Working it all out
What does being transgender mean?

Gender is a person’s inner sense of being male, female, or somewhere inbetween. We know that gender is programmed from birth. It is not a choice and is biologically determined like any other human trait such as eye colour. Only you know your gender, no one else can work that out for you. For transgender and gender diverse individuals, their inner sense of gender (known as gender identity) is different to their birth-assigned sex. Many trans individuals have always known since their first memories of childhood that their gender identity is different. Others know something is different, but may not realise or be able to express their gender identity until puberty or later in life after years of searching and experimentation. The gender unicorn (designed by Landyn Pan and Anna Moore from TSER) is an excellent pictorial description of gender as a spectrum and describes the differences between gender, sex and sexual orientation.

Regardless of birth-assigned sex, someone may identify towards the feminine side, towards the masculine side, or anywhere along the gender spectrum between male and female.

Common feelings expressed by transgender or gender diverse individuals are that they feel that they have been born in the wrong body; their brain is one gender and their body is another. They may not feel right in their body, feel disconnected, some wish that they were the opposite gender, some wish that they were both genders, and many have dysphoria, a severe discomfort for their body or severe discomfort when not perceived as their gender identity (i.e. when called ‘he’ instead of ‘she’). This severe discomfort can cause depression and anxiety, and puberty can be particularly a particularly distressing time. These feelings are often persistent and felt everyday. Often transgender people will feel more comfortable, more confident, or be able to be their true self when they are able to express themselves in their desired gender (see social transitioning section). There are no medical tests to tell if you are transgender, and if you are questioning your gender we want to let you know that you don’t have to work this out on your own. It is normal to have doubts and fears. Whilst the internet can be useful, we strongly recommend that you go and get professional support from a therapist who can help you work through your feelings, and give you the space and freedom to explore your gender identity. See your GP or find a health provider on the ANZPATH website. If the first therapist isn’t understanding, find another. Your feelings are valid.

What do all these terms mean?

There are many different terms under the trans or transgender umbrella. Some individuals are born male, and identify fully as female or vice versa. Some identify as partly male, and partly female, gender fluid or somewhere inbetween the two binary genders. There are many genders and if you don’t feel like you fit into any category, that is ok. Here are some common terms and definitions which fall under the trans umbrella.

We also found this excellent article published by Minus18 “I just came out as non-binary! Here’s what that means”

Just a note that transvestite/crossdresser/drag refers to people (usually men) who dress in clothes associated with the opposite sex and generally identify as straight men rather than transgender. These terms generally do not fall under the trans umbrella. As with all labels, nothing is black and white and there is plenty of gray area.

We will use the terms trans masculine to refer to individuals who wish to masculinise and trans feminine to refer to individuals who wish to feminize.

Gender transition

There are many pathways to gender transition and every trans person has their own, individual goals and path to transition if so desired.

Some trans individuals may wish to have hormones or surgery to change their physical apperance to match their gender identity, but others may not. Many will undergo social transition without any medical treatments.

We will discuss the various aspects of transitioning; social, medical and legal.

Social transitioning

For many trans people social transitioning is the most important part of transitioning. Social transitioning can mean many things for many people but generally includes wearing clothes that reflect your gender expression, telling people your prefered name and pronouns and so on.

Clothing

Clothing can help affirm your gender and make you feel more comfortable with yourself. For trans feminine people this could include wearing skirts and dresses, wearing rings and other accessories, buying more feminine shoes. Many trans feminine people also decide to grow out their hair as it is a typically more feminine trait. Tucking is also a common practice for trans feminine people. Tucking can involve compressing the genitals to create a flatter area when wearing tight clothing.

You can find out more about penis tucking here (Canadian resource):
http://transhealth.phsa.ca/social-transition-options/binding-packing-tucking/tucking

Many trans masculine people choose to wear more masculine clothing such as tee shirts, shirts as opposed to more feminine clothing. Many trans masculine people also may cut their hair shorter too. Packing and binding are also very common. Packing involves placing a prosthetic penis inside your underwear to give a more bulgy appearance and binding involves wearing a tight underlayer that compresses the chest to make a flatter appearance. Do not use ordinary tape as this can severely damage your skin. You can find out more about safe binding and where to get a binder here:
https://www.ygender.org.au/tag/binders

Everyone’s journey through transition is different and there is no one or correct way to do it!

Voice

For both trans feminine and masculine people voice training can help create a higher or lower pitch voice. For trans feminine people who have a deeper voice, voice training can help increase the pitch of the voice and to help create a more feminine sounding voice. This can be done with the help of a voice therapists who can train you to change the sound of your voice. The same can be done to help trans masculine people to deepen and masculinise their voice

Names and Pronouns

Names and pronouns are the words that we use to refer to people. Names and pronouns are used in every day speech, and in all forms of communication to reflect a person’s gender. Most trans people when they decide to transition will choose a new name and often identify with different pronouns.

Coming out to family and friends

Coming out as trans to anybody is a scary step for most people, largely because it is hard to predict how the person you are telling will respond. We assure you that things will get better over time. Many trans people describe coming out as a hugely liberating experience being able to introduce others to who you truly are. Even initial negative responses can change with time. Before you do come out, make sure you feel that you are entirely ready, that you feel prepared with all the knowledge that you need to handle questions and that you have support for yourself. You should feel confident about your decision to come out. Here are some helpful tips that may be useful.

  • Choose who you are going to come out to. It may be useful to first confide in someone you entirely trust (a close friend or close sibling) before embarking on informing others. The first person you confide in may be able to be a support for you.
  • Choose a method of coming out; a conversation, a letter, social media.
  • Choose an appropriate place; i.e. a quiet time where there is plenty of time to talk, discuss, explain and answer questions.
  • Practice what you are going to say out loud. Have a think about how you will tell them, what you want them to do, how you will respond if their response is positive, how you will respond if their response is negative (remember than initial responses may not necessarily reflect how they feel later on), how you will answer questions. What you say is completely individual for everyone and who you are telling.
  • Invite them to read our page “What is trans” which explains how to be an ally and support for someone who is trans.
  • Get as much support for yourself as possible. Whilst online forums and support groups will be of benefit, having your own individual counsellor, psychologist or doctor experienced in gender transition will help you work through this process.

This Australian facebook app and website lets you anonymously “come out” to friends and family and gauge their responses https://youreaccepted.com.au/#/about

We found this list useful to help prepare for common questions and reactions when you come out as transgender. It was created by the LGBT Youth Scotland’s Green Light Project:

Depending on who’s being asked and who’s asking, answers will vary, but the questions and guide answers below will hopefully help you to prepare for some of the common questions and reactions when someone comes out as transgender.

Q: What does that mean?
A: Your own definition of how you identify.

Q: What if you meet a nice boy/girl?
A: If they are that nice they will accept me for who I am. Who I fancy is not determined by my gender.

R: You’ll never be able to have kids.
A: There are lots of options for trans people to have kids.

R: You’ll never be a real man/woman.
A: What’s the definition of a real man/woman, who’s to say what a man/woman is?

R: I’ll always see you as a son/daughter/brother/sister.
A: Hopefully over time it will change and it would mean a lot to me if you tried.

R: But I love having a son/daughter/brother/sister.
A: I’m still the same person inside, I’ve just changed on the outside.

Q: Personal questions about body/surgery/sex life.
A: It’s your choice what you feel comfortable answering. Would you ask someone who wasn’t trans that sort of question?

Q: You don’t have a penis/breasts & a vagina how can you be a man/woman?
A: It’s how you feel inside that counts, not what’s on the outside.

R: But I would never have guessed.
A: Why would you have expected to be able to tell? I wouldn’t have expected you to.

R: So that’s why you’re so masculine/bitchy/etc…
A: I’m like that because that’s who I am not because of my gender. That’s just my personality.

Other Coming Out Resources
https://headspace.org.au/headspace-centres/wollongong/purple-pack/
https://www.ditchthelabel.org/8-tips-for-coming-out-as-trans/
https://www.wikihow.com/Come-Out-As-Transgender

Coming out to partners

Coming out to partners, often the person you love most is an important step in a relationship. Honesty is an important aspect of most relationships and by being honest and truthful to yourself and your partner can relieve a lot of stress. Your partner is likely going to have a lot of questions and it is important to be sensitive to their needs. They may be a large number of emotions experienced by your partner when you first come out including anger, fear, sadness, betrayed, hurt, confused, cheated or worried. Having a supportive professional such as a counsellor or psychologist experienced in gender transition can help you talk through relationship issues which may encompass

  • The meaning of the relationship to you and your partner.
  • Relationship expectations; do you stay or do you just want to be friends?
  • Sexuality. This is different for everyone and every relationship. There are many ways to be intimate which does not necessarily involve genitals; kissing, cuddling, masturbation, oral, vaginal or anal sex but the key is to feel comfortable with your partner and understand what each of you want.
  • Children and fertility. The ability to have biological children will be affected by hormone therapy or surgery but there are many ways to have a family.

There are support groups for partners and families:

TransFamily is a Peer Support Group for parents, siblings, extended family, partners and /or friends of a trans person. The group offers a warm and supportive environment.
Transgender and Partners Support Facebook Group: https://www.facebook.com/groups/380318889000771/about/

Coming out at school

Coming out at school can cause a lot of angst, and it’s not just if you attend a single-sex school or a religious school. It can help to start with a staff member at school who you think will be supportive. This could be a school counsellor, a trusted teacher or administration person. It is against Australian law for schools to discriminate against you because of your gender identity.

Once you have a supportive staff member(s) consider discussing an approach to

  • Names and pronoun use at school and on school documents/records
  • Use of toilets and changing rooms
  • School uniforms
  • Sports
  • School camps and events
  • Coming out to the school community

Your family, counsellor and or psychologist experienced in gender transition can also help you work through these areas. An excellent guide for the whole school to support trans students has been created by the Safe Schools Coalition Australia and is available here:
https://www.studentwellbeinghub.edu.au/resources/detail?id=d2184922-d5c5-6d32-997d-ff0000a69c30#/

Coming out in the workplace

In Australia, discrimination or harassment in the workplace is against the law. A human resources manager is a useful first contact. For employees, employers and co-workers, there is an excellent comprehensive guide titled Coming out in the workplace published by the Anti Discrimination Commission Queensland.
Download here.

This article is also worth reading: Transgender: a new frontier in workplace diversity by Michael Starkey.

Medical Transition
Hormone Therapy

For many transgender people, hormone therapy (masculinizing or feminizing), is a very important step during their transition. Hormone therapy is different for everybody so it is important to go through the right avenues to obtain and use hormone therapy.

Hormone therapy or sometimes called hormone replacement therapy, for transgender people, is the use of masculinizing or feminizing hormones to help align their secondary sexual characteristics with the person’s gender identity. Hormone therapy is different for trans masculine and trans feminine people so we will go through the differences here.

To start, for any trans person who wants to begin hormone replacement therapy, they will first need to see their GP. If your GP is not sure what to do, you can tell them to see our Health Professionals page. Your GP will then refer you to a get a mental health assessment. The mental health assessment will take three to six sessions where the psychiatrist or psychologists will get to know you and assess your overall mental health before writing a letter to your GP, sexual health physician or endocrinologist to allow you to start HRT.

For trans feminine people, oestrogen can be prescribed in many forms but tablets and patches are the most widely used in Australia. Tablets are generally taken once a day and patches are applied to the skin and changed twice a week. Along with either of these methods an anti-androgen tablet may be prescribed (commonly cyproterone acetate or spironolactone). Antiandrogens prevent the naturally produced testosterone in the body from being being absorbed. Oestrogen treatment causes the body to develop the female secondary sex characitsts such as breast development, redistribution of body fat to create a more feminine figure, softening of the face and reduction of body hair.

For trans masculine people who are wanting to start taking testosterone, options include injections or gels/creams which are applied to the skin. Injections can be given in a long-acting form (testosterone undecanoate) every 3 months, or short-acting form (testosterone enanthate) every 2 – 3 weeks. to get testosterone subsidised by the Australian Government Pharmaceutical Benefits Scheme (PBS), you will need to be seen by your GP with either an Endocrinologist or Sexual Health Physician.

Testosterone treatment causes male secondary sex characteristics to develop, this includes the lowering of the voice, growth of facial and body hair and increased muscle mass.

For non binary people HRT can be somewhat tailored to meet your own specific physical transition goals.

Fertility preservation

Hormone therapies can make trans people infertile. Feminising hormones with oestrogen can block sperm production, and if biological children are desired in the future, sperm storage is recommended before starting hormones. This can be done at some hospital andrology clinics and some specialized pathology clinics (ask your GP) and there is a cost involved (usually a few hundred dollars) for collection and then annual storage costs (a few hundred dollars).

Masculinising hormone therapy with testosterone will usually stop menstrual cycles (periods) and also stop egg release from the ovaries (ovulation). When testosterone therapy is stopped, menstrual cycles and ovulation will often return and many trans men have reported pregnancies. Egg storage can be an option but is usually costly, involves a lot of feminizing hormones (which can make a trans male feel very dysphoric) and the pregnancy success rate is not particularly high.

Surgery

For many trans people, surgery is an important step. Many do not have surgery. There are many different types of surgeries available.

For trans feminine people this can include:

  • Facial Feminisation Surgery: FFS is a combination of facial reconstructive procedures thats aim is to change the effects testosterone has had on the person’s face and to create a more typically feminine face.
  • Voice surgery: The effects testosterone has on someone’s voice permanently deepens their voice and for some voice training (more information in Social Transitioning) isn’t enough to help feminise the voice so voice surgery can help raise the pitch of your voice and create a more feminine sounding voice.
  • Bottom surgery/gender confirmation surgery: bottom surgery for trans women is when a surgeon surgically constructs a vagina from the existing genitals the person was born with at birth.

For trans masculine people this can include:

  • Chest reconstructive surgery: chest reconstructive surgery or top surgery removes breast tissue to create a more flat, masculine chest. There are many methods to do this but some of the popular methods include keyhole surgery and the inverted “T” method.
  • Reproductive surgery: Reproductive surgery involves removing the reproductive system including the uterus and fallopian tube with either a hysterectomy and or bilateral oophorectomy.
  • Bottom surgery/gender confirmation surgery: For trans men there are multiple options for having bottom surgery. The most common types include metoidioplasty and phalloplasty and are usually done over multiple stages.

Do you have a surgeon that you would recommend? Email us at [email protected]

Legal transitioning

Legal transitioning are steps many trans people wish to take to affirm the name and or gender with the government. This can include legally changing your name and your gender.

Name Change

In all states and territories of Australia anyone can freely change their name. This is done through your state’s Births, Deaths and Marriages registry. To change your name you will have to visit your state’s Births, Deaths and Marriages registry website and navigate to the change of name section. Once there you will be able to find the required documents needed to be filled out and either handed in in person at the nearests registry office or online if your state allows it. After filling out the forms and paying the fee you will have a new, updated birth certificate sent out to you with your new chosen name.

Once you have legally changed your name you are required to update your name on your other identity documents such as your license, passport, medicare card, bank accounts, insurance and so on. Most organisations will require you going into an office and presenting your new birth certificate as proof of your name change.

Gender Change

In all states and territories, excluding Western Australia and Australian Capital Territory, the only way to legally change your gender listed on your birth certificate is by having sexual reassignment surgery (as covered in medical transitioning). This is unfortunate as many people can not afford or simply do not want to get srs as part of their transition. As stated above in WA and ACT you DO NOT need to have undergone SRS in order to legally change your gender on your birth certificate. In these states all that is needed is a letter from a medical practitioner or psychologist.

A bill was recently put forward in Victorian parliament that would allow trans people in Victoria to be allowed to change their gender without undergoing SRS but unfortunately got rejected.
Through medicare however you are able to change your gender with just a letter from a GP. By doing this you may be eligible to get some medications at a lower price.

More excellent Australian trans resources

Ygender – a peer led social support and advocacy group for young trans individuals

Minus18 – Australia’s largest youth driven network for LGBTIQ youth

Transcend – Transcend provides parent/carer support, community connection, information, advocacy & fundraising

Transgender Victoria – TGV is an Australian organisation dedicated to achieving justice, equity and quality health and community service provision for trans and gender diverse people, their partners, families and friends.

Transfamily – A group offers a warm and supportive environment for the parents, siblings, friends and family of transgender people.

FTM Australia – a peer based Australia-wide network offering contact, social support and information for men identified ‘female’ at birth who medically transition to male in Australia.

Gender Help for Parents Australia – created by Australian parents who have struggled to find information about services and support for issues around their children’s gender identity.

If you have suggestions, feedback or comments regarding the content here, please email us at [email protected]