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What Is Gender Transitioning?

The process of expressing and affirming one's gender identity

• What It Means
• What It Involves

Social Transitioning

Legal transitioning, medical transitioning, where to find support, how to be an ally.

Gender transitioning describes the process of affirming and expressing one's internal sense of gender rather than the gender assigned to them at birth. It is a process through which transgender and gender-nonconforming people align their presentation or sex characteristics with their gender identity .

Gender transitioning, known more commonly today as gender affirmation, not only involves aesthetic appearances but may also involve changes in social roles, legal recognitions, or physical aspects of the body. Gender transitioning is often described as a binary (male or female) but can also be non-binary , meaning a person is neither strictly male nor female.

This article describes what gender transitioning involves as well as the social, legal, and physical aspects of gender affirmation.

Verywell / Theresa Chiechi

What Does It Mean to Transition?

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 transitioning"—in part because transitioning is often taken to mean the process of transforming one medically. In fact, a person doesn't need to undergo medical treatment to affirm their identity, and some transgender people avoid hormones or gender-affirming surgery.

Gender transitioning is a holistic process, addressing all aspects of who a person is inwardly and outwardly. It can be broadly categorized into three types:

• Social transitioning : Relating to how you present yourself to the world
• Legal transitioning : Relating to the recognition of your gender through legal means
• Medical transitioning : Relating to treatments that align your body with your gender identity

Certain aspects of gender transitioning may be more important to some people than others (such as changing your name and gender on your birth certificate). It is also possible to reevaluate and revise your gender identity as part of a lifelong continuum rather than as a step-by-step, one-way process.

Exploring Your Gender Identity

Gender transitioning is a process that often starts in response to gender dysphoria . Gender dysphoria describes the persistent sense of unease that occurs when the gender you were assigned at birth does not match how you experience or express your gender internally. Some people have experienced symptoms of gender dysphoria as early as 3 or 4 years of age.

Gender dysphoria can be largely informed by the culture you live in, particularly in cultures where there are strict codes as to what is masculine/male and feminine/female.

The unease can be expressed in children in different ways, including:

• A strong preference for clothes typically worn by the other gender
• A strong aversion to clothes typically worn by their own gender
• A strong preference for cross-gender roles in fantasy play
• A strong preference for the toys, games, or activities typically used by the other gender
• A strong preference for playmates of the other gender
• A strong dislike of one’s sexual anatomy

For many, gender dysphoria fully emerges during puberty when awareness about how their body defines them creates internal distress. Feelings of unease may be amplified when a child is described as "tomboy" or "sissy," or is criticized and attacked for "acting like a girl" or "acting like a boy."

With physical changes during puberty, long-standing feelings that "I don't fit in" may evolve into feelings that "I don't fit into my own body." It is then that children or teens may undergo a process referred to as internal transitioning. This is when you start to change how you see yourself.

Gender transitioning/affirmation is the next step. There is no set course as to how a person aligns their internal sense of gender with their outward expression of gender identity. Gender transitioning is not about "changing" or "recreating" oneself. It's about expressing one's authentic self and asserting who you are socially, legally, and/or medically.

Social transitioning involves how a person publicly expresses their gender to the world at large.

Social transition can take many forms:

• Changing your pronouns
• Using your chosen name
• Coming out to friends, family, and colleagues
• Wearing new clothes
• Cutting or styling your hair differently
• Changing your manner (such as how you sit)
• Changing how you speak or use your voice
• Packing (wearing a penile prosthesis to create a penile bulge)
• Tucking (tucking your penis to conceal a penile budge)
• Binding (strapping your chest to hide your breasts)
• Wearing breast and hip prosthetics to accentuate "feminine" curves

Social affirmation may also include playing certain sports, pursuing different lines of work, or partaking in activities that some might typically see as "male" or "female."

Legal transitioning is about legal recognition. It involves changing legal documents to reflect your chosen name, gender, and pronouns.

This includes governmental and non-government documents such as:

• Bank records
• Medical and dental record
• Driver's license
• Voter's registration card
• Birth certificates
• Social Security ID

The provisions allowing for these changes can vary by state.

Some states will only allow changes if "bottom surgery" (genital reconstruction) is performed, while others will allow you to do so without any form of gender-affirming surgery. Other states have begun to offer an "X" gender option for people who are non-binary.

Medical transitioning most commonly involves hormone therapy to develop some of the desired secondary male or female sex characteristics. It can also involve surgery to change certain physical aspects that hormone therapy alone can't change.

Hormone Therapy

Hormone therapy helps people look physically more like the gender they identify as. They are sometimes used on their own and may also be used before gender-affirming surgery to improve outcomes.

Gender-affirming hormone therapy takes two forms:

• Transgender men can take testosterone to help deepen their voice, increase muscle mass, promote body and facial hair, and enlarge their clitoris.
• Transgender women can take estrogen as well as a testosterone blocker to redistribute body fat, increase breast size, reduce male-pattern baldness, and reduce testicle size.

Gender-Affirming Surgery

Gender affirmation surgery is used to align a person's physical appearance to their gender identity. Many hospitals offer gender-affirming surgery through a department of transgender medicine.

Gender-affirming medical procedures include: 

• Breast augmentation : Increasing breast size with implants
• Chest masculinization : Removing and contouring of breast tissues
• Facial surgery : Including facial feminization surgery
• Tracheal shaving : Used to reduce the Adam's apple
• Phalloplasty : Construction of a penis 
• Scrotoplasty : Construction of a scrotum
• Vaginoplasty : Construction of the vaginal canal
• Vulvoplasty : Construction of the outer female genitals
• Orchiectomy : Removal of the testicles

Barriers to Gender Transitioning

Transgender people are protected from public and private insurance discrimination under federal and state laws, including Medicare and Medicaid.

Even so, Medicaid programs in nine states offer no coverage of gender-affirming medical treatments, and only two (Illinois and Maine) offer the comprehensive standard of care recommended by the World Professional Association for Transgender Health (WPATH).

Medicare also has no consistent policy regarding the approval of gender-affirming surgery. It instead relies on precedents in individual states to direct whether a treatment is approved or not. As such, states in which Medicaid coverage is denied may also be more likely to deny Medicare coverage.

In terms of private insurance, most providers have removed restrictions on gender-affirming care. Although larger insurers (like Aetna and Cigna) usually cover a more comprehensive array of services, in full or in part, many smaller insurers do not (or may only cover things like hormone therapy).

Even if treatments are covered, private insurers will often require psychological evaluations and health screenings that non-transgender people would never be asked to undergo (such as for breast reconstruction).

Another barrier is stigma and discrimination. Studies have shown that no less than 53% of transgender people report being harassed or bullied in public. Others report family or partner disapproval as the main reason why they abandon gender affirmation.

These factors can discourage transgender people from seeking gender-affirming care or embarking on treatments they would otherwise desire.

Gender transitioning can be complex and overwhelming, but there are organizations that can help with everything from insurance coverage to simply having someone to share your feelings with.

Here are some of the leading support organizations:

• Transgender Institute offers individual and group therapy for transgender youths and adults to better cope with stigma, discrimination, family issues, substance abuse problems, and transphobia .
• World Professional Association for Transgender Health offers a list of mental health providers by state who are experienced and trained in gender-affirming care.
• Pride Counseling is a paid mobile app that connects users to licensed therapists specializing in LGBTQI+ counseling.
• National Center for Transgender Equality offers a step-by-step guide to help transgender people obtain insurance coverage for gender-affirming care.
• The Trevor Project offers a 24/7 hotline for transgender youths in crisis or in need of a safe space to talk.
• Gay & Lesbian Alliance Against Defamation (GLAAD ) offers a comprehensive list of resources for transgender adults and youth.
• Transgender Legal Defense and Eductions Fund offers resources to assist with legal affirmation, insurance access, financial assistance, and legal action for transgender people who are unjustly denied gender-affirming care.

If you know someone who is transgender or is considering transitioning, learning how to be supportive is the best way to be an ally. Educate yourself about gender and gender transitioning. Everyone's transition is different, and there is no right or wrong way to do it.

Take the first step by asking the person's pronouns and affirmed name. It’s an act of respect, and everyone deserves to be addressed in the way they choose.

Gender transitioning, more commonly known today as gender affirmation, is the process taken by transgender people to align their internal gender identity with their external gender expression.

Gender transitioning may involve social affirmation (such as dressing differently or coming out to friends and family), legal affirmation (changing your name and gender on legal documents), or medical affirmation (using hormones and/or surgery to change certain physical aspects of your body). Transgender people can pursue some or all of these.

Barriers to gender transitioning include cost, lack of insurance, stigma, discrimination, and lack of family or partner support.

Gülgöz S, Glazier JJ, Enright EA, et al. Similarity in transgender and cisgender children’s gender development.  PNAS . 2019;116(49):24480-24485. doi: 10.1073/pnas.1909367116

King WM, Gamerel KE. A scoping review examining social and legal gender affirmation and health among transgender populations . Transgend Health. 2021;6(1):5–22.. doi:10.1089/trgh.2020.0025

Irwig MS, Childs K, Hancock AB. Effects of testosterone on the transgender male voice. Andrology . 2017;5(1):107-112. doi: 10.1111/andr.12278

Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women.   Lancet Diabetes Endocrinol . 2017;5(4):291-300. doi: 10.1016/S2213-8587(16)30319-9

National Center for Transgender Equality. Know Your Rights in Health Care.

Kaiser Family Foundation. Update on Medicaid coverage of gender-affirming health services .

Center of Medicare and Medicaid Services. Gender dysphoria and gender reassignment surgery .

Transgender Legal Defense and Education Fund. Health insurance medical policies .

National Center for Transgender Equality and National Gay and Lesbian Task Force. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.

Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Factors leading to “detransition” among transgender and gender diverse people in the United States: a mixed-methods analysis . LGBT Health. May/June 2021;8(4):273–80. doi:10.1089/lgbt.2020.0437

By S. Nicole Lane Lane is a freelance health journalist focusing on sexual health and LGBTQ wellness based in Chicago, Illinois. She began writing about health after living with vaginismus for eight years.

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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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gender reassignment

• male-to-female or female-to-male transformation involving surgery and hormone treatment

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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.

Related Articles

• How Gender Identity Disorder Works
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• Why do girls wear pink and boys wear blue?

More Great Links

• DSM-5: Gender Dysphoria
• National Center for Transgender Equality
• The Williams Institute
• American Medical Student Association (AMSA). "Transgender Health Resources." 2014. (April 20, 2015) http://www.amsa.org/AMSA/Homepage/About/Committees/GenderandSexuality/TransgenderHealthCare.aspx
• American Psychological Association (APA). "Definition of Terms: Sex, Gender, Gender Identity, Sexual Orientation." 2011. (July 1, 2015) http://www.apa.org/pi/lgbt/resources/sexuality-definitions.pdf
• AP. "Medicare ban on sex reassignment surgery lifted." May 30, 2014. (April 20, 2015) http://www.usatoday.com/story/news/nation/2014/05/30/medicare-sex-reassignment/9789675/
• Belkin, Lisa. "Smoother Transitions." The New York Times. Sept. 4, 2008. (Aug. 1, 2011) http://www.nytimes.com/2008/09/04/fashion/04WORK.html
• Crane, Curtis. "The Total Guide to Penile Implants For Transsexual Men." Transhealth. May 2, 2014. (April 20, 2015) http://www.trans-health.com/2013/penile-implants-guide/
• Donaldson James, Susan. "Trans Chaz Bono Eyes Risky Surgery to Construct Penis." ABC News. Jan. 6, 2012. (April 20, 2015) http://abcnews.go.com/Health/transgender-chaz-bono-seeks-penis-genital-surgery-risky/story?id=15299871Gates, Gary J. "How many people are lesbian, gay, bisexual, and transgender?" April 2011. (July 29, 2015) http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf
• Glicksman, Eve. "Transgender today." Monitor on Psychology. Vol. 44, no. 4. Page 36. April 2013. (April 20, 2015) http://www.apa.org/monitor/2013/04/transgender.aspx
• Harrison, Laird. "Sex-Change Operations Mostly Successful." Medscape Medical News. May 20, 2013. (April 20, 2015) http://www.medscape.com/viewarticle/804432
• HealthResearchFunding.org (HRF). "14 Unique Gender Identity Disorder Statistics." July 28, 2014. (April 20, 2015) http://healthresearchfunding.org/gender-identity-disorder-statistics/
• International Foundation for Gender Education. "APA DSM-5 Sexual and Gender Identity Disorders: 302.85 Gender Identity Disorder in Adolescents or Adults." (April 20, 2015) http://www.ifge.org/302.85_Gender_Identity_Disorder_in_Adolescents_or_Adults
• Moskowitz, Clara. "High Suicide Risk, Prejudice Plague Transgender People." LiveScience. Nov. 18, 2010. (April 20, 2015) http://www.livescience.com/11208-high-suicide-risk-prejudice-plague-transgender-people.html
• Nguyen, Tuan A. "Male-To-Female Procedures." Lake Oswego Plastic Surgery. 2013. (April 20, 2015) http://www.lakeoswegoplasticsurgery.com/grs/grs_procedures_mtf.html
• Public Religion Research Institute. "Survey: Strong Majorities of Americans Favor Rights and Legal Protections for Transgender People." Nov. 3, 2011. (April 20, 2015) http://publicreligion.org/research/2011/11/american-attitudes-towards-transgender-people/#.VSmlgfnF9bw
• Steinmetz, Katy. "Board Rules That Medicare Can Cover Gender Reassignment Surgery." Time. (April 20, 2015) http://time.com/2800307/medicare-gender-reassignment/
• The Philadelphia Center for Transgender Surgery. "Phalloplasty: Frequently Asked Questions." (April 20, 2015) http://www.thetransgendercenter.com/index.php/surgical-procedures/phalloplasty-faqs.html
• U.S. Office of Personnel Management. "Guidance Regarding the Employment of Transgender Individuals in the Federal Workplace." 2015. (April 20, 2015) http://www.opm.gov/diversity/Transgender/Guidance.asp
• University of California, San Francisco - Department of Family and Community Medicine, Center of Excellence for Transgender Health. "Primary Care Protocol for Transgender Patient Care." April 2011. (April 20, 2015) http://transhealth.ucsf.edu/trans?page=protocol-hormones
• University of Miami - Miller School of Medicine, Department of Surgery, Plastic, Aesthetic and Reconstructive Surgery. "Transgender Reassignment." 2015. (April 20, 2015) http://surgery.med.miami.edu/plastic-and-reconstructive/transgender-reassignment-surgery
• University of Michigan Health System. "Gender Affirming Surgery." (April 20, 2015) http://www.uofmhealth.org/medical-services/gender-affirming-surgery
• World Professional Association for Transgender Health (WPATH). "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People." Version 7. 2012. (April 20, 2015) http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf
• World Professional Association for Transgender Health (WPATH). "WPATH Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage for Transgender and Transsexual People Worldwide." 2015. (April 20, 2015) http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947

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gender reassignment surgery

Definition of gender reassignment surgery

Note: This term is sometimes considered to be offensive in its implication that a transgender or nonbinary person takes on a different gender through surgery, rather than using surgery to align their outward appearance with their gender identity. Gender confirmation surgery and gender-affirming surgery are the preferred terms in the medical and LGBTQ+ communities, and surgery is seen as one of many possible ways to affirm one's gender identity, rather than as an essential part of transitioning (see transition entry 2 sense 2 )

Examples of gender reassignment surgery in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'gender reassignment surgery.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

1969, in the meaning defined above

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Dictionary Entries Near gender reassignment surgery

gender reassignment

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Cite this Entry

“Gender reassignment surgery.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/gender%20reassignment%20surgery. Accessed 28 Jun. 2024.

Medical Definition

Medical definition of gender reassignment surgery.

Note: This term is sometimes considered to be offensive in its implication that a transgender or nonbinary person takes on a different gender through surgery, rather than using surgery to align their outward appearance with their gender identity. Gender confirmation surgery and gender-affirming surgery are the preferred terms in the medical and LGBTQ+ communities, and surgery is seen as one of many possible ways to affirm one's gender identity, rather than as an essential part of transitioning (see transition entry 2 ).

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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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• Gender reassignment discrimination

Published: 22 December 2021

Last updated: 23 February 2023

On this page

What the equality act says about gender reassignment discrimination, different types of gender reassignment discrimination, circumstances when being treated differently due to gender reassignment is lawful, pages in this guide.

• 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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Definition of gender reassignment noun from the Oxford Advanced American Dictionary

gender reassignment

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Nearby words

Gender reassignment

What does it mean.

This term has two different meanings depending on context.

Legal definition

According to the Equality Act 2010 , a person has the protected characteristic of “gender reassignment” if that person:

“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.”

UK law makes it unlawful to discriminate against anyone on the basis of their gender reassignment. It also makes it unlawful to discriminate against someone because they are perceived to be undergoing gender reassignment, even if they aren’t.

This legal definition applies to you regardless of what you have or have not had any particular treatment, and is intended to be interpreted broadly. It includes people who have only had social aspects of transition such as a name change.

Medical definition

In medicine, the term “gender reassignment” can refer to any medical treatment to do with gender, but most often refers to “bottom” surgeries such as vaginoplasty , phalloplasty , or metoidioplasty .

"Gender reassignment" is a word that has a specific meaning in UK law.

Words like this can:

• be useful if you want to assert your rights under law

However, words like this can also:

• be confusing, as a word's legal definition may differ from its use in casual speech
• sound overly rigid or formal
• imply that the law's definition is the main one that matters

Think carefully before using this word to describe someone or a group of people - they may not wish to be described that way.

Medical treatment

"Gender reassignment" is a word that describes a broad class of medical treatments.

• give a broad and holistic view of medical treatments to do with gender
• be ambiguous as to which treatments are or are not included
• imply that such treatments are inherently to do with gender
• imply that these treatments are "necessary" for your identity to be valid

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Taking Care of Ourselves & Each Other

Health & Well-Being

Glossary of Terms Related to Transgender Communities

Terminology frequently morphs within LGBTQIA communities, and a word that means one thing in one community may mean something else in another community. The terms used here are commonly used in the Stanford LGBTQIA community.

Basic Definitions

• Assigned Female At Birth (AFAB) or Female-Assigned-at-Birth (FAAB) : An individual assigned female at birth.
• Assigned Male At Birth (AMAB) or Male-Assigned-at-Birth (MAAB) : An individual assigned male at birth.
• Assigned Sex or Sex Assigned At Birth : The sex (typically M or F) that is assigned to a person based on external genitalia at birth.
• Cisgender, Cis : Someone whose gender identity corresponds with expectations based on the sex they were assigned at birth. For example, a person who was assigned female at birth and identifies as a woman is regarded as cisgender or as a cisgender woman.
• Gender-Affirming Surgery : Any surgical procedure that aims to increase a sense of congruence with one’s gender identity and physical body. Gender-affirming surgeries may include: chest reconstructive surgeries (e.g., double mastectomy, feminizing mammoplasty), genital reconstructive surgeries (e.g., orchiectomy, vaginoplasty, metoidioplasty, phalloplasty), facial feminization surgeries (e.g., tracheal shave, rhinoplasty, brow lift), or other procedures (e.g., vocal cord surgery). In California, surgery is not required to change one’s legal gender marker. Note: This term is preferred over the outdated term Sexual Reassignment Surgery (SRS). It is also preferred over the term gender confirmation surgery (GCS) because gender cannot be “confirmed” by having surgery. A person’s gender is to be respected regardless of surgical history/status or what kind of genitals they have or had. It is best to avoid terms such as “pre-op”, “non-op”, or “post-op,” as they reinforce the assumption all trans people want to or will have the opportunity to have surgery.
• Gender Dysphoria : Emotional distress related to the sense that one’s assigned sex is not in line with one’s gender identity. Gender Dysphoria is also a medical and mental health diagnosis that may warrant treatment in the form of gender-affirming medical interventions.
• Gender Expression : The ways in which a person outwardly expresses their gender, often through hair, makeup, clothing, and other aspects of appearance. Gender expression does not always correspond to gender identity.
• Gender Identity : The inherent feeling within an individual of what gender they are; a person may identify as a man, woman, neither, in-between, both, or fluidly moving between these two binary categories.
• Gender-Neutral Pronouns : Pronouns that a person may use when they do not fully identify with binary gender categories. Examples of gender-neutral pronouns include singular they/them/their, ey/em/eir, zie/hir/hirs, or no pronouns. It’s best to ask what pronouns are appropriate for them.
• Genderqueer : A gender identity that denotes someone who does not fully identify with the binary genders of male/man/masculine or female/woman/feminine. A genderqueer person may identify as neither a man nor a woman, in-between, both, fluidly moving between these two categories, or as a third/alternate gender. Related to the term  nonbinary , which has become more popular in the 2010’s.
• Intersex : A general term used for a variety of conditions in which a person is born with a physical characteristics (e.g., gonads, chromosomal makeup, external genitalia, internal reproductive or urinary organs) that do not fit typical medical or social definitions of female or male. Some people use the term DSD (Disorders of Sex Development) to describe intersex people, but this is not seen as affirming by intersex communities.
• Nonbinary : A gender identity that denotes someone who does not fully identify with the binary genders of male/man/masculine or female/woman/feminine. A nonbinary person may identify as neither a man nor a woman, in-between, both, fluidly moving between these two categories, or as a third/alternate gender. Related to the term  genderqueer , which was used more often prior to the 2010’s.
• Passing : Being perceived as cisgender or as a gender in line with one’s gender identity. This term is not considered affirming to many, as it implies that trans people are deceptive or are not truly the gender they say they are. Passing is important to some people (e.g., for safety reasons), but it is not the goal of every trans person.
• Queer : Used to describe non-normative identities (both sexual identities and gender identities) that might not easily be classified under other terminology (gay, lesbian, etc.). Queer can also be used as an umbrella term to describe LGBTQIA identities as a whole. In many communities, the term “queer” also has a political connotation that is connected to LGBTQIA activism. The term queer may be offensive to older LGBTQIA individuals, so it is best to use caution and only use this term when you know that someone uses it as an affirming term to describe themselves.
• Sexual Orientatio n: A way to describe a person’s romantic and/or sexual attractions to others. Sexual orientation may consist of attraction, behavior, and identity, and not all of these factors need to be aligned/consistent. For example, a person may have attractions towards trans women, be sexually active with cisgender men, and have an identity as heterosexual. Some labels to describe sexual orientation include: heterosexual, straight, lesbian, gay, bisexual, pansexual, queer, or fluid.
• Transgender man, trans man, trans masculine
• Transgender woman, trans woman, trans feminine
• Genderqueer
• Gender neutral
• It’s best to ask how a transgender person identifies. Be aware that the word “tranny” is considered offensive.
• Transgender Man, Trans Man, Trans Masculine : Someone who was female assigned at birth who identifies as a man or on the masculine spectrum. Note: The term FTM is no longer considered affirming.
• Transgender Woman, Trans Woman, Trans Feminine : Someone who was male assigned at birth who identifies as a woman or on the feminine spectrum. Note: The term MTF is no longer considered affirming.
• Transition : The process of shifting one’s gender identity and/or expression. Transition is a process that occurs over time, varies greatly among individuals, and may consist of physical/medical, emotional, social, and legal components. There is no uniform or set path for how a person transitions, if at all. Some transgender people consider themselves post-transition, and some no longer consider themselves to be transgender. Others feel that they are in a state of transition for the rest of their lives.
• Transsexual : A term that was commonly used before the term “transgender” came into more popular usage in the 1990’s. Some people still identify as transsexual, but this term is no longer considered affirming.

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  Vocabulary      

What does gender reassignment mean?

Definitions for gender reassignment gen·der re·as·sign·ment, this dictionary definitions page includes all the possible meanings, example usage and translations of the word gender reassignment ., wiktionary rate this definition: 0.0 / 0 votes.

gender reassignment noun

The process of changing one's sex, usually by a combination of medicinal and surgical means; sex change.

How to pronounce gender reassignment?

Alex US English David US English Mark US English Daniel British Libby British Mia British Karen Australian Hayley Australian Natasha Australian Veena Indian Priya Indian Neerja Indian Zira US English Oliver British Wendy British Fred US English Tessa South African

How to say gender reassignment in sign language?

Chaldean Numerology

The numerical value of gender reassignment in Chaldean Numerology is: 2

Pythagorean Numerology

The numerical value of gender reassignment in Pythagorean Numerology is: 8

Examples of gender reassignment in a Sentence

Jo Avelyn Grey :

No one sees me as physically female, just obviously transgender. This makes me an outcast and puts me at an extremely elevated risk for discrimination and harassment, just covering hormones and gender reassignment surgery is a half measure that still leaves us exposed to great risks and complications in our everyday lives.

Alex Schmider :

Some people just choose not to because that's not an essential part of their gender, nor should it be for anyone, gender reassignment surgery does not define who someone is, just in the same way that certain parts of our bodies don't define who we are as people.

• ^  Wiktionary https://en.wiktionary.org/wiki/Gender_Reassignment

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Why do people bike nude? We asked 6 people at the World Naked Bike Ride in Milwaukee

The World Naked Bike Ride made its way through Milwaukee for its fourth run on June 22. Close to 150 bodies, partially and fully naked, gathered at the parking lot on the corner of Orchard and Barclay to converse, drink and collectively enjoy the nude experience. 

According to the ride's website, the 15-mile ride doubles as a peaceful protest for body positivity, cyclist awareness and energy independence, or the use of clean energy. What does that mean for participants? From veteran naked bike riders to those making their nude debut, we spoke to six individuals on why they bike or run naked. 

Andy Olsan: “Maybe we’ll be seen more if we’re seen nude.” 

For Andy Olsan, one of the few runners in the race, the attention and gawking from spectators can be a form of power, an antidote to invisibility.

Vehicles don’t always stop for bike riders or pedestrians, even when these non-vehicular travelers have the right of way, Olsan said. When you’re running or biking naked, they most definitely stop.

“We all in general, as a whole, feel invisible to the world at times because there are certain circumstances where people just will not see you,” Olsan said. “That's one big reason why to go nude. Maybe we'll be seen more if we're seen nude.” 

Sonny Walden: “I like to stand out a little bit.” 

Sonny Walden has been with World Naked Bike Ride since its start in 2021 and has yet to miss a ride. Donning a cheese-shaped hat and holding a cheese-shaped can holder, Walden was a noticeable figure among the crowd of naked bodies. 

With a beer in hand, Walden seemed to embody Wisconsin’s most famous food and drink. Although this year, he upgraded his cheese ensemble by adding a leather collar and bracelets, as well as a flower garland he found in his costume closet. 

“Everybody’s naked, so I like to stand out a little bit,” Walden said. He continued, sarcastically, “It’s so embarrassing, I hate to be so naked in front of these people.” 

9-year-old daughter & her mother: “We’re here and we’re proud to be here.” 

A 9-year old girl, who led the collective of riders last year, biked at the front of the pack again this year. The minor’s participation in the naked bike ride has garnered scrutiny , particularly from Wisconsin Republican politicians who have tried to ban the event. These efforts, including requests for the U.S. Department of Justice to investigate and two GOP-authored bills, have not gone far. 

When the Journal Sentinel interviewed the mother of the young girl, she said that the event has “always been optional” for her daughter. Two years ago, her daughter chose not to participate. This year, she “absolutely insisted” to ride at the front of the group, the mother said. 

For the mother, the “heart of the reason” for her and her daughter’s attendance is to feel comfortable in their own skin. According to her, her daughter feels more connected to the protest as she learns about climate change in the classroom. Given last year’s controversy, she said that the decision to continue participating was a difficult one. 

“It's hard because a part of me wants to shield her from feeling that she's responsible for other people's reactions to her body,” she said. “The other part of me wants to say, 'screw them,' and wants to be open and out and be able to say, ‘Here we are, we're here, and we're proud to be here.’” 

Kate Travis: “Dude, I’m proud of you.” 

When John Jankowski Sr., the organizer of the ride, asked first-time nude bikers to raise their hands, Kate Travis’ shot up. Travis had planned to go the previous year, but did not follow through, after hearing her father talk about potentially attending. 

This year, she told her family and close friends: “Steer clear. This is my zone. Stay out of it or else you might see something you don’t want to see.” 

For Travis, her initial goal was to push her boundaries and attend topless. After realizing how accepting and non-judgmental the community was, she decided to go fully nude.

“I went topless for like 45 minutes,” Travis said. “I was like, ‘No one’s really looking at me. It’s really not that big of a deal.' And as soon as I took it off someone high-fived me, and they were like, 'Dude, I’m proud of you.'” 

Crystal Kowalczyk: “Accepting my body now, after pregnancy” 

It’s been a year and a half since Crystal Kowalczyk gave birth. Now, as she bikes on a rented Bublr bike, she is learning to love her postpartum body. 

Kowalczyk attended the ride with her own mother, who did not participate in the nude bike riding, after her mother discovered the event through Facebook last year. Like Travis, this year is Kowalczyk’s first time participating in the event. 

“It's just fun. It feels good, like body empowerment,” Kowalczyk said. “I'm just accepting my body now, after pregnancy. I love how it's all about body acceptance, too, and all that."

Andy Tinzelman: “I got an 'ostomy, nobody cares” 

A lot of people would shy away from showing off their ‘ostomy bag,’ a prosthetic attached to the abdomen that helps the body pass waste. Not Andy Tinzelman. 

Tinzelman has been participating in naked bike rides, in both Madison and Milwaukee, for more than nine years. In getting an colostomy, a surgery to treat those with digestive or urinary disease, plenty of doctors and nurses had already seen Tinzelman’s naked body. According to Tinzelman, riding naked was “no problem.” 

“I got an 'ostomy, nobody cares,” Tinzelman said. “There’s a woman missing a breast over there, nobody cares. There’s people in transition for gender reassignment. People don’t care. And it’s really encouraging and enlightening that people aren’t judgmental.” 

The first recorded naked bike ride took place in Zaragora, Spain, in 2001. Since then, naked bike rides have gained popularity and have spread to more than 30 countries.