What does it mean to be trans?

Being trans — or transgender — means having a gender identity that does not correspond to the sex assigned at birth. A person who was assigned male at birth but who identifies as a woman is a trans woman. A person who was assigned female at birth but who identifies as a man is a trans man. It is not a choice, not a phase, not a trend: it is a fundamental component of a person’s identity [1][4].

Gender identity and assigned sex

To understand what it means to be trans, it is necessary to distinguish two concepts that are often confused: sex assigned at birth and gender identity.

Sex assigned at birth is the medical classification based on anatomical characteristics visible at the time of birth — typically “male” or “female.” This classification is based primarily on the observation of genitals, but biological sex is actually a complex combination of chromosomes, hormones, gonads, and anatomical features that do not always align neatly [7].

Gender identity is the inner and deep sense of being a man, a woman, both, neither, or something else [1]. This awareness is not determined by physical appearance, the upbringing one receives, or the culture in which one grows up. Scientific research indicates that gender identity has neurological and biological foundations, and is established in the early years of life [3][6].

For most people, gender identity and sex assigned at birth coincide: these people are defined as cisgender. For trans people, however, there is a discrepancy between the two.

It is not a mental illness

Until 2019, the International Classification of Diseases (ICD) by the World Health Organization included transgender identity among mental disorders. With the ICD-11, this classification was removed [2]. Gender incongruence — the medical term describing the discrepancy between gender identity and assigned sex — was moved to a chapter dedicated to sexual health, recognizing that it is not a pathology but a condition that may require healthcare.

The American Psychological Association, the Endocrine Society, and all major international medical organizations agree: being trans is not a mental disorder [1][3][4]. What can cause significant distress is gender dysphoria — the discomfort, sometimes intense, caused by the discrepancy between one’s body and one’s identity. But dysphoria is not inevitable, and when present, it can be alleviated through gender-affirming pathways [4].

What being trans does not mean

Numerous misconceptions exist around trans identity that are important to clarify.

It is not a matter of sexual orientation. Gender identity (who you are) and sexual orientation (who you are attracted to) are distinct dimensions. Trans people can be heterosexual, homosexual, bisexual, asexual, or have any other orientation, exactly like cisgender people [1].

It is not cross-dressing. Cross-dressing concerns clothing and does not necessarily imply a gender identity different from the assigned sex. Trans people do not “dress up”: they live in the gender that corresponds to their identity [1].

It is not a phase. Longitudinal research shows that people with a consolidated gender identity in adulthood rarely change their mind. Detransition rates are between 1% and 5%, and in most cases are motivated by external pressures (discrimination, lack of support) rather than an actual change in gender identity [4].

It is not contagious. The hypothesis of so-called “transgender social contagion” has found no support in scientific research. The increase in the visibility of trans people is linked to greater awareness and more open social contexts, not to imitation phenomena [6].

Gender dysphoria

Gender dysphoria is the clinical term describing the distress that some trans people experience due to the discrepancy between their gender identity and the physical characteristics or social role associated with the sex assigned at birth [1][4].

Dysphoria can manifest in different ways: discomfort with one’s body, anguish at being perceived as the wrong gender, difficulty recognizing oneself in the mirror, distress related to the name or pronouns used by others. The intensity varies enormously from person to person and can fluctuate over time.

It is important to emphasize that not all trans people experience gender dysphoria, and its presence or absence does not make a person “more or less trans” [4]. Some trans people describe their experience more in terms of gender euphoria — the joy and relief felt when they are recognized in the correct gender.

Transition

Transition is the process through which a trans person aligns their external life with their gender identity. There is no single path of transition: each person chooses the aspects best suited to their situation [4].

Social transition includes changes such as adopting a new name, using different pronouns, and changing clothing and presentation. It does not require medical interventions and can be the first step or the only step in a trans person’s journey.

Medical transition can include hormone therapy (testosterone for trans men, estrogen for trans women) and various gender-affirming surgical procedures [3]. Not all trans people choose medical transition, and among those who do, not everyone follows the same path. Some people take hormones without undergoing surgery; others choose only certain procedures.

Legal transition concerns changing identity documents (name and gender marker). In Italy, this process is regulated by Law 164 of 1982, which provides for the possibility of obtaining legal gender recognition through a court ruling [5]. In many other countries, legal recognition processes vary significantly — some allow self-determination, while others require medical or psychiatric evaluations.

Trans people in society

According to the most recent estimates, transgender people represent between 0.3% and 0.6% of the adult population in Western countries, with higher percentages among younger generations [7]. These numbers are likely underestimates, as they do not account for people who have not yet come out or who choose not to pursue formal transition.

Trans people face significantly higher rates of discrimination, violence, unemployment, and mental health problems compared to the general population [8]. These problems are not caused by being trans itself, but by social stigmatization, institutional discrimination, and the lack of family and community support [1][6].

Research consistently demonstrates that social acceptance, family support, and access to appropriate medical care drastically reduce the psychological distress of trans people, bringing their well-being indicators to levels comparable to those of the general population [6].

Language

Language is an important tool in respecting the identity of trans people. Some key guidelines:

• Use the name and pronouns chosen by the person, regardless of the stage of transition. Calling a trans woman by her previous male name (deadnaming) or using the wrong pronouns (misgendering) is a form of disrespect that can cause significant distress.
• Say “trans person”, not “a trans.” The adjective “trans” describes one aspect of identity; it does not define the person in their entirety.
• Avoid the term “transsexual” unless the person themselves uses it to describe themselves. The term “transgender” or simply “trans” is preferred today by the community and scientific organizations [1].
• Do not ask details about medical transition (surgical procedures, genitals, hormones) unless the person themselves wants to share them. These are private medical information.

Conclusion

Being trans means living with a gender identity that does not correspond to the sex assigned at birth. It is not a pathology, not a choice, not a phase. It is a fundamental aspect of a person’s identity, recognized by modern science and medicine [1][2][4].

Understanding what it means to be trans is the first step toward building a society in which every person can live authentically, without having to justify their own existence.