These pages are about the special health concerns of transsexual people, those who want to change their bodies to be like the other sex. The process of changing the body, through hormones, surgeries, and other means, is commonly referred to as "transitioning."

Transgendered people are a diverse group, including people who feel a strong identification with the other gender; people who cross-dress occasionally or regularly; and people who actually change their bodies to look and feel more like the other sex.

People whose genes, genitals, or reproductive organs aren't clearly male or female are intersexual. To learn more about intersexuality, visit the Intersex Society of North America website.

	What does transsexual mean?
	Why do transsexual people have special health concerns?
	Emotional issues for transgendered and transsexual people
	Frequency of mental health problems in transgendered people
	Medical issues for transsexual people
	Gender identity and youth

Transsexuals are persons who identify so strongly with the other sex or gender (biologic females who identify as men and vice versa) that they change their bodies, through hormones and sometimes surgery, to look and feel more like the other sex. Following transition, transsexual people often function quite normally in society in their sex of reassignment, and often those around them do not know that they were born the other sex. They may be straight, lesbian, gay, or bisexual -- gender identity is neither the same as, nor is it necessarily related to, sexual orientation.

Biologic females who transition to live as men are also called transgendered (transsexual) men or FTM (female to male). Biologic males who live as women are called transgendered (or transsexual) women or MTF (male to female).

Transsexual people face a unique set of emotional health issues. Living in a body that feels foreign, and being perceived widely as a gender that feels wrong and unnatural is enormously challenging. In addition, the process of transitioning to the other sex brings up a myriad of specific challenges, some anticipated and others harder to predict.

Transsexual people typically take cross-sex hormones throughout their lives and they may also undergo surgeries to change their bodies. Both the hormones and the surgeries can have specific health effects that need to be acknowledged and monitored to maintain the good health of a transsexual person.

Persons who are contemplating the process of transitioning from male-to-female (MTF) or female-to-male (FTM) may encounter a range of emotional reactions both in themselves and among those around them. Some of these reactions may be anticipated and prepared for; others may be unanticipated and difficult to manage.

From a very early age, our culture makes a large and specific set of assumptions about individuals based on perceptions of gender. Sex role socialization is a powerful force that our culture uses to define "appropriate" and "inappropriate" boundaries and activities for each gender. Transgender individuals often experience anxiety and stress as they attempt to fit into a gender role that may match the outward appearance of their physical body but not their emotions or their more internal sense of their gender.

Relief

The decision to transition is often the result of a long and difficult process. Many transgendered individuals identify a sense of great relief that comes with finally being able to acknowledge their true selves and live in the body and gender role that is most natural for them. Transgendered people often feel enormous satisfaction at watching their bodies change with hormone treatments and surgeries, and at being seen by others as they feel themselves to be inside.

Although societal acceptance of transsexual and transgendered people is far from complete, there is a growing and active community of transgendered people, both MTF and FTM, particularly in the coastal areas of the United States. There are also increasing numbers of books and online information and support for people transgendered people.

Difficulties

The transitioning process can also bring with it a new set of difficulties (and sometimes dangers) that result from the reactions of acquaintances, loved ones and the larger society to the transitioning process.

New problems that may arise include:

• Employers and colleagues who are not prepared for, understanding of or sympathetic to the issues of transgendered individuals. Many individuals find themselves either fired from their jobs or facing workplace hostilities that force them out of employment. The risk that individuals will experience acts of hostility and even violence directed against them is real.
  
  
• Family members and friends who are not able to understand or accommodate the change process. Many transgendered persons begin the transition process long after they have married and raised their own families. Spouses, domestic partners, parents, children and close friends may be confused by the transition that is occurring and will need education and support to help them deal with what is happening. Some relationships end; others are able to survive the transtioning process. Sometimes children remain emotionally close to the transitioning parent; at other times children have taken years to reconcile with the transitioned parent, if they ever come to terms with the issue at all.

Most importantly, the person who is in the midst of transition her or himself may be surprised at the feelings that emerge during the process. Being able to identify and work with a counselor or therapist who has expertise in transgender issues is critically important as the individual begins to explore the realities of becoming more fully themselves. Individuals socialized and seen their whole lives as male may experience significant difficulties as they begin to live and function as female, and visa versa.

The journey across the gender divide is rarely an easy one. The combination of physical and emotional issues that can emerge can make the transitioning process a time of increased stress and risk for symptoms of depression, substance abuse, and anxiety.

Despite this reality, most transgender individuals report that the joy they experience in becoming more fully themselves makes the journey worthwhile.

While research is scant, transgendered persons appear to be at similar risk for mental health problems as other persons who experience major life changes, relationship difficulties, chronic medical conditions, or significant discrimination on the basis of minority status.

• Depression
  There is some evidence that transgendered persons may be less likely to seek treatment for depression-fearing that their gender issues will be assumed to be the cause of their symptoms, and that they will be judged negatively. Because of these and other factors, depression associated with gender transition may be underdiagnosed.
  
  
• Victimization and Post Traumatic Stress Syndrome (PTSD)
  Many transgendered persons experience some form of victimization as a direct result of their transgender identity or presentation. This victimization ranges from subtle forms of harassment and discrimination to blatant verbal, physical, and sexual assault, including beatings, rape and even homicide. The majority of assaults against transgender persons are never reported the police. A link between these experiences and mental health disorders such as Post Traumatic Stress Disorder (PTSD) is widely suspected, but has not been adequately documented.
  
  
• Suicide and self-harm
  Both suicide attempts and completed suicides are common in transgendered persons. Studies generally report a pre-transition suicide attempt rate of 20% or more, with MTFs relatively more likely to attempt suicide than FTMs. There is some evidence that transsexual people are less likely to attempt suicide once they have completed the transition to the other sex.
  
  Another form of self-harm in transgendered persons is genital mutilation. This is most common among transsexuals, although cross-dressers have done this as well. A 1984 study of a cohort of transgendered individuals who applied for services at gender identity clinics reported genital mutilation by 9% of the biologic males and breast mutilation was attempted by 2% of the biologic females.