"Oh, s#!t, I think I'm not cis."

What you need to know when you got your gender wrong

Hi there, friend. I’m guessing you’re having a pretty intense time recently, huh?

Let’s talk about it.

First thing’s first: I want you to know that you’re really, really, really not alone. I’ve been there. A lot of trans people have been. The fear, the confusion, the joy that you’re feeling right now? It’s absolutely, completely, totally normal.

But uhh… I’m guessing you’re not sure what to do now. And I’m guessing that you’ve got a lot of questions and stuff you’re worried about. This is a guide to answer the most common questions that people like you ask, and give you some options about what you can do next.

And yeah, I’m gonna give you sources for everything. That’s kinda my jam around here.

Just so you know I’m not some random dummy on the internet, my name’s Zoe, and I’m an associate professor of technical writing. One of my areas is biomedical communication, which is just a fancy way of saying that I specialize in explaining complicated medical research in terms everyone can understand.

Stuff like this. So, let’s get to it.

Vocabulary

There’s a lot of terms that the trans community uses, so let’s get you comfortable with a couple of the most common ones, so that you can feel like you understand what the heck we’re talking about, okay?

• Transgender/Trans: Anyone whose gender doesn’t match what the doctor guessed when they were born.

  • This is something known as an umbrella term. That means that it’s sort of a bucket that exists to describe a whole lot of different experiences that generally fall into a single category.

  • Nonbinary people count as being transgender, but not all nonbinary people vibe with the label. That’s fine!

• Binary: Someone who’s just a guy or a gal.

• Nonbinary: Someone who’s not just a guy or a gal.

• Cisgender/Cis: Anyone whose gender matches what the doctor guessed when they were born.

• AGAB: An acronym for “the gender you were assigned at birth.” Sometimes you’ll see AMAB (assigned male at birth) or AFAB (assigned female at birth), but they’re getting less common.

• Transmasculine or Transfeminine: modern replacements for AMAB/AFAB. Generally, they mean “someone who is transitioning towards masculinity and/or away from femininity” and the inverse. They’re not perfect, but at least they don’t tie our identities to some doctor’s wrong guess a few decades ago.

• Dysphoria: Distress of some sort that your body or place in society doesn’t fit your gender.

• Euphoria: A feeling of joy and relief when your gender fits well.

• Presentation: How you dress and look. It’s the main way we tell other people what our gender is without saying anything.

• Transition: The process of changing your body or presentation to fit your gender, whatever it is. This does not need to include any surgery or hormones.

See? Not so bad. But knowing these terms will help us answer some questions you’ve probably got on your mind.

Now, let’s get to them.

How do I know what my gender is?

That’s a really good question, but it’s a tricky one to answer, because that’s something you need to figure out for yourself. Your gender is an internal sense, a lot like your sense of balance, and just like your sense of balance, only you can know whether it’s in the right spot or not.

…so how do I figure that out?

It can be a process, and a lot of us have to make some corrections down the road—someone who thought they were nonbinary turns out to be binary or vice versa. That’s normal. The best way to explore your identity and start to get a handle on it is with a good gender therapist. I can’t overstate how good an idea it is to sit down with a gender therapist—ideally one who’s trans themselves—to help you through this time. It’s stressful. You deserve the help.

But most of all, give yourself a little grace. You don’t need to have all the answers before you start taking care of yourself.

Don’t trans people need to have always know they were trans?

No. I didn’t.

Believe it or not, a whole lot of what you’ve heard about being trans—from this to the whole “born in the wrong body” thing to a lot of other stuff—was made up by cisgender doctors back in the 1960’s, because they believed it was their duty to keep as many people from transitioning as possible. It’s… kinda messed up.

In reality, there’s no one way to be trans. There are no rules, no requirements, no “you must be this trans to count.” If you want to be a gender that’s not your AGAB? You’re one of us. Period.

But don’t trans people need to feel bad to transition?

What, like from dysphoria? Goodness, no. Not all trans people feel dysphoria. Even if that was a thing that every trans person felt dysphoria, isn’t it kind of a messed up idea that a whole group of people should be ranked and rated according to how much they suffer?

We are not our suffering. We are our liquid, radiant joy.

And if you want to be a boy, a girl, both, neither, or some other gender entirely?

You can just do that. You’re allowed.

Do I have to transition?

No.

I want to be absolutely, perfectly clear here: not all trans people transition. There can be a lot of reasons for this. Some of us don’t feel any dysphoria, and decide the trouble isn’t worth it. Some people have genders that make transition impractical, like some genderfluid folks whose gender changes frequently—no matter what they’d transition to being or looking like, their body would be wrong for them sometimes. A few people are even allergic to the hormones we use as part of hormone replacement therapy (HRT)!

Being trans is a state of being. Whether or not you transition is up to you, and only you, and whether you transition or not doesn’t have any effect at all on you being trans.

Why would anyone transition, then?

Well, the most common reason is that it’s the only treatment we have for gender dysphoria that actually works.

Most trans people feel gender dysphoria, and need to do something to make it better, or go away entirely. Transition gets the job done really consistently, and really thoroughly.

Nothing else makes dysphoria go away?

No. Sorry. And science has been looking for other possibilities for over a hundred years now. We’ve tried everything from conversion therapy—that’s when someone tries to talk their way into believing they’re another gender—to actual literal lobotomies. Absolutely nothing works except for transition.

And it makes sense. Dysphoria comes from living as a gender you’re not, and if living as the wrong gender hurts you? It’s going to keep on hurting them as long as they keep living as that wrong gender. In some ways, it’s a little bit like having arthritis—you can live with the pain, or you can have a doctor do stuff, whether it’s cortisone injections or orthopedic surgery, to fix things once and for all.

Only you can know which way is right for you, and you’re allowed to change your mind.

What if I don’t feel enough dysphoria to transition?

No such thing.

You don’t need to feel dysphoria to transition. You can do it just because it makes you happy, or because it helps you live a more authentic life.

There is no “you must be this trans to count.”

What if I don’t think my family will be okay with it?

Oof. That one’s tough.

The truth is that you can’t light yourself on fire to keep someone else warm. The only way that ends is with you burnt up and them cold anyway.

Here’s the thing, though: people really surprise you. Sometimes folks have a hard time early, only to circle back later once they’ve had time to adjust to things, and other times, you get instant acceptance when you expected a bad outcome.

One of the things that surprised me was that basically nobody in my life had any problem at all when I told them I was trans and I was going to transition. Most of them…? Well, most of them weren’t exactly surprised. A couple had even guessed that I was trans a long time ago.

Believe it or not, you might be the last person in your family to figure everything out.

Why would I transition? I’ll never look like I wish I looked anyway.

So… I have news for you.

That’s dysphoria. It’s not the truth.

But maybe you don’t believe that. Fair.

This is what I looked like a month or two before I realized I was trans:

I’ve been in transition for three and a half years. This is what I look like today:

And I didn’t start my transition until I was 35. It’s not too late. You’d be amazed at what transition can accomplish. Promise.

Whoa, how’d you do that?

Seems wild, huh? The answer is hormone replacement therapy and surgery.

Yep, I got a boob job as part of that.

But the thing is, estrogen and testosterone are incredibly powerful chemicals that can reshape every single part of your body, from boobs to butts to hips to your face—it can even change your height and how big around your ribcage is! Going on HRT is like going through the puberty you didn’t go through the first time. It takes a long while for you to get the full effects, but they’re really huge.

If you were assigned female at birth, here’s what testosterone can do for you.

If you were assigned male at birth, here’s what estrogen can do for you.

…is all that safe?

As safe as any other drug, and safer than most. You’ve got to remember that no medicine is zero risk, even really common stuff like Tylenol and hydrocortisone.

The main risk from estrogen is, if you take it in pill form, you’re a little more likely to have blood clots. Those can be really dangerous, but if you’re active, or if you get your estrogen from a cream, patch, or from injections, that risk doesn’t exist. There’s also an increase in your risk of breast cancer, but it’ll still be lower than the risk cisgender women live with. If there’s a history of a lot of breast cancer in your family, it might be a good idea to get tested for the BRCA gene before starting estrogen, though!

The main risks from testosterone are an increase in someone’s risk of heart attack, but that risk is still lower than the risk cisgender men live with. The other risk is that—and I know this is going to sound weird—you’re going to develop a few prostate cells over time, and there’s a very small chance those could get cancer, but that risk is much, much lower than the risk cis guys live with.

Yeah. Hormones are really amazing.

And the thing to remember is that medical science tracks these risks in cases per thousand, over a lifetime. The risk increases we’re talking about here are really, really small. Like, a few in a thousand, for any of these, and mostly comparable to the risk cisgender men or women live with every day, respectively.

So, what do I have to do to transition?

Whatever you want to, and no more.

All a transition is means that you’re going by a different gender, a different name, and/or a different appearance. You can transition a dozen times a day if you want, just by changing clothes or pronouns—some genderfluid people do exactly that all the time!

Generally speaking, though, transition involves changing some aspect of how you’re treated by others and how you look. Most of us choose a new name, but you don’t have to. Most of us change our pronouns, whether that involves a she, a he, a they, or even some more exotic ones! Some of us go on hormone replacement therapy to reshape our bodies. And some of us get surgeries, to do what hormones can’t.

But none of it is mandatory. You don’t have to do anything you don’t want to, period.

I heard some scary things about surgeries. Are they true?

Let me guess—something about an open wound and getting infected all the time, right?

Yeah, that’s absolute bullshit. A literal lie that people made up about trans people because they don’t like us, to scare people like you.

The truth is that there are a lot of different kinds of surgeries trans people get, from breast removal to breast augmentation to facial surgeries to, yes, genital surgeries. And every single one of those surgeries was originally developed for cisgender people. Phalloplasties, for instance—how they make a penis for trans guys—were figured out after World War 1, so guys who’d lost their genitals in the war could have them back.

Make no mistake: some of these—particularly genital surgery—are big surgeries, and like any other big surgery, they come with risks, but they’re risks that are a lot like any other big surgery.

Here’s some more information about bottom surgery for people who want a penis, and for those who want a vagina. Obviously, there are a whole lot of other kinds of gender-affirming surgery, but people don’t make things up about them, so I’m guessing you’re not too worried about them.

What if I want to keep the genitals I have?

Most trans people do! Believe it or not, only three percent of trans guys get genital surgery, and only about twenty percent of trans women do the same, let alone nonbinary folks, who we don’t really have good numbers for.

If you love your stock bottom bits, keep them, love them, and enjoy them! What you have in your pants doesn’t have anything to do with your gender.

What if it’s just a fetish?

It’s not, but that’s a whole other article to explain.

What if I lose my job because I’m trans?

Generally? You can sue their pants off.

It’s illegal in most countries to fire or retaliate against someone because they’re trans. Even in the United States, where our legal protections are only a few years old, the government is really serious about that stuff.

Won’t I lose my partner, my kids, my home?

I didn’t. In fact, my wife and I just had a vow renewal in October of 2023, on our tenth wedding anniversary.

A lot more partnerships make it than you’d think, partly because a lot more people are queer than they think. Remember that part where you’re just realizing that you’re trans? That happens to people with their sexuality all the time too. It’s surprisingly common for a cis partner to realize they they’re definitely not as straight as they thought when their partner starts their transition.

And kids? Kids have an easier time with transition than anyone else. Generally, you just tell them you’re going by a new name and that’s all they need. When I came out to my nieces, they became the pronoun police, correcting their family members when they forgot early on. It was adorable.

But it’s understandable to worry about your partnership breaking up, because some folks are just plain straight, and transition results in the attraction fallingnoff. Some folks in those situations end up opening the relationship, so each of you can get the sex you need to be fulfilled while still being in love with and married to each other. Sometimes the romance ends, and the partnership becomes a best friends situation.

Even in the cases where things get ugly, you have rights as a parent, and your kid has a right to receive care from you. They literally can’t just take your kids from you.

I’ve heard a lot of things about trans people regretting their transitions…

I bet you have. People talk about trans people having regrets a lot.

But have you ever noticed that almost everyone who does talk about regrets… is cis?

Let’s cut all the myths out, then, and look at hard numbers. The 2022 US Transgender Survey is the single largest study on trans people that has ever been done. Over 97,000 trans people responded, so it’s by far the most reliable source of information we have about trans people in a whole bunch of areas. So, what did it say?

Over 97% of all respondents said they were more satisfied or equally satisfied with their lives in transition, and that’s from all sources, including stuff that's got nothing to do with being trans, like having a heart attack. And for the people who went on to start HRT? Less than 1% said that they were anything less than satisfied.

And that meshes up with a bunch of other research too. All-causes regret for trans surgeries ranges from about 1% to 0.3%, depending on the study—which is incredibly low, because all surgeries come with regrets. Regrets for lifesaving emergency surgery, for example, are a little over 14%, as much as 48 times higher than regret for gender-affirming surgery.

It’s hard to say right now how many people who transition later detransition, but most studies find somewhere in the single digit percentages, with a lot of range. Historically, though, the overwhelming majority of those who do detransition later retransition, and only ever detransitioned for safety or employment reasons. The thing is, trans people have recently gotten a lot more legal protections at work, and that’s going to change those numbers a lot.

What if I know I want to start HRT right away?

Then you can.

If you’re in the US, there are a lot of clinics called Informed Consent clinics, and if you go there, ask for HRT, they’ll just do some tests, make sure you know the things it’ll do to your body, and write the prescription. No muss, no fuss. This map can help you find a clinic near you who’ll help you get going!

If you’re not in the US, things can be a bit more patchwork. If you’re in the EU or Great Britain, for instance, GenderGP can work with your existing GP to get you started, and bypass long lines for gender clinics.

I’m not an expert at the rest of the world, though. Sorry; I wouldn’t want to point someone in a bad direction.

What should I do right now?

For someone like you, who’s early on, probably still figuring stuff out, and who I’d guess is scared as hell? I’d suggest three things:

1. Find a gender therapist—ideally, someone who’s trans themselves. A good gender therapist can help you find answers that you don’t have right now, and even if you somehow have all your answers, it’s really stressful to be where you are. They can help you feel safe.

2. Reach out to the LGBT center in the city nearest to you. Pretty much all of them have gender support groups, and talking about all this to other trans people—people who've been where you are now, who understand—can help more than you’ll ever know. And don’t worry—you’re trans enough to belong. Promise.

3. Rest. Take a sick day or two. Or three. You’re in the middle of a huge personal crisis. You’ve got some feelings to feel, and you deserve to feel them, to work through them, in a safe and private place.

It’s going to be all right. I promise. And someday, you’re going to look back on right now and thank yourself for every single kindness you show yourself.

Be gentle with yourself.

And you deserve to be happy.