that registers include no information on the reasons for discontinuing hormonal GR. Given the ample publicly funded health services and the special reimbursement for hormonal GR, financial problems are an unlikely reason. Further changes in identity, medical complications or concerns over them, not being helped by GR or social reasons, may contribute [ 10 , 11 , 20 ]. It is also possible that some achieved their goals and therefore discontinued, although this seems implausible in the case of discontinuation after many years. A more profound understanding of the reasons for discontinuing medical GR will require studies using information elicited directly from patients. A further limitation is that regarding the need for psychiatric treatment, this research focused on specialist-level service contacts reflecting severe psychiatric needs. Mild to moderate mental disorders are treated in primary health care. Thus, the need for psychiatric treatment was likely somewhat underestimated in the present study. A limitation is that the possible use of hormonal GR through unofficial routes was not addressed. Publicly funded medical GR interventions are possible only through nationally centralized gender identity services. Obtaining hormonal GR via unofficial routes would likely be related to medical GR not being considered timely in the official treatment route. This finding may suggest that the discontinuation of hormonal GR can be more common among those who obtain hormones unofficially. We combined minors (< 18 at intake to the GIS) and late adolescents (18–22-year-olds at intake) because before 2011, minors entered the assessments only occasionally. Brain development, personality development and identity consolidation continue well beyond the age of reaching legal adulthood [ 23 , 26 , 27 , 28 , 29 , 30 ]. Finally, discontinuing hormonal GR, desisting from identifying in a sex-discordant way, detransitioning and regretting medical GR are concepts referring partly to the same phenomenon but not totally overlapping [ 20 ]. A register-based study cannot reach these nuances.

Discontinuing established medical GR appears to be less common in Finland than reported elsewhere. This is likely due to careful, comprehensive assessment before initiating physical treatments. The risk of discontinuing established medical GR has nevertheless increased alongside increases in the number of patients seeking and proceeding to medical GR. In later intake cohorts, discontinuation also appears to emerge earlier. The threshold to initiate medical GR may have decreased, resulting in greater risks of suboptimal decisions. More research is needed on practically all aspects of detransitioning from medical GR.

Data availability

The authors are not allowed to give the data to any party. Information about how to apply Finnish register data for research purposes can be found in www.findata.fi.

Abbreviations

Gender dysphoria

Gender identity service

Hazard ratio

Confidence interval

Thompson L, Sarovicid D, Wilsonid P, Sä Mfjordid A, Gillberg C. A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology. 2022; https://doi.org/10.1371/journal.pgph.0000245

Kaltiala R, Holttinen T, Tuisku K. Have the psychiatric needs of people seeking gender reassignment changed as their numbers increase? A register study in Finland. Eur Psychiatry. 2023;66(1).

Thompson L, Sarovic D, Wilson P, Sämfjord A, Gillberg C. A PRISMA systematic review of adolescent gender dysphoria literature: 2) mental health. PLOS Global Public Health. 2022;2(5):e0000426.

Article PubMed PubMed Central Google Scholar

Cass Reviw. Independent review of gender identity services for children and young people 4 Independent review of gender identity services for children and young people: Final report [Internet]. 2024 [cited 2024 Jun 7]. https://cass.independent-review.uk/home/publications/final-report/

Dhejne C, Öberg K, Arver S, Landén M. An analysis of all applications for sex reassignment surgery in Sweden, 1960–2010: prevalence, incidence, and regrets. Arch Sex Behav. 2014;43(8):1535–45.

Article PubMed Google Scholar

Wiepjes CM, Nota NM, de Blok CJM, Klaver M, de Vries ALC, Wensing-Kruger SA, et al. The Amsterdam cohort of gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and regrets. J Sex Med. 2018;15(4):582–90.

Hall R, Mitchell L, Sachdeva J. Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review. BJPsych Open. 2021;7(6).

Boyd I, Hackett T, Bewley S. Care of Transgender patients: a General Practice Quality Improvement Approach. Healthcare. 2022;10:121.

Roberts CM, Klein DA, Adirim TA, Schvey NA, Hisle-Gorman E. Continuation of gender-affirming hormones among Transgender adolescents and adults. J Clin Endocrinol Metab. 2022;107(9):E3937–43.

Littman L. Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition who subsequently detransitioned: a Survey of 100 detransitioners. Arch Sex Behav. 2021;50(8):3353–69.

Vandenbussche E. Detransition-related needs and support: a cross-sectional online survey. J Homosex. 2022;69(9):1602–20.

Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of Care for the health of transgender and gender diverse people, Version 8. Int J Transgend Health. 2022;23(S1):S1–259.

Article CAS PubMed PubMed Central Google Scholar

Rafferty J, American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health C on AS on LGB and TH. and W. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics [Internet]. 2018;152(4). http://publications.aap.org/pediatrics/article-pdf/142/4/e20182162/1529435/peds_20182162.pdf

Palveluvalikoimaneuvosto (COHERE Finland). Palveluvalikoimaneuvoston suositus. Alaikäisten sukupuoli-identiteetin variaatioihin liittyvän dysforian lääketieteelliset hoitomenetelmät [Internet]. 2020 [cited 2023 Jul 20]. https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf?t=1592317701000

Socialstyrelsen S. 2022 [cited 2023 Jul 20]. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2023-6-8586.pdf

Pimenoff V. On the care of transsexuals in Finland. Int J Transgenderism. 2006;9(2):23–33.

Article Google Scholar

Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child Adolesc Psychiatry Ment Health. 2015;9(1).

Palveluvalikoimaneuvosto (COHERE Finland). Palveluvalikoimaneuvoston suositus. Transsukupuolisuudesta johtuvan dysforian lääketieteelliset hoitomenetelmät [Internet]. Helsinki. 2020 [cited 2023 Jul 20]. https://palveluvalikoima.fi/documents/1237350/22895838/Transsukupuolisuus+suositus.pdf/82b60104-291c-7d8c-9e88-1b1fc9bba527/Transsukupuolisuus+suositus.pdf?t=1592318544000

Palveluvalikoimaneuvosto (COHERE Finland). Palveluvalikoimaneuvoston suositus. Aikuisten muunsukupuolisuuteen liittyvän sukupuolidysforian lääketieteelliset hoitomenetelmät [Internet]. Helsinki. 2020 [cited 2023 Jul 20]. https://palveluvalikoima.fi/documents/1237350/22895623/Muunsukupuolinen+suositus.pdf/058ac8f5-560d-da00-7b03-20644f97674a/Muunsukupuolinen+suositus.pdf?t=1592318040000

Jorgensen SCJ. Transition regret and detransition: meanings and uncertainties. Arch Sex Behav. 2023;52(5):2173–84.

EUR-Lex. Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation). 2016.

Gissler M, Haukka J. Finnish health and social welfare registers in epidemiological research. Vol. 14, Norsk Epidemiologi. 2004.

Kroger J, Martinussen M, Marcia JE. Identity status change during adolescence and young adulthood: a meta-analysis. J Adolesc. 2010;33(5):683–98.

Marchiano L, Outbreak. On Transgender teens and psychic epidemics. Psychol Perspect. 2017;60(3):345–66.

Google Scholar

Haidt J. The anxious generation: how the Great Rewiring of Childhood is causing an epidemic of Mental Illness. Penguin Books LImited; 2024.

Paus T, Keshavan M, Giedd JN. Paus et al why do mental disorders emerge in adolescence. Nat Rev Neurosci. 2008;9(12):947–57.

Klimstra TA, Hale WW, Raaijmakers QAW, Branje SJT, Meeus WHJ. Maturation of personality in adolescence. J Pers Soc Psychol. 2009;96(4):898–912.

Luyckx K, Robitschek C. Personal growth initiative and identity formation in adolescence through young adulthood: mediating processes on the pathway to well-being. J Adolesc. 2014;37(7):973–81.

Baxendale S. The impact of suppressing puberty on neuropsychological function: a review. Acta Paediatrica, International Journal of Paediatrics. Volume 113. John Wiley and Sons Inc; 2024. pp. 1156–67.

Petanjek Z, Judaš M, Šimić G, Rašin MR, Uylings HBM, Rakic P, et al. Extraordinary neoteny of synaptic spines in the human prefrontal cortex. Proc Natl Acad Sci U S A. 2011;108(32):13281–6.

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This research has received funding from the Wihuri Foundation and the Suomen Kulttuurirahasto. The funders had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.

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Riittakerttu Kaltiala

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Mika Helminen

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RK, MH, TH and KT all contributed substantially to the design of the work; TH and RK curated the data; RK performed the analyses; MH consulted in statistical analyses; RK, MH, TH and KT interpreted the results; RK had the main responsibility of drafting the manuscript; MH, TH and KT participated in drafting the manuscript and approved the version submitted. All the authors have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. All the authors reviewed and approved the manuscript.

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Kaltiala, R., Helminen, M., Holttinen, T. et al. Discontinuing hormonal gender reassignment: a nationwide register study. BMC Psychiatry 24 , 566 (2024). https://doi.org/10.1186/s12888-024-06005-6

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Missouri agency quietly made it harder to change gender marker on driver’s licenses

Medical documentation of gender reassignment surgery or court order required to align state identification to gender identity, by: annelise hanshaw - august 19, 2024 1:48 pm.

Transgender Missourians will need proof of surgical transition or a court order before their driver's license can match their gender identity (photo illustration by Ross Williams/Georgia Recorder)

It became much harder this month for Missourians to change the gender marker on their driver’s licenses following a quiet move by the state Department of Revenue.

The department, which issues state driver’s licenses, switched from requiring the signature of a physician, therapist or social worker to approve a change in gender designation to mandating documentation of gender reassignment surgery or a court order.

The shift happened earlier this month, though it was not announced publicly by the department. The Wayback Machine , which archives web pages, shows the gender designation change request form requiring physician signoff, known as Form 5532, was available Aug. 6. The next day, the web page with the form was offline.

A spokesperson for the Department of Revenue told The Independent in a statement that “Form 5532 is no longer needed.”

“Customers are required to provide either medical documentation that they have undergone gender reassignment surgery or a court order declaring gender designation to obtain a driver license or non-driver ID card denoting gender other than their biological gender assigned at birth.”

PROMO, Missouri’s largest LGBTQ advocacy organization, reached out to the department after hearing that people could no longer make changes to their identification using Form 5532 and heard that “an incident” spurred the move, said executive director Katy Erker-Lynch.

According to the Movement Advancement Project , which maps states’ policies affecting LGBTQ residents, Missouri is one of 10 states with this policy. Just three states do not allow residents to change their gender markers.

The policy change occurred soon after controversy erupted earlier this month over a transgender woman who used the women’s locker rooms at a private gym in Ellisville.

State Rep. Justin Sparks, a Republican from Wildwood, told The Independent that his office “would have never even known about (Form 5532) unless the Lifetime Fitness incident had occurred.”

Sparks was among a group of elected officials who convened a press conference outside the gym Aug. 2, and Missouri Attorney General Andrew Bailey announced an investigation into the incident the same day.

During a radio appearance Aug. 1, Sparks said the transgender woman “displayed a state ID describing (herself) as female.”

“We are going to get to the bottom of what happened in the Department of Revenue and that form they issued several years ago,” he said. “It was inappropriate and in my opinion, it is not legal.”

Later that evening, in a live broadcast via Facebook, he told followers that he had been in contact with the department.

“I have assurances from the Department of Revenue that they are going to change their policies and their form,” he said, promising to follow up with the department.

Sparks told The Independent that he had questions about the creation of the form, which was made in 2016 with the help of LGBTQ advocates.

“I don’t even know if the people that have used that form, if that’s even valid,” he said.

He is looking into whether or not the department is allowed to change a policy without the legislature’s direction, which would determine whether the change in 2016 and this month’s switch are authorized.

“State law does not allow them to change that (policy). That’s something that we’re looking into right now, meaning can the Department of Revenue arbitrarily change policy without legislative oversight or legislation? And to the best of my knowledge, they cannot,” he said.

The change of gender markers on state identification is not explicitly mentioned in state law. The section of Missouri state law that describes driver’s license application forms allows the department to “promulgate rules and regulations necessary to administer and enforce this section,” though they must follow normal rulemaking procedure.

Sparks felt like his initial interaction with the department was unhelpful. When he involved Bailey and state senators, he says the Department of Revenue promised to change the form.

He believes the change might have been out of appeasement, to stop them from “digging.”

Erker-Lynch had a similar impression.

“It seems the mere mention and threat of a potential investigation into the policies and practices of the Department of Revenue caused Director (Wayne) Wallingford to end a policy that worked to help people,” Erker-Lynch said. “This decision reflects a state and state departments run by fear and intimidation — not a state run to serve its residents.”

PROMO is gathering stories of those who are struggling to change their gender marker on their state identification, calling the campaign “The ID for Me .”

This story was updated at 2:28 p.m. to include reaction from Rep. Justin Sparks.

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Annelise Hanshaw

Annelise Hanshaw writes about education — a beat she has covered on both the West and East Coast while working for daily newspapers in Santa Barbara, California, and Greenwich, Connecticut. A born-and-raised Missourian, she is proud to be back in her home state.

Missouri Independent is part of States Newsroom , the nation’s largest state-focused nonprofit news organization.

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Gender reassignment Definition & Meaning
The meaning of GENDER REASSIGNMENT is a process by which a transgender or nonbinary person comes to live in accordance with their gender identity through changes to their appearance and presentation often with the aid of medical procedures and therapies : gender transition. How to use gender reassignment in a sentence.
What is gender reassignment
What is gender reassignment A decision to undertake gender reassignment is made when an individual feels that his or her gender at birth does not match their gender identity. This is called 'gender dysphoria' and is a recognised medical condition. Gender reassignment refers to individuals, whether staff, who either: Have undergone, intend ...
FAQs
The Equality Act 2010 at Section 7 defines the protected characteristic of "gender reassignment" as relating to a person who is: "proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person's sex by changing physiological or other attributes of sex.".
Gender Confirmation (Formerly Reassignment) Surgery: Procedures
Today, many transgender people prefer to use the term "gender confirmation surgery," because when we say something like gender "reassignment" or "sex change," it implies that a person ...
Gender Transitioning: Meaning, Process, Barriers
Gender transitioning is the process by which you express your gender externally ( gender expression) so that it aligns with how view your gender internally (gender identity). The process has no particular timeline and isn't always linear. Many transgender and gender-nonconforming people prefer the term "gender affirmation" to "gender ...
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Knowing that sex, sexuality and gender aren't interchangeable terms, updating "sex change" to "gender reassignment" or "gender affirmation" and "transsexual" to "transgender" moves the focus away from what sounds like something to do with sexual orientation to one that is a more accurate designation.
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What is gender-affirming care? Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions "designed to support and affirm an individual's gender identity" when it conflicts with the gender they were assigned at birth.
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GENDER REASSIGNMENT definition: 1. a process, sometimes including medical operations, by which someone's sex is changed from male…. Learn more.
GENDER REASSIGNMENT definition
gender reassignment meaning: 1. a process, sometimes including medical operations, by which someone's sex is changed from male…. Learn more.
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The Equality Act 2010 uses the term 'transsexual' for individuals who have the protected characteristic of gender reassignment. We recognise that some people consider this term outdated, so we have used the term 'trans' to refer to a person who has the protected characteristic of gender reassignment.
Gender Affirmation Surgeries: Common Questions and Answers
Gender affirmation surgery, also known as gender confirmation surgery, is performed to align or transition individuals with gender dysphoria to their true gender. A transgender woman, man, or non-binary person may choose to undergo gender affirmation surgery. The term "transexual" was previously used by the medical community to describe people ...
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Definition of gender reassignment noun in Oxford Advanced Learner's Dictionary. Meaning, pronunciation, picture, example sentences, grammar, usage notes, synonyms and more. Toggle navigation. ... to match their gender identity Some people prefer to use the term gender confirmation.
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Gender reassignment definition: male-to-female or female-to-male transformation involving surgery and hormone treatment. See examples of GENDER REASSIGNMENT used in a sentence.
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gender reassignment: Acknowledgement of the true mental and emotional sex (gender identity) of an individual when this does not correspond to the apparent anatomical sex. Gender reassignment is a necessary, and serious, preliminary to any serious consideration of sex-change surgery.
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Important terms related to Gender Dysphoria: 18 Cisgender: Describes a person whose gender identity aligns in a traditional sense with the sex assigned to them at birth.; Gender diverse: An umbrella term describing individuals with gender identities and/or expressions and includes people who identify as multiple genders or with no gender at all. Gender dysphoria: A concept designated in the ...
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noun. variants also sexual reassignment. : gender reassignment. In the conventional narrative about sex reassignment, a person is so sure from such a young age that he or she inhabits the wrong body that a surgically corrected self is a lifelong dream. Lisa Miller, New York Magazine.
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Gender-reassignment definition: The process of changing one's sex, usually by a combination of medicinal and surgical means; sex change.
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gender reassignment. ( dʒendər riəsaɪnmənt ) uncountable noun. Gender reassignment is the process of changing a person's physical sexual characteristics from male to female or from female to male with an operation and other medical procedures. Collins COBUILD Advanced Learner's Dictionary.
Discontinuing hormonal gender reassignment: a nationwide register study
Background With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation ...
Missouri agency quietly made it harder to change gender marker on
The department, which issues state driver's licenses, switched from requiring the signature of a physician, therapist or social worker to approve a change in gender designation to mandating documentation of gender reassignment surgery or a court order. The shift happened earlier this month, though it was not announced publicly by the department.

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