General questions
The word transgender is used to describe people whose gender identity differs from the sex they were assigned at birth.
Gender identity is a person’s internal and social sense of being a man or a woman (or a boy or girl). This is often related to whether they would feel most at home in a typically male or female body or social role. Those who are non-binary have a gender identity that does not fit neatly into those two options.
People who are transgender may describe themselves using additional terms, like transsexual or non-binary. These terms can be found in the glossary.
Anyone with a gender identity that is at odds with the gender assigned to them at birth is transgender, regardless of whether they have taken any steps to socially or medically transition.
A transgender man is a man even if his body still looks female and he lives as a woman. A transgender woman is a woman even if her body looks male and she lives as a man.
Gender identity is not defined by how you dress or what body parts you have.
Yes; not all trans people experience dysphoria, and some might only understand at a later time during transition that what they have been experiencing for most of their lives was, indeed, dysphoria.
Some trans people report experiencing gender euphoria instead when their gender identity is embraced and affirmed in little ways.
This may present in many different ways — for instance, happiness at being ‘mistaken’ for someone opposite of your assigned gender, such as being called ma’am on the phone when you’re still identifying or presenting as male.
Euphoria can also manifest when wearing clothing or having a hairstyle associated with your gender, or when being addressed by your chosen name.
Yes. Whether you transition is a very personal decision that should not be made lightly, and is something that you will have to decide for yourself.
Transition may be liberating but will at times be painful or come at a high cost in terms of your safety, relationships, career and finances.
Be patient with yourself and take some time to think this through before taking any action. You might change your mind multiple times before coming to a decision. That’s normal. Transitioning is a major life decision filled with risks and unknowns, and is often a last resort for many people.
Before opting for medical transition, you can also consider social transitioning as an easier first step, such as dressing in a more masculine or feminine way, or privately affirming your gender identity in online groups or communities while continuing to live outwardly as your assigned gender.
Ultimately, how you choose to resolve or live with your gender dysphoria is completely up to you.
The term non-binary is usually used to describe people who do not identify with the label of either ‘man’ or ‘woman’.
Non-binary people may use terms like genderqueer or genderfluid to describe themselves, as well as other terms like demigirl or demiboy - you can find the definitions to these terms in the Glossary.
People may also try on non-binary identities as a tentative source of comfort as they seek to explore their gender further. These identities may change as personal and social contexts evolve.
Often, non-binary people prefer a third pronoun other than he or she - they being the most common. People who use the word non-binary to describe themselves often typically also say that they are transgender, though this may not always be the case.
No. Some are content dressing and living as the gender they identify as, without medical intervention. They may be happy living their lives as a woman with a typically male body (or vice versa), and distress may only come when society reacts negatively.
Others are non-binary, and may be most comfortable with a more androgynous gender expression or one that changes over time.
Some people who do experience dysphoria may also find it manageable and decide not to seek medical intervention, or wish to only begin medically transitioning when their financial or social situation is stable.
Still more may only seek medical transition after they manage to store their gametes, as their fertility may be affected with medical transition.
No. Being transgender in itself is not considered a mental illness. Many trans people are mentally healthy by all standards of measurement, especially after transitioning.
Gender dysphoria — the distress experienced from the mismatch between one’s gender identity and sexual characteristics — was once considered a mental illness, similar to depression, if it led to severe difficulties in functioning.
Not all trans people have dysphoria severe enough to be diagnosed. In either case, the recommended treatment was gender transition, which has proven to be effective in resolving (rather than merely suppressing) dysphoria.
Gender dysphoria has since been moved out of the mental health category and is no longer considered an ‘illness’. Transition continues to be the recommended and effective course of action for people who experience gender dysphoria.
If left untreated, gender dysphoria has been found to lead to negative effects on one’s mental health and create psychological distress, including a worsening risk of actual mental illnesses that may not fully resolve even after transition.
However, like everyone else, trans people’s mental health is also highly dependent on structural factors like poverty, employment, abuse and level of social acceptance.
These conditions tend to be much worse for trans people compared to the rest of society, resulting in poorer mental health on average.
Mental health outcomes have been positive — sometimes even outstripping the general population — in trans people who transition early in supportive environments.
There is no one objective test that can tell you if you are transgender. The desire to be another gender may sometimes be rooted in other causes. In these scenarios, transitioning may worsen rather than improve your situation.
However, if you are feeling uncomfortable with the gender you are assigned at birth, here are some questions that might help guide you along in determining what is behind these feelings, and to figure out your identity.
- How would you feel if you were given the freedom to live life the way you want with the gender you were assigned at birth? Would you be comfortable simply being a feminine man, or masculine woman, if the people around you accepted you as such?
- If you feel restricted or frustrated by gender roles, where does this pain stem from? Does it come primarily from the burden of fulfilling these gender roles, or does it stem from a discomfort from being forced into them?
- If women were made to serve National Service and men were made exempt, would you be content being a man?
- Conversely, if you were magically brought to a world where you no longer had to deal with any sexism, would you be content being a woman?
- Similarly, does the thought of transitioning fill you with fear because you like your body, but are afraid you secretly want to?
- Teenagers go through a period of identity formation while they try to work out their place in the world. This may extend to gender.
- They may grapple with what it means to have a female body in a society that often sexualises and infantilises them, or being male in a society that often expects toughness and emotional repression.
- If you are a teenager (or a pre-teen), consider giving yourself some time to figure out what your identity is. If, however, you experience distress about your assigned gender that seems largely unusual, you may wish to look further into this with a trusted counsellor.
- If you are seeking a same-sex relationship and are dealing with homophobia, would you still be uncomfortable with your gender if you were free to love your partner?
- Do people around you wish that you were a different gender, and scorn you for being the ‘wrong’ gender? If you solely wish to transition just so that they would be happier, you might wish to reconsider.
- Do you want to transition just so a crush would be attracted to you? You should definitely reconsider.
These are just guidelines, however — there are no right answers, and the trans people you meet may not always give the same answers, but these can act as a starting point.
Ultimately, what you should be asking is not “am I transgender?” but:
Common myths
Trans people often advocate for gender-neutral language as a way to be inclusive and avoid misgendering trans people.
For example, addressing an audience as ‘distinguished guests’ is more concise than ‘ladies and gentlemen, boys and girls’, and also includes non-binary guests without singling them out.
However, this applies to groups, not individuals. On the individual level, just like cisgender men and women, transgender men wish to be treated as men and transgender women as women. This includes being referred to with the relevant gendered terms: sons and daughters, brothers and sisters, husbands and wives, Mr and Ms, sir and ma’am. Using gender-neutral terms in this context instead degenders them, implying that they are not ‘real’ men or women.
For non-binary people, affirmation instead means recognising them as neither men nor women. That is when gender-neutral terms come into play at the individual level: child, sibling, parent, spouse, Mx. Some non-binary people are also comfortable with or prefer certain male/female gendered terms, and will often take the lead in referring to themselves as such.
Fully recognising trans men and women also involves treating them as you would others of their gender, without ignoring realities. For example, treating a trans woman as a woman might mean inviting her to a girls’ night out or to be a bridesmaid at a wedding, but would not mean telling her to be careful not to get pregnant.
Sometimes, affirmation can look like exclusion — such as not inviting a trans man to an event that normally excludes men, as doing so would imply that he’s not really a man.
Trans people who have just come out or are early in transition may still be living fully or partly as their assigned gender and prefer a more neutral approach for the time being. In those cases it would be helpful to ask them.
It is very common for transmasculine people — and transgender men in particular — to struggle with knowing if they are truly transgender or simply suffering from internalised misogyny. This typically comes with the belief that most women similarly hate being women, but are willing to suffer together in solidarity rather than take the ‘easy’ way out and become men.
However, while most women naturally hate sexism, their dream is a world where they are treated as equals; not a world in which they are men, which is what trans men hope for.
The rampant transphobia in society also means that transitioning to male is by no means an easy way out.
Life is harder in many ways for the average trans man compared to the average cis woman in Singapore. This includes risks of physical and sexual assault and harassment, which is then exacerbated by the lack of resources for male survivors that mean trans men either go without help or have to misgender themselves to receive help. Trans people also face difficulties in education, finding employment, housing, romantic relationships, starting a family, and more. Trans men who are attracted to men additionally become subject to homophobia, and also face transphobia within the gay community.
In other words, transitioning to male and exchanging misogyny for transphobia would make no sense if what this person is after is a life free from societal oppression.
We do not expect cisgender men to transition to female to suffer in solidarity with women, and should not expect that of transgender men.
If women were indeed transitioning just to escape misogyny and sex-related trauma, it would say a lot more about society's treatment of women that it would drive them to those extremes. The focus should then be on fixing society, not on further victimising those who are merely trying to escape. The first step would then be to work to make society better for women and see if this reduces the number of trans men.
Meanwhile, if trans men are distressed at being female, sometimes to the point of suicide, but find that they can live happy, fulfilling lives as men who would be much better placed to work alongside women for equality, it would be both cruel and counterproductive to deny them transition and insist they suffer instead. It would position womanhood as something to be meted out as punishment and manhood as an exclusive freedom gifted solely to those born with it — and that would only reinforce misogyny, not resolve it.
A common claim is that trans women are ‘men who believe they are women’ (and vice versa for trans men), suggesting that trans people are delusional and out of touch with reality.
However, if the person making this claim defines 'man' as 'someone born with a penis' and 'woman' as 'someone born with a vagina', this means they are saying that trans women were born with penises but believe they were born with vaginas — which is clearly untrue. If trans women truly believed they were born with typical female bodies, they would never think they were trans nor have a reason to want to transition, as there would be nothing to change.
Trans people are very aware of our sexual biology. The disparity between our physical bodies and our gender identities is often a large source of our gender dysphoria.
When trans people describe ourselves as men, women or non-binary, we are not referring to our bodies but our gender identities: that gendered sense of self that is strongly linked to which sexed bodies are most congruent with who we are. While outliers exist, men are most at ease with typically male bodies because they are men, and women with typically female bodies because they are women. Non-binary people have more nuanced experiences.
For parents
As transgender people become more visible, many parents have been voicing concerns and confusion over the rise in youths and children coming out as transgender and wishing to transition. Some are concerned that this is due to social media influencing confused teenagers to identify as trans, or that some parents are forcing their children to transition, perhaps because they wanted a child of the other sex.
The common counter is that greater social acceptance and awareness has made it easier for more people to realise they are trans and come out. That is certainly a huge factor, but what’s more relevant is that the ones coming out now represent a much broader spectrum of trans identities than before.
Until recently, the stigma of expressing any kind of diverse gender identity was so high (and dangerous) that many of these people dared not even wonder if they might be trans. Instead, the ones who did transition back then were those who were willing to risk their lives because they simply could not live otherwise. Their gender dysphoria was so severe, or their behaviour so clearly non-normative, that they would not have been able to hide it.
This is also why trans women have historically been criticised as giving in to extreme female stereotypes: it is precisely the highly feminine trans women who found themselves completely unable to live as men. Others would have still struggled, and some did transition, but most found the risks to far outweigh the rewards.
Today, being trans is less of a death sentence. This is a good thing. We're thus seeing a rise in masculine trans women and feminine trans men, non-binary people who do not identify as men or women, people who move between gender identities and expressions, non-heterosexual trans people, trans people with mild or no gender dysphoria, and so on.
Many would have previously resigned themselves to lives of quiet misery or resentment. Some are now finding their way out. Those with minimal dysphoria may never transition, contented with simple changes to their name or the way they dress.
This means a rise in trans identification does not necessarily imply a sharp rise in medical treatments. Many statistics cited in overseas studies are of those seeking counselling at gender clinics, regardless of what comes after. Even those statistics were not accurately reflected - such as the spurious claim that the number of ‘natal girls’ visiting gender clinics in Great Britain has soared by 4,000%. What’s rarely mentioned is that the baseline number was 40 children, which had risen to 1,800 almost a decade later. There were 12.7 million children in Great Britain at that point — meaning the number of ‘natal girls’ visiting gender clinics in Great Britain was only 0.01% of the total population of children.
Social media has greatly increased the visibility and awareness of transgender issues, especially among youths. This has allowed trans people to find words for how they feel, and find others who feel the same way.
It has also encouraged others to think more deeply about their own gender identities and perhaps try out different identities to find what fits best. For teenagers, this is part of the usual exploration that comes with adolescence, and leads to them eventually emerging with a firmer sense of who they are. Some may come to realise they are trans or non-binary; others may realise they are not.
Not having access to that exploration and education does more harm than good. For example, a tomboy with no access to trans spaces might think she must be trans because she has stereotypically masculine interests and prefers a masculine appearance. Conversely, a trans boy may think he can’t be trans because he has stereotypically feminine interests, or is attracted to guys. Trans youths may also end up thinking that there is only one way to transition, and feel obliged to pursue medical treatment that they may not actually want.
Greater education, awareness and interaction with trans peers is what resolves these problems. Ultimately, just as how it’s not possible for social media to make a trans person no longer trans, it’s also not possible for social media to make someone trans when they are not.
One major source of this misconception is the theory of ‘Rapid-Onset Gender Dysphoria’ (ROGD) originating from the UK. A researcher noted many parents talking about how their teenagers, especially their daughters, were coming out as transgender after spending a lot of time on social media. The parents noted that they were friends with other trans youths online. The parents concluded that those online friends had been influencing them, or that their children were identifying as trans for social approval and belonging.
The study has since been repeatedly debunked, including by this 2022 study of over 200,000 adolescents. It found firstly that the skewed gender ratio was due to a decrease in trans feminine youths, rather than an increase in trans masculine youths, whose numbers had remained steady. Secondly, trans youths experienced far more bullying and social ostracism after coming out, countering the notion that they did so for social acceptance. It also found that the number of youths coming out as trans had actually fallen over time – from 2.4% to 1.6% between 2017 and 2019, even though greater and more sensationalised media coverage had given the opposite impression.
The ROGD paper was also criticised for how the parents were recruited from several anti-trans online forums and drew its conclusions based on their speculations, rather than actual statistics. The researcher has since retracted her paper and confirmed that no actual trans youths or clinicians were included in the study.
Young people in general are spending a lot more time on social media than before, often to an excessive degree; this applies equally to those who are and are not transgender. Parents who grew up in a different time may end up linking those two concerns, but the evidence does not support one leading to the other.
At the same time, social media spaces can often be hostile and psychologically unhealthy. If your teenager seems to be spending too much time on social media and it is negatively affecting their well-being, consider finding them other ways to obtain the same benefits in a healthier space. If they are trans or are questioning their gender identity, they may wish to check out dedicated support groups for LGBTQ+ youths.
No. Trans healthcare providers take a step-by-step, harm-reduction approach when it comes to youths and children. Transition itself comes in many stages, and is not something that children are rushed into when brought to a gender clinic for assessment. The first step is typically counselling to better understand the child’s identity, during which some may come to understand that they are not trans. (As with all healthcare – including children’s healthcare – there are bad actors, but that is a separate concern.)
The American Academy of Pediatrics (AAP) has a comprehensive set of guidelines for the care of transgender children and adolescents that lays out this process.
Among parents, even those who do believe their child is trans are very hesitant to allow them to transition, out of fears of social backlash, or how others would treat their child or respond to them as parents. Practical issues are another huge concern.
In Singapore, where public schools may not accommodate students who are transitioning, living that double life can be psychologically stressful and unsustainable. Private schools are prohibitively expensive for most families, so trans youth and trans children have to limit their social transition to non-school settings.
At the same time, not transitioning is not an option for trans students with severe gender dysphoria. These trans students end up dropping out of school as a result.
Parents are especially hesitant about any medical treatment due to fear of the medical and social risks involved. All that is exacerbated for parents who are not convinced their child is really trans.
Less often seen are parents who may be supportive of their trans child and may even have their whole transition planned out. Sometimes it’s their way of showing how much they love and support their child. But if the child seems less certain than their parents, and it’s primarily the parents driving things, that’s usually a sign to hold back. Healthcare professionals who work with transgender minors would be familiar with the red flags.
In Singapore medical transitioning is unavailable for anyone under 18 (private) or 21 (public).
Young children may not yet understand what being trans is, but they are not too young to know when something feels wrong. A child who really does not want to wear a dress is not too young to know that they really don't want to wear a dress, regardless of whether or not they are trans. Children are able to tell you what gender they are from a very young age, and the same is true when the child is trans.
Nonetheless, children are also more susceptible to gender stereotypes, as well as atypical ideas of what gender is. For example, a young child might think that having long hair is what makes someone a girl. A child may also express wishes to be other gender because they prefer certain clothes, toys or activities, and believe that those things are only allowed for that gender; or they may think their parents will love them more or treat them better if they are that gender.
That’s where parental discernment and education comes in. For the most part, those declarations are fleeting and harmless. The majority of those kids (as many as 80-90%) won’t grow up to be trans, and many end up gay, bisexual or lesbian. (This has commonly been misrepresented to suggest that most trans children will grow out of it.)
However, if there seems to be something more to it — such as persistent, insistent, consistent claims of being or wanting to be another gender, or discomfort around their body’s sexual characteristics, especially if accompanied by worsening signs of distress or depression – it is possible that the child is transgender. Unlike gender non-conforming children, this distress is not alleviated by simply allowing them to pursue the interests they want, as the distress centres instead around their bodies and/or how their gender is perceived by others.
For example, a tomboy may be satisfied at being told that girls can do anything boys can do, and thrive when she's encouraged to pursue the traditionally masculine activities she loves and excels at. In contrast, a trans boy may only be pursuing those activities because he thinks it will help him be seen as a boy. Being told that girls can do those things too would not address the source of the pain, and may in fact worsen it because it would undermine his efforts to prove that he's a boy.
In more extreme cases, children who experience a strong sense of their body being wrong may resort to self-mutilation, such as trans girls as young as 4 or 5 who have attempted to cut off their genitalia, tearfully insisting they're not supposed to be there.
If your child is experiencing deep anguish around their gender and how they are perceived, and letting them dress and play as they like has not substantially alleviated that, it would be worth seeking out a professional who works with transgender youths and children. This can help bring clarity to the situation, and assess if taking steps towards social transition would be suitable at that point.
Sometimes, just hearing about trans people can be a source of relief for the child, helping them make sense of what they feel, learn that they are not alone, assure them that transition is a possibility, and give them hope for the future.
This claim initially originated from the American College of Pediatricians (ACPeds), a small fringe group that was explicitly established to pursue an anti-LGBTQ+ agenda. Their president, Quentin Van Meter, was invited to do a webinar in Singapore in 2021. We wrote a response to his webinar, which involved numerous contradictions and indicated a fundamental misunderstanding of who trans people are.
ACPeds is not to be confused with the official American Academy of Pediatrics (AAP), a professional association of over 64,000 pediatricians.
Snopes debunked ACPeds’s claims, and included a presentation from the AAP supporting an affirming approach to gender non-conforming children. The AAP emphasises that this does not encourage or push gender transition. Instead, it aims to provide the child with an supportive environment that lets them know they are loved and accepted just as they are – which is the opposite of abuse. Over time, the approach aims to help families differentiate between children with a persistent transgender identity and those who are gender non-conforming or exploring gender atypical interests.
For children who continue to assert a transgender identity, the AAP notes the positive outcomes when they are allowed to socially transition. Quoting the linked study:
“We provide novel evidence of low rates of internalizing psychopathology in young socially transitioned transgender children who are supported in their gender identity. These data suggest at least the possibility that being transgender is not synonymous with, nor the direct result of, psychopathology in childhood. Instead, these results provide clear evidence that transgender children have levels of anxiety and depression no different from their nontransgender siblings and peers.”
This finding is especially significant in light of the high rates of mental health problems historically observed in transgender children and adolescents who are not able to transition until adulthood.
Trans children whose dysphoria was successfully alleviated with social transition but who experience renewed body dysphoria as they approach puberty may be further assessed for puberty blockers. We have written more about that here.
No. It is common for parents to blame themselves or feel guilty that their child is transgender, wondering what they did 'wrong' for their child to end up this way. However, there is no known correlation between parenting styles and gender identity. It might only determine whether or not a child feels safe enough to come out.
Some parents worry that they were too strict in enforcing gender roles, making their child think they had to be another gender in order to freely be themselves. Conversely, other parents worry that they weren’t strict enough in enforcing gender roles, such that their child's gender-atypical behaviour wasn’t stamped out before it developed into a trans identity – even though this is not possible, and only results in children repressing who they are in order to be accepted by their parents.
For every parenting style, there are parents who did the exact opposite and whose children were still trans. Trans people come from families that are conservative and liberal, religious and non-religious, rich and poor, loving and abusive, across all classes and races and cultures.
There is some weak evidence that being transgender runs genetically in families. It is not uncommon for more than one sibling to be transgender, or for a parent to eventually come out as transgender after their child does so, admitting that they had been repressing it all these years. Multiple members of an extended family may turn out to be transgender, even those who had no idea the others existed.
The only things parents can determine are whether or not their child feels safe enough to come out to them, or to discuss any struggles around gender they may have. Having a supportive family environment will also enable children to explore any gender-atypical interests and ask questions in a safe, non-judgemental space, rather than feel they have to work things out on their own or with peers who may not have the knowledge or wisdom to provide good advice.
On gender and sexuality
This question confuses gender expression (outwardly dressing or acting in a masculine or feminine way) with gender identity (being a man or woman).
Just because a girl enjoys stereotypically masculine activities does not mean she’s really a boy. Similarly, some men may be feminine, or enjoy and excel at things that society typically labels as “female”, but are still men and content to be seen as such. A person’s interests often fluctuate over their lifetime, but they remain the same person and gender.
Transgender people fundamentally desire to be seen as their gender. A trans man wants to be seen as a man regardless of how masculine or feminine he is by society’s current standards; he may even identify himself most with feminine men, such that being a masculine woman would not satisfy him in any way. Likewise, some trans women may enjoy stereotypically masculine interests and presentation, but identify most with tomboys, not men.
Being gay is about who you are attracted to. Being transgender is about who you are.
It’s a common misconception that transgender people are simply extremely feminine gay men or extremely butch lesbians who think life would be easier as a straight woman or man, or to make it easier to attract partners.
However, like everyone else, trans people can be straight, gay, bisexual, asexual or any other sexual orientation.
A person’s gender identity refers to their internal sense of being male, female or neither. This often but not always corresponds with their sex assigned at birth.
A person’s sex refers to their biological sexual characteristics such as reproductive anatomy. Some people are intersex - meaning they were born with (or naturally developed at puberty) bodies with reproductive organs, chromosomes or hormones that are not easily classifiable as either male or female.
A person’s sexuality or sexual orientation refers to the gender they are attracted to sexually and/or romantically. Trans people may be straight, lesbian, gay, bisexual, or queer based on their gender identity.
A trans woman who is attracted solely to other women would typically identify herself as a lesbian, while a trans man who does not consider gender a factor in who he is attracted to would typically identify himself as pansexual.
On mental health
While body dysmorphia may seem similar to gender dysphoria due to the similar spelling, they have different causes, different manifestations and most importantly different treatments that have been reliably proven to work.
Body Dysmorphic Disorder (BDD) is a condition in which a person becomes obsessed with imagined defects in their body. Someone with BDD might erroneously perceive their normal-sized nose as gigantic, for instance. After they’ve undergone surgery to make it tiny, they may still be distressed at the misperception that it is huge. This is a psychiatric issue, and more surgery would not fix the problem.
Anorexia is a similar condition, where a thin or average-sized person might believe they are fat. Losing more weight does not ease the distress.
Individuals with BDD respond successfully to psychiatric treatment and medication. In contrast, hormonal therapy, surgery, transition and affirmation are what successfully provide relief for a transgender person’s gender dysphoria.
A transgender person fundamentally does not identify with the gender they are assigned at birth. Unlike with BDD, their perception of their bodies matches up with reality: a trans man who is upset about not having a penis does, in fact, not have a penis. His distress over that is similar to what it would be for any other man.
Psychiatric treatment to make him cease being upset about it and to enjoy living as a woman would instead be as damaging and traumatising as trying to do the same for a cisgender man who is upset about losing his penis in an accident. In both cases, surgery would be the only way to fully resolve the issue, or at least therapy that is focused on moderating distress, rather than changing one’s gender identity.
The opposite is true. The longer gender dysphoria goes untreated, the more likely the person is to develop other mental health issues with time.
New York’s Cornell University produced a meta review of all 52 peer-reviewed studies published between 1991 and June 2017 concerning the effects of transition on the well-being of transgender people. They found that 93% of studies showed that transition was beneficial, with the remaining 7% being inconclusive.
This 2021 meta review published in the Journal of the Endocrine Society evaluated studies up to 2020 concerning the effects of hormone therapy specifically. It found associations with increased quality of life, decreased depression and decreased anxiety across gender identity and age groups.
Similarly, this 2023 review of 46 studies published in Nature found that gender-affirming HRT consistently reduced depressive symptoms and psychological distress. Both studies accounted for potential bias in the included studies.
Transitioning significantly reduces the risk of suicide. It is not the cause behind suicide and self-harm attempts.
The high risk of suicide and suicide attempts that trans people experience comes largely from a combination of gender dysphoria and experiencing discrimination and abuse, rather than transitioning itself.
A 2012 survey of transgender people in the US found that 41% of respondents had attempted suicide in their lifetime compared to the national average of 1.6%. Many trans people get disowned, fired from jobs and made homeless, resulting in poverty, elevated risk of mental illness and drug abuse, all of which are strongly correlated with suicide risk. In the 2012 survey, some factors led to greater risk: losing a job due to bias (55%), harassment and bullying in school (51%), physical assault (61%) and sexual assault.
Another 2012 study of 433 transgender youth found that those with supportive parents reported a 4% attempted suicide rate, versus 57% for those whose parents rejected them. Trans youth in supportive environments who were able to medically transition at puberty were found to score similar or better on measures of mental well-being compared to their non-trans peers.
Studies around transgender people and suicide have often been misinterpreted. The most well known is a 2011 Swedish study, which found that trans people who had undergone sex reassignment surgery (SRS) before 1989 had a suicide rate 20 times that of the general population. The study’s authors themselves noted that the rate could have been even higher if they had never transitioned. The same study found that trans people - both trans men and women - who had sex reassignment surgery after 1989 had no elevated suicide risk compared to the norm, which they attributed to greater social support and acceptance.
Another misintepreted 2014 report by the Williams Institute in UCLA, California found that trans people who medically transitioned had had a higher lifetime suicide attempt rate than those who had no desire to pursue medical transition. It would be expected that those who medically transitioned had more severe gender dysphoria than those who saw no need to, and these people would have had a higher suicide risk to begin with.
It is notable that the same study found that trans people who wanted but had yet to pursue medical transition had the highest lifetime suicide attempt rates, more than trans people who had transitioned or cis people.
When we measure the effects of transition within the transgender population itself, transition is found to be a major protective factor against suicide, and the most effective way to lower this risk.
On detransitioning
A comprehensive study of 28,000 trans respondents in the US found that 8% had detransitioned at some point due to pressures from family or workplaces, or being unable to cope with discrimination. 62% of those had since managed to retransition. Separately, out of 3,398 patients who attended a UK gender clinic, 3 (0.09%) had detransitioned permanently, while 10 (0.29%) did so temporarily.
Here are some reasons given by people who did regret surgery or transition, both from anecdotal online accounts as well as from the studies previously linked:
It is important not to conflate regret with detransition. Not all trans people who regret transitioning end up detransitioning; not all detransitioners regret transitioning.
It may sometimes seem that a large number of trans people regret transition, but this is due to the disproportionate coverage that the most extreme cases receive.
Much of this is funded by organisations for political purposes – digging deeper often reveals the same organisations behind them, some with explicitly anti-LGBTQ+ stances. It is notable that it is usually the same few people who appear in these stories. In some cases, they seem to fall into the category of those whose regret had more to do with the difficulties of living as a trans person in society, rather than a change in identity, but where this is glossed over to push a narrative that transition should be banned.
Yes, but regret rates are very low, and regret is especially rare when it comes to surgery.
Regret rates for trans surgeries have consistently remained under 1% since the 1960s, with similar numbers in a newer review of 27 studies.
A January 2023 study of 1,989 trans patients in the US found that 0.3% regretted surgery and requested a reversal or detransitioned.
The majority of regret was due to medical complications and dissatisfaction with surgical outcomes, or social factors such as rejection from family, rather than a change in gender identity.
Regret for hormone therapy is higher but difficult to quantify as many trans and non-binary people intentionally choose to only be on hormones for a while.
Some non-binary people may do so to seek an androgynous appearance. This may mean a low dose of hormone therapy, or ceasing treatment after desired permanent changes have been obtained (e.g. voice drop, breast growth).
Hence, available studies have a wide range of figures, from as low as 0.47% to a possible high of 12.2% of patients at one UK clinic who detransitioned or expressed regret.
(Note: a different study had 29.8% of patients ceasing hormone therapy with the US military healthcare system, but this would have included those who no longer qualified for military healthcare services and transferred to other clinics to continue treatment.)
Among young people who had passed stringent assessments and been approved to go on puberty blockers in the Netherlands, 98% persisted in their trans identity and continued with transition when they are older. The remaining 2% ceased taking blockers and proceeded with their regular puberty.
9.4% of young people who presented themselves to gender clinics in the UK chose not to pursue medical treatment or came to realise they were not trans. None of them had started on any medical treatment, and thus regret was not relevant.
As with all healthcare, doctors and researchers should do their best to ensure that patients receive the highest level of evidence-based care. This will still never be perfect, and unfortunately there will still be cases when the wrong call was made. However, when those treatments are necessary and life-saving for close to 99% of surgical patients – or around 90% for hormone therapy – the suffering of the 1% who make a mistake should not be a reason for the 99% should suffer instead.
The response should instead be to look at how to further reduce regret, and how to ensure that those who do end up regretting treatment likewise have access to high-quality care to undo its effects.
In the worst case scenario, those who regret transition would end up with gender dysphoria and in a similar but much better state than even the average trans person who transitions. In most cases, they can have children, their bodies produce their own hormones, and most importantly they are not constantly bombarded by societal messages challenging the validity of their gender identity and painting them as deceptive, deluded and dangerous.
The things they despair over and that the public sympathises with – having a body with sexual characteristics that don’t match their gender identity, feeling like freaks, getting rejected by friends, family and potential romantic partners – are the exact same things that many trans people suffer to a much greater degree, but which is instead often met not with sympathy but ridicule.
So if people can empathise with a cisgender woman’s despair at having mistakenly transitioned and developed a deep voice, facial hair and flat chest that make people see her as a man instead of a woman, they should be equally able to empathise with a transgender woman who has been grappling with a far more intense version of the same thing all her life, and be just as fired up on her behalf to ensure she gets the care she needs.
The pain of those who transitioned and regretted it – and the empathy from those who hear their stories – shows that gendered embodiments and perceptions do matter. It also shows that most people do, instinctively, understand what it means to be trans, and understand why someone might be desperate to transition away from a self that does not feel like them.
The goal of transition healthcare is ultimately to ensure that no one needs to be stuck looking like a sex that does not match their sense of self and causes them distress. This includes helping those who wrongfully transitioned transition back to a body that is more aligned with who they are. Eradicating or restricting trans healthcare will trap them too; making exceptions for them would be hypocritical, and indefensibly imply that their gender dysphoria is real while that of trans people is not.
If people are moved by the pain of those who made a mistake and are now trapped looking like a sex they do not feel like, the response should be to do all they can to ensure that as few people as possible ever feel trapped that way. Banning transition healthcare will achieve the complete opposite effect.