Language and terminology

The following are explanations and definitions intended as useful references for this resource and for your work with trans and non-binary patients. As language is constantly evolving and seldom universally agreed upon, it is key to mirror back language people use to express their lived experience and understanding of self. In line with WPATH’s Standards of Care, we aim to recognize and support the full spectrum of gender identity and gender expression.

While providing concrete definitions for terms that are fluid and evolving is bound to be imperfect, some generalizations have been made for the sake of practicality and to improve communication with, and understanding of, trans and non-binary patients. Throughout this website, the term “transmasculine” is used to refer to patients who were assigned female at birth but whose sense of self is of being a man or on the masculine spectrum. Similarly, “transfeminine” is used to refer to patients who were assigned male at birth but whose sense of self is of being a woman or on the feminine spectrum.

Gender diversity

It is important to understand that concepts of gender identity and expression have moved beyond the gender binary paradigm. Binary conceptions of gender (ie., man/woman) do not reflect the experiences of many people; for example, genderqueer (aka. gender non-binary) individuals tend to negotiate the world with a with a less rigid concept of gender.

Glossary of terms

For a full list of terms, please refer to the glossary in the Guidelines

Sex (biological)
A label we are given at birth to describe our physical bodies and reproductive capacity. Characteristics of the body used to determine biological sex may include genitals, gonads, hormones, chromosomes, and secondary sex characteristics.

Gender identity
A person’s internal self-awareness of being a certain gender

Gender role/expression
The social expression of gender. Often described as being on a spectrum between masculine to feminine. Often related to, but sometimes distinct from, gender identity. For example, some trans or cis women may identify as butch or have a masculine presentation, and some cis or trans men may be feminine or identify as femme.

Having a non-trans gender identity. You may also sometimes see “cissexual” or “cisgender”. Thus, non-trans men are “cis men” and non-trans women are “cis women”. It is preferable (and more accurate) to use “cis” than to use terms such as “bio”, “genetic” or “real”. It is also preferable to use “cis” rather than only using “woman” or “man” to describe non-trans persons. If cis is not used as a descriptor for non-trans persons, then such persons may be presumed to be the more “normal” or “valid” instantiation of that particular gender, thus contributing to cissexism.

Trans refers to a state of incongruence of one’s gender identity with the gender assigned at birth. It is an umbrella term for people who are not cis, includes persons who are (or identify as) non-binary as well as transmasculine and transfeminine people.

Umbrella term for anyone who does not identify with static, binary gender identities. Includes persons who may identify as having an intermediary gender (e.g. genderqueer), as being multiple genders (e.g. bigender, polygender, etc.), as having a shifting gender (gender fluid), or as not having a gender altogether (agender).

An umbrella term describing the diversity of gender expressions and sexual orientations present in traditional belief systems held by North American First Nations persons.

Depathologizing gender difference

There have been concerted efforts to abandon the psychopathological model of transgender people, and support the provision of gender-affirming treatments to a wider population of trans and nonbinary people. The revision of the psychiatric diagnosis for trans individuals and its criteria in 2013’s DSM-V represented a step towards depathologizing gender difference and validating the spectrum of gender identities. In addition, a distinction was established between gender nonconformity and the diagnosis of gender dysphoria4:

Gender nonconformity
Gender nonconformity refers to the extent to which person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex.
Gender dysphoria
Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics). Only some gender nonconforming people experience gender dysphoria at some point in their lives

The WHO has renamed the diagnosis Gender incongruence and removed the diagnosis from the category of mental health disorders. Changes include eliminating the criteria for significant distress or impairment.

In anticipation and support of this positive development, Sherbourne Health advocates for the provision of gender-affirming care to those who meet the diagnostic criteria for gender dysphoria and/or the criteria for gender incongruence. In line with the updated Endocrine Society Guidelines5 we will thus use “gender dysphoria/gender incongruence” when referring to diagnoses for which hormone therapy is indicated. We will continue to use the term “gender dysphoria” on its own when specifically referring to the discomfort/distress experienced by some trans people due to incongruence of gender.

Urgency for trans care

Trans patients health care needs