Transition is a complex process that occurs over a long period of time, and the steps involved in transition will vary from person to person.

One of the most common misunderstandings about transgender individuals is that they are all the same. How they transition, the degree to which they transition, the timing and pace, and how they express their identity all vary tremendously. This article is not a list of all the options, but it can be helpful to understand transitioning as rough categories rather than one event or path.

“Coming In” or the personal transition

Most human cultures are heavily gendered. There are strong patterns and expectations of boys/girls and women/men. Transgender individuals live in this environment and know very well what patterns may be expected of them based on their birth gender.

The personal transition is a process that begins when individuals experience dissonance between the patterns surrounding them, how others view and react to them, and how they feel about themselves. This can occur at any time, from early childhood to puberty to adulthood.

Playing with trucks or dolls in early childhood is not an indicator. Most children experiment at young ages with a variety of toys or mimicking adults or characters on TV or in movies. What is more important is the duration and constancy of the role the person chooses. For parents trying to understand their child, it’s helpful to know how to evaluate the child’s view. A key is time, and that the person is:

  • Persistent – maintaining their identity over time
  • Insistent – pushing back against efforts to change their view and adamant about their identity
  • Consistent – the person is constant in their description or claiming of their identity

For adolescents this personal transition can take many forms. Sometimes it occurs around puberty but not always. It’s a time of reflecting on how they see themselves compared to how they are perceived in the world around them. When they become firm in their self-image and want to portray that in their daily life they may share with a friend or trusted family member that they are transgender. Peers or online acquaintances may know before family members. How and when transgender youth talk with family can vary from email or text to letters to voicemails to one-on-one conversations and more.

Social transition

Social transitioning refers to when the transgender person begins living their identity around others. Telling family, friends and co-workers is often a start. Individuals may begin using a different name, one they chose for themselves that is meaningful to them. Pronouns may change and they ask for others to use the chosen pronouns. They may begin to dress differently, groom differently, add/stop/change their jewelry, makeup, and hairstyles.

Social transitions can look very different depending on the person. Just as there are many ways we see gender expressed every day, there is considerable variety in the ways people come into transgender identities. Some may make efforts to align in dress, behavior and actions to express  the gender with which they identify. This may be a gradual process, or it may move quickly. Some individuals may choose a mash-up of styles for their gender expression or make few visible changes, and it may differ over time. The latter approach is common among non-binary individuals – someone whose gender identity can’t be described as exclusively woman or man. (Note: some non-binary individuals do not consider themselves transgender, just non-binary.)

There are many variations of how transgender individuals claim their identity, but the social transition focuses on how they present themselves in the world. Some transgender individuals live in this stage. Others transition in other areas as well.

Legal transition

Legal transitioning involves changing official identification of all types to align with their gender identity.  Examples are changing a name and/or sex marker on documents like a driver’s license, passport, Social Security record, bank accounts, etc. It can extend to birth certificates, medical records, medical insurance or any record that typically records gender.

Changing a name on legal documents is not uncommon, but changing sex markers can be complicated and varies from state to state. There are resources to help. The National Center for Transgender Equality offers self-help guides and information that can be searched by state/territory or Federal ID type.

Interestingly, as public acceptance and understanding grow, it is increasingly common to see medical portals or other online registrations offer a gender option of “other.”

Medical transition

There has traditionally been a misperception that most or all transgender people desire or obtain a medical transition, which can include hormone treatment, surgery, or other actions aimed at changing the body. In fact, not all transgender people want to pursue medical transition and again, there are varying degrees. Even hormone therapy takes many forms.

Puberty blockers can be used to delay the onset of secondary sex charateristics and/or physical changes that occur during puberty, such as breast development or the enlarging of an Adam’s apple. This offers an adolescent more time to learn who they are before changes occur that are  harder to reverse than to delay. Once puberty blockers are stopped, puberty resumes.

Hormone therapy (HT), such as supplying estrogen, testosterone, etc., is used to alter a person’s hormone levels to match their gender identity. Changes that result from hormone therapy are not as reversible, and often are not provided until an individual is older. The Mayo Clinic has overviews of feminizing hormone therapy and masculinizing hormone therapy for more information.

Various kinds of surgery are possible as well, though surgical procedures may be less commonly used due to costs and availability. Top surgery (to reduce or enlarge breasts), voice surgery, and genital surgery are all options transgender people pursue depending on how important these issues are to them.


There is tremendous misunderstanding (and often misinformation) about what transition means. Assumptions and beliefs are often influenced by political rhetoric and legal concerns. It is important to be well-informed, because the type and degree of transition your child pursues can vary enormously. This is a long and gradual process that may transpire over years. Let your child make their wishes known and options can be chosen in consultation with your child, your family, and your physicians and counselors.