For a transition to be considered successful, it must work for the person in transition, for the people the individual works with and for the organization. If the organization follows basic guidelines, this process can go smoothly. A complete discussion on managing a gender transition in the workplace is outside the scope of this article, but some general principles are offered. Management typically meets with the employee in transition, discusses changes that need to be made, and lets the timing of those changes be guided by the employee.
Matters that may come up for consideration during the process include the following:. No two transitions are exactly alike. Some people, because of medical circumstances, are precluded from taking hormones or having surgery. Some postpone or decide against major surgical procedures because the costs are prohibitive for them and are not covered by their health insurance. Some in transition may choose cosmetic surgery, electrolysis, voice training or other procedures.
The specific steps of transition and their timing vary among individuals, and individuals vary in how public they want their transition to be. Some prefer that very few people know about the transition, and they want to blend in quietly as members of their new gender. Others are committed to educating people about transgender issues, are eager to answer questions and continue to talk openly about being transgender long after transition. Work situations vary, too.
The many circumstances that may have a bearing on how the transition should be handled include the nature of the enterprise and the degree to which it is public or private, the organizational culture, the composition of the workforce, the type of work being done, the physical layout of the workplace, and the amount of interaction the transgender employee has with peers, superiors, subordinates, vendors and clients. Because of such variables, there is no single formula for managing transitions in the workplace; rather, the process must be tailored to meet the needs of each specific situation.
There is no single means of defining a person's legal gender, and there is no point in time when a transgender person changes from one gender to the other. The laws and rules on gender vary according to jurisdiction. For example, many states permit a transgender person to obtain a new driver's license with relative ease; this can help accommodate the medical requirement that a transgender person in surgical transition must live as a member of the person's new gender for at least a year prior to undergoing genital reconstructive surgery.
In other states, changing the sex designation on any form of state-issued identification may be very difficult or even impossible. No uniformity on this issue exists among the states, between state and federal policies, or even among federal agencies. Another influence on how transgender people are viewed is the context in which legal gender is being considered. Having a driver's license that shows the person's new sex is generally sufficient to enable a transgender person to be treated legally as a member of that gender.
Some agencies, however, will not acknowledge a transgender person's new sex until the person presents evidence that the individual has taken an irreversible step to alter the body in the direction of the target sex. Such an irreversible step could be taking hormones over a period of time or having chest or genital reconstructive surgery.
For some purposes, only genital surgery meets the requirement for having changed sex, but the exact nature of the genital surgery may be unspecified. Given the variables in the law, tying recognition of gender in the workplace to legal recognition of the person's sex is problematic.
Even more dubious is any attempt to base the person's acknowledged gender on medical or surgical treatment milestones. The most sensible approach for the employer is to consider the person to be a member of the sex in which the person presents. This approach is in accord with the growing legal trend toward recognizing that a transgender person should be treated as a legal member of the gender in which the individual lives life.
Many co-workers want to be supportive of transgender workers. Some employees, however, may be offended by the idea of a transgender person. Gender transition may run counter to their religious beliefs or moral standards. To reduce the likelihood of negative reactions to gender transition, the organization can establish a culture of appreciation of differences, provide adequate training and treat all employees fairly.
Diversity in a workplace means employees are able to work with all people; it does not require that employees believe in or accept transgenderism.
Employees are entitled to their beliefs, but they should also be required to treat the transgender person—and every other employee—with respect. Inclusion is about a diverse workforce becoming more productive, innovative and creative. It is about effectively harnessing the full range of available perspectives and experiences to create business advantage. To create a more inclusive environment, some organizations define appropriate workplace behaviors that are consistent with the employer's stated beliefs and values about inclusion and productivity.
This process is about changing employees' workplace behaviors to be in accordance with the company's values, not changing an employee's personal beliefs and values. See Creating a Trans-Inclusive Workplace. Like all workers, transgender employers will be happier and more productive in a positive, supportive working environment. Just as an older worker employed in a workplace with mostly younger employees or a male employee working with mostly women might feel out of his element and comfort zone—and maybe even a bit ostracized—a transgender person regularly encounters such environments.
Therefore, an employer that can foster and provide a positive, inclusive working environment, based on respect and professionalism, will likely enjoy workers who are happy to be there, engaged in their work and in the organization's success, and respectful of others. Information about the organization's policies and guidelines for managing a gender transition should be widely accessible for employees, supervisors and managers, and HR professionals. Some trans people might not have the language or understanding of what it means to be trans until later in life.
Other trans people do not know until they are teenagers or adults. Trans people in the UK face huge levels of abuse and inequality. In our research found that two in five trans people have had a hate crime committed against them in the last year, two in five trans young people had attempted suicide and one in eight trans people had been physically attacked by colleagues or customers at work.
More recent research from Galop found that in four in five trans people had experienced a hate crime in the previous 12 months. This shows a worrying increase in transphobic violence and abuse. That said, these stats only tell one part of the story. Being trans is not what causes trans people harm and distress, transphobia is. Transition can be any steps you take to express your gender identity, such as changing your pronouns.
You do not have to have taken any medical steps in your transition in order to be protected by this legislation. You can use the bathroom that fits your gender, expect your employers to recognise your gender, and access gender-specific public services. To update your gender on a passport and driving licence most people will just need a note from a doctor. One thing that causes a lot of difficulty and pain for some trans people is getting the gender on their birth certificate changed.
The majority of feedback supported full reform, including de-medicalisation, non-binary recognition, and a simplified, cost-free process for obtaining a Gender Recognition Certificate.
In spite of this, the Government decided only to reduce the fee for applying for a Gender Recognition Certificate, and to move the application process online.
However, a positive Employment Tribunal ruling stated that non-binary and genderfluid people could be protected from discrimination under the Equality Act. This judgment will be key in supporting future judicial decisions. A Gender Recognition Certificate GRC is a document that allows some trans men and trans women to have the right gender on their birth certificate.
This can make life easier when it comes to things like getting married, or having your death recorded respectfully. Often this will be from a Gender Identity Clinic, and the current waiting times for a first appointment vary between years. This can leave trans people trapped in abusive or controlling situations.
The Government ran a public consultation on reforming the Gender Recognition Act, which closed on 19 October Tens of thousands of people get involved, with the vast majority of respondents supporting a demedicalised process so that trans people would not need a psychiatrist to diagnose them with gender dysphoria. Despite this, the Government made very few changes to the GRC process. It can also take several years to go through and involves a lot of bureaucracy and medical assessments — which are costly for those who can go private, and have waiting lists of several years for those who go through the NHS system.
Being able to get a Gender Recognition Certificate matters: it means you can have a birth certificate with the right gender on it. While a trans person can access services and have ID that reflects their gender without a GRC, having a GRC is important for major life events such as marriage — so that your marriage certificate can reflect who you are.
You do not need to have had any surgery or medical intervention to be trans. For some trans people, having surgery to relieve dysphoria or create gender euphoria is an important part of their transition. Getting access to surgery has become increasingly difficult in recent years, with NHS waiting lists growing longer and Covid compounding the existing delays.
More investment is desperately needed so that trans people can get the procedures they need. The fact that teachers, doctors, families and caregivers are talking about gender more is a good thing. It means that children are more empowered and more able to explore their identity as they grow up, as well as helping them understand and celebrate difference in others. All children and young people deserve the right to be happy and to be themselves. They want someone to talk things through with, someone who can understand their thoughts and feelings, and help them to have similar conversations with others around them.
Those who do explore their identity and realise they are trans deserve love, support and age-appropriate care. For some, it will involve purely social steps, such as changing their name or pronouns. For others, transitioning may also include medical steps — meaning hormone blockers or hormone therapy. Under 18s cannot access surgery within the UK. Research 1 , 2 , 3 shows that allowing trans young people to explore their gender identity, and using their chosen pronouns, can greatly reduce the risk of suicide and mental distress.
When it comes to medical transition, some children and young people may not want or require any medical support. Some may choose to wait before making decisions about future medical care. For some young people who are certain about who they are, and who may become increasingly distressed by changes in their body as they get older, medical treatment can be the right course of action.
In the UK, after assessment, this can involve being prescribed puberty blockers. This gives young people time and space to work out what is right for them, without the distress of the heightened dysphoria that puberty can bring on. It can also help those who know for sure that they do not want to experience the puberty that will occur for them without intervention. From 16 onwards, after further assessment, this can include cross-sex hormones such as oestrogen or testosterone.
In the UK, only adults over 18s can access gender-affirming surgery. People respond differently to cross-sex hormones, but changes in vocal pitch, body hair, and other physical characteristics, such as the development of breast tissue, can become permanent. Kids who go on puberty blockers and then on cross-sex hormones may not be able to have biological children. Surgical interventions can sometimes be reversed with further surgeries, but often with disappointing results.
The concerns of the detransitioners are echoed by a number of clinicians who work in this field, most of whom are psychologists and psychiatrists.
But they worry that, in an otherwise laudable effort to get TGNC young people the care they need, some members of their field are ignoring the complexity, and fluidity, of gender-identity development in young people.
These colleagues are approving teenagers for hormone therapy, or even top surgery, without fully examining their mental health or the social and family influences that could be shaping their nascent sense of their gender identity.
To make sense of this complex reality—and ensure the best outcome for all gender-exploring kids—parents need accurate, nuanced information about what gender dysphoria is and about the many blank spots in our current knowledge. For gender-dysphoric people, physical transition can be life enhancing, even lifesaving. While representative long-term data on the well-being of trans adults have yet to emerge, the evidence that does exist—as well as the sheer heft of personal accounts from trans people and from the clinicians who help them transition—is overwhelming.
For many if not most unwaveringly gender-dysphoric people, hormones work. Surgery works. Hormones and surgery grant transgender people profound relief. Historically, they have been denied access to that relief. Christine Jorgensen, the first American to become widely known for transitioning through hormones and surgery, in the s, had to go to Denmark for her care. In the United States, many physicians simply dismissed the rapidly growing number of individuals seeking gender-affirming surgeries as being mentally ill.
Today, the situation in the U. Whether trans people in this country can access treatments such as hormones and surgery depends on a variety of factors, ranging from where they live to what their health insurance will cover if they have any to their ability to navigate piles of paperwork. No referral or offer to help. She sent me away with nothing, feeling like I was an undesirable. For this reason, among others, trans communities can be skeptical of those who focus on negative transition outcomes.
Groups like W path , the primary organization for psychologists, psychiatrists, endocrinologists, surgeons, and others who work with TGNC clients, have attempted to reverse this neglect in recent years. For gender-questioning children and teens, the landscape is different. W path and other organizations that provide guidance for transitioning young people call for thorough assessments of patients before they start taking blockers or hormones. This caution comes from the concerns inherent in working with young people.
Adolescents change significantly and rapidly; they may view themselves and their place in the world differently at 15 than they did at For younger children, gender identity is an even trickier concept. In one experiment, for example, many 3-toyear-olds thought that if a boy put on a dress, he became a girl. For decades, trans-ness was sometimes tolerated in adults as a last-ditch outcome, but in young people it was more often seen as something to be drummed out rather than explored or accepted.
So-called reparative therapy has harmed and humiliated trans and gender-nonconforming children. These days, mainstream youth-gender clinicians practice affirming care instead. They listen to their young patients, take their statements about their gender seriously, and often help facilitate social and physical transition. The affirming approach is far more humane than older ones, but it conflicts, at least a little, with what we know about gender-identity fluidity in young people.
What does it mean to be affirming while acknowledging that kids and teenagers can have an understanding of gender that changes over a short span? What does it mean to be affirming while acknowledging that feelings of gender dysphoria can be exacerbated by mental-health difficulties, trauma, or a combination of the two? Clinicians are still wrestling with how to define affirming care, and how to balance affirmation and caution when treating adolescents.
When Max Robinson was 17, getting a double mastectomy made perfect sense to her. In fact, it felt like her only option—like a miraculous, lifesaving procedure. Surgery would finally offer her a chance to be herself. On her head, a gray winter cap; at her feet, a shaggy white service dog. She grew up a happy tomboy—until puberty. Her discomfort grew more internalized—less a frustration with how the world treated women and more a sense that the problem lay in her own body.
At 14, she witnessed a friend get molested by an adult man at a church slumber party. Around this time, Max was diagnosed with depression and generalized anxiety disorder.
In ninth grade, Max first encountered the concept of being transgender when she watched an episode of The Tyra Banks Show in which Buck Angel, a trans porn star, talked about his transition. It opened up a new world of online gender-identity exploration. She gradually decided that she needed to transition. She recalled that the specialist was very open to putting her on a track toward transition, though he suggested that her discomfort could have other sources as well. Max, however, was certain that transitioning was the answer.
When Max was 16, her therapist wrote her a referral to see an endocrinologist who could help her begin the process of physical transition by prescribing male hormones. The endocrinologist was skeptical, Max said. Max started taking testosterone. She experienced some side effects—hot flashes, memory issues—but the hormones also provided real relief.
Her plan all along had been to get top surgery, too, and the initially promising effects of the hormones helped persuade her to continue on this path. When she was 17, Max, who was still dealing with major mental-health issues, was scheduled for surgery. Because Max had parental approval, the surgeon she saw agreed to operate on her despite the fact that she was still a minor. The medical norms are more conservative when it comes to bottom surgeries; W path says they should be performed only on adults who have been living in their gender role for at least one year.
Max went into the surgery optimistic. Max was initially happy with the results of her physical transformation. After surgery, between her newly masculinized chest and the facial hair she was able to grow thanks to the hormones, she felt like she had left behind the sex she had been assigned at birth. After her surgery, Max moved from her native California to Portland and threw herself into the trans scene there.
Today, Max identifies as a woman. She believes that she misinterpreted her sexual orientation, as well as the effects of the misogyny and trauma she had experienced as a young person, as being about gender identity. Max is one of what appears to be a growing number of people who believe they were failed by the therapists and physicians they went to for help with their gender dysphoria. While their individual stories differ, they tend to touch on similar themes.
Most began transitioning during adolescence or early adulthood. Many were on hormones for extended periods of time, causing permanent changes to their voice, appearance, or both.
Some, like Max, also had surgery. Many detransitioners feel that during the process leading up to their transition, well-meaning clinicians left unexplored their overlapping mental-health troubles or past traumas. Despite the fact that she was a minor for much of the process, she says, her doctors more or less did as she told them. Over the past couple of years, the detransitioner movement has become more visible. Detransitioners who previously blogged pseudonymously, largely on Tumblr, have begun writing under their real names, as well as speaking on camera in YouTube videos.
Cari Stella is the author of a blog called Guide on Raging Stars. Stella, now 24, socially transitioned at 15, started hormones at 17, got a double mastectomy at 20, and detransitioned at Carey Callahan is a year-old woman living in Ohio who detransitioned after identifying as trans for four years and spending nine months on male hormones. She now serves as something of an older sister to a network of female, mostly younger detransitioners, about 70 of whom she has met in person; she told me she has corresponded online with an additional The detransitioners who have spoken out thus far are mostly people who were assigned female at birth.
Traditionally, most new arrivals at youth gender clinics were assigned male; today, many clinics are reporting that new patients are mostly assigned female. There is no consensus explanation for the change. I met Carey in Columbus in March. She told me that her decision to detransition grew out of her experience working at a trans clinic in San Francisco in and Carey said she met people who appeared to be grappling with severe trauma and mental illness, but were fixated on their next transition milestone, convinced that was the moment when they would get better.
She detransitioned, moved to Ohio, and is now calling for a more careful approach to treating gender dysphoria than what many detransitioners say they experienced themselves.
What the SOC describes and the care people get before getting cleared for hormones and surgery are miles apart. Detransitioners, understandably, elicit suspicion from the trans community. Imagine being a trans person who endured a bruising fight to prove to your psychiatrist and endocrinologist that you are trans, in order to gain access to hormones that greatly improve your quality of life, that relieve suffering.
You might view with skepticism—at the very least—a group calling for more gatekeeping. Conservative media outlets, for their part, often seize on detransition narratives to push the idea that being trans is some sort of liberal invention.
No one knows how common detransitioning is. A frequently cited statistic—that only 2. It comes from a study , conducted in Sweden, that examined only those people who had undergone sex-reassignment surgery and legally changed their gender, then applied to change their gender back—a standard that, Carey pointed out, would have excluded her and most of the detransitioners she knows.
It stands to reason that as any medical procedure becomes more readily available, a higher number of people will regret having it. Why focus on detransitioners, when no one even knows whether their experiences are all that common? One answer is that clinicians who have logged thousands of hours working with transgender and gender-nonconforming young people are raising the same concerns.
When it comes to helping TGNC young people gain access to physical interventions, few American clinicians possess the bona fides of the psychologist Laura Edwards-Leeper.
She helped bring that protocol back to Boston, where she worked with the first-ever group of American kids to go through that process. In February, I visited one of her classes at Pacific, just outside Portland. For an hour, she let me pepper her students with questions about their experiences as clinicians-in-training in what is essentially a brand-new field.
When the subject of detransitioners came up, Edwards-Leeper chimed in. Edwards-Leeper believes that comprehensive assessments are crucial to achieving good outcomes for TGNC young people, especially those seeking physical interventions, in part because some kids who think they are trans at one point in time will not feel that way later on.
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