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