Social Transition without Medicalization

When discussing gender transition, the collective imagination immediately goes to medical interventions: hormones, surgery, physical changes. But the reality is different. For many transgender people, transition begins—and sometimes ends—in a completely different sphere: the social one. Changing one’s name, pronouns, and clothing. Presenting oneself to the world in the gender one identifies with. No medications, no scalpels. Just the choice to live consistently with who you are.

This article explains what social transition is, what it entails, who does it, why it is a valid and complete path in itself, and how it works in practice in Italy.

What is social transition

Social transition is the set of non-medical changes through which a transgender person begins to live in the gender they identify with. The WPATH Standards of Care, Version 8 (2022) describe it as a process that may include changes in name, pronouns, outward appearance, clothing, and how one presents oneself in relationships and social contexts [1].

There is no rigid definition of what a social transition must include. For some people, it means changing everything: name, pronouns, wardrobe, presentation. For others, it involves more subtle adjustments, perhaps limited to specific contexts. Social transition does not have a formal beginning, a form to fill out, or authorization to obtain. It is made up of daily choices, and these choices can evolve over time.

A fundamental aspect: social transition is completely reversible. It involves no medical interventions, does not alter the body, and requires no prescriptions. Any change can be modified or reversed at any time. This makes it particularly important as a first step for those exploring their identità di genere, and as the only recommended form of transition for prepubescent children [7].

What social transition entails

Name

The name is often the first element of social transition. Choosing a name that aligns with one’s gender identity and asking people around to use it is an act of affirmation that research has linked to measurable mental health benefits.

A 2018 study by Russell and colleagues, published in the Journal of Adolescent Health, examined 129 transgender youth and found that chosen name use was associated with a significant reduction in depressive symptoms, suicidal ideation, and suicidal behaviors [4]. The most relevant finding: for each additional context in which the chosen name was used—home, school, work, friendships—there was a statistically significant decrease in distress. Youth who could use their chosen name in all four contexts showed the lowest levels of depression and suicidality [4].

This is not a marginal detail. It suggests that something seemingly simple like calling a person by the right name has a concrete and measurable impact on their well-being.

Pronouns

Asking for and obtaining the use of correct pronouns is another central element of social transition. For a trans woman, being called “she”; for a trans man, “he”; for a non-binary person, the pronoun they prefer. The guidelines of the American Psychological Association (2015) explicitly recommend that mental health professionals respect the pronouns indicated by the person, recognizing that using the correct pronouns is a fundamental component of identity affirmation [6].

In the Italian language, gender pronouns are less frequent in everyday speech than in English, but the endings of adjectives and past participles make grammatical gender pervasive in almost every sentence. Social transition in Italian, therefore, also involves a change in the linguistic structures with which others address the person: “stanco” (tired, masculine) or “stanca” (tired, feminine), “andato” (gone, masculine) or “andata” (gone, feminine). It might seem like a detail, but for those experiencing it, it is not at all.

Appearance and clothing

Gender expression through clothing, hairstyle, accessories, and body grooming is an aspect of social transition that can be as visible as it is personal. There is no “correct” way to dress to be a man or a woman, and social transition does not require adhering to gender stereotypes. A trans woman does not necessarily have to wear skirts; a trans man does not necessarily have to cut his hair short. Social transition is about authenticity, not conformity.

That being said, for many people, changing their outward appearance is a significant part of the process: it is how the outside world begins to perceive them in the correct gender, and this social recognition has important psychological value.

Documents and alias identity

In Italy, modifying official documents (ID card, tax code, diploma) requires demographic rectification through a judicial procedure provided by Legge 164/1982. But before that formal step—which can take months or years—there is an increasingly widespread tool: the alias career (carriera alias) or alias identity.

The alias career is an agreement that allows a transgender person to use their chosen name on the internal documents of an institution—school, university, company—even before legal demographic rectification. According to available data, over 450 Italian schools have adopted an alias career protocol, and most public universities have regulations regarding it [12]. The association GenderLens has published school regulation templates that schools can adopt [12].

The alias career has no legal value outside the institution that adopts it: the diploma will bear the legal name, and external documents remain unchanged. But in daily life—class registers, emails, badges, internal communications—the person is recognized by their chosen name. For those living in a school or work environment, this change can make the difference between daily suffering and the ability to focus on studying or working.

Who undergoes social transition

Everyone, at the beginning

An often overlooked point: every transgender person goes through a social transition, regardless of whether they undertake a medical path. Before any hormones or surgery, there is always a moment when one starts living in their gender: telling someone their name, asking for different pronouns, changing how they present themselves. Social transition is the universal first step.

The WPATH Standards of Care Version 8 removed the requirement for a mandatory period of social transition as a prerequisite for accessing medical treatments [1]. This change recognizes two things: first, that not all transgender people desire or can live openly in their perceived gender in all contexts of their lives before accessing care; second, that social and medical transitions are not sequential phases of a single mandatory path, but different dimensions that each person combines according to their needs [1].

Those who stop here

For some transgender people, social transition is all they need. They don’t desire hormones, they don’t want surgery. Their transition is strictly social: they live in the gender they identify with, have changed their name and pronouns, and this is enough to feel comfortable.

This path is perfectly valid. There is no hierarchy of transitions where the medical one is “more real” or “more complete” than the social one. APA guidelines emphasize that transgender people’s experiences are diverse and that the role of professionals is to support the person in the path that feels right for them, not to steer them toward a predefined model [6]. No one is “more trans” or “less trans” based on the type of transition they choose.

The 2022 Pew Research Center survey on transgender and non-binary adults in the United States documented a wide variety of experiences: some people describe entirely social transitions, others combine social and medical elements, and still others are in different stages of the journey [10]. The diversity of trans experiences is the norm, not the exception.

Children and social transition

The only recommended transition before puberty

For prepubescent children, social transition is the only form of transition recommended by international guidelines. The 2017 Endocrine Society guidelines explicitly recommend against undertaking medical treatments (puberty blockers or hormones) before the onset of puberty, limiting intervention to the social sphere: using the preferred name and pronouns, allowing free gender expression, and ensuring adequate psychological support [7].

Research on these children tells a precise story. A 2016 study by Olson and colleagues, published in Pediatrics, examined 73 transgender children (ages 3 to 12) who had socially transitioned with family support [2]. The results showed that depression levels were comparable to those of cisgender peers, with only a slight increase in anxiety [2]. This finding is particularly significant when compared to previous studies on children with gender dysphoria who had not socially transitioned, which showed much higher rates of psychological distress.

The TransYouth Project, the largest longitudinal study ever conducted on transgender youth, followed over 300 children for five years after social transition. The results, published in Pediatrics in 2022, show that 94% continued to identify as transgender after five years [3]. 3.5% identified as non-binary. Only 2.5% had returned to identifying with their sex assigned at birth [3]. These data debunk the idea that social transition in children is a “phase” destined to pass in most cases.

The issue of reversibility

One of the most used arguments against social transition in children is the fear that it’s “too early”. But this argument confuses social transition with medical transition. Social transition consists of using a different name, different pronouns, and allowing the child to dress as they prefer. If the child’s gender identity should change over time—which research shows happens in a very small percentage of cases [3]—the social transition can be modified without physical consequences.

Diane Ehrensaft, among the leading experts on childhood gender development, wrote in 2018 in the International Journal of Transgenderism that prepubertal social transition, when it occurs with the support of family and professionals, is a facilitator of the child’s gender health: it allows them to live in the gender that feels authentic, reducing distress and promoting healthy psychological development [9].

Adults and social transition

A gradual process

Adult social transition is often a gradual process, not a single event. It can begin in private and safe contexts—with trusted friends, with a partner, online—and then progressively extend to other areas of life: extended family, work, public settings.

There is no “right” timeline. Some people coming out and socially transition quickly and completely; others proceed in stages over months or years; still others choose a selective transition, living in their perceived gender in some contexts but not all. The WPATH SOC 8 explicitly recognize this diversity, stating that not all transgender people desire or can live openly in their perceived gender in all contexts of their lives [1].

Social transition at work

The workplace is one of the most complex contexts for social transition. Changing name and pronouns with colleagues, modifying the company email, dealing with reactions—all this happens in an environment where the person must also maintain their professionalism and, often, their economic security.

In Italy, as we have seen, the alias career tool is also spreading in companies and public administration. In 2024, the Ministry of Justice issued a circular for the activation of alias identities for employees of the Judicial Administration. Some large private companies have adopted similar policies. But the daily reality for many trans people remains difficult: the lack of explicit national legislation on gender identity as an independent protected category from workplace discrimination leaves a void that jurisprudence only partially fills.

Social transition at school

For transgender students, school is the daily context where social transition perhaps has the greatest impact. Being called by the wrong name in front of the class, every day, for years, is an experience that research associates with significant psychological distress [4].

A 2021 study by Turban and colleagues, published in the Journal of Adolescent Health, analyzed data from over 27,000 transgender adults in the US, examining the relationship between the timing of social transition and adult mental health outcomes [5]. The results show that social transition during childhood was not associated with negative outcomes compared to transitioning in adulthood. When social transition occurred during adolescence, associations with higher suicidality initially seemed to emerge, but these disappeared once controlling for the factor of harassment experienced at school [5]. In other words: the problem is not social transition itself, but the hostile environment in which it occurs.

The alias career in Italian schools is a concrete tool to reduce this distress [12]. As already described, over 450 schools in Italy have adopted a protocol. If your school doesn’t have one, associations like AGEDO and GenderLens can provide support and templates to propose [12].

Social transition is a valid and complete path

This is the central point of this article, and it is worth stating clearly: social transition is not an intermediate step waiting for the “real” one. For those who choose it as their only path, it is complete in itself.

The dominant narrative on gender transition tends to present it as a linear sequence: first awareness, then psychological therapy, then hormones, then surgery. But this sequence does not match the reality of most transgender people. Many do not desire medical interventions; others desire them only partially; still others change their minds over time. Transition is a personal journey, not a standardized protocol.

A 2023 review published in Archives of Sexual Behavior examined the relationship between social gender transition and mental health in children and adolescents with gender dysphoria [8]. The results suggest that social transition, in itself, is associated with benefits for psychological well-being, regardless of access to medical interventions [8]. This finding is consistent with the growing body of evidence showing how social recognition of gender identity is a protective factor for the mental health of trans people.

The relationship with medical transition

Social transition and medica transition are not mutually exclusive alternatives. They are complementary dimensions that each person combines in the way that feels most right for them.

For those who choose both, social transition often precedes the medical one—simply because changing name and pronouns is faster and more accessible than starting hormone therapy. But the WPATH SOC 8 clarified that there is no obligation to socially transition before accessing medical treatments [1]: a person who cannot or does not want to undergo a complete social transition still has the right to care.

Similarly, a person who has completed a social transition is not “obligated” to proceed with a medical one. The journey stops where the person feels they have arrived. International guidelines agree on this point: the self-determination of the transgender person is the guiding principle [1][6].

How to start: practical aspects

If you are considering a social transition, here are some practical aspects based on experiences shared by the trans community and clinical guideline recommendations.

Start where you feel safe

You don’t have to change everything in one day. You can start by trying your name with a trusted person, or in an online space. You can experiment with clothing in private, or in contexts where you feel protected. Proceeding gradually is not a weakness: it is a strategy.

Build a support network

Having at least one person who knows you, respects you, and uses your name and pronouns is a protective factor documented by research [4]. This person can be a friend, a family member, a mental health professional, or a member of the trans community. You don’t have to face everything alone.

Know your rights

In Italy, your gender identity is sensitive data protected by the GDPR. No one can reveal your status as a transgender person without your consent. Privacy is your right, not a concession. If you experience non-consensual outing or discrimination, you have legal tools at your disposal.

Consider professional support

Talking to a professional expert in gender identity is not a prerequisite for social transition, but it can be a valuable resource. A good professional will not tell you what to do: they will help you explore what you feel and manage the practical and emotional challenges of the journey. The InfoTrans.it portal of the Higher Institute of Health contains a map of services dedicated to transgender people in Italy, region by region [11].

Don’t compare yourself to a single model

Your social transition does not have to look like anyone else’s. There is no right way to be transgender, there is no minimum level of change to “qualify”. If you have only changed your name with three friends, that is a social transition. If you have modified every aspect of your public life, that is too. Both are valid.

Resources in Italy

• InfoTrans (infotrans.it): institutional portal of the Higher Institute of Health and UNAR with an interactive map of all services for transgender people in Italy [11].
• GenderLens (genderlens.org): resources for families, regulation templates for the alias career in schools [12].
• AGEDO (agedonazionale.org): association of parents and family members of LGBT+ people, with support groups throughout Italy.
• Gay Help Line: 800 713 713 (free and anonymous). Dedicated section for trans issues.
• Transgender support desks (Sportelli transgender): present in various cities (MIT Bologna, SAT Milan, Consultorio Transgenere in Torre del Lago, and others).

One takeaway

Social transition is not “plan B” for those who cannot access a medical one. It is not a half transition, an incomplete transition, or a transition in waiting. It is a journey that millions of transgender people worldwide experience every day, and it is the way gender identity becomes visible and recognized in the fabric of daily relationships.

If you are experiencing a social transition, or are thinking of starting one, know that research is on your side: living in the gender you identify with, with the support of the people around you, is associated with concrete and measurable benefits for mental health and well-being [2][4][8]. You don’t have to justify your journey to anyone. You don’t have to conform to a model. You just have to find the way that works for you.