Transitioning

The word ‘transitioning’ refers to the process of changing your gender expression (how you present your gender to the world) to match your gender identity (how a person sees or feels about themselves), rather than the sex you were assigned at birth.

Transitioning is an inner journey of reflection that often begins with a person coming out to themselves. This can feel lonely if they are not ready to share their thoughts with anyone else, but it can also feel exciting and relieving to have some understanding from the people in their lives. It can also take a while to fully process, so anyone who is transitioning should take all the time they need.

There are three main types of transition, which are:

• social
• medical
• legal

A person who is transitioning may do so in one, some, or all of these ways. The process of transitioning is unique and personal, and no two people’s transitions will be the same.

Some trans people experience something called gender dysphoria, which means the distress or discomfort someone might feel when their sex assigned at birth doesn’t match their gender. This may influence someone’s decision about how they want to transition. Trans people may experience different levels of dysphoria, and some trans people don’t experience dysphoria at all.

Transitioning can be very hard, but many trans people are happier after they’ve transitioned. If someone tells you they are transitioning, be friendly and supportive. They will be taking a huge step in their life by transitioning, and it is important for them to have support with this process.

It is also important to remember that not everyone chooses to transition. For some trans people it might be unsafe to transition. It can also be very difficult, expensive and stressful to get hormones or have surgery, and some trans people simply don’t want to transition at all. Those who don’t transition for whatever reason are still valid and deserve to have their gender respected.

When someone changes their gender expression and/or social identity, this is called ‘social transitioning’.

Social identity

As part of their transition, some people might change their social identity by changing their name and/or using different pronouns (e.g. he/her/them). Pronouns are often associated with gender, which means they can be very important to trans people as a reflection of their gender identity.

It may feel easier for someone to change their name and/or pronouns informally with friends or family at first, and then build up to doing this at school or work. It is also common to experiment with names and pronouns before making a decision. It’s okay not to know which labels you want to use; it can be a while before a person settles on what they like. Asking people to use different names or pronouns than the ones they have been using for you can feel scary, but it is a very reasonable request. Every person’s name and pronouns should be respected, and it can play a huge role in someone feeling comfortable in themselves. 

The pronouns people want to be referred to by may not be obvious to you. It can be helpful to ask people what pronouns they want you to use when you talk about them, and always use the pronouns that people ask you to use, whether they are there or not. 

If in doubt, you can refer to people as ‘they’, ‘them’ or ‘theirs’, because ‘they’ is a gender neutral pronoun, which means it isn’t associated with any gender. Other gender neutral pronouns exist, which you may not have heard of; ‘ze’, ‘zem’ and ‘zirs’ and ‘xe, xem and xeir’ are examples of gender neutral pronouns, but there are many others.

More about coming out

Remember: Always be respectful of the way people want to be spoken about.

Gender expression

Some trans people may also change their gender expression to reflect their gender identity as part of their transition. They might change the clothes they wear, cut their hair differently, start or stop wearing makeup, and/or have voice training to soften or deepen their voice.

Some trans people may also modify how their body appears. For example, by making it look like they have bigger breasts or a penis. Trans men/transmasculine people might also ‘bind’ their chest using a binder or piece of material to make it look flatter. (See our page Looking After Your Breasts or Chest for more information about binders and how to bind safely.)

Some trans people may take hormones or have surgery. This is known as ‘medical transitioning’.

What is hormone therapy?

Sex hormones are chemicals in our bodies which produce ‘male’ and ‘female’ characteristics during puberty. The male hormone testosterone is produced in the testes and the female hormone, oestrogen is produced in the ovaries. 

Hormone therapy is when sex hormones are given to people who want to change their bodies physically to reflect their gender identity.

In the case of transfeminine people, oestrogen can be used to develop female physical characteristics. These changes can include:

• Breast growth
• Increased fat on the hips
• Reduced facial and body hair
• Reduction in size of the penis and testicles
• Stopping production of sperm
• Reduced muscle mass
• Reduced sex drive

In the case of transmasculine people, testosterone can be used to develop male physical characteristics. These changes can include:

• Periods stopping after 5-6 months
• Increased facial and body hair
• Change in facial structure
• Lowering of the voice
• Muscle growth and fat redistribution
• Growth of the clitoris
• Increased sex drive

Taking hormones causes some changes which are irreversible, which is why most doctors will recommend someone lives as their gender identity for at least three months before having hormone therapy, so they can make a careful and informed decision. They will also be offered counselling to support them through this process. 

What are puberty blockers?

Hormone-suppressing medication or ‘puberty blockers’ can be used to delay the physical changes of puberty that would usually happen from the naturally occurring hormones in a young person’s body.

Taking hormone blockers can give a person time to think about opting for more permanent physical changes, such as taking testosterone or oestrogen, whilst suspending puberty. Once someone stops taking the hormone blockers the suspended puberty will resume.

How to access hormone therapy with the NHS

To receive hormone therapy on the NHS, you will need to be referred to a gender specialist or a gender clinic by your GP.

Currently the law prevents new prescriptions of puberty blockers being provided for trans and gender questioning young people in the UK. Anyone who was prescribed puberty blockers by their GP before June 2024 can continue using puberty blockers. However, it will not be possible to get puberty blockers with a new or private prescription whether from within or outside of the UK.

In future anyone requesting puberty blockers will be provided with them if they agree to be part of a research study that will assess the risks and benefits of these medicines for trans and gender questioning children. Puberty blockers are routinely prescribed to children experiencing early puberty, and this group will not be affected by these changes.

The NHS in England now provides all support for trans and gender questioning children through two clinics, one in London and one in the North West. In the next two years several more clinics will open. In order to access support from the clinic all children and young people will need to be referred by an NHS paediatric service or Child and Young People’s mental health service.

Gender Affirming Surgery

Having gender affirming surgery is a personal choice that not every trans person makes. For those who do, they may only choose to have some surgery.

For trans women/transfeminine people, surgical options may include:

For trans men/transmasculine people, surgical options may include:

The International Standards of Care for the treatment of trans people require that you live in your gender identity for at least a year before having Gender Affirmation surgery. In the UK, that requirement is extended to 24 months.

For more information on medical transitioning and treatment, visit the gender dysphoria section of NHS Choices. You can also look at these helpful resources on trans health and medical care:

• Gendered Intelligence – A guide for young trans people in the UK
• The National LGBT Partnership – Trans health factsheets
• The Terrence Higgins Trust – A health guide for trans women
• Men’s Health Forum – A health guide for trans men

Some trans people may officially change their name, gender and/or sex on legal documents, which is called ‘legal transitioning’.

The Gender Recognition Act 2004 gives certain legal rights to trans people. Under the Gender Recognition Act of 2004, trans people can:

• apply for and obtain a Gender Recognition Certificate to acknowledge their gender identity
• get a new birth certificate, driving licence and passport
• marry or enter a civil partnership as that sex/gender

To apply for a Gender Recognition Certificate, you must be over 18. The application process requires you to prove that:

• you have or have had gender dysphoria
• you have lived in your gender identity for at least 2 years
• you intend to live permanently in your gender identity