Living Transgender: Frequently Asked Questions, Resources

As part of our series on living transgender, WBUR reporter Martha Bebinger collected these answers to frequently asked questions about transgender or genderqueer issues. We will also host a live chat to answer your questions on Friday, Jan. 24 at 12 p.m.

What is transgender?

A general term for men and women who prefer to live as the gender opposite the one acknowledged at birth. A man living as a woman is called a transgender woman or transfemale.  You may also see the shorthand MtF. A woman living as man is a transgenderman or transmale — FtM.

Transgender men and women may or may not have taken medical steps to change their bodies.

What is transexual?

This term, which is less commonly used these days, has more of a medical connotation. It generally refers to transgender men or women who have taken a medical step to alter their physical appearance.

What is genderqueer?

This term is used by some men and women who don't identify as male or female. Some genderqueer people will ask you to use the pronouns they/their/theirs to avoid male and female references.

What is do all the acronyms mean?

The letters in LGBTQ stand for lesbian, gay, bisexual, transgender and queer. Various groups add letters, stretching out to LGBTQQIAAP — lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, allies and pansexual.

What pronouns do transgender people use?

Many transgender men go by he/his/him and many transgender women use she/her/hers. There are alternatives, ze/zer/zis, for example. A handful of cultures and countries around the world have adopted a third gender pronoun. Sweden added "hen" as a gender neutral pronoun to its national encyclopedia this year, amid some controversy.

What is a cis male or cis female?

Cisgender men and women are living the gender identified at birth. They are not transgender. Cis is the prefix meaning "on this side of" whereas trans is a prefix meaning "on the other side of."

How many transgender Americans are there?

Estimates vary from one in a thousand to five in a thousand. A 2011 report from the Williams Institute at UCLA Law puts the number at three in a thousand. This is the estimate we use for this series. That translates to roughly 19,800 residents of Massachusetts and 942,000 Americans.

Is transgender just a phase?

Doctors say yes, sometimes among children ages 12 and under. But after puberty, many of these same physicians will say that the identity young teenagers embrace will be their gender for the rest of their lives. The most definitive research supporting puberty as the defining period for children who want to change their gender comes from the Netherlands. But there is very little rigorous research on this question and most other medical issues for transgender children and teenagers.

There are also no firm rules about when doctors begin puberty blocking drugs that buy children and their parents more time to decide the child's gender identity.

How often do transgender men and women change their minds and return to their birth sex?

There is very little clinical research on this general topic and none done in the U.S. There is some research on men who have sex reassignment surgery. One study based on the patients of a surgeon in Oregon says "none reported outright regret and only a few expressed even occasional regret." A study of 20 adolescents in the Netherlands found no regret after sex reassignment surgery. But this study from the Netherlands summarizes the case of a transgender female who did express regret after surgery and summarizes earlier research that found regret in 10 to 30 percent of patients.

Can a transgender man or woman change their legal records?

Yes, although some attorneys recommend seeking a court order to assure uniform changes. The rules for drivers licenses, passports, birth certificates and other records changes vary some from state to state.

How are schools in Massachusetts dealing with transgender students?

Again, this varies, but the state has guidelines that took effect earlier this year. They say that schools must provide a safe, clean bathroom option for transgender children. These children and teenagers can have their name and gender changed on all school records. Records the school can't alter, such as a birth certificate, are supposed to be kept in a secure file that is not part of the larger record.

What medical steps do transgender men and women take to change their gender?

Hormone therapy: Men becoming women take weekly estrogen shots. Women becoming men take testosterone as a weekly shot, or via a daily cream or gel. Some of the effects of hormone treatment are irreversible.

Top surgery: Transgender men (females becoming male) may have surgery to flatten their chests. Transgender women may have breast implants.

Bottom surgery: Transgender women may opt for surgery that turns their penis inside out and pushes it into the body to form a vagina. A portion of the head of the penis is used to create the clitoris.

Transgender men are less likely to try bottom surgery because the results aren't very good yet. "Nobody has a good operation for female to male. It’s just so complex," says Dr. Norman Spack from Boston Children's Hospital. Some doctors are creating a penis using tissue removed from the forearm and rolled into a cylinder. Spack says this procedure can cost as much as $200,000.

Why do men and women become transgender?

There is no firm answer to this question. There are theories about chemicals that affect a pregnancy and hormone imbalances and brains that, by size, don't match their male or female body. But again, there is no definitive research. Some doctors report seeing more females becoming males than males becoming females in recent years. Theories about why are just speculation.

What is gender dysphoria?

This is the medical diagnosis for people in distress about their gender identity.

Does health insurance cover transgender medical procedures?

Generally, no. A handful of employers in Massachusetts, mostly universities, offer this benefit. Harvard, Boston University, MIT and Tufts are among the universities that cover hormone treatment and gender reassignment surgery.

At what age can children or teenagers begin medical procedures to change their sex?

The legal age of consent in Massachusetts is 18. With a parent's consent, teenagers can have surgery to either flatten or create breasts. Very few, if any doctors, will change a patient's genitalia before the age of 18. There is vigorous debate about the age at which it is ethically appropriate to begin hormones that will trigger permanent changes in girls who want to become boys or boys who want to become girls. Most doctors who treat transgender children say gender is set during puberty.

From the Massachusetts Catholic Conference (MCC):

"God created man in His own image, in the image of God He created him; male and female He created them."
-Genesis 1:27

Every human being possesses an inherent personal dignity that includes the right not to be subjected to violence or unjust discrimination. All violence against persons is reprehensible and deserves condemnation regardless of the motivation. Differential treatment in the provision of services, accommodations, or access, however, is not always objectionable. Rather, it is only arbitrary discrimination, based on prejudice that lacks any connection to principles of justice or the common good, which must be opposed.

In testimony at the State House this summer, the MCC said "the Church has consistently taught that gender, male or female, remains constant from birth until natural death."

The Islamic Society of Boston Cultural Center in Roxbury:

"We welcome people of all backgrounds," says Imam Suhaib Webb. "Whatever gender a person feels inclined towards is fine." Transgender men pray in the men's section of the mosque and transgender women in the women's section.

Traditionally, Imam Webb says, Islamic scholars held to the idea that the dominant organ determined a person's sex. But Webb says that is no longer the thinking of most religious scholars. Culturally, he says, you'll find many Muslims who do not agree with this perspective.

The Episcopal Church:

The church added "gender identity and expression" to its non-discrimination clause last year and Boston University has one of the first openly transgender chaplains on its staff. A faction of the Episcopal church continues to oppose the church's increasing acceptance or lesbian, gay and transgender members and leaders.

Judaism:

Orthodox Jewish organizations do not post their positions on transgender, but one rabbi explained the movement's stance in response to a Yeshiva University professor who transitioned from male to female. "Jewish law does not recognize sex changes as a legitimate change in one’s halakhic status; if someone was born male, then Jewish law considers him to be a male regardless of any subsequent medical procedures."

Jews in the Conservative Movement, through their Committee on Jewish Law and Standards in 2003, recognize gender change if the man or woman has had sex reassignment surgery.

Reform Jews are beginning to ordain transgender rabbis, but at least one leader says it's too early to say if they will be widely accepted.

The Massachusetts Family Institute (whose mission is to strengthen the family and its Judeo-Christian values):

MFI says its "opposition to laws categorizing Gender Identity as an immutable characteristic like race or anatomical sex is based on scientific fact. For example, the American Psychiatric Association categorizes gender identity as a 'dysphoria,' and it was only recently relabeled from a 'disorder.' We disagree with creating special legal privileges to normalize a recognized mental health issue."

Samara Breger helped research this FAQ.

WBUR reporter Martha Bebinger will moderate a live chat at noon on Friday, Jan. 24 to answer any questions you might have about transgender or genderqueer issues. Ask your questions in advance here.