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In everyday language “sex” and “gender” are used interchangeably; however, in the context of transgender people, the meanings differ. Gender expression describes the outward manner in which an individual expresses or displays gender, including choices in clothing and hairstyle, speech, and mannerisms. Gender identity and gender expression may differ; for example, a woman (transgender or non-transgender) may have an androgynous appearance, or a man (transgender or non-transgender) may have a feminine form of self-expression. Transgender people may not feel comfortable, or be unable to, outwardly express their internal felt sense of gender due to societal, work, or family pressures. Transgender people who have a well documented and persistent gender identity that differs from their sex assigned at birth and are experiencing distress as a result of this mismatch, meet the diagnostic criteria for gender dysphoria as described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

For the purposes of this text, “transgender” is inclusive of those who identify with the terms gender non-binary, nonconforming, genderqueer, and transsexual. Transmasculine will refer to those who have a male or masculine-spectrum gender identity but were assigned female at birth, and transfeminine will refer to those who have a female or feminine spectrum gender identity but were assigned male at birth. A non-transgender person may be referred to as cisgender (Latin root cis = near/next to), which refers to people whose gender identity and birth sex are the same, ie, non-transgender. Non-binary, gender nonconforming, or genderqueer describes a person whose gender identity differs from that assigned at birth but may be more complex, fluid, multifaceted, or otherwise less clearly defined than purely male or female. Non-binary people may use neutral pronouns such as “they,” “them,” or “their.” The term transsexual is an older term that has fallen out of favor and referred specifically to a transgender person who seeks medical interventions. Other related terms include cross dresser, which describes someone who may wear clothing of the opposite gender without a clear identification with that gender, and drag, which describes cross dressing for performance purposes.

Sexual orientation, which describes sexual attraction and behaviors, is not directly related to gender identity. The sexual orientation of transgender people should be described based on the lived gender; a transfeminine person attracted to other women would be a lesbian, and a transmasculine person attracted to other men would be a gay man.

Transgender people may seek any one of a number of gender affirming medical, surgical, or related interventions. Based on research demonstrating positive effects on multiple psychosocial measures, such interventions are recognized as medically necessary by the World Professional Association for Transgender Health (WPATH), an international, multidisciplinary professional organization that publishes widely recognized standards of care. Not all transgender people seek all interventions, and some may seek none; the current standard of care is to allow each transgender person to seek only those interventions ...

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