Understanding gender, sex, and transgender identity

Why this chapter matters

Transgender and nonbinary people are integral parts of every community. It is likely that you have met someone who is trans, even if you did not know it. Trans people may be neighbors, teachers, restaurant workers, students, mentors, children, artists, advocates, and many other members of your community. Service providers are likely to work with trans people, whether or not a client has disclosed that part of their identity.

This section introduces foundational concepts about gender, gender identity, and actions people may take to affirm their gender. It also explains why terminology varies across individuals and communities, and why respectful practice depends on listening to how each person describes themself. Later sections cover nonbinary experiences, historical context, key terms providers may hear, and a glossary.

Gender identity and sex assigned at birth

The word transgender is an adjective to describe people whose gender identity (their internal sense of who they are) differs from the sex they were assigned at birth.  Sex assigned at birth is the label, usually limited to male or female, that is placed on a birth certificate based on how an infant’s body is interpreted at birth. This designation is often made by doctors or birthing staff based on the appearance of external genitalia.

As people grow, they develop their own sense of their gender. This sense of self is shaped by culture, family, language, relationships, and internal experiences. For many people, gender remains consistent throughout their life. For others, gender shifts as they gain language, safety, support, or new self-understanding. Some trans people know and express their gender early in life, some do so much later, and some experience gender in ways that change over time. All of these experiences are real and valid, and everyone should have access to social and medical support that helps them live safely and authentically.

Understanding intersex experiences

Some people are intersex, meaning their sex characteristics, such as genitals, internal reproductive anatomy, hormone patterns, or chromosomes, do not fit neatly into binary medical categories of male or female. These variations may be visible at birth, may become apparent later in life, or may never be identified.

Respecting individual language and identity

Language used to refer to trans people should reflect each person’s affirmed or actual gender: the gender the person knows themself to be and uses to describe themself. For example, someone who is a woman and was assigned male at birth should be described as a woman, or as a trans woman if she uses that term for herself.

Trans people may align with certain language or phrases, or may find some terms offensive, inaccurate, or not aligned with their identity or experience.  Following your client’s lead is always the best way to show respect and gain trust.  The following are some examples of different ways trans and nonbinary people may value specific terms or embody various identities or experiences:

Trans and nonbinary people might:

• Always use the term trans when describing their gender
• Not use the word trans to describe themselves – for privacy reasons or because they don’t consider it to be accurate
• Consider being trans central to their identity, one part of who they are, or something they rarely think about
• Be comfortable with their bodies as is, or with medical or other changes
• Be uncomfortable with their bodies and want to make physical changes
• Have mixed feelings about their body, with comfort at times or about some parts of their body; discomfort at other times or with some parts of their body
• Have shame, pride, dislike, joy or any other emotion related to their experiences and identities.
• Be of any sexuality (trans and nonbinary people can be straight, asexual, aromantic, pansexual, gay, lesbian, bisexual, or any other sexual orientation or sexual identity)
• Have relationships or family structures that are considered “traditional” or culturally mainstream, or that fall outside dominant cultural norms, recognizing that these norms vary widely across cultures. This might include non-sexual nesting partners, more than one partner, or a chosen family.

There is extensive nuance to language. Culture, ethnicity, age, location, politics, and so much more impact the words that people use and relate to. Providers can benefit from engaging with trans people and culture to become more familiar with people’s experiences. This could include reading books, both fiction and nonfiction, by trans/nonbinary people, watching movies and television that is created by trans people, listening to music, visiting museums, clubs, or other spaces that are trans inclusive, and attending trainings, meetings, or other events hosted by trans organizations.

Provider foundations for affirming practice

Providers do not need to be experts on every aspect of trans lives and culture to provide trans-affirming care. They do need enough familiarity and comfort to talk respectfully about gender, follow each person’s lead, and avoid making assumptions about a person’s body, history, identity, or needs.

Providers can support respectful, affirming practice by doing the following:

• Listen to how people describe their own experiences,
• Reflect their language, and
• Focus on the issues that the person is bringing to them.

Providers rarely need to know a person’s medical history, what genitals they currently have, what sex is listed on their birth certificate, or when and how they transitioned. When this information is necessary, providers can explain why they are asking and how it will be used. Providers can respect and affirm a person’s gender by using their affirmed name and pronouns and treating them consistently with the gender they know themself to be.

For more on putting these principles into practice, see the Trans-Affirming Services section of this Toolkit.

Understanding trans and nonbinary lives beyond gender

People are more than their gender

Transgender people have full, complex lives, as do all other humans. It is important that service providers do not oversimplify the lives of trans people by only focusing on their gender.

Transgender people come from all races, ethnicities, languages, cultures, and locations. They exist across age groups, rural and urban communities, and around the world. They can have any sexual orientations, including not experiencing sexual or romantic attraction. They may do any type of work, have any type of relationship structure, and any religion or none at all.

Current estimates of how many people identify as transgender or nonbinary vary depending on the study, the population surveyed, the wording of the question, and whether younger people are included. Research also suggests that younger people are more likely than older adults to identify openly as transgender or nonbinary. Between 1% of adults and 5% or more of young adults under 30 years old identify as transgender or nonbinary.[i]

Even when population estimates appear small, service providers across the country should be prepared to work respectfully with transgender and nonbinary people.

Understanding nonbinary experiences

What nonbinary means

Nonbinary people may describe their gender in many different ways. Some identify as both a man and a woman, neither a man nor a woman, somewhere between binary genders, outside of those categories, or as a gender that changes over time. Some nonbinary people also identify as transgender, while others do not. Providers should not assume what nonbinary means for a particular person. The best approach is to use the words, name, and pronouns the person uses for themself and to ask only the questions that are relevant to the service being provided.

Diversity of nonbinary experiences

There is no single nonbinary experience. Nonbinary people come from every race, culture, age group, religion, profession, and community. Some have known their gender for as long as they can remember, while others find language that fits their experience later in life. Some are highly connected to nonbinary and/or trans communities, while others may not use the term nonbinary until they encounter it through friends, social media, books, or other sources.

Some nonbinary people experience their gender as stable over time. Others experience their gender as fluid, shifting, or changing. Some feel connected to masculinity, femininity, both, neither, or something else entirely. The words people use to describe these experiences vary widely and can change over the course of someone’s life. Providers do not need to understand every identity label. What matters most is respecting how a person describes themself and avoiding assumptions based on appearance, voice, clothing, body characteristics, or legal documents.

Nonbinary “transition”

Some nonbinary people take steps to affirm their gender through social, legal, or medical changes. Others do not. There is no specific set of actions that makes someone nonbinary, or not nonbinary.

A nonbinary person might socially transition by changing their name, pronouns, clothing, hairstyle, or other aspects of their presentation. Some may use they/them pronouns, while others use she/her, he/him, multiple sets of pronouns, or pronouns that are less familiar to providers. Pronouns are not a reliable way to determine whether someone is nonbinary, transgender, or cisgender.

Some nonbinary people pursue gender-affirming medical care, while others do not. A nonbinary person may use hormones, seek surgery, pursue other forms of gender-affirming care, or decide that none of those options are right for them. Some seek changes that are commonly associated with binary transition pathways, while others seek only certain changes or have goals that do not fit neatly into existing medical categories. Providers should avoid assuming what care a person wants based solely on their identity label or medical actions they have taken or are pursuing.

Similarly, some nonbinary people change legal documents such as their name or gender marker, while others do not. Legal changes may be limited by cost, safety concerns, family circumstances, employment concerns, immigration status, state policies, or personal preference. Many times, the available options in legal documents does not affirm or align with a person’s gender.  For example, if someone does not identify as male or female, a person may not want to change their driver’s license gender marker if those are the only two options available.  A person’s legal documents do not necessarily reflect their gender identity, and providers should use a person’s affirmed name and pronouns and not default to their legal name or gender.

Gendered systems and service barriers

Many systems were designed around the assumption that everyone is either a man or a woman. As a result, nonbinary people may encounter barriers that are different from those experienced by some binary trans people.

For example, forms may require someone to select from only “male” or “female” options. Databases may not allow a person’s affirmed name to be displayed. Waiting rooms, shelters, housing programs, restrooms, and other services may be organized in ways that require people to fit into categories that do not accurately reflect who they are.

These barriers can create confusion, stress, privacy concerns, or fear of discrimination. A nonbinary person may have to repeatedly explain their identity, decide whether to correct inaccurate information, or choose between disclosing personal information and accessing services. Even when these situations seem minor to providers, they can have a cumulative impact over time.

Providers may not be able to immediately change every system they work within. However, they can often reduce barriers by using a person’s affirmed name and pronouns, explaining why certain information is required, offering options whenever possible, and advocating for more inclusive policies and practices within their organizations.

Supporting nonbinary clients

Providers do not need to fully understand a person’s gender in order to work effectively with them. They do need to treat people with respect, remain open to learning, and avoid making assumptions.

When working with nonbinary clients, providers can:

• Use the name and pronouns the person uses for themself.
• Avoid assuming someone’s identity based on appearance, voice, clothing, or body characteristics.
• Ask only the questions that are necessary for providing services.
• Recognize that legal documents may not reflect a person’s current identity.
• Remain flexible when forms, policies, or systems do not adequately reflect a person’s experience.
• Focus on the person’s goals, needs, strengths, and concerns rather than treating gender as the primary issue in every interaction.

Like all people, nonbinary individuals are experts on their own experiences. Service providers do not need to be perfect or have a vast amount of knowledge to provide respectful support. Listening, respecting self-identification, and remaining willing to learn are what is most important.

Historical and contemporary context

Trans and nonbinary people throughout history

Understanding contemporary experiences also requires some understanding of history. Trans and nonbinary people have existed across cultures and throughout history, although the language used to describe gender has varied widely across time and place. In many societies, people lived outside binary definitions of male and female, and some cultures recognized specific gender roles beyond man and woman. Much of this history is incomplete because trans and nonbinary people’s experiences were often not documented from their own perspectives.

Historical criminalization and exclusion

For centuries, laws and social systems have punished people for living outside dominant gender norms. Some of these laws were tied to colonialism. Many Indigenous nations in what is now called the United States have long recognized gender roles and identities beyond the European binary of man and woman, each with their own names, meanings, and histories. European colonizers imposed Christian and European gender norms and tried to suppress many Indigenous cultural practices, including gender and sexual diversity.[ii] Today, some Indigenous people use Two-Spirit, a contemporary pan-Indigenous term adopted in 1990, to describe identities that may include cultural, spiritual, gender, and sexual dimensions.[iii]  Colonial laws banned “cross-dressing.”[iv] In the 1800s, more than 40 U.S. cities passed similar laws.[v]  In the late 1800s and throughout the 1900s, people assigned female at birth were incarcerated if they did not “act as women” – which punished both nonbinary or trans people as well as women who did not fit gender stereotypes.  Anti-trans laws and policing practices also punished people for clothing, appearance, or behavior that authorities viewed as inconsistent with assigned sex or gender expectations.  Even though cultural attitudes have changed over time, the current rise in anti-trans hate and culturally specific legislation is not entirely new.

Anti-trans legislation and violence are discussed further in the Overview of Experiences with Violence section of this Toolkit.

Trans lives today

Trans and nonbinary people have been part of social movements throughout history and work in many professional roles, including as service providers. Trans people are advocates, doctors, therapists, EMTs, community organizers, interpreters, and more.

In this Toolkit, we have aimed to include the voices of trans people with a broad range of identities and experiences. Some survivors spoke about specific forms of violence they experienced as a Black or Indigenous trans person, a disabled nonbinary person, a gay trans man, or a sex worker who is trans. Sometimes, people were unsure how they were being perceived when they experienced violence, or didn’t know why they had been targeted.

Intersectionality and multiple forms of marginalization

Trans and nonbinary people have a broad range of identities and experiences, and those experiences may be shaped by other aspects of their lives. For example, transphobia may intersect with racism, ableism, homophobia, misogyny, poverty, immigration status, or other forms of marginalization. Providers should avoid treating gender as the only relevant part of a person’s experience.

Understanding people’s identities, experiences, and social contexts provides important background for service providers. The next section introduces terminology that may arise in services, advocacy, healthcare, and community settings.

Key terms and concepts

This section introduces key terms that providers may hear from trans and nonbinary clients, colleagues, community members, or training materials. These definitions are a starting point. They are not a substitute for listening to how each person describes themself, what language they use, and what information is actually relevant to the service being provided.

Using terms respectfully

Trans and nonbinary people may use a broad range of terms to describe their identities and experiences. These terms can change over the course of someone’s life, and language used within communities can also change over time.  Throughout the Toolkit, we use these words in their broad ways while recognizing that individuals may define specific words and phrases differently.

Trans survivors may define terms that are extremely important to them in very different ways from one survivor to another. Language is powerful, and being able to describe who they are and what they have experienced can help survivors reclaim control over their lives. It’s important for providers to learn what a term means for the individual they are working with and avoid assuming it will mean the same thing for someone else.

Within transgender communities, there has been change over the decades in how people refer to themselves, their process of identifying their gender to others, medical procedures, and other matters related to privacy and wellbeing. Service providers may come across words and concepts related to being transgender such as transition, outing,  and disclosure. Each of these concepts is explored more below.

Gender affirmation and transition

Transition

Transitioning can refer to social, legal, medical, or personal actions a person takes to live more fully in alignment with their gender. Transitioning varies widely from person to person, and there is no single step-by-step process everyone follows. Some people take many steps, some take only a few, and some do not describe their experience as transitioning at all. A person’s past choices do not automatically indicate what they want or need in the future. Transition steps can include sharing one’s identity with others, changing one’s appearance, updating paperwork or legal identification, or using medications or surgical procedures.

Decision-making around transitioning is very personal. Some people prefer to tell people they are transgender first before taking medical steps. Others prefer to medically and physically transition before they come out. Many people consider their transition to be “complete” after a certain point. Others consider themselves to be transitioning for many years, for example, while they work toward medical or legal goals. Providers can follow each person’s own language about whether they are transitioning or have transitioned.

Social transition

Social transition refers to steps taken in one’s social life to affirm one’s gender identity. This could look like someone changing their name or pronouns or exploring a different gender presentation (the way someone outwardly conveys their gender through things like clothing, hairstyles, accessories, etc.).

Someone might choose to socially transition in certain spheres of life (like at work or at home), but not others. They might also take certain steps and not others (like changing their pronouns, but not their name). These are all valid ways to socially transition.

Medical transition

Medical transition includes care someone might receive to affirm their gender (also known as gender-affirming care). There are many different forms of gender-affirming care someone might access, including: gender-affirming hormone therapy, puberty blockers, and gender-affirming surgeries. Medically transitioning may impact someone’s healthcare needs. More detail is included in the Toolkit’s sections for healthcare providers. Not all trans people want or need medical transition, and access to care does not determine whether someone’s gender is valid.

Legal transition

Legal transition involves taking legal steps to update one’s name, gender marker, or other identity information in the eyes of the law. This often includes updating identity documents, such as a driver’s license, state ID, passport, Social Security record, or birth certificate. Whether someone can update these documents depends on the policies that apply in their state, Tribal nation, federal agency, or country. Some policies create additional barriers, such as requiring medical documentation, a court order, publication of a name change, fees, or proof of gender-affirming surgery.

Because of these barriers, many trans people have not changed their legal documents to reflect their current name or gender identity. This can be challenging when agencies require the use of someone’s legal name or gender. Whenever possible, it’s important to use the name and pronouns someone uses, rather than those listed on their ID documents.

Privacy and disclosure

Disclosure

Disclosure refers to a trans person choosing to share that they are trans with another person. In other parts of this Toolkit, disclosure may also refer to telling a provider or support person about a crime, abuse, or other violence someone has experienced.

When using disclosure to refer to gender identity, it’s important to know that people may disclose on their own time, if and when they feel comfortable to do so. Some people do not disclose that they are trans in some or all areas of their lives. Some describe this as being “stealth,” although not everyone uses or likes that term. Others will only disclose when they feel comfortable enough with a provider or advocate or when they deem the information to be relevant.

It should always be up to each person whether and when to disclose to someone else. This means that providers should avoid outing the trans people they work with.

Outing

Outing happens when someone discloses a trans person’s identity without their permission to another person. Outing might happen intentionally (for example, an abusive partner telling others about someone’s trans identity to cause harm), or unintentionally (for example, paperwork revealing someone’s birth name during legal proceedings).

Outing can be dangerous and should be avoided. When someone is outed, it might expose them to further hate-motivated violence or discrimination by other service providers, and it could put their housing or employment in jeopardy.

There may be limited situations when service providers are required to provide information that might disclose  a trans person’s identity or history, such as mandatory reporting, court orders, insurance billing, or other legal or administrative requirements. When this happens, providers should explain what must be shared, who will receive it, what choices the person may still have, and what steps can reduce risk or protect privacy as much as possible.

Social recognition and respect

Passing

Passing is a term that is sometimes used by trans and nonbinary people to describe their experiences with being perceived as cisgender instead of transgender. This may be something that some trans people want to experience as an outcome of their transition, but for others, it may be undesirable to be perceived as cisgender. Many nonbinary people do not want to “pass” as one binary gender.

“Passing” is heavily based on cultural norms surrounding gender, and different expectations for ways that men and women are expected to look, dress, and act.

While this term is still used by many people in the community, others find it problematic because of the implications that a trans person is “passing as something they are not,” when they’re really being perceived as their gender identity. Transgender activist Angelica Ross speaks about an alternative to passing called “cis-assuming privilege,”[vi] which highlights the benefits of safety that someone might experience while being perceived as cisgender rather than trans, without the connotation that trans people are “pretending” to be something they are not. Providers can follow the language an individual uses rather than describing someone as “passing” on their behalf.

Misgendering

When someone uses the wrong pronouns, gendered terminology (such as ma’am/sir, or Ms./Mr./Mx.) or name for someone, this is referred to as misgendering. Although everyone makes mistakes, misgendering can be deeply upsetting and traumatic, especially when it happens repeatedly, and the people doing the misgendering do not make an effort to correct their mistakes.

We cannot know a person’s pronouns by just looking at them.   To reduce misgendering, providers can share their own pronouns when introducing themselves and offer people an easy, optional way to share theirs. This can be as simple as: “Hi, my name is Sara, and I use she/her pronouns. What pronouns do you use?”

Note: It is ideal to do this with everyone, not just people who may be perceived to be transgender/gender non-conforming.

When someone makes a mistake, it is best to correct it quickly and move on rather than lingering in the moment or apologizing repeatedly. Repeated apologies can shift attention to the person who made the mistake and may put pressure on the person who was misgendered to offer reassurance.

If someone corrects you about their pronouns, you can thank them for reminding you, and make efforts to use the correct pronouns next time.

For more guidance on names and pronouns, see the Pronouns and Referring to People section of this Toolkit.

Deadnaming

Deadnaming refers to using a name that a trans person no longer uses, such as a birth name, instead of their current name. Deadnaming is closely related to misgendering. Not every trans person calls a former name a “deadname,” so providers can follow the person’s own terminology.

Glossary

Cisgender

Cisgender refers to someone whose gender identity aligns with the sex they were assigned at birth.

Gender expression

Gender expression refers to the ways someone outwardly conveys their gender, through things like clothing, hairstyles, voice, mannerisms, or accessories. Gender expression does not necessarily indicate someone’s gender identity.

Gender identity

Gender identity refers to someone’s inner concept of self as a man, a woman, a blend of both or neither, or something else – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different from their sex assigned at birth.

The list below is a small collection of words that some people use to describe their gender or gender identity.  This list is not complete, and not every term means the same thing to every person or community. Language can vary based on a person’s age, region, cultural background, community, or other lived experiences.

• AFAB (assigned female at birth)
• Agender
• AMAB (assigned male at birth)
• Bigender
• Butch
• Demiboy/demigirl
• Enby or nonbinary
• Femme
• FTM
• Gender-expansive
• Genderfluid
• Genderqueer
• Mahu
• Man
• Masc
• Masculine of Center
• MTF
• Neutrois
• Questioning
• Trans man
• Trans woman
• Transfeminine
• Transgender
• Transmasculine
• Two-Spirit
• Woman

Intersex

Intersex describes people whose sex characteristics, such as genitals, internal reproductive anatomy, hormone patterns, or chromosomes, do not fit neatly into binary medical categories of male or female. Being intersex is different from being transgender, although some intersex people also identify as trans or nonbinary.

Nonbinary

Nonbinary is a term that some people use to describe their gender identity as one that does not neatly fit into the binary categories of “man” or “woman.” Nonbinary is an umbrella term, and people may use more specific terms to describe their identity, such as genderfluid, transmasculine, transfeminine, or agender. Some nonbinary people identify as transgender, while others do not.

Sex assigned at birth

Sex assigned at birth refers to the sex designation, usually female or male, given to a person at birth. It is typically recorded on the person’s original birth certificate. People may use terms like “AFAB” (assigned female at birth) or “AMAB” (assigned male at birth) to describe their assigned sex. This language initially came from intersex activists describing the way that doctors nonconsensually assign a binary sex to intersex infants.[vii] A person’s sex assigned at birth is rarely relevant to providing services and should not be requested simply because someone is transgender.

Sexual orientation

Sexuality or sexual orientation describes how someone experiences sexual attraction. Romantic attraction is often included in this conversation, although people may experience romantic and sexual attraction differently. Types of sexualities and orientations include:

• Aromantic
• Asexual
• Bisexual
• Demisexual
• Gay
• Lesbian
• Pansexual
• Queer
• Straight

Transgender

Transgender is a descriptive term for people whose gender identity is different from what is typically associated with the sex they were assigned at birth.

Two-Spirit

Two-Spirit is a contemporary pan-Indigenous term used by some Indigenous people to describe identities or roles related to gender, sexuality, spirituality, culture, or community. Its meaning varies among individuals and Indigenous nations. Two-Spirit is not simply an Indigenous synonym for transgender, nonbinary, or LGBTQ+, and non-Indigenous people should not generally use it to describe themselves.

 

 

[i] Brown, A. (2022, June 7). About 5% of young adults in the U.S. say their gender is different from their sex assigned at birth. Pew Research Center. https://www.pewresearch.org/short-reads/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/

[ii] Indian Health Service. (n.d.). Two-spirit. U.S. Department of Health and Human Services. https://www.ihs.gov/lgbt/health/twospirit/

[iii] Filice, M. (2025). Two-Spirit. In The Canadian encyclopedia. https://www.thecanadianencyclopedia.ca/en/article/two-spirit

[iv] American Social History Project. (n.d.). Massachusetts Bay Colony outlaws cross-dressing (1695). SHEC: Resources for Teachers, City University of New York. https://shec.ashp.cuny.edu/items/show/3710

[v] Sears, C. (2015). Arresting dress: Cross-dressing, law, and fascination in nineteenth-century San Francisco. Duke University Press.

[vi] Fox-Suliaman, J. (2020, March 31). Angelica Ross on “passing,” Pose, and her approach to style. Who What Wear. https://www.whowhatwear.com/angelica-ross

[vii] Clarke, J. A. (2022). Sex assigned at birth. Columbia Law Review, 122(7). https://columbialawreview.org/content/sex-assigned-at-birth/