What does it mean to be transgender?

What does it mean to be transgender?

Being transgender is a term used for individuals who feel that the gender they were assigned at birth does not match the gender they identify with. A transgender woman is born male but identifies as female.

We can distinguish between assigned gender at birth, the gender we are labelled as when born, and gender identity – the gender one identifies as. Most people experience alignment between these two, but for some it is not a given.

The discomfort with one's gender can be so profound that it leads individuals to seek help from healthcare providers for treatment that can align their gender expression with their experienced gender. This does not mean changing one's gender, but rather receiving treatment to ensure alignment between gender expression and experienced gender. This is what we call "gender-affirming treatment." It is not a "gender change."

Being transgender has nothing to do with sexuality – it is solely about gender discomfort: "My gender does not match how I feel."

How many people are affected?

Recent studies show that 0.5-2% of the Danish population experiences some degree of gender discomfort. To put it in perspective, 0.5% of the Danish population has type 1 diabetes.

At the clinic in Odense, we receive approximately 220 referrals per year.

Do we know why people may experience gender discomfort?

The short answer is no. We do not know. There is increased awareness in society, but we cannot explain why we are seeing a persistent increase in the number of referrals to our clinics.

What types of treatments are available?

Treatments are referred to as gender-affirming or gender-confirming. These are treatments that alter gender expression to align with the experienced gender.

There is medical treatment involving hormone therapy, where either male or female sex hormones are administered.

Transgender women usually receive female hormones along with what is called a "blocker," a medication that blocks the male sex hormone. This results in effects such as testicular shrinkage and reduced sperm quality.

Transgender men receive testosterone, the male sex hormone. The dosage is gradually increased, suppressing female hormones. This leads to effects such as deepening of the voice and changes in hair growth, such as facial hair.

We can discontinue medical treatments if the patient desires, but there will be some permanent effects – even after stopping the medication. Hence, it is important to recognize that it is essentially a lifelong treatment.

Surgical treatment is definitive. Gender-affirming surgery involves procedures like breast or genital removal. The National Board of Health has decided that the effects of hormone therapy must be assessed for at least a year before surgery. Before providing surgical treatment, we again assess the gender discomfort comprehensively.

How does one access hormone therapy?

You need a referral to one of the country's three gender identity clinics. Your primary care physician can provide this referral. Clinics are located in Odense, where I work, as well as in Aalborg and Copenhagen.

When we receive a new patient at the Center for Gender Identity, the first thing we do is offer counseling sessions with a psychologist. We do this to determine if there is gender discomfort and to ensure the patient has a persistent desire for the treatment we offer.

Physicians and psychologists make a comprehensive assessment. The gender discomfort must be significant enough to warrant lifelong medical treatment and potentially surgery. Like with other patients, we have a responsibility to ensure optimal treatment, especially since we are dealing with something that, fundamentally, is not physically problematic.

Why is researching transgender identity important?

We know that there can be physical and possibly mental side effects of hormone therapy. Therefore, it is crucial that we understand as much as possible about it. We are essentially inducing a second puberty in patients, so it is important to investigate its long-term effects on cardiovascular health and overall well-being.

We also know that transgender individuals face mental health challenges. Hence, it makes sense for us to explore how we can better support them. This could involve identifying if some individuals have specific needs for counseling and support.

The most important aspect of our research is that it must be patient-centered. We continually describe and adjust our approach to provide the best possible assistance with the fewest possible side effects.

The National Board of Health sets the framework for what we offer in terms of so-called gender-affirming treatment. They are in dialogue with us, the practitioners, and researchers in the field to develop guidelines.

What does the future hold for your research field?

We are beginning to see the first results from a study examining the short- and long-term effects of hormone therapy in transgender individuals. The project particularly focuses on mental health and cardiovascular health.

This includes a registry-based study with over 4,000 transgender individuals from across the country and a clinical study examining changes in physical and mental health among 400 transgender individuals at the Center for Gender Identity in Odense.