Teaching Transgender: A Guide to Leading Effective Trainings

January 15, 2009

Many thanks to all who helped with this publication: Justin Tanis, primary author; Daniel Gould, who, with Justin, developed the original workshop that formed the basis of this resource; and Mara Keisling, policy resource and information. Assisting us with editing and helpful uggestions were: Simon Aronoff, Donna Cartwright, Stephen Glassman, Richard Juang, Lisa Mottet, and Cole Thaler.


Transgender people and our allies are often asked to lead trainings for groups, classes and businesses about our lives and experiences. We can give people information which may help them understand more about who we are, the discrimination we face, and the ways in which we can be fully welcomed into our workplaces, families and communities. This education is critical to the success of our movement for transgender equality.

It takes courage to stand in front of a group of people and share about our lives. It is also a very powerful step that has the potential to change hearts, minds and lives. Thank you for being willing to consider leading a training.

This manual is designed to give you some practical tools for leading these trainings in a way that is effective for your audience and affirming for you. Leading groups is a skill we can learn and the more you know about the process, the more comfortable you’ll feel and the more effective you will be.

Throughout this manual, we’ll make suggestions for ways to say or describe things. These are just examples—you should use your own words and ways of talking because that is the clearest way to communicate with your audience. Most of the time, we’ll give you more than one example to help you get an idea of how you might want to say it.

The majority of the information in this manual is designed for general audiences who want to learn more about transgender people. There is information about specific groups, such as medical providers and law enforcement personnel. You can tailor the information you share to be most appropriate for the group.



The clearer you are about what you’d like to accomplish during the training, the more likely you are to be able to achieve it. Some useful goals for a Transgender 101 training are:

  • Present clear, balanced and accurate information about the lives of transgender people
  • Communicate to audience members the discrimination that transgender people face in our society and what can be done about it
  • Give the audience an opportunity to see the issue in a personal and positive way

Keep in mind that you cannot force the audience to understand or be compassionate; what you can do is give them the opportunity to learn and broaden their horizons. It is up to them to put what you have offered them into practice. All you can do is to do your best and present useful, correct information to them.



How do you get started leading Transgender 101 trainings? Maybe you have decided that you’d like to get out in the community more and help build understanding. Maybe a particular situation has highlighted the need for training. Or maybe an organization has contacted you requesting a training. Here we’ll talk about how to set up the workshop set up and clarify all of the details.

If you have been contacted by an organization requesting someone to lead a Transgender 101 session:

Begin by thanking the person who has been in contact with you for thinking of you and for wanting to hold the training. Building allies can start from the very first moment of contact. Be friendly and encouraging.

Be sure to get the details from them about what they want so that you can have the information you need to plan a successful workshop:

  • Have they selected a date and time for the workshop or is that still flexible?
  • What group do they represent? If it is unfamiliar to you, ask for some information about who they are and what their purpose is.
  • Who would be present for the workshop?
  • What led them to look for a Transgender 101 workshop right now? This is very important because it will let you know whether there has been a recent incident that needs to be addressed, whether this is part of an ongoing series of trainings, etc.
  • Will an interpreter (for a spoken language or American Sign Language) be necessary and will the organization provide one if needed?
  • Where will the session be held? Is the space accessible?
  • How long would they like the workshop to be?
  • Are they able to cover your expenses and/or pay a speaker’s fee?
  • With whom should you follow up and what is the appropriate contact information for you to use?

Also, be prepared to let them know a little about you and your background. They may want to know:

  • Your experience in presenting workshops.
  • How many people your organization (if you are affiliated with one) usually sends to lead a training.
  • Whether you charge a fee.
  • Sometimes they will want to see your outline or handouts in advance; unless there is a compelling reason not to do so, this is reasonable.

Remember that you do not have to say “yes” to every request. The time may be inconvenient for you or another person in the community might be a better fit for this particular group. Successful trainings are led by people who have enthusiasm to bring to the group. If you are feeling tired or just aren’t interested in this particular group, say no and give the opportunity to someone who can bring a high level of positive energy to the workshop. This gives you a break and will let you do a dynamic job with a different group in the future.

Consider who would be the best match for this particular group. For example, a police officer can be very effective in speaking to other law enforcement personnel while a doctor can address the questions of other physicians. Establishing a sense of rapport and connection with the workshop participants is very important in creating a positive experience.

If you think the audience might be difficult (for example, a workplace-mandated training in a setting where a transgender person has encountered hostility), think about asking the most experienced trainers in your community to work on this assignment.

Be back in touch with your contact person to confirm the workshop. If they contact you several months before the workshop, calling or sending an e-mail a few weeks ahead of time is courteous. If the time frame is shorter, you might want to contact them a week or two before the event. This lets you confirm the time, place, and other information like how many people they expect to be present.

If you would like to approach an organization about hosting a Transgender 101 workshop:

  • Begin by researching who the person is in that organization or company who has the authority to schedule trainings. The more specific you can be, the more likely you’ll be to succeed in setting something up.
  • It is usually best to send a letter or e-mail to the organization, introducing yourself and your group. Let them know that you have people ready and trained to lead Transgender 101 workshops and would be happy to talk with them about this. You can later follow up by phone if that seems appropriate. Only offer what you are able to deliver and have ready right now.
  • Be prepared to let them know your experience presenting workshops, what approach you take, and whether you are asking to be paid for the training. You may also wish to provide references to other groups where you have led a training.

If you are selecting a location for the training:

You will want to select a place to hold that training that will enhance your program. Some things to think about are:

  • Is the location accessible to people who use wheelchairs? Are there appropriate ramps, restrooms, and wide enough doors to accommodate them?
  • Is public transportation nearby? Can people safely walk from the nearest bus, subway or train stop?
  • Is there parking available? If the training is at night, are there lights in the parking lot?
  • Will people be able to find the place easily? Is it well-marked or can you have a volunteer who will direct people?
  • What is the cost of using this space?

You will also want to try to select a space that is as comfortable and pleasant as possible. People pay better attention if they are able to sit in reasonably comfortable chairs, can hear well, and are not in a space with a lot of distractions.



If you will be leading the training with other people, make sure you contact them in plenty of time, with clear information about where and when the training will take place.

You will also want to schedule a meeting to go over the session. Decide who will lead which parts of the workshop and how you will work together. Good planning will make the session run smoothly.

Review the curriculum carefully and think through how you will answer the questions. Decide what parts of your story you feel comfortable sharing and how you want to tell it.

Gather together any supplies that you will need, such as copies of any handout(s) and pens. If you are part of an organization, you may want to bring brochures and business cards. It can also be helpful to bring a list of community organizations and contact information in case anyone comes who is seeking additional information.

Make any handouts that you need ahead of time. It can be helpful to provide larger print handouts if they are needed. Consider whether you will need materials in languages other than English or if you’ll need an American Sign Language interpreter. Arrange for flip chart paper and plenty of markers. Bringing extras is usually a good idea so you’ll be sure you have them.

Think through as much as you know about your audience. You might ask yourself:

  • What might this audience specifically want to know? What information can I prepare that will help them learn that? For example, a book club might want to know about recent articles and books on gender issues while a law firm might need information about groups doing legal advocacy.
  • What is the level of education and ages of the audience members? Given that, how can I best communicate information to them? It is important to use terminology, vocabulary and ideas that affirm your audience where they are.
  • Will this audience primarily want concrete information or theory? For example, emergency medical personnel are seeking different information than a college Queer Studies class.
  • Am I being asked to present my personal story or general information about transgender people?
  • Are my audience members from a specific culture? Is there information about gender, transgender issues or communication that I need to know in order to treat them respectfully? For example, some cultures consider direct eye contact to be rude while others think that it is polite.

Decide if you are comfortable telling your own personal story. Many people have not knowingly had the opportunity to talk with a transgender person face-to-face, so sharing your story can have a profound effect on the audience. On the other hand, sharing details about your own life can be tiring and emotionally difficult. Other community members may be more comfortable sharing their personal stories in the context of a training.

Being well prepared for the training and for your audience will make the experience much more satisfying—and less stressful—for you as well as for the group.


Be sure to leave early so you are sure that you have plenty of time to find the place where the training will be held. Arriving early gives you the chance to catch your breath and relax before having to give a presentation. Keep in mind that different individuals, places and cultures have different understandings of what it means to be on time. Some people believe it is rude to begin later than the posted starting time, interpreting lateness as disrespectful of their time. Other people consider it rude to rush people without giving them time to arrive, check in with friends and get settled before beginning. One way to deal with this as a workshop leader is to ask your host ahead of time when they usually begin their meetings: “Does your organization like to get started right on time or should we allow 15 minutes for people to socialize before we begin?”



This guide is divided into sections that you can use to help plan a workshop. Depending on your audience, you can vary the time for each section. For example, a group that already knows quite a bit about transgender issues may want a longer discussion time, while folks who are very new to the topic might need more help with terminology and may have more questions. It is important to think through how much time you’d like to spend on each section so you don’t run short on time at the end and have to skip things you think are important to include. Times suggested below are for a 90 minute workshop; if your time is longer or shorter than that, you will need to adjust accordingly.

Introductions (5 minutes)
Your opportunity to explain why you are here and to introduce the audience to what you will be covering.

Terminology (10 minutes)
It is important for your audience to understand the terms you will be using and have an introduction to the concepts you will be discussing. This is set up as an interactive exercise so that participants become an active part of the training.

Telling Your Story (10-15 minutes)
Learning about transgender lives can break stereotypes and help your audience put a human face on an issue they may not have encountered personally.

Teaching about Issues (30 minutes)
It is important that your audience leave with facts about transgender people. Including this information along with your story makes it personal, but also helps people understand that this is broader than just one or two peoples’ experiences.

Questions (10-15 minutes)
This gives your participants a chance to clear up anything that may be confusing to them and lets them explore other topics that are of interest to them in addition to what you’ve covered.

Discussion (20 minutes)
This is a time when participants can apply the information you’ve given them. In particular, you can encourage them to talk about how transgender people are treated in their community and ways in which they’d like to be more inclusive.




It is helpful to have a clear beginning point for the training. Begin by setting the right tone for the session right from the start. Welcome the attendees to the workshop. You want people to feel comfortable, so that they can explore a topic that might be unfamiliar to them. People learn best when they are relaxed and feeling safe. It is your job as the facilitator to do what you can to create these conditions.

You want participants to see you as an authority on this topic and to respect your role as a presenter. Tell people only what you know for sure and speak slowly and calmly. It is helpful to keep an outline or notes nearby, to help you stay on track, but do not rely too heavily on them or read from the paper. Audiences stay most engaged when you are speaking directly to them. At the same time, you can lose people’s attention if you go off on too many tangents. Know your material ahead of time so that you can consult your notes briefly, follow your outline, and talk to the audience in your own words.


Start by letting people know a little bit about who you are and why you are speaking on this topic. This should just be a brief introduction. Be sure to include:

  • Your name
  • Why you personally are speaking on transgender issues
  • A brief statement about what your qualifications are to speak on this topic
  • Any connection you have to the group
  • That you are glad to be here

Example: “My name is Maria Sanchez and I’m here to speak to you today about the transgender community. My sister, Viviana, was born as a little boy. As she grew up, it became more and more clear that she would never be comfortable living as a man. She transitioned from male to female about 5 years ago. There have been challenges but our family loves her very dearly and I’d like to share with you today from a family member’s perspective. I’m also a registered nurse and can help answer questions you may have about the medical side of this process. I’m really glad to be here and am looking forward to spending this time with you this afternoon.”

Example: “Hi, my name is Chris and I’m really glad to be a part of this discussion on transgender issues today. I am someone who doesn’t identify as either male or female; those labels just never have felt right for me. I think that we should be free to live our own lives, without having to fit into someone else’s category. I have personally given a lot of thought to these issues and been active in the transgender community for the last 12 years and am looking forward to our conversation today.”


Next, you’ll want to describe for participants what you will be doing during the session. People are much more comfortable when they know how long the class or workshop will last and what is going to happen during the session. Include any specific information you may need people to know (restrooms, breaks, rules etc.).

Example: “Our workshop today will last from 2:00 until 3:30. During this time, we’re going to go over some terminology that transgender people use and then we’re going to discuss some information about who transgender people are and what our lives are like. Finally, we’ll talk about some ideas of what you can do here at your school to help transgender people feel welcome. If you have questions at any time, please raise your hand and we’ll call on you. Okay, let’s get started.”

Example: “During our diversity retreat this morning, we’re going to start by talking about some language that transgender people use to describe ourselves. Then, our panelists will each share briefly from their personal experiences as transgender people. Finally, we’ll go over some facts and figures about transgender people that may be helpful to you. If you need to stretch at any point, please feel free to get up—it won’t bother us. The restrooms are out the door and to the left. We’ll be breaking for lunch at noon and there will be sandwiches available in the other room.”


If you have a relatively small group and enough time, you may want the audience members to introduce themselves. Be careful not to take too much time on this—while it can be helpful to know who is in the room, remember that people are there to learn and gain information they don’t already know.

You can ask participants to share any or all of the following:

  • Name
  • A brief word or phrase of what they know about the transgender community
  • One thing that they would like to get out of the workshop

If you ask them what they’d like to get out of the workshop, write it down, preferably on a large piece of paper that everyone can see. Try, when reasonable, to cover what people have come to learn.

  • If they ask for something you don’t know, say, “This is outside of my area of expertise, but talk to me after class and we’ll connect you with someone who can answer that for you.”
  • If someone asks for something very inappropriate, simply say, “That wouldn’t be appropriate for today’s class,” and move on to the next person.



Let’s face it—transgender people use a lot of words often known only to our community. There are also many outdated or offensive terms that the general public may know. Some terminology is medically based. It is important to begin the workshop by giving everyone a common vocabulary with which to discuss the topic. This helps people feel like they are included in the conversation and helps them to follow what you are saying.

Transgender is an umbrella term that refers to people who live differently than the gender presentation and roles expected of them by society. There are many kinds of people who fit this term and the rest of terms describe some of them.

Intersex people have physical characteristics that do not match the typical understandings of male and female; previously called hermaphrodites. It is now considered offensive to use the term hermaphrodite, so it is more appropriate to call people intersex. Some intersex people identify as transgender while others do not. Some intersex conditions are known at the time of birth while others are not discovered until later in life, if it all; some intersex conditions are anatomical, while others are chromosomal. For more information, contact Advocates for Informed Choice (

Crossdressers refers to people who choose to wear the clothing generally associated with the opposite gender. They do so because they find it fulfilling in emotional or sexual ways. Crossdressing is about more than sexuality—it is a way that a person expresses all of who they are, both masculine and feminine. The word “transvestite” is outdated and offensive to some people. The currently used term is “cross dresser.”

FTM and MTF are abbreviations used by many female-to-male transgender persons (also known as transmen) and male-to-female transgender persons (also known as transwomen).You’ll often hear transgender people referring to ourselves as MTF or FTM, so if you know these terms, you’ll sound much more knowledgeable about our issues. Remember, the first letter is the gender assigned to someone at birth, the “T” stands for “to,” and the last letter is how the person identifies now. So, MTF refers to someone who is male-to-female.

Gender refers to the societally-determined characteristics of a particular sex; these characteristics are commonly referred to as “feminine” and “masculine”. Different societies have different ideas about what it means to be feminine or masculine and how people are expected to act.

Sex refers to the designation of the biological differences between females and males. This is the scientific term for what makes males and females different; remember, though, that not everyone fits into these 2 categories. There are a number of different factors that determine sex, not just chromosomes.

Drag Queen is a term historically used by gay men who dress in the clothing usually associated with women for the purposes of entertainment or personal fulfillment. There are also drag kings, who are biologically female and dress as men. In the African-American community, some people use the word “Queen” (not drag queen, just queen) to refer to gay men—these men may or may not cross dress.

Transsexual is a term for people who seek to live in a gender different from the one assigned at birth and who may seek or want medical intervention (through hormones and/or surgery) for them to live comfortably in that gender. Transsexuals are the people who generally live full time as a different gender than the one they were assigned at birth.

Sexual Orientation describes who people fall in love with and/or are sexually attracted to, while Gender Identity describes how people perceive their own internal sense of maleness or femaleness. Transgender people can be straight, gay, lesbian or bisexual—gender identity is separate from your sexual orientation.


You can also add other terms that are important or that your audience might know but don’t feel you need to include every possible term; there are just too many. Some examples you might want to include are:

  • Transition—the process of moving from one gender to another. For example, you might say, “I transitioned from male to female in 1996.”
  • Passing—being seen as the gender you are presenting as, rather than being identified as transgender
  • Stealth—keeping your transgender past hidden from others
  • Genderqueer—people who live outside of the gender norms of society
  • Transman and transwoman—FTM and MTF, respectively. It may be important to note the difference between the way the transgender community uses these terms (man referring to people who identify as male and woman referring to people who identity as female) and the way the media, police or scientific community sometimes use them incorrectly. For example, the media may (incorrectly) call a transwoman “a transgender man.”
  • Two-Spirit—a term from some Native American cultures for people whose gender identification includes both male and female
  • People of Transgender Experience—used in some parts of the country for people who have transitioned and now identify as male or female rather than transgender
  • Terms that are culturally appropriate for your audience—some cultures have specific words for people who live in a gender different from that assigned to them at birth. You or your audience members may wish to share these. For example, hijras from India.

You can ask the audience if there are other terms they have heard that they would like a definition for. You can also review that there are terms that transgender people are called which are offensive to us. These words should not be used by non-transgender people. Some examples are:

  • “He-she”
  • “She-male”
  • Tranny—should only be used by transgender people; non-transgender people should avoid this word
  • Fag, faggot, dyke, queer—sometimes words used against gay, lesbian and bisexual people are also used against transgender people. While these words have been reclaimed and used by some members of the LGBT communities, they should never be used by people who don’t identify as LGBT themselves.



People often want to hear our stories be-cause they are a way to personalize the issue and to learn more about us. Here are some important guidelines to consider:

  1. Only share what you want to share and are comfortable saying to the group. You are in control of what people learn about you and your life. You do not have to disclose anything to them about your body, your transgender status or any other detail that you don’t want to.
  2. Tell the truth and tell your own story. Focus on the personal because that is much more compelling to people than statistics.
  3. It is helpful for people to hear a balanced perspective about our lives. While they need to know that we face discrimination and the road isn’t always easy, we also don’t want to convey to them that we are only victims. Share both the positives and negatives of your story with them.
  4. Consider your audience when deciding what medical and sexual details to share. You are not under any obligation to discuss specific medical and surgical information with the audience; what you share about your body is entirely your choice. Be aware that some people are uncomfortable with bodies, particularly in relation to genitals and sexuality, and with explicit information about surgery of any kind. Talking too much about this might upset or alienate some members of your audience so tailor your remarks to the specific people you are talking to. If you are leading a training for a group of sex educators, you will probably choose different content than if you are telling your story to your local book club.
  5. Keep it brief. Short and focused stories will grab their attention and make them want to learn more. Talking for too long can cause people to become distracted or bored.

In addition to telling your story, it is very helpful to provide some broader, concrete information about the transgender community. This helps people move from the personal to a broader understanding of who we are and how we live in the world.



This section will give your audience some basic information about transgender people. Again, please use your own words; the text here is just a guideline to get you started. These topics cover what people often want to know about us.

Important Note: There is more information here than you will use during the average presentation. Use only what seems useful to you and add things that you know as well.


We don’t know for sure the answer to this question. There are a number of reasons for that. First, there really isn’t anyone collecting this data. It’s not something that the US Census or other agencies keep track of. Second, many transgender people are not public about their identities, so they might not tell anyone about it.

NCTE estimates that between ¼ and 1% of the population is transsexual.


There are a number of theories about why transgender people exist although there is not yet scientific consensus.

When you look across cultures, you will find that people have had a wide range of beliefs about gender. Some cultures look at people and see six genders, while others see two. Some cultures have created specific ways for people to live in roles that are different from that assigned to them at birth. In addition, different cultures also vary in their definitions of masculine and feminine. In some places, men are expected to be gentle and nurturing, while in others, they are expected to be strong and stoic. Whether we view someone as transgender depends on the cultural lenses we are looking through as well as how people identify themselves.

Biologists tell us that sex is a complicated matter, much more complex than what we may have been taught in school. A person has XX chromosomes is generally considered female, while a person with XY chromosomes is generally considered male. However, there are also people who have XXY, XYY, and other variations of chromosomes; these genetic differences may or may not be visibly apparent or known to the person. Some people are born with XY chromosomes, but are unable to respond to testosterone and therefore develop bodies with a vagina and breasts, rather than a penis and testes. A variation in gender may just be part of the natural order and there are more varieties than we generally realize. People with biological differences in gender may be considered intersex; they may or may not identify as transgender.

There are medical theories about why people are transgender. Some speculate that fluctuations or imbalances in hormones or the use of certain medications during pregnancy may cause intersex or transgender conditions. Other research indicates that there are links between transgender identity and brain structure.

Some people believe that psychological factors are the reason for the existence of transgender people. There are theories about early childhood influences and other factors; however, it is clear that there are people who are aware that they are transgender from their earliest memories. Many trans people feel that their gender identity is an innate part of them, an integral part of who they were born to be.

Then there are people who feel that everyone has a right to choose whatever gender presentation feels best to that individual. People should have the freedom to express themselves in whatever way is right for them.

Sex and gender are complex issues. A huge variety of factors are at work in making each individual the person that they are and there is no one reason that causes people to be transgender. Trans people are part of the variety that makes up the human community.


No, but this remains a stereotype about transgender people. Gender Identity Disorder is listed in the Diagnostic and Statistical Manual-4th Edition (DSM-IV), a guide used by mental health professionals to diagnose psychological conditions.

Transgender identity is not a mental illness that can be cured with treatment. Rather, transgender people experience a persistent and authentic difference between our assigned sex and our understanding of our own gender. For some people, this leads to emotional distress. This pain often can be relieved by freely expressing our genders, wearing clothing we are comfortable in, and, for some, making a physical transition from one gender to another.

For people who identify as transsexual, counseling alone, without medical treatment, is often not effective.

Until 1973, homosexuality was considered a mental illness; mental health professionals now know that it is part of the normal range of human sexuality. In the same way, we believe that in the future people will recognize that gender differences are also part of the spectrum of human expression.

Our society is, however, very harsh on gender-variant people. Some transgender people have lost their families, their jobs, their homes and their support. Transgender children may be subject to abuse at home, at school or in their communities. A lifetime of this can be very challenging and can sometimes cause anxiety disorders, depression and other psychological illnesses. These are not the root of their transgender identity; rather, they are the side effects of society’s intolerance of transgender people.


Note: The information in this section applies only to transsexuals, not to transgender people in general. You may want to remind your audience that not all transgender people want to transition. However, many audiences are curious about this process and want information on it.

There are a variety of paths that people follow, but many use a series of guidelines set out by the World Professional Association for Transgender Health. These guidelines are called the Standards of Care (SOC) and they outline a series of steps that people may take to explore and complete gender transition. These may include:

  • Counseling with a mental health professional
  • A “real life” experience where an individual lives as the target gender for a trial period
  • Learning about the available options and the effects of various medical treatments
  • Communication between the person’s therapist and physician indicating readiness to begin medical treatment (usually in the form of a letter)
  • Undergoing hormone therapy
  • Having various surgeries to alter the face, chest and genitals to be more congruent with the individual’s sense of self

Not all transsexual people follow these steps nor does the community agree about their importance. The Standards of Care is not legally mandated. We believe that people should make their own decisions about their health care, in consultation with medical or mental health professionals as appropriate to their individual situation.

Transsexual people may undergo hormone therapy. Transgender women may take estrogen and related female hormones; transgender men may take testosterone. It is important that people obtain hormones from a licensed medical professional if at all possible to be sure that the medications are safe and effective. Doctors should monitor the effects on the body, including checking for negative side effects. Some of the effects of hormone treatment are reversible when a person stops receiving hormone therapy; other effects are not.

Hormones impact the body by:

  • Estrogen for MTFs
    • Softening the skin
    • Redistributing body fat to a more feminine appearance
    • Reducing some body hair
    • Altering moods
  • Testosterone for FTMs
    • Lowering the voice
    • Causing the growth of body and facial hair
    • Redistributing body fat to a more masculine appearance
    • Causing the menstrual cycle to end

Hormones can have an impact on some people’s emotional states. Many people report feeling more at peace after they begin hormone treatments, but hormones may also cause other fluctuations in mood. For many transgender people, there is no discernible difference in moods after beginning hormone treatments.

Some people and their doctors decide to pursue a full dose of hormones while others choose to go on a lower dose regimen or not take hormones at all for personal or medical reasons. Hormone therapy is covered by some medical insurance.

Some transsexuals have surgery to change their appearance. There is no single “sex change surgery.” There are a variety of surgeries that people can have, including:

  • Genital reconstructive surgery, to create a penis and testes or clitoris, labia and vagina
  • Facial reconstruction surgery, to create a more masculine or feminine appearance
  • Breast removal or augmentation
  • For FTMs, surgery to remove the ovaries and uterus
  • For MTFs, surgery to reduce the Adam’s apple or change the thorax.

Surgery is often excluded from health insurance plans in the United States. At NCTE, we believe that the decisions about appropriate medical procedures should be made by people and their health care providers, not by insurance companies or government bodies.

Whether someone has had surgery should not make a difference in how they are treated.

In addition to the medical procedures, transsexual people often follow a series of legal steps to change their name and gender markers. The process may vary in each state. Some of the things that may need to be changed are:

  • Legal name and/or gender change (done through the courts)
  • Driver’s license
  • Social Security Account
  • Passport
  • Bank accounts and records
  • Credit cards
  • Paychecks and other job-related documents
  • Leases
  • Medical records
  • Birth certificate
  • Academic records

Different states have different procedures for changing driver’s license and state IDs. If you know the procedure for your state and confirm that you are still correct before the presentation, you might share that with the audience.


People decide to transition from one gender to another because they are seeking a sense of well-being and wholeness in their lives. They feel that they will have a better quality of life as a result of this change. For some people, gender transition is the only effective therapeutic treatment for real, disabling distress.


Some people feel that their lives would not be improved by transitioning and so decide not to. Others are unwilling to risk losing their family, job or other things that are also very important to them that would be threatened by a decision to transition. Because little is known about the long term effects of hormone therapy, some transsexuals feel that the medical risks are too high. Others have medical conditions that make it dangerous for them to take hormones or have surgery. Finally, because insurance rarely covers these treatments and so many transgender people do not have insurance or even jobs, many people are simply unable to afford the medical treatment that they need and desire.

There are a variety of reasons people don’t have surgery—because they don’t want to, because they can’t afford it, because it is not medically possible for that person, because it is not therapeutically necessary, etc.—and therefore it is not helpful to draw distinctions between “pre-op,” “post-op” and “non-op.” Not everyone will have surgery and we support the rights of individuals to determine their own path. Civil rights—such as employment non-discrimination, the ability to have accurate identity documents, etc.—should not be based on this distinction either. Remember, too, that not all transgender people are transsexual, and therefore do not want to access medical treatment to change their sex.


There are social costs to transitioning. Because discrimination is widespread, transsexuals face a great deal of prejudice. This may mean losing a job or career, including their source of income, or not being able to find a job at all. Under- and unemployment in the transgender community is many times the national average. People may have to go from well-paying stable jobs to minimum wage work, seasonal employment or unemployment. This impacts their ability to support themselves and their families. Some people are ostracized from their families, losing relationships with parents, spouses, children, siblings and others. They may be forced from their home by family members or no longer be able to pay their rent or mortgage. In addition, medical costs are high and are often not covered by insurance.


While there are many costs associated with transitioning, there is also a cost when people who desire it do not do so. They may live a lifetime in which they never feel congruence between their body and their sense of self. They may be depressed and unhappy, or even suicidal, because they are not able to dress, live or work as they are comfortable. They may not have the opportunity to fulfill their dreams or live as they wish to live. Some transgender people are able to keep their jobs, stay with their families and maintain their support networks—while enjoying their life much more fully because they have transitioned.


Crossdressers wear the clothing generally associated with the opposite gender because it gives them a sense of happiness and fulfillment. They may also wish to express more than one aspect of their personalities—both a sense of masculinity and a sense of femininity—that are part of them. Crossdressers, drag queens and drag kings like to change their appearance at times while generally identifying with the gender they were assigned at birth. People used to believe that crossdressing was a purely sexual fetish. Now, however, we know that for most people it is much more complex than that. While crossdressers may find it sexually appealing and gratifying, they may also experience emotional and psychological fulfillment from it. It is one way that people may express who they are.


Gender identity refers to the way you understand yourself and your gender. It is about the internal sense of masculinity or femininity that a person feels. Sexual orientation is our attraction to someone else of the same or opposite gender or both. It refers to the kinds of relationships that you have with others. Transgender people can be heterosexual/straight, bisexual, homosexual/gay/lesbian or identify as queer. (Use the words that are most appropriate for your audience.) Many transgender people are in fulfilling and happy relationships. Transgender people are often included in the LGBT (lesbian, gay, bisexual and transgender) community, which is increasingly aware of the need to address issues of gender identity and expression as well as sexual orientation. This alliance is important to our movement for civil rights.


Around the country, laws, policies and attitudes are changing making life better for transgender people overall. More and more employers, for example, now have policies which ban discrimination based on gender identity; they recognize that intolerance is bad for business. In addition, 39% of people in America (as of January 2009) are covered by anti-discrimination laws that include gender identity. Transgender activists around the country and in Washington, DC, are working to pass anti-discrimination laws that provide protections for transgender people and send a message to their communities that intolerance is not acceptable. The United States should be a place where people can live free from discrimination and violence. The transgender movement is part of a long line of activism as people have worked to claim their civil rights in this country. Yet there is much work still to do. The discrimination that transgender people of color face is compounded by racism; lower income transgender people face economic challenges and classism. The work for transgender equality needs to address these critical issues as well. Trainings like this one are available to help people better understand the lives of transgender people and create new allies for our movement.

You may want to talk about local issues related to the transgender community, such as efforts to pass laws, address hate crimes and celebrate the diversity of the area. You might also talk about efforts to do sensitivity training with local law enforcement, politicians, medical personnel, etc.




You may want to ask the audience if they have other questions that they would like you to answer. You can set the limits with the audience as broadly or narrowly as you are comfortable with. Some groups are shy about asking questions and need to be encouraged while others will blurt out almost anything. Generally, it is useful to let people ask anything they want to, but only answer what you know and what you feel comfortable sharing. It can be helpful to say something like, “Feel free to ask me any questions you’d like. If I’m not comfortable answering something, I’ll let you know that and direct you to someplace where you can find that out.”

If people ask you questions that you don’t know the answers to, ask for their contact information and get back to them or the group later. If people ask personal questions that you aren’t comfortable answering, give them general information about the topic. If you anticipate that your audience may be very hesitant to ask questions, there are two things you can do ahead of time. Pass out index cards and pens as people arrive. Have them write their questions on the cards. Then, during the question and answer time, read the cards and address any issues that haven’t been covered in your presentation. Arrange with someone who is a leader in the group to ask the first question. For example, if you are doing a training for a police department, the captain or another authority figure can ask a question that makes it clear to the officers present that their leaders are engaged in the training and seeking more information. If you think this will be helpful, discuss it ahead of time with the person who is setting up the training.


Here are some ideas for how to respond to difficult questions:

If someone asks a question that feels too personal, you can say so. For example, if someone asks if you are in a relationship and you are currently ending one and don’t wish to discuss it with the audience, you could say any of the following:

  • “I’m in the process of getting a divorce. Leaving this relationship has been very painful for me and it’s not something I’m comfortable discussing with the group. Does anyone have another question?”
  • “I’m not really comfortable discussing my relationships today, but what I can tell you is that transgender people have a variety of loving relationships. My friend Joan is in a great relationship with … etc.”
  • “I’d rather talk more generally about relationships. There was a recent article in People magazine that talked about a married couple who stayed together after one of them transitioned and …”

If you are asked a question about your genitals or surgical status, we recommend that you answer discreetly and non-specifically for most audiences. Keep in mind:

  • People are generally not asking about you as much as they are expressing curiosity about the topic. Direct the focus on the general information and away from you personally. If the person is genuinely curious, be careful not to shame them for asking the question; affirm their positive curiosity while maintaining your boundaries.
  • If you discuss your genitals with your audience, they will likely see you in a sexual context. In most cases, unless you are dealing with a specific group such as sex educators or medical providers who are seeking information about surgical procedures, that may undermine your authority with your audience. We recommend you keep your answers general—not because we think the conversation is off limits, but so that you continue to be treated with dignity and safety.
  • Even if you are comfortable discussing your surgery or genitals, remember that your audience may not be. Some of the various cultures that make up our country are uncomfortable with discussions of the body and sexuality so it is usually better to give people general information, rather than specific information. You can point people to other sources of information for those who want it. Books and web pages are good resources.
  • Remind people that not every transgender person has or wishes to have surgery and that drawing the distinction between pre-operative and post-operative is not helpful. It is really only relevant to people that we are intimate with or in certain medical situations. You might say something like, “I don’t talk about my genitals/surgery in public because that can be inappropriate. But you’ve asked an important question about something many people are curious about. If you’d like to see specific examples of transsexual surgeries, there are many on the internet. You could also look at a book like Body Alchemy, by Loren Cameron, which has a number of photos. I can give you the information about it after the class if you’d like.”

If someone asks a religious question, they may be asking in a positive or negative way. Don’t feel you have to get into a religious debate; simply state your truth. Some suggestions:

  • If you are a person of faith, you can briefly share your perspective. For example, “I believe that God loves everyone and I’ve been very blessed by God’s presence with me on this journey.” You can offer to discuss specific points of your doctrine or scriptures with them afterwards.
  • If you are not a person of faith, you may want to direct the person to someone who is who can answer their questions. This might be someone from a friendly community of faith.
  • Don’t engage in religious debate. The majority of your audience is probably not interested, so don’t let one person set the direction for everyone else. Some of them may be uncomfortable with a religious conversation. If someone persists, you can say something like, “Well, it seems that you have your beliefs and I have mine. One of the great things about our country is that we have freedom of religion and we can each believe different things. Let’s take another question …” and then call on someone else.
  • If someone says, “I believe that it’s a sin to crossdress” or a similar statement, you can simply say something like, “Well, I don’t believe that” and move on.

If you are asked about the presence of transgender sex workers in your community, keep the following in mind:

  • Do not put down people who are sex workers. The fact is that some members of our community use sex work as a means of economic survival or because they choose to do so. They are also part of our community.
  • Remind your audience:
    • Both transgender and non-transgender people do sex work.
    • The transgender community faces epidemic levels of unemployment and underemployment, making sex work necessary for some people’s survival.
    • There are a variety of attitudes about whether sex work should be legal or is moral … you simply don’t have time in this workshop to go into that so re-focus the conversation.

In addition to answering your audience’s questions, you may want to ask some as well.



This can help the group personalize the issue and think about how these issues might impact them. It is helpful to ask the questions about the specific place you are speaking. For example, you could say something like, “Let’s talk about the experiences of transgender people here at the University” or “at this synagogue.” The more concrete people can be in their answers, the more useful the conversation will be in helping them address the situation of transgender people in their midst.

Some questions you might want to ask are:

  • What are some of the challenges that people who are gender different face in this group?
  • What are some barriers that you see to transgender people participating here?
  • Sometimes audiences don’t perceive barriers in their group, so you can ask what barriers people might face in other groups.

Some answers could include:

  • Fear and unfamiliarity
  • Language issues (the organization says “LGBT” but doesn’t mean it)
  • No gender neutral bathrooms
  • Gender specific programming that excludes transgender people or is not clear about transgender inclusion
  • Pathologizing transgender people or labeling them as sinful, sick etc.
  • Clear hostility towards transgender people
  • Transgender people’s fears of all of the above
  • What are some ways in which your group is welcoming for transgender people?
  • What are some things you could do to make this space more welcoming?

Some answers could be:

  • Be a safe place in general
  • Have non-discrimination policies
  • Have safe bathrooms and locker rooms
  • Use appropriate and inclusive language (lgbT)
  • Visibility
  • Hold events like the Day of Remembrance or Day of Silence
  • Having discussions like this




End the training by thanking the participants for their time and attention. Pass out evaluation forms and your contact information, including business cards, if you have them. After the session, be sure to thank the person who made the arrangements for the training. You may want to stick around for a little while afterwards to answer any questions that people may have that they didn’t have time to ask during the training or were uncomfortable asking in front of the whole group.


When the training is done, it may be helpful to sit down afterwards—alone or with the others who helped you with the training—and think through what worked well and what you might do differently the next time. This gives you an opportunity to affirm the positive and think through a good solution to any problems you encountered. Evaluating the session is an important way to improve your skills as a presenter. We hope that it was a great experience for you and for your audience!



You may be asked to speak to a group that needs information about a very specialized area of knowledge. Below are some pointers to help you in speaking with these groups. It can be helpful to get someone who has a background or expertise in that area; for example, having a physician speak to a group of medical personnel.


You may be speaking to law enforcement personnel as part of ongoing diversity training or in response to an incident in the community. Make sure that you know exactly how long you’ll have to present the information. If you are speaking at roll call (generally the beginning of the shift) you may only have a very short period of time to present (even as short as 5-10 minutes), so be sure to make your most important points up front. Law enforcement personnel generally want just the information that relates to them as they do their jobs. Their focus is pragmatic. Typically, they will be more interested in how to deal with arrests than they will be in your personal story. They want concrete information, rather than gender theory. Handouts, with key points in bulleted lists, can be well received.

Some important points to make when dealing with law enforcement:

  • Being transgender is not a crime. It is legal to crossdress, to transition, and to not be clearly male or female.
  • Transgender people are disproportionately affected by hate crimes. Police officers and other law enforcement personnel can play an important role in maintaining community safety.
  • It is very important to treat people with respect, including using the correct pronouns and names. You can model ways to politely ask how a person would prefer to be addressed, for example, “Would you prefer to be listed in my report as Ms. Smith or Mr. Smith?” or “Are you more comfortable with male or female pronouns?”
  • It is not appropriate or accurate to assume that all transgender people are sex workers. Transgender people should not be detained just to see if they are sex workers.
  • Transgender people should not be asked about their surgical or genital status unless it is absolutely necessary in order to:
    • accurately complete a report of the crime; for example, if the person was sexually assaulted
    • provide medical care because of injury or illness
    • allow a booking officer to determine housing
  • If a transgender person has been arrested, safety should be the number one priority in determining placement. Transgender people may be targeted for sexual assault and bias-motivated violence.
  • Transgender women are not a risk for other female prisoners. There is no reason to think that a transgender women, whether or not she has had any surgery, is any more risk to women than any other woman.
  • Transgender people may be fearful or untrusting of law enforcement personnel because of past experiences or community perception. This can be overcome when people are treated fairly and respectfully.

Before your presentation, make sure that you have accurate and up to date information about the laws relating to transgender people in your jurisdiction.


When dealing with medical personnel, it is very useful to have someone who has a medical background with you. Again, be sure you know how long you have to present. Some facilities have very brief training programs during staff meetings; others set aside longer periods of time.

Some important points to make with medical personnel:

  • Transgender people need the same kinds of medical care as everyone else.
  • Specific expertise around transgender issues is not required to treat patients with unrelated problems. For example, if a patient presents with a fever and cough, treat that illness as you would with other patients.
  • Specialists, such as endocrinologists, are available to deal with specific areas related to transgender care.
  • It is very important to treat people with respect, including using the correct pronouns and names. Model ways to politely ask how a person would prefer to be addressed, for example, “Would you prefer to be listed in your chart as Ms. Garcia or Mr. Garcia?” or “Are you more comfortable with male or female pronouns?”
  • There may be a difference between how the patient wishes to be addressed in the office and the name on their insurance card or other ID.
  • Be careful to maintain the privacy of transgender patients by using correct pronouns and names. For example, calling someone who is visibly male, “Ms. Veronica Jones,” in the waiting room alerts other patients that something is different and draws unwanted attention. You might simply use the patient’s last name.
  • Transgender people are disproportionately affected by hate crimes. If you are treating someone for trauma, it is helpful to be sensitive to this possibility.
  • Transgender people should not be asked about their surgical or genital status nor should genitals be examined unless all of the following are true:
    • The information and exam are medically necessary because of injury or illness
    • It is necessary for appropriate health screening
    • The provider is sensitive and recognizes that the experience may be difficult for the patient.
  • Transgender people often avoid routine health care because of their discomfort with medical personnel.
  • Transgender people may be fearful or distrustful of medical personnel because of past experiences or community perception. This can be overcome when people are treated fairly and respectfully.
  • Recognize that transition-related care may not be covered by health insurance.
  • Be prepared to discuss options with the patient and to serve as a patient advocate when needed. Sometimes insurance companies will deny medically necessary procedures for transgender patients (such as pap smears for transgender men); you may be called upon to provide additional documentation for care that is normally considered routine.



These organizations have more information about transgender rights:

GLAAD promotes fair, accurate and inclusive media representation of LGBT people and events.
Los Angeles: 323-933-2240
New York: 212-629-3322

Advocates for Informed Choice

Lambda Legal
Lambda Legal works on litigation and public education on behalf of lesbian, gay, bisexual and transgender people and people with HIV/AIDS
New York headquarters: 212-809-8585

National LGBTQ Task Force
The Task Force is a national progressive organization working for the civil rights of gay, lesbian, bisexual and transgender people.

Transgender Law Center
The Transgender Law Center provides legal services, as well as advocacy, for the transgender community.

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