By: Plume Community Member (they/them)
People who need gender affirming healthcare sometimes may be hesitant to get the care we need if we face barriers that prevent us from socially transitioning. Everyone’s path is different, but I was definitely someone who delayed my medical transition until I was ready to share the news socially. My journey taught me a lot about where and when to share my gender identity, and who really needed to know.
What I’ve learned is that you never have to tell people that you are using hormones, how you identify, or any other personal information. The only person who really needs to know that you’re using hormones is your medical provider—and they abide by HIPAA, which protects your privacy.
Coming out is a deeply personal decision. And deciding when or even whether to share this information with people in your life does not need to depend on when (or if!) you start hormones. Indeed, some transgender folks begin medically transitioning months or even years before they fully socially transition. This article is about the three major aspects of gender transition and how “visible” you may choose to be at different times.
What is transition?
Transition refers to a complex and deeply personal process. In general, “transition” refers to the period of time when individuals realize their gender identity assigned at birth is not accurate. The time it takes to re-align your personal expression with another gender—including male, female, agender, nonbinary (enby or NB), or genderfluid—is your gender transition.
First off, let’s unpack the word “transition” because there are different layers to the ways this happens. Not everybody undergoes each one or all at the same time.
Physical transition — initiating gender-specific changes in the body. Physical transition is different for everyone. Generally, it means using medication like gender-affirming hormone therapy (GAHT, also called HRT or hormone replacement therapy) or other medical interventions to help bring alignment to a person’s internal gender identity.
Social transition — changes in social behavior that affect how others perceive your gender. Social transition is very complex and has a lot of different aspects. Some examples of social transition are updating your pronouns, choosing a new name, buying clothing that reflects your identity, and changing which bathroom you use. The goal of social transition is to align how you are seen and how you interact with the world.
Legal transition — amending official government records to reflect your identity. Legal transition involves updating your documents, such as your birth certificate, passport, and driver’s license. This aspect of your transition might include a formal name change, gender marker change, and other paperwork.
Each of these layers of transition takes time and energy. For some folks, legal transition is the most important. They feel affirmed as soon as they change their gender marker! Other people feel that accessing testosterone or estrogen is the most important layer of their transition. You can mix and match to reflect your needs and transition goals.
Do I have to “come out” to access gender-affirming care?
No, you do not have to come out in order to use or access gender-affirming hormones. People in our community do sometimes begin their medical transition before they socially or legally transition. This means that they disclose their health needs to their medical provider, but don’t necessarily feel comfortable living openly in their gender identity.
For instance, researchers in one study highlighted the case of a transgender woman who chose to make a medical transition but nonetheless sometimes still presented as a cisgender man. Her reason? Social constraints. Her spouse worked at a fundamentalist church and the woman’s family was unsupportive. It wasn’t a safe or supportive environment for her, so she chose to take hormones and make other changes, but not share her identity outside her home.
Choosing not to come out can be for all kinds of reasons. If this is something you’re struggling with, consider working with a Plume support group to talk about your feelings regarding gender transition. These safe, private groups are facilitated by community members. They’re a great way to meet other trans and nonbinary folks, hang out, and talk about how you’re doing.
Who decides how I can access healthcare?
It’s true that previously, the World Professional Association for Transgender Health (WPATH) required a “real life test” in which patients lived for one year in the gender they identified with before accessing medical treatment. But these guidelines have fallen away with greater awareness of the fact that the pace and extent of everyone’s socially transitioning is unique.
The most current WPATH guidelines now make clear that the “nature and duration” of transition is “variable and individualized.” Not everyone who undergoes medical transition can fully socially transition. Not all of us have the same gender transition goals. And not all of us have a fixed gender identity—many people are nonbinary, gender non-conforming, agender, or genderfluid.
But by initiating medical transition first, gender non-conforming (GNC) patients—such as the trans woman who chose not to come out socially—can still benefit from hormones. Indeed, medical transition may be appropriate for people who cannot socially transition and may want a more private expression of their gender identity.
Can medical transition help social transition?
Yes, initiating medical transition first can help patients more fully socially transition later on. Accessing gender-affirming medical care is a powerful and affirming step for many people. It has benefits that likely outweigh most of the risks or anxiety of beginning to transition. According to a review of more than 50 peer reviewed studies, researchers found many positive outcomes of gender-affirming medical care. These outcomes include:
- Improved quality of life
- Greater relationship satisfaction
- Higher self-esteem and confidence
- Reductions in anxiety, depression, suicidality, and substance use
It’s also true that for many thinking about medical transition, many folks may think the changes will happen overnight. The dream is often that once we decide to acknowledge who we are, that change automatically will become obvious to everyone in our lives. The reality, however, is a bit different.
Depending on your needs and transition goals, you can decide how and when to transition. For example, some people change their legal gender marker but make no other changes. They don’t use hormones, plan for gender confirmation surgery, or change their names. Some people prefer to keep their documents the same while using medical support for their transition. Other people do it all! There’s no “wrong way” to transition—only what works for you.
This Plume Community Member (they/them) is a freelance writer living in the Washington, DC area. A former newspaper reporter, they have written extensively on healthcare and issues such as access to life-saving medication.
As the largest provider of gender-affirming care for the trans and nonbinary community, Plume is committed to providing information about many types of information, including questions about hormones like estrogen and testosterone, gender transitioning tips and experiences, and guidance on social transition and self care.
While we strive to include a diverse range of voices and expertise, not everything will be for every person. Each individual’s experience is unique, and the information Plume provides is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Always first seek the advice of your primary and/or specialist physician, the Plume Care Team, or other qualified health provider with any questions you may have regarding a medical condition, your mental health and emotional needs, or your health care needs regarding gender-affirming hormone therapy. If you are experiencing an emergency, including a mental health crisis, call 911 or reach out to Trans LifeLine.
