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Transition Care | FAQs

  • Q |​ What does it mean to transition medically, legally, or socially?

    ​

    Transitioning is a process that is unique to each individual. Transitioning can be medical, legal, and/or social. A trans or gender-expansive person may transition in some, all, or none of these areas.

     

    Medical. Medical transitioning is a process in which a trans or gender-expansive person undergoes medical treatments or procedures to align the way they look and feel with their gender identity. Medical transitioning may involve hormone replacement therapy (HRT). Surgical transitioning includes procedures like top surgery, bottom surgery, and facial feminization. For more information, see this list of gender-affirming treatments and procedures from Johns Hopkins Medicine→.

     

    Legal. Legal transitioning is process in which a trans or gender-expansive person changes their name and/or gender marker on official records and government documents, such as their passport, driver’s license, Social Security record, and bank accounts. For a guide to government policies on name and gender markers by state, see the Movement Advancement Project Identity Documents Laws and Policies→.

     

    Social. Social transitioning is a process in which a trans or gender-expansive person expresses their gender identity through their name, pronouns, clothing, or hairstyle, among other forms of “coming out” to family, friends, and community. Social transitioning is non-medical and reversible.

    __________

    Reisner SL, Radix A, Deutsch MB. Integrated and Gender-Affirming Transgender Clinical Care and Research. J Acquir Immune Defic Syndr. 2016;72 Suppl 3(Suppl 3):S235-S242. doi:10.1097/QAI.0000000000001088

  • Q |​ How do I start my transition journey?

    ​

    Each person’s transition journey is unique. Some people may transition gradually, starting with social measures only or adding medical and legal measures later on, while others transition socially, medically, and legally within a short period of time. Some trans people choose not to transition. Factors to consider include:

     

    • Your personal goals and preferences
       

    • Cost of medical and legal measures
       

    • Insurance coverage for medical treatments and procedures
       

    • Support within your social network
       

    • State and federal policies governing name and gender markers

     

    If you are having trouble knowing where to start, check out the Transition Roadmap→ from the University of California at San Francisco. Talk to people you trust, including family, friends, healthcare providers, psychologists, and/or spiritual leaders, to help you decide what forms of transitioning are most important for you.

  • Q |​ What steps could I take to transition?

    ​

    Each person’s transition journey is unique and the steps you decide to take do not necessarily have to be in a certain order. This chart gives an overview of social, legal, medical, and surgical transition options:

    Infographic about different types of gender transitioning

    Carefully consider these questions as you decide how you'd like your transition journey to look:

    ​

    • Which kinds of gender-affirming care do I need?

    • Which kinds of gender-affirming care do I need most right now?

    • What will my insurance or personal funds cover?

    • What documents and types of support will I need to transition?

    ​​

    Note. Be careful not to rush or assume that a particular selection may be right for you based on others' experience.

    __________

    Advocates for Trans Equality. (n.d.). Identification Documents and Transgender People: An Overview of the Name and Gender Marker Change Process in the United States. Retrieved from https://transequality.org/sites/default/files/docs/resources/ID-Documents-Overview.pdf

    ​

    Deutsch, M.B. (2016). Overview of gender-affirming treatments and procedures. University of California, San Francisco. Retrieved from https://transcare.ucsf.edu/guidelines/overview

    ​

    Liang, F. (n.d.). Gender Affirmation Nonsurgical Services. Johns Hopkins University. Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-nonsurgical-services

  • Q |​ Do I have to transition medically, surgically, legally, or socially?

    ​

    Expressing your gender identity does not require medication, surgery, or changes to legal identification. For some trans people, it may not be safe or possible to transition in these ways. The decision to transition is based on your individual circumstances and goals.

  • Q |​ What should I expect after transitioning medically or surgically?

    ​

    After starting HRT or having gender-affirming surgery, it's important to plan for follow-up procedures and long-term monitoring by a healthcare provider.

     

    Examples

    ​

    • Trans and gender-expansive people should consult with their healthcare providers regularly about their medication(s) and blood tests as long as they are on HRT.
       

    • Generally speaking, trans and gender-expansive people should get screenings based their anatomy. For example, a trans woman who still has a prostate may need to get screened for prostate cancer according to current guidelines. Note. The prostate is usually not removed during bottom surgery due to the risk of complications. 
       

    • A trans person assigned male at birth who has had vaginoplasty (bottom surgery) may need regular dilation to prevent narrowing of the vagina.
       

    • A trans person assigned female at birth who has had phalloplasty (bottom surgery) is at risk for complications such as narrowing of the urethra due to scar tissue and should plan for lifelong follow-up urology appointments.

     

    After transitioning medically or surgically, you may get some relief from preexisting depression or gender dysphoria, but this is not guaranteed. Continuing to get care from a mental health professional is important. It is also important to rely on trusted people in your network for support after your transition.

     

    With maintenance, monitoring, and support, you can find joy, satisfaction, and validation of your gender identity long after transitioning medically or surgically.

    __________

    Kalavacherla S, Riviere P, Kalavacherla S, Anger JT, Murphy JD, Rose BS. Prostate Cancer Screening Uptake in Transgender Women. JAMA Netw Open. 2024 Feb 5;7(2):e2356088. doi: 10.1001/jamanetworkopen.2023.56088. PMID: 38353948; PMCID: PMC10867675. 

    ​

    Park RH, Liu YT, Samuel A, et al. Long-term Outcomes After Gender-Affirming Surgery: 40-Year Follow-up Study. Ann Plast Surg. 2022;89(4):431-436. doi:10.1097/SAP.0000000000003233

     

    Sterling J, Carbonella J, Jones T, Hanchuk S, Kelly P, Garcia MM. Cancer Screening for Transgender Individuals: Guidelines, Best Practices, and a Proposed Care Model. Urol Clin North Am. 2023 Nov;50(4):563-576. doi: 10.1016/j.ucl.2023.06.014. 

  • Q |​ What health screenings should I consider?

    ​

    While more evidence is needed about cancer screening for trans adults, it is recommended to talk to your healthcare providers about the need for specific screenings based on your individual risk factors for cancer, your family history, and your unique body composition and transition history. 

    ​

    Examples
     

    • Trans and gender-expansive people assigned male at birth may benefit from prostate cancer screening according to current guidelines→.
       

    • Trans and gender-expansive people assigned female at birth who are at risk for breast cancer may need regular mammograms according to current guidelines→.

    __________

    Sterling J, Carbonella J, Jones T, Hanchuk S, Kelly P, Garcia MM. Cancer Screening for Transgender Individuals: Guidelines, Best Practices, and a Proposed Care Model. Urol Clin North Am. 2023 Nov;50(4):563-576. doi: 10.1016/j.ucl.2023.06.014. 

  • Q |​ If I start hormone therapy/HRT, what are some common medication interactions to watch out for?

    ​

    Gender-affirming hormones may interact with some of your medications. Here are a few common examples of medication interactions to watch out for:

     

    Estradiol (feminizing hormone) may reduce the effectiveness of insulin, causing blood sugar levels of a person with diabetes to increase. A healthcare provider may adjust their insulin dose and monitor their blood sugar more closely.

     

    Spironolactone (anti-male hormone) in combination with certain blood pressure medications, called ACE inhibitors, may lead to high potassium in the blood. High potassium can cause irregular heart rhythms, which can be life-threatening. A healthcare provider can monitor your potassium levels more closely, and they may recommend limiting foods high in potassium like potatoes and bananas.

     

    Testosterone (masculinizing hormone) increases the effect of certain blood thinners, like Warfarin, which would make it difficult to control bleeding. A healthcare provider may lower your dose of blood thinner or consider changing your medication regimen.

     

    Talk to your healthcare provider about drug interactions specific to the medications you take.

     

    __________

    Source. UpToDate Lexidrug Standard

  • Q |​ What are the long-term effects of hormone therapy/HRT?

    ​

    More research is needed on the long-term effects of HRT for trans and gender-expansive people. But some effects are known from patient stories and from research involving cisgender adults.

     

    • People taking feminizing hormones and people taking masculinizing hormones may experience better mood and lower depression over time.
       

    • People taking estrogen who smoke or start HRT after age 50 may have a higher risk for blood clots.
       

    • People taking testosterone may have thicker blood which may increase risk for stroke or heart attack.
       

    • Depending on the length of treatment, some physical effects of HRT are reversible, while effects like breast development, hair growth or loss, and infertility are not.

     

    For more details, see resources on Estrogen→ and Testosterone→ from the University of California at San Francisco.

    __________

    University of California, San Francisco. (2025). Information on Estrogen Hormone Therapy. Retrieved from https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy

    ​

    University of California, San Francisco. (2025). Information on Testosterone Hormone Therapy. Retrieved from https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy

  • Q |​ What gender-affirming surgeries are available?

    ​

    The following is a list of common gender-affirming surgeries in no particular order:

     

    • Vaginoplasty (feminizing bottom surgery)

    • Phalloplasty or metoidioplasty (masculinizing bottom surgery)

    • Chest surgery (masculinizing top surgery)

    • Breast augmentation (feminizing top surgery)

    • Facial feminization/masculinization

    • Tracheal shave (Adam’s apple reduction)

    • Orchiectomy (testicle removal)

    • Hysterectomy (removal of uterus, cervix and/or ovaries)

  • Q |​ What should I know about the logistics of gender-affirming surgery?

    ​

    If you're planning to have gender-affirming surgery, keep the following logistical considerations in mind:

     

    • Wait Time. Sometimes the wait time between starting the process and having the surgery can take months to years.
       

    • Letters. You may be required to submit 1-2 letters of support from healthcare providers before your insurance will cover the procedure. See WPATH Standards of Care→ for more details.
       

    • Insurance. Insurance coverage for gender-affirming surgery depends on federal policy, state policy, and insurer policy.
       

    • Aftercare. Your care after surgery is essential. Think about who could help you with things like wound cleaning, light housework, driving, a place to stay, etc.
       

    • Physical Therapy. Depending on the procedure, you can ask your healthcare provider about physical therapy to improve the healing process. Example. A nonbinary person starts physical therapy after top surgery.

  • Q |​ What should trans and gender-expansive people of color know about gender-affirming surgery?

    ​

    Black trans adults are at higher risk, relative to White trans adults, for complications following gender-affirming surgery. This may be due to long-standing health disparities and racism affecting Black people in the US healthcare system. If you are Black and you are interested in having gender-affirming surgery, talk to your surgeon about any concerns you have for complications and what strategies can be put in place to prevent them.

     

    People with darker skin tones, including Black, Asian, and Native Hawaiian people, may be more likely to have hypertrophic scarring after surgery. Hypertrophic scarring is a firm and discolored scar that is raised above the skin and may be minimized through methods such as silicone wound dressings, steroid injections, and massage. Talk to your surgeon before the procedure about your risk for hypertrophic scarring and about strategies to reduce the scarring if it occurs.

    __________

    Nuamah D, Patterson JB, Lewis JE, et al. Unequal healing: Racial differences in hypertrophic scarring following burn injuries. J Natl Med Assoc. 2025;117(5):315-322. doi:10.1016/j.jnma.2025.07.004

     

    Shamamian PE, Kwon DY, Oleru O, et al. Assessing racial disparities in gender-affirming surgery utilization and hospital-level experience. J Plast Reconstr Aesthet Surg. 2025;100:16-23. doi:10.1016/j.bjps.2024.10.034

  • Q |​ What does it mean to legally transition?

    ​

    Legal transitioning involves changing your name and gender marker on official documents like:

     

    • Social security record

    • License or state ID

    • Financial, insurance, medical, and employment records

    • Passport

    • Birth certificate

    • Voter registration

    • Immigration records (if applicable)

     

    For more details, see this resource from Advocates for Trans Equality→.

    ​

    Note. Name change clinics and workshops are often available free (based on income) or at low cost.

  • Q |​ If I change my legal name and gender marker, which documents need to be updated?

    ​

    Update your legal name and gender marker for all of the following that apply:

     

    • Social security card

    • Driver’s license or state ID

    • U.S. passport*

    • Tax returns

    • Birth certificate

    • Marriage license

    • Veterans benefits

    • Voter registration

    • Vehicle registration

    • Bank accounts

    • Insurance

    • Postal service

    • State benefits

    • Credit accounts

    • Subscriptions

    • Personal accounts

     

    Updating government documents and insurance records is an important way to ensure that your name is reflected accurately in your medical record and to prevent delays in insurance coverage.

     

    *Legal action is being taken to protect the right for trans and gender-expansive people to change their name and gender marker. See a list of recommendations from Lambda Legal→ for more information.

  • Q | Is it possible to start transitioning later in life? What if I have a health condition?

    ​

    All forms of transitioning are possible later in life! But it’s important to talk to a healthcare professional who can help you weigh the pros and cons of your gender-affirming care options and what the risks would be based on your age and any health conditions you have. While some health conditions like heart disease or blood clotting disorders may make it difficult for someone to transition medically, it may be possible with the right medications and careful monitoring. Talk to your healthcare provider to find out what treatments and procedures would be right for you given your individual health needs.

     

    Example. A trans woman starts her gender transition at age 79. She first starts transitioning socially by dressing as a woman and coming out to her therapist. Then she starts HRT and has bottom surgery. Her doctors closely monitor her for complications especially given her age. She does well, feeling a sense of joy after so many years of hiding her true self.

  • Sources

    Corlette, S. (August 1, 2025). “New Federal Rules Affecting Coverage of Treatment for Gender Dysphoria: Considerations for States.” Retrieved from https://shvs.org/new-federal-rules-affecting-coverage-of-treatment-for-gender-dysphoria-considerations-for-states/

     

    Lambda Legal. (August 19, 2025). “Policy violates constitutional protections and multiple federal anti-discrimination laws.” Retrieved from https://lambdalegal.org/newsroom/us_20250819_ll-condemns-trump-admin-illegal-exclusion-of-gender-affirming-care-from-employee-health-benefits/

     

    Kalavacherla S, Riviere P, Kalavacherla S, Anger JT, Murphy JD, Rose BS. Prostate Cancer Screening Uptake in Transgender Women. JAMA Netw Open. 2024 Feb 5;7(2):e2356088. doi: 10.1001/jamanetworkopen.2023.56088. PMID: 38353948; PMCID: PMC10867675. 

     

    Nuamah D, Patterson JB, Lewis JE, et al. Unequal healing: Racial differences in hypertrophic scarring following burn injuries. J Natl Med Assoc. 2025;117(5):315-322. doi:10.1016/j.jnma.2025.07.004

     

    Park RH, Liu YT, Samuel A, et al. Long-term Outcomes After Gender-Affirming Surgery: 40-Year Follow-up Study. Ann Plast Surg. 2022;89(4):431-436. doi:10.1097/SAP.0000000000003233

     

    Reisner SL, Radix A, Deutsch MB. Integrated and Gender-Affirming Transgender Clinical Care and Research. J Acquir Immune Defic Syndr. 2016;72 Suppl 3(Suppl 3):S235-S242. doi:10.1097/QAI.0000000000001088

    ​

    Shamamian PE, Kwon DY, Oleru O, et al. Assessing racial disparities in gender-affirming surgery utilization and hospital-level experience. J Plast Reconstr Aesthet Surg. 2025;100:16-23. doi:10.1016/j.bjps.2024.10.034

     

    Sterling J, Carbonella J, Jones T, Hanchuk S, Kelly P, Garcia MM. Cancer Screening for Transgender Individuals: Guidelines, Best Practices, and a Proposed Care Model. Urol Clin North Am. 2023 Nov;50(4):563-576. doi: 10.1016/j.ucl.2023.06.014. 

    ​

    Resources

Page updated January 2026

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