It is important to know whether and when it is necessary to know a person's identity (how someone thinks of themselves or what is inside), and when it is key to know their behavior (how a person acts or the choices they make). The difference between identity and behavior will become clearer in this section, which explains the many choices that transgender people may make. Although the word "choice" is sometimes controversial within transgender circles, every individual (transgender and non-transgender) makes daily and long-term choices about how they will present themselves to the world and how they will live their lives.
One choice that transgender people make is whether they will transition. "Transition" occurs when a person goes from predominantly being seen or identifying as one gender to predominantly being seen or identifying as another gender (e.g., male to female, female to male, female to gender non-conforming). Transition can involve one or more of the following aspects:
Many transgender people never transition, either because they desire no physical changes, are content to have the world see them in a way that differs from how they identify internally, or they cannot transition due to work, family, health, or financial reasons.8 Some transgender people simply ease into a more neutral or gender non-conforming presentation without undergoing a transition that will be noticed by others.
Some transgender individuals strongly state that transition is not a choicethat they must transition or they will die. Although this is true for some (e.g., they exhibit suicidal thoughts or behaviors), transition is a process of making choices. Some choices may be more feasible than others due to finances or living situations. Some choices may directly affect others and thus require more joint decisionmaking, negotiation, and compromise.
For those who do transition, the process is usually public. Transgender individuals, and possibly their loved ones, may be subject to a tremendous amount of curiosity, questions, judgment, and, in some cases, hostility.
Transgender people may transition at any point in their lives. Transitioning in mid- to later lifeoften when children move out, the person retires, parents die, or there is a health scareis common.9 In some cases (e.g., those involving hormone use), transition mirrors certain aspects of puberty, such as body changes and mood swings. People who are transitioning may experiment with different clothing styles and roles, some of which may strike loved ones and other observers as age inappropriate or even offensive. They may start negotiating changes in all aspects of their lives, including family, work, and social relationships. For all these reasons, others may view them as being self-centered, which can create challenges for any relationship.
Once someone has taken all of the steps they want to take, they may no longer see themselves as transgender, instead identifying simply as female or male. They may never disclose their gender history to others, including health care providers, new spouses, or children, because they do not view it as relevant.
The rest of this section covers many of the social, medical, and legal choices that transgender people make in more detail: