Healthy lives for young people
Gender

Transitioning

Every person’s transition journey is different and personal to them. Find out about the various different types of gender transition: social, medical and legal.

What is Transitioning?

The word ‘transitioning’ refers to the process of someone coming out and living in their gender identity, rather than the gender they were assigned at birth. Transitioning can involve many different elements and stages, such as changing their social identity, legal identity and/or gender expression.

Gender identity

A person’s internal feelings and convictions about their gender. This can be the same or different to the gender they were assigned at birth.

Gender expression

The outwardly-visible behaviours and choices that a person makes in relation to their gender identity. This can include choices about their appearance, for example clothing and hairstyles, their behaviour and mannerisms, and their name and pronouns.

Not everyone chooses to transition, and those who do transition do so in different ways. There is generally a lot of focus on medical transitioning and changes to physical appearance, but ultimately it’s an inner journey of reflection and 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. No one should ever feel pressured to transition or come out in a certain way. Read our page on coming out as trans.

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.

Social Transitioning

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.

Pronouns

Pronouns are words that we use instead of names, like ‘he’, ‘her’ or ‘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. You should always 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.

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. Trans men/transmasculine people might ‘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.) They might also do something called appearance impression/look of a penis underneath their clothes. Trans women/transfeminine people might wear padding, for example on their chests, to create a more typically feminine body shape.

Medical Transitioning

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

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. 

Sex and Gender

Sex and gender are two very separate terms, despite people often thinking they are the same thing.

‘Sex’ refers to our biological traits, such as our genitals, internal reproductive organs and hormones.

‘Gender’ refers to the socially constructed ideas about human behaviour, actions and roles in relation to ideas of ‘masculinity’ and ‘femininity’.

Read more about the difference between sex and gender here

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 3 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. 

If a person is under 16, they may be offered hormone blockers, which delay the physical changes of puberty that would usually happen from the naturally occurring hormones in their body. Taking hormone blockers can give a person time to think about opting for more permanent physical changes, whilst suspending puberty. When the person turns 16, they can then be prescribed testosterone or oestrogen. However, if the person turns 16 and decides they don’t want to physically transition, then they can stop taking the hormone blockers and the suspended puberty will resume.

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.

If you are under 16, you will need to be referred to a specialist young person’s clinic such as The Tavistock and Portman, who may then offer you hormone blockers. In 2011, the age at which young people could be offered this treatment was lowered from 16 to 12. At the age of 16 you can begin receiving hormones that help you transition but currently the Tavistock and Portman is the only clinic in the UK that offers this. From 18, you can attend any NHS gender clinic.

Gender Affirming Surgery

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

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

  • Breast implants
  • Removal of testicles (orchidectomy)
  • Removal of penis (penectomy)
  • Creation of a vagina (vaginoplasty)
  • Creation of a clitoris (clitoroplasty)
  • Creation of labia or ‘lips’ of the vagina (labiaplasty)
  • Facial feminisation surgery
  • Trachea (or Adam’s apple) shaving
  • Removal of male brow bossing
  • Jaw reshaping

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

  • Breast removal and chest recontouring (double mastectomy), also known as top surgery
  • Removal of the womb (hysterectomy)
  • Removal of the ovaries (oophorectomy)
  • Removal of the vagina (vaginectomy)
  • Creation of a ‘micropenis’ from the clitoris (metoidioplasty)
  • Construction of a phallus (phalloplasty)
  • Creation of a scrotum with testicular implants (scrotoplasty)

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:

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 in their gender identity

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

Gender identity clinics in the UK

Gender identity clinics in London and South East England

West London Mental Health NHS Trust Gender Identity Clinic
179-183 Fulham Palace Road, London, W6 8QZ
Telephone: 020 8483 2801

The West London clinic’s website has an overview of information useful for anyone with gender identity needs, not just those in the area.


The Tavistock and Portman NHS Foundation Trust Service for children and young people with gender identity issue
The Tavistock Centre, 120 Belsize Lane, London, NW3 5BA
Telephone: 020 8938 2030
Email: gids@tavi-port.nhs.uk

The Tavistock’s website includes information about the kinds of treatment the service offers people with gender identity issues.

Gender identity clinics in the North of England

Sheffield Health and Social Care NHS Foundation Trust Sexual and Relationship, Sexual Medicine and Transgender Services
Porterbrook Clinic, Michael Carlisle Centre, Nether Edge Hospital, 75 Osborne Road, Sheffield, S11 9BF
Telephone: 0114 271 6671

The Sheffield Gender Identity Services website includes information about referrals, clinic opening hours, and links to eligibility criteria and the Porterbrook Clinic.


Leeds Gender Identity Clinic
Management Suite, 1st floor, Newsam Centre, Seacroft Hospital, York Road, Leeds, LS14 6WB
Telephone: 0113 855 6346

The Leeds clinic’s website covers referrals and commonly used medications.


Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Northern Region Gender Dysphoria Service

Benfield House, Walkergate Park, Benfield Road, Newcastle, NE6 4QD
Telephone: 0191 287 6130

The Northumberland Gender Dysphoria Service website has a leaflet outlining eligibility and how to access service.

Gender identity clinics in the Midlands

Northampton Gender Clinic
Danetre Hospital, London Rd, Daventry, Northamptonshire NN11 4DY
Telephone: 01327 707200
Email: genderclinic@nhft.nhs.uk

Visit the Northampton Gender Clinic’s website for more information.


Nottingham Gender Clinic
Mandala Centre, Gregory Boulevard, Nottingham, NG7 6LB
Telephone: 0115 960 2820

The Nottingham Gender Clinic’s website has information about staff at the clinic and the legal standing of gender dysphoria services.f7c412

Gender identity clinics in South West England

The Laurels Gender Identity and Sexual Medicine service (Devon Partnership NHS Trust)
The Laurels, 11-15 Dix’s Field, Exeter, EX1 1QA
Telephone: 01392 677077

The Laurels’ website has information about the types of services on offer and the help available during transition.

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