Affirming Gender

Affirming Lives
A Report of the 2011
Transition Survey

Colin Close
July 2012

Affirming Gender, Affirming Lives

A Report of the 2011 Transition Survey

Colin Close
July 2012

About the Author

Acknowledgements

ColinClosecofoundedFTMSonomaCountyin2004and

Firstandforemost,aheartfeltthankyouisofferedtoallof

servedasDirectorforsixyears.FTMSC(www.FTMSC.org)

thestudyparticipants.Bysharingyourdeeplypersonal

isanallvolunteernetworkfortransmen,transmasculine

experiences,youhavemadeitpossibletocompileaunique

people,andtheirlovedones.Colinisalsoapassionate

andpowerfulbodyofknowledgeabouttheimpactsofusing

advocatewhospeakswithdozensofcollegeclasses,civic

medicaltechnologytoaffirmgenderidentity.Thankyou.

groups,andfaithbasedorganizationseachyeartoraise
awarenessandunderstandingaboutgenderdiversity.

Beforethesurveywasdistributed,anumberofindividuals
contributedtoitssuccess.InputfrommembersofFTM

AsthesoleproprietorofGATE(GenderAdvocacyTraining

SonomaCountyimprovedthewordingofsomequestions.

&Education),heprovidesconsultingservices,technical

Inaddition,LeslieHansen,M.F.T.,providedenthusiastic

assistance,andtrainingformedicalandmentalhealthcare

encouragementandhelpedtorefinethesectionsrelatingto

providers,governmentagencies,nonprofits,socialservice

emotionalprocessingandsexuality.AmyMooresuggested

organizations,educationalinstitutions,andbusinessesthat

muchneededimprovementstothestructureofthesurvey.

areseekingtobetterservetransgenderandgender

NickLawrence,M.A.,offeredavoteofconfidenceand

nonconformingemployees,patients,students,andclients.
Bydayheworksasacivilservant,managingenvironmental
projectsforacityinNorthernCaliforniaandservingonthat
agencysInclusionCouncilanddiversitytrainingteam.

technicaladvicefordataanalysisandtheformulationof
findings.Thereadabilityandsensibilityofthisreport
benefitedfromthesharpmindandwarmgenerosityof
MeredithGuest,M.Div.

Colinisalsopursuingamastersdegreeinhistoryfocused

Allofthesecontributionswereinvaluable.However,it

onearlytwentiethcenturyideasaboutgenderintheU.S.He

shouldbenotedthatanyshortcomingsorerrorsthatmay

canbereachedbyemailatCloseConnections@yahoo.com.

existinthesurveytool,dataanalysis,orthisreportarethe
soleresponsibilityoftheauthor.

RECOMMENDED CITATION

Close,Colin,AffirmingGender,AffirmingLives:AReport
ofthe2011TransitionSurvey.SantaRosa,CA:GATE,2012.

2012ColinClose
Permissionisgrantedtoreproduceanddistributethis
publicationinwholeorinpart,providedthatitisdoneso
withattribution.Furtherwrittenpermissionisnotrequired.

Table of Contents

ExecutiveSummary..

Introduction

Methodology..

Participants.

Sexandgender......

Demographicprofile

Statusofmedicaltransition.....

11

Findings......

14

Genderdysphoria.

14

Qualityoflife.....

17

Personalitytraitsassociatedwithhappinessandlifesatisfaction.

19

Emotionalstability....

21

Satisfactionandregrets....

23

Emotionalawarenessandexpression

24

Experiencingbasicemotions..

28

Emotionsincloserelationships..

30

Preferenceforsharingemotionsversustakingaction

31

Sexuality.

33

Conclusion..

37

AppendixAGlossary....

39

AppendixBSurveyInstrument...

41

Executive Summary
The2011TransitionSurveyReportexaminestheimpactsofmedicallyassistedtransition(theprocessofchangingonesoutward
genderpresentationwithhormonesand/orsurgerytobetteralignwithonesgenderidentity)onthelivesof448transgender
people.Thestudywasconductedinanefforttobridgeagap,aspreviouslynolargescalestudieshadbeenconductedtoassess
howmedicallyassistedtransitionaffectsgenderdysphoria(feelingamismatchbetweenanatomicalsexandgenderidentity),
qualityoflife,emotionalwellbeing,andsexuality.Thesurveysampleincludesadiversegroupofpeoplewhoidentified
themselvesasmen,women,oranonbinarygender(somethingotherthanexclusivelymanorwoman).Bysharingtheirdeeply
personalexperiences,theymadeitpossibletodocumentmanyofthewaystransitionhasaffectedtheirlives.

KEY FINDINGS

PERSONALITY TRAITS

Mostparticipantsreportedthatmedicallyassistedtransition
resultedinlessgenderdysphoria,betterqualityoflife,and

Morethantwothirdsofparticipantsreportedimprovements

moreemotionalwellbeing.Timeonhormonesandgenital

infourpersonalitytraitsassociatedwithhappinessandlife

surgeryappearedtohavepositiveimpactsonparticipants.

satisfaction.Women,participantswithmorethanfiveyears

GENDER DYSPHORIA

genitalsurgeryweremorelikelytoreportimprovements.

onhormones,andthosewhohavestartedorcompleted

Almostallparticipantsreportedfeelinglessgender

Personality traits associated with

happiness and life satisfaction

dysphoriathanbeforetheytransitioned.Rateswerehigher

Better

formen,participantsonhormonesformorethanfiveyears,

Overall gender dysphoria

89%

8% 3%

93%

6% 2%

All participatnts

No change

91%

5% 4%

Men

Less

97%

2% 1%

> 5 yrs on
hormones

QUALITY OF LIFE
Almostallparticipantsreportedimprovementsintheir

Agreeableness

qualityoflifecomparedtobeforetheytransitioned.Men,
participantsonhormonesformorethanfiveyears,andthose
whostartedorcompletedgenitalsurgeryweremorelikely
toreportimprovements.
Overall quality of life

2% 4%
All participatnts

No change
96%

1% 3%
Men

Better
96%

1% 3%
> 5 yrs on
hormones

96%

Being
conscientious

Worse
94%

2% 2%
Genital surgery

No change

Worse

All

84%

14%

2%

>5 yrs

83%

15%

2%

GS

86%

11%

3%

Women

88%

All

Genital surgery

Social
involvement

More

Openness
to experience

andthosewhohadstartedorcompletedgenitalsurgery.

75%

10%
18%

2%
7%

>5 yrs

78%

16%

6%

GS

80%

14%

6%

Women

81%

16%

3%

All

72%

24%

5%

>5 yrs

74%

21%

5%

GS
Women

84%
77%

14%
23%

2%
0%

All

68%

29%

3%

>5 yrs

65%

34%

1%

GS
Women

70%
74%

30%
24%

0%
1%


EMOTIONAL STABILITY

SATISFACTION

Mostparticipantsreportedfeelingmoreemotionallystable

Nearlyallparticipantsreportedfeelingsatisfiedwiththe

aftertransition.Additionally,abouttwothirdsreported

stepstheytooktotransition.

feelinglessdepression,anxiety,andexcessiveanger.Men,

Satisfaction

participantsonhormonesformorethanfiveyears,andthose

Satisfied

whohadstartedorcompletedgenitalsurgeryweremore
likelytoreportimprovementsinemotionalstability.

No change

Emotional
stability

ALL
GRS

84%

> 5 yrs

Tendency to
feel depressed

12%

85%

Men
ALL

11%

12%

86%
70%

12%
19%

2%
96%

Hormone therapy
(n=441)

2%
1%

97%

2%

4%

Chest surgery
(n=264)

96%

4%

4%

Genital surgery
(n=97)

3%

Hysterectomy
(n=144)

3%

Electrolysis
(n=79)

11%

Facial feminization
surgery (n=18)

100%

Trachea shave
(n=14)

100%

Worse

85%

Dissatisfied

Overall transition
(n=444)

Emotional stability

Better

Neutral

GRS

78%

13%

9%

> 5 yrs

75%

18%

8%

Men

74%

18%

8%

3%
7%

90%

4%
96%
5%
90%

5%

REGRETS
Almostallparticipantshadnoregretsorwouldrepeatthe

Tendency to
feel anxious

ALL
GRS
> 5 yrs

73%
63%

21%
16%
23%

16%

stepstheytooktotransitioneveniftheresultswerenot
perfect.

11%
14%

I have no regrets.

Regrets

The results aren't perfect, but I'd do the same thing again
Men

Tendency to
feel excessive anger

63%

ALL
GRS
> 5 yrs
Men

67%
59%
69%
65%
57%

20%
26%
20%
20%
28%

13%

I would do this step again, but I'd do it differently.

15%

I wish I could undo this step. I would NOT do it again.

2%

Hormone
therapy (n=442)

10%
15%

Chest
surgery (n=265)

15%

Genital
surgery (n=97)
Hysterectomy
(n=146)

Electrolysis
(n=80)
Facial feminization
surgery (n=19)
Tracheal
shave (n=14)

88%
69%
60%

9%
22% 9%
25%

15%
2% 5%

92%

1%
3%

75%
68%

20%

3%

16% 16%
7%

79%

14%


EMOTIONAL AWARENESS AND EXPRESSION

EXPERIENCING BASIC EMOTIONS

Manyparticipantsreportedincreasedemotionalawareness

Themajorityofparticipantsreportedfeelingmorejoy,hope,

andexpressioncomparedtobeforetransition.Women,

loveandsafety,andlesssadness,despair,anger,andfear

participantswithmorethantenyearsofhormonetherapy,

aftertheytransitioned.Womenweremorelikelytoreport

andthosewhostartedorcompletedgenitalsurgerywere

increasesinjoy,hope,andlove,whilemenweremorelikely

morelikelytoreportimprovements.Resultsforfourofthe

toreportanincreaseinsafety.Participantswhohadstarted

eightquestionsposedtoparticipantsareshownbelow.

orcompletedgenitalsurgerywerealsomorelikelythan
otherparticipantstoreportfeelingmorejoy,hope,love,and

How has transition affected

safetyandlessdespair,sadness,anger,andfear.

Frequency of noticing your emotions?

23%

47%

>10 yrs

16%

53%

GS

14%

55%

Women

Decrease

Hope

ALL

Experiencing basic emotions

Increase

1%

Despair

Decrease

85%

Ease of accessing your emotions?

>10 yrs

15%

GS

19%

Women

GS
Women

7%

GS

15%
1%

20%
10%

72%

59%

All

88%

Women
GS

Love

50%

59%

14%
6%

Women
GS
All

50%
62%

86%

MEN
GS

83%

3%
52%
67%

76%
18%
13%
20%

61%
19%

MEN

All

57%

69%

2%

GS

83%

21%

73%

Women

All

80%

14%

62%

All

Fear

18%

58%

89%

GS

>10 yrs

Women

GS

12%

4%

Safety

23%

Women

63%

GS

Ability to express your emotions?

ALL

All

82%

61%

56%

1%

4%

90%

62%

9%

GS

86%

3%

Anger

>10 yrs

5%

Women

0%

16%

Women

77%

4%

Ability to identify your emotions?

ALL

4%

All

48%

Joy

26%

Sadness

ALL

All

Increase

62%
68%

12%
17%
52%
55%
62%

68%
18%
12%
15%


SEXUALITY

EMOTIONS IN CLOSE RELATIONSHIPS

Womenwereaboutthreetimesmorelikelythanmento

About70%ofparticipantsreportedexperiencinglessgender

reportincreasesintalkingaboutemotionswithaclosefriend

dysphoria(feelingamismatchbetweenanatomicalsexand

orintimatepartneraftertransition.Aboutonethirdofmen

genderidentity)duringsexandindicatedthattheirsexlives

reporteddecreases,whileveryfewwomendidso(only3%

werebettercomparedtobeforetransition.Whenaskedmore

inonescenario).Ratingsbynonbinarygender(NBG)

detailedquestionsabouthowtransitionhadimpactedtheir

participantstendedtofallinbetweenthoseofmenand

sexuality,menandwomenreportedverydifferent

women.Timeonhormonesandstatusofgenitalsurgerydid

experiences.

notappeartohaveanimpact.
Almostnineoutoftenmensaidthattheirsexdrive
increasedandindicatedthattheyhadsexualthoughtsmore
frequentlycomparedtobeforetransition.Conversely,more

PREFERENCE FOR SHARING EMOTIONS AND

TAKING ACTION

thansevenoutoftenwomenindicatedthattheirsexdrive
decreasedandnearlytwothirdsreportedthattheyhad
sexualthoughtslessfrequentlycomparedtobefore

Beforetransition,NBGparticipantsweremorelikelyto

transition.

prefersharingemotions,followedcloselybymen,while
womenwereleastlikelytoprefersharingemotionsinmost

Sixoutoftenmensaidthatsexbecamemoreimportantin

scenariosposed.Aftertransition,womenweretwotothree

theirintimaterelationshipsaftertransition,whileonly6%

timesmorelikelythanmenandNBGparticipantstoprefer

saidthatsexbecamelessimportant.Whileabout20%of

sharingemotions.Conversely,menwereatleastfivetimes

womenagreedthatsexbecamemoreimportantafter

morelikelythanwomenand50%morelikelythanNBG

transition,almosthalfindicateditbecamelessimportant.

participantstoprefertakingactionaftertransition.Timeon
hormonesandstatusofgenitalsurgerydidnotappearto

Aminorityofparticipantsreportedthattheirsexual

impactpreferencesforsharingemotionsortakingaction.

orientationchangedaftertransition.Theoverallrateof
attractiononlytowomenorfemininepeoplefellbyabout

To feel supported when I'm upset or

distressed
Prefer sharing emotions

onethird,whiletherateofattractiontomenormasculine
peopleincreasedbyhalf.Attractiontobothmasculineand

Prefer taking action

femininegendersandattractiontoanyormultiplegenders

Men

45%

Nonbinary

40%

Women

24%

Men

27%

Nonbinary

Women

43%

81%

26%

Sexual orientation (n=400)

Before transition

24%
Men or
masculine gender

34%
Attracted to

Today (n=384)

Before
transition (n=383)

roughlydoubled.Asexualitydecreasedbyonequarter.

49%

34%

6%

Women or
feminine gender

12%

67%

41%

Both masc. and

fem. genders

9%

Any or multiple
genders

12%

Asexual
(not attracted)

8%

Today

4%

16%

28%
3%

Affirming Gender, Affirming Lives

A Report of the 2011 Transition Survey

Introduction

mysexualorientation,andmutilatemybody.Dependingon

Inrecentyears,aseriesofexcellentstudieshave
documentedthediscriminationandbiasfacingmany

whichsourceIconsidered,theoutcomesofhormonesand

transgenderpeopleintheirdailylives.Inaddition,

surgerylookedtobeeitherexhilaratingorterrifying.

numerouscasestudiespublishedinmedicaljournalshave
Ihadnowaytoeffectivelysortfactfromfiction.Soafterthe

providedimportantinsightaboutwhetherindividualsfeel

excruciatingprocessofweighingworstcasescenarios

satisfactionorregretfollowinggenitalsurgery.

againstmycurrentconditionanddesiredoutcomes,I
However,itappearsthatnolargescalestudieshavebeen

decidedtotakealeapoffaithandriskeverythinginthe

conductedtoassesstheoverallimpactsofmedicallyassisted

hopesofcreatingamorelivablelife.ImgladIdid.Itwas

transition(theprocessofchangingonesoutwardgender

therightpathforme,andaveryrewardingone.Noneofthe

presentationwithhormonesand/orsurgerytobetteralign

doomsdayscenarioscametrue,andIhaveneverregretted

withonesgenderidentity).Nobodyofdataexiststo

mychoicesotherthanwishingIdbeenabletotransition

confirmorcorrectcommonassumptionsabouthow

muchearlierinmylife.

medicallyassistedgenderaffirmationchangesthelivesof
transgenderpeople.

Lookingbackonthatdifficultperiodofmylife,Icanvividly

The2011TransitionSurveywasundertakeninaneffortto

knowfromyearsoffacilitatingsupportgroups,social

bridgethatgap.Thisstudywasnotdoneinpursuitofa

networks,andonlineforumsthatpeopleconsidering

recalltheuncertaintyandfearIfeltbeforetransition.Ialso

graduatedegree,anditwasconductedwithoutfinancial

whethertransitionisrightforthemcontinuetoface

assistanceorstaffsupportfromanyorganization.Forbetter

uncertaintyandadearthofreliabledataabouthow

orworse,Ididthisprojectonmyownfromdeveloping

transitionaffectslives.

anddistributingthesurvey,tocollectingandanalyzingthe
In2011itoccurredtomethatacommunitysurveywas

data,toidentifyingandpresentingthefindings.

needed.Ibelievedthatsuchastudywouldbeveryhelpful,
Itsoundsonerous,butinfactitwasalaboroflove.Iwanted

butIalsoknewthatitwasariskyundertaking.Thefindings

tocreatesomethingthatIwishedhadbeenavailable10

couldconfirmortheycouldcountermyownassumptions

yearsagowhenIwasconsideringwhethertoundergoa

abouthowtransitionaffectedpeople.Aftersomecareful,

transitionfromfemaletomale.Atthattime,Isearched

thoughtIrealizedthatthefindingswouldbevaluableeither

voraciouslyforsoundinformationabouttheimpactsof

waybecausetheywouldbebasedonreputabledata

transitiononemotionallife,personalitytraits,andsexuality.

collectionandanalysisratherthanonallegory,urban

IwastheonlytransgenderpersonIknew,andIfoundit

legend,ortransphobicbias.Thus,thisprojectwasborn.

incrediblydifficulttosortthroughtheresultsofonline
Althoughittooknearlyayeartodevelopthesurvey,launch

searchesandfriendlyadvicefrompeoplearoundme.

it,cleanandanalyzethedata,andwritethisreport,itwas
FromwhatIcouldgather,transitionwouldeithermakemy

wortheveryminute.Inlargepart,thisisbecauseIhavebeen

lifetrulylivableoritwouldfillmewithtestosterone

movedrepeatedlybytheparticipantsbravery,honesty,and

drivenrage,convertmefrombeingafeministtobeinga

integrity.Theirresponsestothisstudyhavebeenonethe

chauvinist,altermypersonalityinunwelcomeways,change

greatestgiftsIvereceivedinmylifetime.

Methodology

advantages,eventhoughtheyinadvertentlyexcludethose

THE SURVEY INSTRUMENT

tobewidelydispersedratherthangeographically

Itmaybeworthnotingthatonlinestudiesofferdistinct
withoutinternetaccess.Thetransgendercommunitytends
concentrated.Withouttheinternet,itwouldhavebeenfar

Thisprojectwasdesignedasacommunitystudy,notasa

morechallengingandresourceintensivetofindandengage

formalresearchproject.Aftertheoriginalsurveyinstrument

participantsinalargescalestudy.Theexistenceof

wasdeveloped,itwasrevisedwithinputfromthe

populationspecificandtopicdrivencybernetworksprovide

communityandfromprofessionalswithexperiencein

avenuesofquickandinexpensivecommunication,reaching

mentalhealth,socialscienceresearch,anddataanalysis.

peoplewhomightotherwisebedifficulttolocate.Infact,the

Thesurveyinstrumentincludes20questions,with10

anonymityofusinganonlinesurveymayfacilitate

focusedondemographicdetailsand10focusedonthe

participationbythosetransgenderpeoplewholiveinvery

impactsoftransition.Elevenquestionswerecompound

remoteareasandthosewhoarestealth(thosewhodonot

(askedrespondentstorateorassessmultiplesubparts)and

disclosetoothersthesextheywereassignedatbirth).

nineaskedonlyonequestion.Intotal,participantswere

Inaddition,onlinesurveyplatformscircumventmanyofthe

askedtoprovide111responsesandofferedtheopportunity

timeconsumingandexpensiveprocessesassociatedwith

toaddcommentsto15ofthequestions.

papersurveys(photocopying,distribution,collection,and

TARGET POPULATION

dataentry)andfacetofaceinterviews(scheduling,
traveling,meeting,anddataentry).

Thetargetpopulationincludedtransgenderpeoplewho

DATA CLEANING

haveundergoneorareundergoingtransition.Forthe
purposesofthisstudy,transgenderwasdefinedasnot

Over600peopleansweredoneormoresurveyquestions.

identifyingexclusivelyasthesexassignedatbirthand

Beforeanalyzingtheresponses,thedatasetwasfiltered

transitionwasdefinedastheuseofhormonesand/orsurgery

usingthreecriteria.Intotal,448questionnairesmetthese

toaffirmgenderidentity.Thesedefinitionsseektoallowfor

criteriaandareincludedinthefinaldataset.

nonbinarygenderidentities(i.e.genderidentitiesotherthan
exclusivelymanorwoman)andfordifferingapproachesto

1.

Doesgenderidentitydifferfromassignedsex?

medicaltransition.

2.

Havehormonesand/orsurgerybeenused?

SURVEY DISTRIBUTION

3.

Isthesurveycompletethroughquestion9?(60%of
survey)

Thesurveywasconductedentirelyonlinefromearly

Openendedanswerswereexaminedtoidentifythosethat

SeptemberthroughlateNovember2011using

couldbeplacedintolistedanswerchoices.Forexample,

SurveyMonkey,awebbasedsurveyplatform.An

question3askedWhichofthefollowingbestmatchesyour

announcementwasdistributedbyemailtotransgender

genderidentity?andprovidedthesechoices:man,woman,

individualsandallies,supportgroups,socialnetworks,list

bothmanandwoman,neither,twospirit,thirdgender,

serves,andnonprofitorganizations.Itwasalsopostedona

genderqueer,andThetermIuseis_____accompaniedby

varietyofonlinetransrelateddiscussiongroups,support

atextboxforparticipantstodescribetheirgenderidentityin

groups,bulletinboards,andtheFTMSonomaCounty

theirownwords.Thosewhotypedinanswerssuchastrans

website(www.ftmsc.org).

manormalewerecodedasman,whilethosewho
wroteanswersliketranswomanorfemalewerecoded

Theannouncementincludedabriefexplanationofthe

aswoman.Thosewhoindicatedatermoutsidethebinary

survey,contactinformation,alinktotheonlinesurvey,and

ofmanorwoman(i.e.thosewhoselectedalistedchoice

arequestthatrecipientsforwardtheannouncementtoother

likegenderqueerorwroteinsomethinglikehybrid)

individuals,organizations,andgroupsthatmightfindthe

wereclassifiedashavinganonbinarygender(NBG).

surveyofinterest.
6

DATA ANALYSIS

LIMITATIONS

Thedatawasanalyzedtodeterminethepercentof

Duetotimeandfiscalconstraints,thesurveywasavailable

respondentswhoselectedeachchoiceforeachquestion.

onlyonlineandinEnglish.Unfortunately,thisexcluded

Percentswereroundedtothenearestwholepercent(e.g.

peoplelackinginternetaccessorEnglishproficiencyskills.

5.9%appearsas6%),resultinginsmalldiscrepanciesin

Asthesurveydidnotundergoauniversitybased

someinstances(i.e.atotalof99%or101%insteadof100%).

InstitutionalReviewBoardprocess,theresultsarenot
eligibleforpublicationinpeerreviewedacademicor

Somerespondentsskippedquestionsorportionsof

researchjournals.

compoundquestions.Therefore,theresultsweretabulated
basedontheactualnumberofresponses.Forexample,if400

Thesurveysamplewasnotrandomlyselected,anditisnot

peoplerespondedtoagivenquestion,thereportindicates

appropriatetogeneralizethefindingstoalltransgender
people.Atthistimeitisimpossibletogenerateatruly

thisnumberas(n=400).

randomsampleoftransgenderpeopleaslargescaleand
Insomecases,dataanalysiswasfurtherlimitedtothose

nationalpopulationresearchstudiesbygovernment

respondentsforwhomthequestionwasapplicable.For

agencieshavenotincludedquestionsontransgender

example,question5askedparticipantstoindicatehowlong

identitytodate.

ithadbeensincetheystartedorcompletedvariousstepsof

Differencesbetweensubsetsofthedataandbetweenthe

transition,andquestion8askedwhethertheyweresatisfied

surveysampleandgeneralpopulationarenotedinthis

withtheresults.Ifarespondentindicatedinquestion5that

report.However,testingwasnotconductedtoestablishthe

theyhadnottakenaspecificstepbutprovidedasatisfaction

statisticalsignificanceofthesedifferences.

ratingforthatstepinquestion8,thatsatisfactionresponse
wasexcludedfromanalysis.

Thisprojectwasnotsponsoredbyanationalorganizationor
university,andthisprobablylimitedparticipation.Potential

Thedatasetwassortedbygenderidentity,yearsof

respondentsmayhavefeltunwillingtocompletethesurvey

hormonetherapy,andstatusofgenitalsurgery

orredistributeitduetotheiruncertaintyaboutwhowas

(started/completedversusnogenitalsurgery)toanalyze

conductingthestudyandhowthedatawouldbeused.

subsetsofthesample.Whenthisrevealednotable
differencesbetweengroups,theresultsarehighlighted.

Despitebestintentions,thesurveyannouncementwas

Sortingthedatabyage,householdincome,andrace

unevenlydistributedbecausetheauthorhadbetteraccessto

(comparingwhitenonHispanicparticipantswithpeopleof

andadirectpresenceinmoreonlinenetworksserving
transmasculinepeoplethanthoseservingtransfeminine

color)didnotappeartorevealsignificantdifferences.

people.Notsurprisingly,75%ofrespondentsaretrans
masculineand25%aretransfeminine.

Wheneverfeasible,verbatimquotesfromopenended
commentsareprovidedthroughoutthereportinitalics.

Finally,thewordingandstructureofsomequestionscould

GENDER CATEGORIES

havebeenimproved.Forexample,question2askedWhat

Participantswhoselectedmanastheirgenderidentityare

options(male,female,intersexmale,orintersexfemale)but

isyoursextoday,asyoudefineit?andofferedalistof

referredtoasmeninthisreport,whilethosewhoselected

didnotprovideanotheroptionwithatextboxfor

womanarereferredtoaswomen,andthosewho

participantstodescribetheirsextodayintheirownwords.

indicatedsomethingotherthanmanorwomanarereferred

Question14askedaboutsexualorientation(priorto

toasnonbinarygender(NBG)participants.

transitionandtoday),buttheansweroptionswerepoorly

Inafewareas,participantsaregroupedastransfeminine

onecategory.Ifthissurveyisrepeatedinthefuture,such

(thoseassignedmaleatbirthwhoidentifyasfemaleora

issueswouldneedtoberesolved.

wordedanddidnotallowparticipantstoselectmorethan

nonbinarygender)andtransmasculine(thoseassigned
femaleatbirthwhoidentifyasmaleoranonbinarygender).
7

Participants

SEX AND GENDER

Q1. What sex were you assinged at

birth? (n=448)

Sex assigned at birth

Respondentswereaskedwhichsextheywereassignedat
birth.Intotal,threequartersindicatedthattheywere

Female
73%

assignedfemaleatbirthandonequarterwasassignedmale
atbirth.Thisincludesthosewhowerebornintersex(4%of
allrespondents),halfofwhomwereassignedmaleatbirth

2%

Intersex
female

2%

Intersex
male

Male
23%

andhalfofwhomwereassignedfemale.

Sex today as defined by participants

Q1. What is your sex today, as you

define it? (n=433)

Respondentswereaskedhowtheydefinetheirsextoday.
Twothirdsselectedmale,3%selectedintersexmale,
morethanonequarterselectedfemale,and2%selected

Female
28%

intersexfemale.Someparticipantsfeltthatthefourlisted
choiceswerenotadequate.Asonerespondentstated,My

2%

sexisbothmaleandfemale,butnotintersex.
3%

Male
67%

Intersex
female
Intersex
male

Gender identity

Participantswereaskedtoindicatetheirgenderidentity.
Morethansixoutoftenselectedman,morethantwoout

Q3. Which term best matches your gender

identity? (n=447)

oftenselectedwoman,andmorethanoneinsixselected
anotherlistedchoice(bothmanandwoman,neither,third
gender,genderqueer,ortwospirit)orselectedThetermI

Man
62%

useis____andtypedintheirownanswer(e.g.
ambisexualoragender).

Inthisreport,thosewhoselectedmanarereferredtoas

Woman
22%

men,thosewhoselectedwomanarecalledwomen,and
thosewhoindicatedsomethingotherthanmanorwoman

3%

Two Spirit

2%

Third Gender

4%

Genderqueer

2%

Both man and woman

1%

Neither man nor woman

4%

The term I use is ...

arereferredtoasnonbinarygender(NBG)participants.


Trans, transgender, transsexual

DEMOGRAPHIC PROFILE

Participantswereaskediftheyidentifiedwiththeterms
Race / ethnicity

trans,transgender,andtranssexual.Slightlymore
thanhalfidentifiedwiththetermtrans,whilehalf

Respondentswereaskedtoindicatetheirracial/ethnic

identifiedwithtransgender,andmorethanonethird
identifiedwithtranssexual.Afewparticipants(5%)did

identitybyselectingasmanycategories(shownbelow)as

notidentifywithanyoftheseterms(8%ofmen,2%of

theydeemedappropriate.Ninetypercent(90%)of
participantsselectedonlyonecategoryand10%selectedtwo

women,and1%ofNBGparticipants).

ormore.
Q4. Do you identify as trans,
transgender, or transsexual? (n=445)
Yes or Usually
Transsexual

Fouroutoffiveparticipantsselectedwhiteonly,whileone

Sometimes or Occasionally
38%

34%

No

outoffiveselectedatleastonerace/ethnicitycategorythat
wasnotwhiteand/orwroteinananswerthatcouldnotbe

28%

categorizedwiththelistedchoices(e.g.Creole).

Transgender

50%

29%

20%

Overall,sixpercent(6%)oftheparticipantsindicatedthat
theyareofHispanic,Latino,orSpanishorigin.Mostofthem

Trans

56%

27%

16%

(twothirds)selectedatleastoneotherracechoice.Onethird
ofthosewhoindicatedthattheyareofHispanic,Latino,or

Spanishorigin(2%ofallparticipants)indicatedthisastheir

Sortingthedatabygenderidentityrevealsthatmen,

onlyrace/ethnicitychoice.

women,andNBGparticipantsrespondeddifferentlytothe

terms,asshowninthechartbelow.

Q15. What is your race/ethnicity? (n=401)

Q4. Trans, transgender, and transsexual

by gender identity (n=443)

Transgender

Transsexual

Yes or Usually
Nonbinary
Women

Sometimes or Occassionally

90%

1%

11

3%

2%

Hispanic, Latino, or Spanish origin

10

2%

Native Hawaiian or Pacific Islander

0%

Other

1%

White

321

80%

41

10%

Asian

No

Black or African American

14%

TWO OR MORE CATEGORIES

Men
Nonbinary
Women
Men

30%
32%

45%

55%

Men

52%

20%
White nonHispanic
80%

23%

2 or more
10%

17% 8%

76%

Women

Q15. What is your racial/ethnic identity?

(n=401)

17% 13%

70%
50%

32%

34%

34%

Nonbinary
Trans

35%

51%

360

American Indian or Alaska Native

32%

32%

36%

ONE CATEGORY ONLY

28%
30%

17%

1%

Amer Indian or AK Native

3%

Asian

2%

Black or African Amer

2%

Hispanic, Latino, Spanish

0%

Native HA / Pac Islander

1%

Other

18%


Age

Education

Thesurveysamplehadalargerpercentageofyoungpeople

Comparedtothegeneralpopulation,participantswere

thantheUSpopulationasawhole.1

nearlytwiceaslikelytohaveachievedabachelorsdegreeor
higher.2

Q16. How old are you? (n=401)

Survey Sample

Q18. What is your highest level of

education? (n=400)

General Population

Survey Sample

28%
20%
18%
18%

16%

62%

19%

13%

16%

17%
29%

10%
12%
3%

18-24

25-34

35-44

45-54

55-64

2%
No HS
diploma

65 and
older

Income

32%

22%

18%

5%
HS diploma
Some
or equivalent college, no
degree

11% 10%

Associates
degree

Bachelor's
degree or
higher

Place of residence

Comparedtothegeneralpopulation,participantsweretwice

MostparticipantsreportedthattheyliveintheUS

aslikelytohaveahouseholdincomelessthan$10,000per

(representing33statesandtheDistrictofColumbia).3About

yearand25%lesslikelytohaveahouseholdincomeofmore

threeoutof25respondentsindicatedthattheyliveoutside

than$100,000.2

oftheU.S.(representing16countries).4

Q17. What is your annual household

income? (n=393)

Survey Sample
23%
16%

General Population

23%

Q19. In which US state or

territory do you live? (n=380)

General Population

25%

18% 18%

18% 18%

21%

20%
41%

15%
11% 11%

10%

8%

16%

< 10,000 10,00024,999

25,00049,999

50,00074,999

75,000- 100,000+
99,999

13% outside US

USCensusBureau,2010CensusSummaryFile2.
2U.SCensusBureau,CurrentPopulationSurvey,2011Annual
1

3U.S.states:AZ,CA,CO,CT,FL,GA,IL,IN,IA,MD,MA,MI,MN,
MO,NV,NH,NJ,NM,NY,NC,OH,OK,OR,PA,RI,SC,TN,TX,
UT,VA,WA,WV,WI,andWash.DC.
4Othercountries:Australia,Austria,Belgium,Canada,Denmark,
Finland,France,India,Italy,Malaysia,Mexico,Netherlands,New
Zealand,Singapore,Sweden,andUnitedKingdom.

SocialandEconomicSupplement.

10

STATUS OF MEDICAL TRANSITION

Myonlyregretisnotdoingthisinmy20s
andwaitingsolong.

Q5. Time on hormones by gender identity

(n=448)
< 1 yr

Hormone therapy

All

1 to 5 yrs

14%

6 yrs or more

46%

38%

Manytransgenderpeopleusehormonestobetteraligntheir
bodieswiththeirgenderidentity.Testosteroneisusedby

Nonbinary

22%

54%

19%

transmasculinepeopletodevelopandmaintainmasculine
physicaltraits,whileestrogen(ofteninconjunctionwith

Women

progesterone)isusedbytransfemininepeopletodevelop

16%

42%

42%

andmaintainfemininephysicaltraits.
Men

12%

46%

42%

Nearlyalloftherespondentsinthesurveysamplereported

beingonhormonetherapy.Overall,themenandwomenin
thisstudyhavebeenonhormonesforlongerthantheNBG

Inretrospect,startinghormonetherapy
at16insteadofspendingnineyears
tryingtoconvincemyselftobeaguy
wouldhavebeenthebetterchoice.

participants.
Only1%ofrespondentswerenotusinghormonetherapyat
thetimeofthesurvey.(Thesefiveparticipantswere
includedinthefinaldatasetbecausetheywereassigned
femaleatbirth,definedtheirsextodayasmale,andhad
chestsurgerytoaligntheirbodieswiththeirgender

Imsomuchmoreatease
withmywholebeing,
especiallysincechestsurgery.

identity.)

Chest surgery
Manytransmasculinepeopleundergochestsurgeryto

Q5. Chest surgery y gender identity

(n=444)

removebreasttissueandcreateamalecontouredchest.
Transfemininepeopletypicallydevelopbreaststhrough

Completed

hormonetherapyandmayormaynotfeeltheneedfor
breastaugmentationsurgery.

All

Want/might want
60%

Don't want/NA
22%

18%

Sixoutoftenrespondentsreportedthattheyhadchest
surgerywhilemorethantwooutoftensaidthattheywantit

Nonbinary

53%

32%

15%

ormightwantitandnearlytwooutoftendidnotwant
chestsurgeryorfeltitwasnotapplicabletothem.Almost

Women

eightoutoftenmenandslightlymorethanhalfofNBG

11%

22%

67%
2%

participantsreportedthattheyhadchestsurgery,compared
Men

toaboutoneoutoftenwomen.

78%

20%

Maleclothingfinallyfitsandlookinggood
inmyclothesisextremelyrewarding.
11

Q5. Genital surgery by gender identity

(n=443)

Genital surgery

Started/completed

Iurgentlywantgenitalsurgery,
butcantaffordit.

All

Want/might want

22%

Don't want/NA

53%

24%

Nonbinary

Sometransgenderpeopleundergosurgicalprocedure(s)to

8%

50%

42%

betteraligntheappearanceoftheirgenitalswiththeir
genderidentity.

Wiomen

Aboutoneinfiverespondentsreportedthattheyhad

Men

alreadystartedorcompletedgenitalsurgery,whileslightly

37%

44%

21%

19%

58%

morethanhalfindicatedthattheywantormightwantitin

21%

thefutureandnearlyonequarterdidnotwantgenital
surgeryorfeltitwasnotapplicabletothem.

Iwouldlovetohavealllowersurgerydone.

Unfortunately,Icantafforditfinancially
andpossiblyphysically.

Sortingthedatabygenderidentityrevealsthatnearlyfour
intenwomenstartedorcompletedgenitalsurgery
comparedwithtwooutoftenmenandfewerthanoneinten
NBGparticipants.Nearlytwointenwomenandslightly

morethantwointenmenreportedthattheydidnotwant

Q5. Hysterectomy by gender identity

(n=437)

genitalsurgeryorindicateditwasnotapplicabletothem,
whilemorethanfouroutoftenNBGparticipantsreported

Completed

Want/might want

Don't want/NA

thattheydidnotwantgenitalsurgeryorfeltitwasnot
applicabletothem.

All

Nonbinary

Hysterectomy

34%

37%

20%

30%

46%

34%

1%
Women

Sortingthedatabygenderidentityrevealsthatnearlyhalfof

99%
6%

themen,oneinfiveNBGparticipants,andoneparticipant
Men

whowasbornintersexandassignedmalehada
hysterectomy.NearlyhalfofthemenandNBGparticipants

48%

46%

indictedthattheywantormightwantahysterectomyinthe

Q5. Hysterectomy among trans masculine

participants (n=333)

future.
Focusingonresponsesfromtransmasculineparticipants

Want or
might want
48%

revealsthatalmosthalfhadahysterectomyandalmosthalf
reportedthattheywantormightwantone,whilelessthan
oneintenindicatedthattheydonotwantahysterectomyor
feelitisnotapplicabletothem.

Dont
want/NA
8%

Completed
44%

12


Q5. Electrolysis among trans feminine
participants (n=112)

Electrolysis

Want or
might want
18%

Morethansevenoutoftentransfeminineparticipants
startedorcompletedelectrolysis,whilealmosttwooutof

Started or
completed
72%

tenreportedthattheywantormightwantitandoneoften
reportedthattheydonotwantitorfeelitisnotapplicableto

Dont
want/NA
10%

them.

Q5. Facial feminization surgery among

trans feminine participants (n=110)

Facial feminization surgery

Almosttwooutoftentransfeminineparticipantsstartedor
completedfacialfeminizationsurgery,whilenearlyfourout

Started or
completed
18%

oftenreportedthattheywantormightwantit,andnearly

Want or
might want
36%

halfindicatedthattheydonotwantfacialfeminization
Dont
want/NA
46%

surgeryorfeelitisnotapplicabletothem.

Q5. Trachea shave among trans feminine

participants (n=108)

Trachea shave

Want or
might want
31%

Morethanoneintentransfeminineparticipantshada
tracheashave,whilemorethanthreeintenreportedthat
theywantormightwantthisinthefuture,andslightlymore

Completed
13%

thanhalfindicatedthattheydonotwantatracheashaveor
feelitisnotapplicabletothem.

Dont
want/NA
56%

ImadechoicestogetthemostsuccessfulsurgeriesIcouldaffordandIamreallyhappywiththeresults,
butIdoknowtheyarenotperfectandifIhadthemoneytodoitdifferentlyIwould.

13

Findings

"Less" gender dysphoria ratings

By gender identity

Women

Ihavemoreenergy,myconfidenceskyrocketed,
myoverallattitudeispositive,andInolonger
dwellonbeingupsetaboutsomething.Itliterally
passesintenminutesandtheissueisforgotten.
Itsawesome!

GENDER DYSPHORIA

NBG

Men
83%
85%
90%

At home
(n=427)

80%

At places of worship
or religious settings
(n=249)

63%
85%
75%
84%
91%

At school
(n=262)

72%
75%

At work (n=391)

Gender dysphoria by gender identity

90%

During exercise,
sports, athletic
activities (n=401)

Almostnineoutoftenrespondentsreportedanoverall
reductioningenderdysphoria(feelingamismatchbetween
anatomicalsexandgenderidentity)sincetheybeganto

67%
59%
80%
69%
68%
69%

During sex or
sexual situations
(n=381)

transition.
Sortingthedatabygenderidentityrevealsthatamajorityof

76%
71%
83%

In long term
relationship or
marriage (n=319)

men,women,andNBGparticipantsreportedfeelingless
genderdysphoriainanumberofscenarios.Alarger
NBGparticipants,especiallyintheareasofwork,school,
andfamily.

In public
restrooms
(n=431)

Q6. Overall, do you feel more or less

gender dysphoria? (n = 431)

More

No change

15%

4%

Women
(n=96)

9% 6%
Nonbinary
(n=68)

70%
49%
78%
75%
79%
90%

In the company
of strangers
(n=424)

Less
93%

85%

81%

78%
72%
88%

In other public
places (n=429)

percentageofmenreporteddecreasesthaneitherwomenor

89%

74%

On casual
dates (n=271)

6% 2%
Men
(n=267)

63%
74%
82%
82%
89%

While alone
(n=429)

8% 3%

69%
63%
72%

While courting
(n=266)

All

With extended
family (n=390)

60%
48%
77%
82%
85%
91%

With friends
(n=423)

With immediate
family (n=417)

14

63%
59%
80%


"Less" gender dysphoria ratings
By years on hormones
< 1 yr

Gender dysphoria by years of hormone therapy

1-5 yrs

> 5 yrs
76%
86%
93%

At home (n=422)

Manytransgenderpeopleusehormonetherapytobetter

At places of
worship or religious
settings (n=246)

aligntheirbodieswiththeirgenderidentity.Testosteroneis
usedbytransmasculinepeopletodevelopandmaintain
masculinephysicaltraits,andestrogen(ofteninconjunction

59%
80%
88%
76%
87%
90%

At school (n=258)

withprogesterone)isusedbytransfemininepeopleto
developandmaintainfemininephysicaltraits.

54%

At work (n=386)

87%
91%

Itappearsthatthenumberofyearsonhormoneshadan
impactonreducinggenderdysphoria.Asthechartbelow

During exercise,
sports, athletic
activities (n=396)

shows,aboutnineoutoftenparticipantswithmorethan
fiveyearsonhormones(>5yrs)reportedadecreasein
participantswithlessthanoneyearonhormones(<1yr).

Less

In public
restoooms (n=426)
8% 8%
< 1 yr
(n=62)

11%

1%

1-5 yrs
(n=197)

69%
67%
71%
64%
77%
85%
67%

In other public
places (n=424)

91%

88%

84%

88%

In long term
relationship or
marriage (n=316)

Q6. Overall, do you feel more or less

gender dysphoria (by years of
hormone therapy)? (n=426)

No change

72%

During sex or
sexual situations
(n=378)

genderdysphoriacomparedtomorethaneightoutoften

More

43%

5% 4%

82%
92%
42%
71%
84%
71%

In the company of
strangers (n=419)

> 5 yrs
(n=167)

85%
91%
71%
70%
75%

On casual dates
(n=268)

Infact,thelengthoftimeonhormonesappearstohavea

75%
86%
90%

While alone
(n=424)

significantimpactonreducinggenderdysphoriainawide
varietyofscenarios.Thechartontherightshowsthe
percentageofparticipants(bytimeonhormones)who

67%
66%
75%

While courting
(n=263)

reportedfeelinglessgenderdysphoria.Inallareas,more
yearsonhormonesseemstohaveasignificantimpacton

With extended
family (n=385)

reducinggenderdysphoria.

43%
69%
80%
83%
86%
92%

With friends
(n=418)
With immediate
family (n=412)

15

54%
69%
85%


Gender dysphoria by status of genital surgery

"Less" gender dysphoria ratings

By status of genital surgery

No GS

Sometransgenderpeopleundergosurgicalprocedure(s)to

Yes GS

betteraligntheappearanceoftheirgenitalswiththeir
genderidentity.Participantswhohadalreadystartedor

85%

At home (n=427)

93%

completedgenitalsurgery(YesGS)weremorelikelythan
thosewithoutgenitalsurgery(NoGS)toreportareduction

At places of worship
or religious settings
(n=249)

77%

inoverallfeelingsofgenderdysphoria.

92%

Q6. Overall, do you feel more or less

gender dysphoria (by status of genital
surgery)? (n=431)

84%

At school (n=262)

95%

More
81%

At work (n=391)
During exercise,
sports, athletic
activities (n=401)

In long term
relationship or
marriage (n=266)

Less

97%

87%

95%

89%

69%

92%
10%

During sex or sexual

situations (n=381)

No change

64%

88%

4%

2%

No GS
(n=329)

8%

1%

Yes GS
(n=97)

3%

All participants

76%

91%

Amajorityofparticipantsreporteddecreaseingender
dysphoria,regardlessofgenitalsurgerystatus.However,as

80%

In other public
places (n=429)

96%

thechartontheleftshows,participantswhostartedor
completedgenitalsurgeryweremorelikelythanthosewho

In public restoooms
(n=431)

66%

dysphoriainallscenariosposed.

82%

In the company of
strangers (n=424)
On casual dates
(n=271)

hadnogenitalsurgerytoreportdecreasesingender

92%

96%

Brief summary: Gender dysphoria

68%

Almostallparticipantsreporteddecreasesingender
88%

dysphoriacomparedtobeforetransition.Men,those
participantswithmorethanfiveyearsonhormones,and

85%

While alone
(n=429)

thosewhostartedorcompletedgenitalsurgeryweremore

93%

While courting
(n=266)

66%

With extended
family (n=390)

64%

likelytoreportdecreasesingenderdysphoria.
Overall gender dysphoria

86%

More

91%

Less
97%

86%

With friends
(n=423)

96%
8%

With immediate
family (n=417)

93%

89%

86%

No change

3%

69%

89%

All
participatnts

16

6%

2%

Men

5%

4%

> 5 yrs on
hormones

2% 1%
Genital
surgery

QUALITY OF LIFE

Quality of life

Quality of life by gender identity

Myqualityoflifeisinfinitelybetter.

Sortingthedatabygenderidentityrevealsthatahigher

Nearlyallrespondentsreportedthattransitionenhanced

percentageofthemenexperiencedqualityoflife

theiroverallqualityoflife.Infact,roughlytwothirdsor

improvementsthandidthewomenorNBGparticipants,

moreofrespondentsreportedthattheirqualityoflife

particularlyintheareasofschool,sexuallife,andwork.

improvedinnumerousareas.

"Better" quality of life ratings

By gender identity

Q7. How has transition affected these

areas? (all participants)

Better

No change

Women

Worse
4%

Overall quality
of life (n=447)

2%

Overall quality
of life (n=447)

1%

Sense of well
being (n=448)

7%

Physical
health (n=445)

3%

School
life (n=230)

13%

Sexual
life (n=415)

94%
3%

Sense of well
being (n=448)

Physical
health (n=445)

School
life (n=230)

Sexual
life (n=415)

Work life (n=401)

Religious or
spiritual life
(n=283)

96%

74%

81%

71%

77%

63%

19%

16%

16%

15%

33%

Work
life (n=401)

8%

Religious or
spiritual life
(n=283)

4%

NBG

Men
88%
92%
96%
94%
92%
97%
65%
74%
78%
78%
68%
85%
61%
61%
76%
58%
67%
85%
61%
51%
67%

Itsaclich,butitslikenightandday.ThepersonIwas10yearsagoreallyisdead.The
personIbecameisunrecognizablephysically,butmoreimportantlyemotionallyandmentally
fromthatoriginalperson.Itsbeenatrueliberation,andIstillmarvelthatIlovelifesomuch.
17


Quality of life by years on hormones

Quality of life by status of genital surgery

Lengthoftimeonhormonesappearedtopositivelyimpact

Participantswhostartedorcompletedgenitalsurgerywere

allofthequalityoflifeindicatorsmeasuredexceptfor

morelikelytoreportincreasesinthequalityoflifeindicators

physicalhealth(whichmightbemorerelatedtoage,as

thanthosewithoutgenitalsurgery.Surgeryseemedtohave

thosewithfiveyearsormoreonhormonestendedtobe

madeasignificantimpactonreligiousorspirituallife.

olderthanotherparticipants).Insomeareas,thedifferences
"Better" quality of life ratings
By status of genital surgery

basedonyearsonhormoneswerequitepronounced.

No GS

"Better" quality of life ratings

By years on hormones

< 1 yr

1-5 yrs

> 5 yrs
91%

Overall quality
of life (n=447)

92%

Yes GS

Overall quality
of life (n=447)

93%
96%

Sense of well
being (n=448)

96%
96%

96%
94%

Sense of well
being (n=448)

95%

69%
78%

Sexual
life (n=415)

75%
76%
71%

75%
82%

Work
life (n=401)

60%

School
life (n=230)

80%
83%

School
life (n=230)

98%

Physical
health (n=445)

75%
72%

Physical
health (n=445)

Religious or
spiritual life
(283)

79%
92%

58%
79%

64%

Sexual
life (n=415)

69%

Brief summary: Quality of life

75%

Almostallparticipantsreportedimprovementsintheir
Work
life (n=401)

qualityoflifecomparedtobeforetransition.Men,

49%

participantswithmorethanfiveyearsonhormones,and

78%

thosewhostartedorcompletedgenitalsurgeryweremore

85%

Religious or
spiritual life (283)

likelytoreportimprovementsinqualityoflife.

41%

Overall quality of life

61%

Worse

75%

94%

2% 4%
All
participatnts

18

No change
96%

1% 3%
Men

Better
96%

1% 3%
> 5 yrs on
hormones

96%

2% 2%
Genital
surgery

PERSONALITY TRAITS ASSOCIATED WITH HAPPINESS AND LIFE SATISFACTION

Personality traits

Personality traits by gender identity

Researchershaveshownthatanumberofpersonalitytraits

Asshownbelow,ahigherpercentageofwomenthanmenor

areassociatedwithhappinessandlifesatisfaction.5,6

NBGparticipantsreportedimprovementsinthefour

Participantswereaskedwhethertransitionhadaffected

personalitytraitsbeingassessed.

someofthesetraits,includingopennesstoexperience,social
"Better" personality trait ratings
By gender identity

involvement,agreeableness,andconscientiousness.
Almostnineoutoftenrespondentsreportedthattransition

Women

NBG

Men

positivelyaffectedtheiroverallpersonality,andmorethan
twothirdsofparticipantsindicatedthattransitionhad
lifesatisfaction.
Q7. How has transition affected these
areas? (all participants)

Better
Overall
personality
(n=448)
Openness
to experience
(n=444)
Social
involvement
(n=446)

No change

75%

85%
88%

88%

Openness to
experience
(n=444)

Worse

82%
83%

10% 2%

89%

84%

92%

Overall
personality
(n=448)

enhancedpersonalitytraitsassociatedwithhappinessand

14%

18%

Social
involvement
(n=446)

2%

81%
68%
75%

77%

7%

Agreeableness
(n=443)

66%
71%

Agreeableness
(n=443)

Being
conscientious
(n=439)

72%

24%

5%
Being
conscientious
(n=439)

68%

29%

3%

74%
59%
68%

Furnham,Adrian&Christoforou,Irene.PersonalityTraits,
EmotionalIntelligence,andMultipleHappiness.NorthAmerican
JournalofPsychology,2007,Vol.9,No.3,439462.
6Patel,HemaliRakesh.AnInvestigationoftheBigFiveand
NarrowPersonalityTraitsinRelationtoLifeSatisfaction.Masters
Thesis,UniversityofTennessee,2011.
5

19


Personality traits by years on hormones

Brief summary: Personality traits

Lengthoftimeonhormonesappearedtohaveapositive

Morethantwothirdsofparticipantsreportedimprovements
infourpersonalitytraitsassociatedwithhappinessandlife

impactonmostofthepersonalitytraitsbeingmeasured.

satisfactioncomparedtobeforetransition.Women,

"Better" personality trait ratings

By years on hormones

1-5 yrs

> 5 yrs

likelytoreportimprovements.

92%
87%
88%

Overall
personality

Personality traits associated with

happiness and life satisfaction

Better

Openness
to experience

89%
83%
83%

Openness
to experience

73%
72%
78%

Social
involvement

69%
71%
74%

Agreeableness

64%
71%
65%

Being
conscientious

Personality traits by status of genital surgery

Participantsthatstartedorcompletedgenitalsurgerywere

No change

Worse

All

84%

14%

2%

>5 yrs

83%

15%

2%

GS

86%

11%

3%

Women

88%

All
Social
involvement

< 1 yr

participantswithmorethanfiveyearsonhormones,and
thosewhostartedorcompletedgenitalsurgeryweremore

75%

10% 2%
18%

7%

>5 yrs

78%

16%

6%

GS

80%

14%

6%

Women

81%

16%

3%

morelikelythanthosewithnogenitalsurgerytoreport

Agreeableness

improvementsinthefourpersonalitytraitsbeingassessed.
"Better" personality trait ratings
By status of genital surgery

Yes GS
89%

Overall
personality

88%

Openness
to experience
Social
involvement

Agreeableness

Being
conscientious

72%

24%

5%

>5 yrs

74%

21%

5%

GS
Women

84%
77%

14%
23%

2%
0%

84%
86%
Being
conscientious

No GS

All

74%
80%
68%
84%

All

68%

29%

3%

>5 yrs

65%

34%

1%

GS
Women

67%

70%
74%

30%
24%

0%
1%

70%

20

EMOTIONAL STABILITY
Transitionhasupsanddowns.Iamenjoyingtheprocessandadapting.
Emotional stability by gender identity

Emotional stability

Lookingatthedatabygenderidentityrevealsthatmen

Participantswereaskedwhethertransitionhadincreasedor

weremorelikelytoreportimprovementsintheareasof

decreasedtheiroverallemotionalstability.Almostnineout

emotionalstability,depression,andanxiety,whilewomen

oftenrespondentsindicatedthattransitionhaspositively

weremorelikelytoreportimprovementsintheareaof

affectedtheiremotionalstability.Inaddition,aboutsixto

excessiveanger.NBGparticipantstendedtobeleastlikelyto

sevenoutoftenreportedimprovementsintheareasof

reportimprovements.

depression,anxiety,andexcessiveanger.

"Better" emotional stability ratings

By gender identity

Q7. How has transition affected these

areas? (all participants)

Better

No change

Women

Worse

NBG

Men

11%
Emotional
stability (n=444)

85%

82%
4%

Emotional
stability (n=444)

85%
86%

Tendency to feel
depressed
(n=424)

Tendency to feel
anxious (n=424)

70%

19%

11%

65%

Tendency to feel
depressed
(n=424)
63%

21%

64%
74%

16%
60%

Tendency to feel
excessive anger
(n=402)

59%

26%

Tendency to feel
anxious (n=424)

15%

54%
67%

Tendency to feel
excessive anger
(n=402)

71%
45%
57%

Beingontestosteronefeelslikeithasbroughtmyemotionstoamuchmoremanageablelevel.
WhereasbeforeIavoidedtalkingaboutemotionsbecauseIwasembarrassedforcryingorthingslikethat,
nowIcanbringamuchmorelevelheadtoanemotionalsituation,confrontation,ordiscussion.

21


Emotional stability by years on hormones

Brief summary: Emotional stability

Participantswithmoretimeonhormonesweremorelikely

Mostparticipantsreportedbeingmoreemotionallystable

toreportimprovementsintheemotionalstabilityindicators.

androughlytwothirdsreportedfeelinglessdepression,
anxiety,andexcessiveangeraftertransition.Men,

"Better" emotional stability ratings

By years on hormones

1-5 yrs

> 5 yrs

likelytoreportimprovementsinemotionalstability.
81%

Emotional
stability

Emotional stability

85%

Better

85%
59%

Tendency to feel
depressed

69%
Emotional
stability

75%
59%

Tendency to feel
anxious

64%

No change

Worse

ALL

85%

11%

4%

GRS

84%

12%

4%

> 5 yrs

85%

12%

3%

Men

86%

12%

3%

63%
52%

Tendency to feel
excessive anger

ALL

55%
65%

Tendency to
feel depressed

< 1 yr

participantswithmorethanfiveyearsonhormones,and
thosewhostartedorcompletedgenitalsurgeryweremore

Emotional stability by status of genital surgery

Participantsthathadalreadystartedorcompletedgenital

70%

19%

11%

GRS

78%

13%

9%

> 5 yrs

75%

18%

8%

Men

74%

18%

8%

surgeryweremorelikelythanthosewithnogenitalsurgery
ALL
Tendency to
feel anxious

toreportimprovementsintheemotionalstabilityindicators.
"Better" emotional stability ratings
By status of genital surgery

Yes GS

Tendency to feel
excessive anger

Men

84%
68%

Tendency to feel
depressed

Tendency to feel
anxious

> 5 yrs

73%
63%

21%
16%
23%

16%
11%
14%

85%

Emotional
stability

Tendency to
feel excessive anger

No GS

GRS

63%

78%
61%
73%
56%

ALL
GRS
> 5 yrs
Men

67%
59%
69%
65%
57%

20%
26%
20%
20%
28%

13%
15%
10%
15%
15%

69%

22

SATISFACTION AND REGRETS

MyonlyregretisthatIwasntconsciousenoughtobeginmytransitioninmyteens.

Satisfaction

Regrets

Nearlyallrespondentsreportedfeelingsatisfiedwiththeir

Nearlyallparticipantsreportedthattheyhadnoregretsor

overalltransitionandwitheachofthemedicalstepsthey

wouldrepeatthemedicalstepstheytooktotransition,even

tooktotransition.

iftheresultswerenotperfect.Onlythreeindividuals
reportedwishingtheycouldundoastep(onewouldnot

Q8. How do you feel about each of the

steps you've taken to affirm your gender?

Satisfied

Neutral

repeathavingahysterectomyandtwowouldnotrepeat
electrolysis).

Dissatisfied
Q9. Do you have regrets about the steps
you've taken to affirm your gender?

2%
Overall transition
(n=444)

96%

I have no regrets.

2%

The results aren't perfect, but I'd do the same thing again.

1%
Hormone therapy
(n=441)

Chest surgery
(n=264)

I would do this step again, but I'd do it differently.

2%

97%

I wish I could undo this step. I would NOT do it again.

4%

96%
3%

Genital surgery
(n=97)

Chest
surgery
(n=265)

7%

90%
4%

Hysterectomy
(n=144)

2%

Hormone
therapy
(n=442)

Genital
surgery
(n=97)

96%

88%

69%

60%

90%

22%

25%

5%
Electrolysis (n=79)

9%

9%

15%
2% 5%

Hysterectomy
(n=146)

5%

92%

1%
3%

Facial feminization
surgery (n=18)

100%

Trachea shave
(n=14)

100%

Electrolysis
(n=80)
Facial
feminization
surgery
(n=19)

Tracheal
shave (n=14)

Ihavenoregrets,butIstillacknowledgethat
myresultsarentperfect.

75%

68%

20%

16% 16%
7%

79%

14%

Idoregretnotsavingeggsbeforestarting
hormones.ButIhavenoregrets
aboutstartinghormones.
23

3%

EMOTIONAL AWARENESS AND EXPRESSION

Emotional awareness and expression by gender identity
Participantswereaskedwhethertransitionhadaffectedtheiremotionalawarenessandexpression.Whileabouthalfofall
respondentsreportedimprovementsintheareasmeasured,therewerenotabledifferencesbasedongenderidentity.Inmostareas,
morethaneightoutoftenwomenshowedincreases,comparedtoroughlyonethirdofmenandhalfofNBGparticipants.
Conversely,aboutonethirdofmenreporteddecreases,comparedtofewerthanoneintenwomenandlessthanonequarterof
NBGparticipants.Thesmallestdifferencesinratingsbygenderinthissectionwererelatedtothedesiretotakeactionwhen
feelinghurt,whilethelargestdifferenceswereseenineaseintheabilitytocry.

Q10. How has transition affected your

Decrease

Q10. How has transition affected your

Increase

Decrease

Level of interest in your emotions?

(n=422)

Frequency of noticing your emotions?

(n=426)
Men
Nonbinary
Women

34%
14%

Men

33%

20%

Women

0%

Men

34%
42%

Nonbinary
88%

Women

Women

1%

19%

50%

4%

77%

Desire to take action when you feel upset

or distressed? (n=425)

39%

Men
17%

35%

Ease in your ability to identify your

emotions? (n=425)

Nonbinary

28%

21%

83%

Desire to process your emotions when

you feel upset or distressed? (n=424)

Men

0%

Ease of accessing your emotions?

(n=427)

Nonbinary

41%

37%

30%

14%

Women

85%

Men

34%

Nonbinary

47%

1%

Increase

10%

57%

45%
Nonbinary

14%

Women

9%

52%

83%

69%

Ease in your ability to express your

emotions? (n=425)
Men

32%

Nonbinary

22%

Women

1%

Ease in your ability to cry? (n=425)

38%

Men

45%
86%

24

67%

10%

Nonbinary

39%

Women

2%

30%
79%

Emotional awareness and expression by years on hormones

Participantsonhormonesformorethantenyearswereroughly20%to30%morelikelytoreportincreasedemotionalawareness
andexpressionthanthosewhowereonhormonesforlesstime.

Q10. How has transition affected your

Decrease

Q10. How has transition affected your

Increase

Decrease

Increase

Frequency of noticing your emotions?

Level of interest in your emotions?
> 10 yrs

16%

53%
> 10 yrs

1-10 yrs

26%

45%
1-10 yrs

< 1 yr

51%

16%

22%

41%

26%

50%
< 1 yr

43%

20%

Ease of accessing your emotions?

> 10 yrs
1-10 yrs
< 1 yr

15%
31%
22%

Desire to take action when you feel upset

or distressed?

61%

> 10 yrs

8%

1-10 yrs

12%

67%

45%
45%

< 1 yr

58%

7%

53%

Ability to identify your emotions?

> 10 yrs

15%

Desire to process your emotions when

you feel upset or distressed?

61%

> 10 yrs
1-10 yrs

31%

1-10 yrs
< 1 yr

22%

17%

52%

45%
45%

< 1 yr

24%

46%

18%

43%

Ability to express your emotions?

> 10 yrs
1-10 yrs
< 1 yr

18%
27%
15%

Ease in your ablity to cry?

62%

> 10 yrs

45%

1-10 yrs

57%

< 1 yr

25

36%
52%
46%

40%
27%
27%


Emotional awareness and expression by status of genital surgery
Participantswhostartedorcompletedgenitalsurgerywereabout20%to30%morelikelytoreportincreasesinemotional
awarenessandexpressionthanthosewhohadnogenitalsurgery.

Q10. How has transition affected your

Q10. How has transition affected your

Decrease

Decrease

Increase

Level of interest in your emotions?

Frequency of noticing your emotions?

Yes GS

No GS

14%

55%

26%

Increase

Yes GS

45%

14%

No GS

55%

26%

40%

Desire to process your emotions when

you feel upset or distressed?

Ease of accessing your emotions?

Yes GS

No GS

19%

59%

28%

Yes GS

44%

15%

No GS

53%

23%

45%

Desire to take action when you feel

upset or distressed?

Ease in your ability to identify your

emotions?
Yes GS

No GS

9%

Yes GS

56%

17%

No GS

48%

12%

66%

10%

57%

Ease in your abilty to cry? ?

Ease in your ability to express your

emotions?
Yes GS

No GS

15%

26%

Yes GS

57%

No GS

48%

26

35%

52%

37%

26%


Brief summary: Emotional awareness and expression
Manyparticipantsreportedimprovementsintheiremotionalawarenessandexpressioncomparedtobeforetransition.Women,
participantswithmorethantenyearsofhormonetherapy,andthosewhostartedorcompletedgenitalsurgeryweremorelikelyto
reportincreasesinemotionalawarenessandexpression.

IcareaboutmyfeelingsnowbecauseIcareaboutmyselfnow.
Q10. How has transition affected your

Q10. How has transition affected your

Decrease

Decrease

Increase

Frequency of noticing your emotions?

ALL

23%
16%

53%

GS

14%

55%

Women

Level of interest in your emotions?

47%

>10 yrs

ALL

23%

>10 yrs

16%

GS

1%

Increase

85%

51%

14%

Women

44%

55%

0%

83%

Ease of accessing your emotions?

ALL

26%

>10 yrs

15%

GS

19%

Women

Desire to process your emotions when

you feel upset or distressed?

48%

ALL

61%
59%

0%

88%

ALL
>10 yrs
GS
Women

16%
7%

50%

56%

1%

17%

52%

GS

15%

53%

23%

>10 yrs

18%

GS

15%

Women

1%

77%

83%

ALL

10%

>10 yrs

8%

67%

GS

12%

66%

Women

59%

9%

69%

Ease in your ability to cry?

Ability to express your emotions?

ALL

4%

Desire to take action when you feel upset

or distressed?

62%

9%

47%

>10 yrs

Women

Ability to identify your emotions?

21%

50%
62%
57%

ALL

48%

>10 yrs

36%

40%

GS

35%

37%

Women

86%

27

2%

29%

79%

EXPERIENCING BASIC EMOTIONS

Prettymuchallofmyemotionshavebecomemorelivelythroughthecourseofmytransition.
Foreventhelessfavorableemotions,Ifeelthisisagoodthingoverall.

Experiencing basic emotions

Experiencing basic emotions by gender identity

Respondentswereaskedwhethertransitionhadincreased

Womenweremorelikelytoreportincreasesinhope,joy,

ordecreasedtheirexperiencesofbasicemotions(hope,joy,

andlove,anddecreasesinangerbutleastlikelytoreport

love,safety,despair,sadness,angerandfear).Themajority

increasesinsafety.Menweremorelikelytoreportincreases

ofparticipantsreportedincreasesinhope,joy,love,and

insafetyanddecreasesindespair,sadnessandfear.NBG

safetycoupledwithdecreasesindespair,sadness,anger,

participantswereleastlikelytoreportincreasesinjoy,love,

andfear.Participantswhoreportednochangesintheir

andhopeanddecreasesinsadness,anger,anddespair.

experienceofbasicemotionsarenotshowninthecharts.

Q10. How has transition affected your

experience of these emotions?

Whentheseresultswerecoupledasfourcontrastingpairs
(joyversussadness,hopeversusdespair,loveversusanger,

Despair decrease

andsafetyversusfear),theyrevealedtheimmenseimpactof
Women

transitiononparticipantexperiencesofbasicemotions.
Q10. How has transition affected your
experience of these emotions?
(n = 429)
Decrease

Men
Nonbinary

58%
66%
55%

Despair

77%

4%

Women
Men

12%

63%

Nonbinary
Joy

Love

14%

6%

Women
Men

69%

Nonbinary
Anger

66%
50%

19%

52%

90%
79%
67%
Love increase

67%
48%
47%
Fear decrease

Fear

Joy increase

83%
68%
53%

18%

52%

Safety

67%

80%

4%

62%

76%

59%

Anger decrease
Sadness

86%

Increase
Sadness decrease

Hope

Hope increase

Women

62%

Men

55%

Nonbinary

54%

18%

28

44%

Safety increase
47%
68%
59%


Experiencing basic emotions by status of
genital surgery

Brief summary: Experiencing basic emotions

Themajorityofparticipantsreportedfeelingmorejoy,hope,

Itdoesnotappearthattheamountoftimeonhormones

loveandsafetyandlesssadness,despair,anger,andfear.

significantlyaffectedexperiencesofbasicemotions.

Womenweremorelikelytoreportincreasesinjoy,hope,

However,genitalsurgerydidappeartodoso.Alarger

andlove,whilemenweremorelikelytoreportanincrease

percentageofthosewhostartedorcompletedgenital

insafety.Participantswhostartedorcompletedgenital

surgeryreportedincreasesinjoy,hope,love,andsafety

surgerywerealsomorelikelythanotherparticipantsto

coupledwithdecreasesinsadness,despair,anger,andfear.

reportfeelingmorejoy,hope,love,andsafetyandless
despair,sadness,anger,andfear.

Q10. How has transition affected your

experience of these emotions?

Experience of basic emotions

Decrease

All participants

63%

77%

No GS

60%

76%

72%

82%
Despair

Yes GS

Joy increase

All participants

62%

80%

No GS

59%

77%

73%

89%
Sadness

Yes GS

Joy

Sadness decrease

Love increase

All participants

52%

69%

No GS

50%

67%

All

4%

Women

5%

GS

4%

All
Women
GS

63%
58%

All participants

52%

62%

No GS

49%

60%

Yes GS

62%

Anger

Safety increase

10%

72%
4%

Women

3%

90%

GS

4%

89%

All
Women
GS

Women

All

59%

21%
14%

73%
6%

All
MEN
GS

29

69%

2%

83%

3%
52%
67%

76%
18%
13%

61%

20%

19%

MEN
GS

80%

14%

62%

Women

GS

68%

82%

All

All

Safety

Fear decrease

76%

Fear

61%

86%

20%

GS
Yes GS

77%

12%

All
Love

Anger decrease

Increase

Hope increase
Hope

Despair decrease

62%
68%

12%
17%
52%
55%
62%

68%
18%
12%
15%

EMOTIONS IN CLOSE RELATIONSHIPS

Ihaveopeneduptremendouslyinmyabilitytotrustthoseclosesttome(primarilymy
partneraswellasclosefriends).Comingoutwithmyidentitywasthebeginningofa
surgeofagreatdealofhonestyonmypart,andIsimplystarteddivulgingeverything.

Emotions in close relationships by gender identity

Participantswereaskedwhethertransitionhadaffectedhowtheyprocessedemotionsincloserelationships.Threequartersor
moreofthewomenreportedincreasesintalkingaboutemotionswithaclosefriendorintimatepartneraftertransition.A
minorityofmenandNBGparticipantsdidso.Menweremorelikelytoreportdecreasesintalkingaboutemotionswitha
friendorpartneraftertransition.Participantswhoreportednochangearenotshownbelow.

Q11. How has transition affected

Decrease
Increase

Q11. How has transition affected

Decrease
Increase

How often you seek out a friend or

partner to talk about emotions? (n=399)
Men
Nonbinary
Women

38%

How much you enjoy talking about

emotions with a friend or partner?
(n=398)

24%

20%

Men

42%

3%

Nonbinary
77%

Women

32%
20%

21%
32%

0%

77%

How much satisfaction you get from

talking in depth about relationship issues
with a friend or partner? (n=390)

How important you feel it is to talk about

feelings and process emotions with a
close friend or intimate partner? (n=399)
Men

31%

Nonbinary

20%

Women

0%

Men

31%

Nonbinary

43%

Women

84%

27%
15%
0%

24%
39%
80%

Brief summary: Emotions in close relationships

Womenwereaboutthreetimesmorelikelythanmentoreportincreasesintalkingaboutemotionswithaclosefriendorintimate
partneraftertransition.Aboutonethirdofmenreporteddecreases,whileveryfewwomendidso(only3%inonescenario,and
noneintheotherscenarios).RatingsbyNBGparticipantstendedtofallinbetweenthoseofmenandwomen.Timeonhormones
andstatusofgenitalsurgerydidnotappeartohaveanimpactonratings.

30

PREFERENCE FOR SHARING EMOTIONS AND TAKING ACTION

Preference for sharing emotion and taking action by gender identity

Participantswereaskedwhethertransitionhadaffectedtheirpreferenceforsharingemotionsandtakingactioninfourscenarios.
Asagroup,menreportedaslightincreaseintheirpreferencefortakingactionandaslightdecreaseintheirpreferenceforsharing
emotionsaftertransition.Conversely,womenasagroupreportedanoticeabledecreaseintheirpreferencefortakingactionanda
significantincreaseintheirpreferenceforsharingemotions.TheresultsweremixedforNBGparticipants.Participantswho
reportednopreferencearenotshowninthetables.

Q12. To feel supported

when youre upset or distressed
Prefer sharing emotions

Q12. To support someone else

when they are upset or distressed
Prefer sharing emotions

Prefer taking action

Before transition (n=386)

Before transition (n=387)

Men

45%

Nonbinary

Prefer taking action

40%

Women

24%

26%

Men

24%

Nonbinary

32%

45%

Women

34%

29%

39%

27%

34%

Today (n=387)

Today (n=383)

Men

27%

Nonbinary
Women

43%
81%

Men

49%

29%

Nonbinary

34%

Women

6%

40%
79%

49%
25%
10%

Overall Change

Overall Change

58%

50%
10%

3%

10%
-5% -2%

-17%

-28%
Women

24%

Nonbinary

Men

-3%

-24%
Women

Nonbinary

31

Men

IthinkIhaveaclarityaboutrelationshipissuesthatwasneverpresentbefore...makesitmorefunto

talkaboutwhenIunderstandboththemaleandfemaleperspectivesothoroughly.

Q12. To get a feeling of trust,

bonding, or closeness to others

Q12. To get a sense of enjoyment

when spending time with others

Prefer sharing emotions

Prefer taking action

Prefer sharing emotions

Before transition (n=383)

Before transition (n=382)

Men

42%

Nonbinary

42%

Women

36%

Men

21%
24%
20%

40%

Nonbinary

Women

28%

51%
87%

Men

27%
20%

Nonbinary

3%

Women

Overall Change

16%

24%

34%
42%
80%

34%
27%
7%

Overall Change

51%

52%
9%

Women

40%

25%

Today (n=382)

Men

-17%

32%

Nonbinary

Today (n=384)

Women

Prefer taking action

7%
-4%

2%

11%

2% 8%

-1%
-18%

Nonbinary

Men

Women

Nonbinary

Men

Brief summary: Preference for sharing emotions and taking action

Beforetransition,NBGparticipantsweremorelikelytoprefersharingemotionsinmostscenariosposed,followedcloselybymen,
whilewomenwereleastlikelytoprefersharingemotions.Aftertransition,womenweretwotothreetimesmorelikelythanmen
andNBGparticipantstoprefersharingemotions.Conversely,menwereatleastfivetimesmorelikelythanwomenandroughly
50%morelikelythanNBGparticipantstoprefertakingaction.Timeonhormonesandstatusofgenitalsurgerydidnotappearto
impactparticipantpreferencesforsharingemotionsandtakingaction.

32

SEXUALITY
Ifeellikeawholenewhumanbeingsexually.IreallyenjoyintimacyinawayInevercouldasafemale,and
moreimportantlyasapersonwhowasnotbeingfullyembracingofmytrueidentity.

Arousal by gender identity

Womenwere50%morelikelythanmentoreportan

Participantswereaskedwhethertransitionhadimpacted

increaseinarousalfromemotionalintimacyaftertransition.

variousaspectsoftheirsexuality.Thereweresignificant
Q13. How has your transition affected
your arousal from emotional intimacy?
(n=379)

differencesbetweenmenandwomen,whiletheratingsof
NBGparticipantstendedtofallsomewhereinbetween.
Participantswhoreportednochangesarenotshowninthe

Decrease

Increase

charts.

Menwerealmostseventimesmorelikelythanwomento
reportanincreaseinarousalfromvisualstimulusafter
transition.Whilenomenreportedadecrease,almost60%of

Men

13%

Nonbinary

15%

Women

45%
52%

12%

66%

womendid.
Womenwerenearlytwiceaslikelyasmentoreportan

Q13. How has your transition affected

your arousal from visual stimulus?
(n=393)
Decrease
Men

Increase

0%

Nonbinary

aslikelyaswomentoreportadecreaseaftertransition.

88%

9%

Women

increaseinhavingeroticfeelingsopenthemtotender
feelings,whilemenandNBGparticipantswerealmosttwice

Q13. How has your transition affected

whether erotic experiences open you to
tender feelings? (n=370)

74%

58%

Decrease

13%

Menwere50%morelikelythanwomentoreportanincrease
inarousalfromphysicalclosenessaftertransition.

Increase

Man

22%

32%

Nonbinary

24%

32%

Woman

14%

60%

Conversely,womenwerealmostsixtimesmorelikelythan
mentoreportadecrease.

Womenwere50%morelikelythanmenandNBG
participantstoreportanincreaseinhavingtenderfeelings

Q13. How has your transition affected

your arousal from physical closeness?
(n=383)
Decrease
Men
Nonbinary
Women

5%
13%
28%

openthemtoeroticexperiencesaftertransition.
Q13. How has transition affected
whether tender feelings open you to
erotic experiences? (n=370)

Increase
76%

Decrease

66%
49%

Men

14%

38%

Nonbinary

14%

40%

Women

33

Increase

12%

62%


Libido by gender identity
Menweremorethanfourtimesaslikelyaswomentoreportanincreaseinsexdriveandthefrequencyofhavingsexualthoughts.
Conversely,almostnomenreportedadecreaseintheseareaswhileamajorityofwomendidso.
Q13. How has your transition affected
your sex drive? (n=399)
Decrease
Men

Q13. How has your transition affected

the frequency of your sexual thoughts?
(n=399)

Increase

4%

Decrease
Men

Nonbinary

13%

2%

88%

76%
Nonbinary

Women

Increase

87%

72%

11%

65%

21%

Women

64%

21%

Sex and relationships by gender identity

Menweremorethantwotimesaslikelyaswomentoreport

toreportanincreaseininterestinmonogamous

thatsexbecamemoreimportantinintimaterelationships

relationships,whilemenwerenearlytwiceaslikelyto

aftertransition,whilewomenweremorethanseventimes

reportadecrease.Conversely,menwere50%morelikelyto

morelikelytoreportadecreaseintheimportanceofsex.

reportanincreaseininterestinopenrelationshipsand
womenweretwiceaslikelytoreportadecrease.Aboutone

Aminorityofparticipantsreportedthattransitionimpacted

quarterofmenandwomenreportedanincreaseininterest

theirinterestinsingleormultiplepartnerrelationships.

inpolyamorousrelationships,butwomenweretwiceas

Withinthatminority,womenwerealmost50%morelikely

likelyasmentoreportadecreaseininterestinpolyamory.

Q13. How has transition affected

Decrease
Increase

Q13. How has transition affected

Decrease
Increase

The importance of sex in intimate

relationships? (n=378)

Your interest in being in an open

relationship? (n=321)

Men
Nonbinary
Women

6%
10%
44%

Men

60%

Nonbinary

54%

Women

25%

12%

35%

10%

38%

28%

22%

Your interest in being in a monogamous

relationship? (n=388)

Your interest in being in a polyamorous

relationship? (n=293)

Men

17%

24%

Men

Nonbinary

17%

24%

Nonbinary

Women

9%

Women

34%

34

13%
7%
28%

22%
33%
24%


Sexual orientation
Aminorityofparticipantsindicatedtheirsexualorientationhadchangedaftertransition.Whenaskedtoindicatewhotheyfelt
attractedtobeforeandaftertransition,somerespondentswroteinanswers.Thosethatwrotemultiplegendersorsomething
similarweregroupedwiththeanygendercategory.Thosethatindicatedmasculinepeopleofeithersexorfemininepeople
ofeithersexorsomethingsimilarweregroupedwiththosewhoindicatedmaleorfemalerespectively.
Sexual orientation of women

Sexual orientation overall

Overall,therateofattractionexclusivelytowomenor

Thepercentageofwomenattractedexclusivelytowomenor

femininepeoplefellbymorethanonethirdafter

femininepeopledecreasedbyover40%aftertransition,while

transition,whileattractiontomenormasculinepeople

attractionsolelytomenormasculinepeoplemorethantripled.

increasedby50%.Attractiontobothmasculineand

Attractiontobothmasculineandfemininegendersandtoany

femininegendersandtoanyormultiplegendersroughly

ormultiplegendersroughlydoubled.Therateofasexuality

doubled.Asexualitydecreasedbyonequarter.

didnotchangeaftertransition.
Q14. Sexual orientation of women (n=95)

Q14. Sexual orientation overall (n=400)

Before transition

Women or
feminine gender

8%

Men or
masculine gender

12%

67%

41%

Both masc. and

fem. genders

9%

Any or multiple
genders

12%

Asexual
(not attracted)

Before transition

4%

Attracted to

Attracted to

Men or
masculine gender

Today

16%
28%

Women or
feminine gender

16%

5%
69%

40%

Both masc. and

fem. genders

14%

9%

Any or multiple
genders

26%

12%

Asexual
(not attracted)

3%

Today

4%

4%

Sexual orientation of men

Sexual orientation of NBG partcipants

Thepercentaageofmenattractedexclusivelytowomenor

ThepercentageofNBGparticipantsattractedexclusivelyto

femininepeopledecreasedbyonethirdaftertransition,

womenorfemininepeopledecreasedbymorethanhalfafter

whileattractionsolelytomenormasculinepeople

transition,whileattractionsolelytomenormasculinepeople

increasedbynearly50%.Attractiontobothmasculineand

didnotchange.Attractiontobothmasculineandfeminine

femininegendersandtoanyormultiplegendersroughly

gendersandtoanyormultiplegendersmorethandoubled

doubledaftertransition.Asexualitydecreasedbyhalf.

aftertransition.Therateofasexulaitydidnotchange.
Q14. Sexual orientation of
NBG participants (n=55)

Q14. Sexual orientation of men (n=250)

Before transition

Women or
feminine gender
Both masc. and
fem. genders
Any or multiple
genders
Asexual
(not attracted)

8%

Before transition

11%

67%

Men or
masculine gender

45%

9%

16%

12%
4%

Attracted to

Attracted to

Men or
masculine gender

Today

25%
2%

Women or
feminine gender
Both masc. and
fem. genders
Any or multiple
genders
Asexual
(not attracted)

35

13%

Today
13%

60%
24%
20%

9%

40%

15%
4%

4%


Brief summary: Sexuality
About70%participantsreportedexperiencinglessgender
dysphoria(feelingamismatchbetweenanatomicalsex
andgenderidentity)duringsexandalsoindicatedtheir
sexlivesarebettercomparedtobeforetransition.When
askedmoredetailedquestionsabouthowtransition
impactedtheirsexuality,menandwomenreported
differentexperiences.
Almost90%mensaidthattheirsexdriveincreasedand
indicatedthattheyhadsexualthoughtsmorefrequently
comparedtobeforetransition.Conversely,morethan70%
womenindicatedtheirsexdrivedecreasedandnearly
twothirdsreportedthattheyhadsexualthoughtsless
frequentlycomparedtobeforetransition.
Sixtypercent(60%)ofmensaidthatsexbecamemore
importantinintimaterelationshipsaftertransition,while
only6%saiditbecamelessimportant.Whileabout20%of
womenreportedthatsexbecamemoreimportantafter
transition,almosthalfindicateditbecamelessimportant.
Themajorityofparticipantsindicatedtheirsexual
orientationdidnotchangeaftertransition.Overall,the
percentageofparticipantsattractedexclusivelytowomen
orfemininepeoplefellbymorethanonethirdafter
transition,whiletherateofattractiontomenormasculine
peopleincreasedbyhalf.Thepercentageofparticipants
attractedtobothmasculineandfemininegendersandthe
percentageofthoseattractedtoanyormultiplegenders
roughlydoubled.Asexualitydecreasedbyonequarter.
Q14. Sexual orientation (n=400)

Before transition

Attracted to

Men or
masculine gender
Women or
feminine gender

8%

12%

67%

41%

Both masc. and

fem. genders

9%

Any or multiple
genders

12%

Asexual
(not attracted)

Today

4%

16%
28%
3%

36

Conclusion

Thisprojectbeganasanefforttoprovidemorereliableinformationtotransgenderpeopleconsideringwhethermedicallyassisted
transitionisrightforthem.Basedondatafrom448individuals,thestudyunequivocallydemonstratesthatmedicallyassisted
transitionenhancedtheirlivesinprofoundways.
Participantsoverwhelminglyreportedawiderangeofimprovementsrelatedtomedicallyassistedtransition,includingdecreases
ingenderdysphoria,betterqualityoflife,andmoreemotionalhealth.Inparticular,thoseonhormonesformorethanfiveyears
andthosewhostartedorcompletedgenitalsurgeryweremorelikelytoreportthattransitionhadenhancedtheirlives.
Itispatentlyclearthataffirminggenderwithmedicalassistancealsoaffirmedthelivesof448people.Yet20%to50%of
participantshadnotstartedorcompletedgenderaffirmingmedicalproceduresthattheysaidtheywantormightwantinthe
future.Whilethesurveydidnotaskwhytheyhadnotalreadyundergonetheseprocedures,itislikelythatanumberofhurdles
makeitdifficultorevenimpossibleforsomepeopletoobtaintransitionrelatedmedicalassistance.Highcosts,lowaccess,andthe
needforextendedrecoverytimeprobablyallplayaroleinlimitingwhichmedicalstepspeoplecomplete.
Evenifapersonisfullyemployedwithexcellentmedicalcoverage,mostinsurancepoliciesdonotcovertransitionrelatedhealth
careexpenses.Inaddition,qualifiedmedicalproviderstendtobefewandfarbetween,withsomeofthemostaffordablelocated
overseas.Someprocedurescallforacaretakerinthefirstweeksfollowingsurgery,andmanyrequireextensiverecoverytime.
Someproceduresareconductedinstages,whichtendstoincreasecosts,traveltime,andthenumberofrecoveryperiods.
Bydocumentingtheimpactsofmedicallyassistedtransitiononthelivesof448individuals,thisreportprovidesawealthof
informationfortransgenderpeopleconsideringwhethermedicallyassistedtransitionisrightforthem.Hopefullyitwillalso
encouragedecisionmakersatalllevelsofthehealthcaresystemtoreduce(orremove)barriersandsignificantlyincreaseaccessto
transitionrelatedmedicalcareforthosewhoseekit.

37

38

Appendix A
Glossary
Please note: The definitions offered here are suggestions only. Meanings change over time and can
be quite different by region or community. It is hoped that these definitions will facilitate further
exploration and understanding of gender diversity.

Anatomicalsex:Biologicaldifferencesusedto

FTM:Femaletomale.Assignedfemaleatbirthbut

categorizepeopleasmale,female,orintersex.

identifyingasmaleand/orman.

Includesbothprimaryandsecondarysex

Gay:Romantic,sexualattractiontopeopleofthesame

characteristics.

sexorgender.

Asexual:Lackinginterestinordesireforsex.

Genderaffirmation:SeeTransition.

Assignedsex:Thesexassignedatbirth,typically

Genderdysphoria:Distressordiscomfortwiththe

basedongenitalia.

sex/genderassignedatbirth.

Binarygendersystem:Classifyingpeopleintotwo

Genderidentity:Deepinnersenseofbeingaman,a

discretesexorgendercategories(male/manand

woman,both,neither,oranothergendersuchasTwo

female/woman).Assumesgenderidentityand

Spiritorgenderqueer.

genderrolesaredistinct,separate,andopposite.

Gendernonconforming:Notconformingtosocially

Bi,Bisexual:Beingromantically,sexuallyattracted

definedgendernormsforclothing,behavior,interests,

tomorethanonesex/gender.

pursuits,etc.

Chest(ortop)surgery:Surgerythateitherenhances

Genderqueer:Nonbinarygenderidentity.Not

orremovesbreasttissuesothatthechestmatches

identifyingasstrictlymaleorfemale.Identifyingas

andaffirmsgenderidentity.

both,neitherorsomethingelse.

Cisgender:Havingagenderidentitythataligns

Genital(orlower)surgery:Surgicalprocedure(s)to

withthemaleorfemalegenderassignedatbirth.

aligntheappearanceofthegenitalswithonesgender

Crossdressing:Wearingclothingthatisconsidered

identity.Alsoknownassexreassignmentsurgery(SRS)

bysocietytobelongtotheoppositesex.

orgenderconfirmationsurgery(GCS).

Drag:Dressingandactingastheoppositesexor

GLBTQI:Gay,lesbian,bisexual,transgender,queer,

genderoftendoneinanexaggeratedwayfor

intersex.Note:G,L,B,andQrefertosexual

entertainmentorasaperformance.

orientation,whileTandIdonot.

Estrogensandprogestogens:Hormonesassociated

Heterosexual:Romantic,sexualattractiontopeopleof

withdevelopingfemalesecondarysex

theoppositesexorgender.

characteristicslikebreastsandwidehips.

39


Hormonereplacementtherapy(HRT):Useof

Testosterone:Hormoneassociatedwithdevelopmentof

hormonestodevelopandmaintaintraitsthatalign

malesecondarysextraitssuchasadeepervoice,more

thebodywithonesgenderidentity.

musclemass,andcoarsefacialhair.

Intersex:Beingbornwithgenitaliaand/orsex

Trans:(adjective)Alternativetotransgenderor

chromosomesthatdonotmatchoursocietys

transsexual.

currentbinarydefinitionsofmaleandfemale.

Transfeminine:Havingbeenassignedmaleatbirthbut

Lesbian:Romantic,sexualattractiontowomenor

identifyingasawomanorclosertoafemininegender

femalesbyawomanorfemale.

thantoamasculineone.

MTF:Maletofemale.Assignedmaleatbirthbut

Transmasculine:Havingbeenassignedfemaleatbirth

identifyingasfemaleand/orwoman.

butidentifyingasamanorclosertoamasculinegender
thantoafeminineone.

Nonbinarygender:Havingagenderidentitythatis
notexclusivelymanorwomanand/orthatisoutside

Transman:Transgenderman.Assignedfemaleatbirth

thedominantmale/femalesexmodelofgender.

butidentifyingprimarilyasmale,man,ormasculine.

Primarysexcharacteristics:Internalreproductive

Transwoman:Transgenderwoman.Assignedmaleat

organs,theendocrinesystem,andgenitalia.

birthbutidentifyingprimarilyasfemale,woman,or
feminine.

Pubertyblockers:Medicationsusedtodelay
pubertyandthedevelopmentofsecondarysex

Transgender:(adjective)Notidentifyingasthe

characteristics.

sex/genderassignedatbirth.

Queer:Nonheterosexualidentity.

Transition:Theprocess(oftenlengthy)ofchanging
onesgenderpresentationtobetteralignwithandaffirm

Secondarysexcharacteristics:Nonreproductive

onesgenderidentity.Mayincludeachangeofname,

physicaltraitsthattypicallydevelopduringpuberty

pronouns,clothing,andcanincludetheuseofmedical

(e.g.facialhairanddeepervoiceorbreastsand

technology(surgeryand/orhormones).

widerhips).

Transphobia:Angry,fearful,and/orhatefulattitudes,

Sexualorientation:Romantic,sexualattractionto

speechand/orbehaviorsthataredirectedtowardpeople

others.Typicallyconsideredtobeinherentrather

whoare(orwhoareassumedtobe)gendernon

thanconsciouslychosen.

conforming,transgender,ortranssexual.

Sexuallydimorphicbrain:Structuraldifferencesin

Transsexual:(adjective)Identifyingasthesexorgender

thebrainthatappeartobeassociatedwithgender

oppositethatassignedatbirthandtakingsteps(or

and/oranatomicalsex.

desiringtodoso)toaffirmonesgenderidentity.

Stealth:Livinginalignmentwithonesgender
identitywithoutdisclosingonesbirthsex.

40

Appendix B
Survey instrument

41

42

Welcome to the 2011 Transition Survey

This is an anonymous peer-to-peer survey to collect information about how transition affects our
lives. In this survey, transition refers to medical steps taken to affirm gender identity. You will
probably need 20 minutes to complete the survey. To skip this introduction and get started, scroll
down and click "next."
Who is conducting the survey?
I am a transgender man and co-founder of FTM Sonoma County. My goal is to help make the world
a safer and saner place for people of all genders. My contact information is below.
How will the results be used?
The results will be posted online at www.ftmsc.org for free download. I plan to share the results with
my local community, cite the survey in articles, and discuss the results in presentations to medical
and mental health care providers, social service agencies, employers, schools and others. You are
welcome to do the same.
What does the survey ask?
The survey asks about your sex (at birth and today), gender identity, sexual orientation, age,
race/ethnicity, and location (state or country). It also asks about your transition -- what medical
steps you've taken and when, how satisfied you feel with the results, whether your experience of
dysphoria has changed, and how transition has affected various areas of your life.
Please don't take the survey if you feel these questions could potentially trigger distress for you.
Thank you for participating!
Your responses will help make this survey a success. If you feel comfortable doing so, please share
the survey link with others: www.surveymonkey.com/s/TransitionSurvey2011
If you have questions or comments, please contact me.
Colin Close
Email: CloseConnections@yahoo.com
43

1. What sex were you assigned at birth?

j Female
k
l
m
n
j Intersex, assigned female
k
l
m
n
j Intersex, assigned male
k
l
m
n
j Male
k
l
m
n
Comments

2. What is your sex today, as you define it?

j Female
k
l
m
n
j Intersex female
k
l
m
n
j Intersex male
k
l
m
n
j Male
k
l
m
n
Comments

3. Which one of the following best matches your gender identity?

j Woman
k
l
m
n
j Man
k
l
m
n
j Two Spirit
k
l
m
n
j Third Gender
k
l
m
n
j Genderqueer
k
l
m
n
j Both man and woman
k
l
m
n
j Neither man nor woman
k
l
m
n
j The term I use is ...
k
l
m
n

4. Do you identify as trans, transgender, or transsexual?

Yes

Usually but not

always

Sometimes
(depends on
circumstances)

Occasionally
but not often

No

Trans

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Transgender

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Transsexual

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Comments

44

5. Thinking about the steps you've taken to transition, how long has it been since you ...
Less than 1
year ago

1-5 yrs ago

6-10 yrs ago

More than 10

Want in the

Might want in

yrs ago

future

the future

Don't want

N/A

Started hormone therapy

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Had chest surgery

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Had hysterectomy

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Began genital surgery (if

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Completed genital surgery

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Started electrolysis

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Completed electrolysis

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Began facial feminization

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Completed tracheal shave

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

multi-stage)

surgery (if multiple)

Completed facial
feminization surgery

Other (please explain)

45

6. Compared to how you felt before your transition, do you feel more or less gender
dysphoria now?
For the purposes of this survey, "gender dysphoria" is defined as discomfort or discontent with the gender
you were assigned at birth and/or the anatomical (physical) characteristics of your body.
Significantly

Somewhat more

No change

Somewhat less

Significantly LESS

N/A

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

While alone

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

At home

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

At work

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

At school

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

At places of worship /

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

In public restoooms

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

In other public places

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

During sex / sexual

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

On casual dates

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

While courting

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

In long term

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

With friends

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

With immediate family

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

With extended family

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

In the company of strangers

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

MORE
Overall experience of
dysphoria

religious settings
During exercise / sports /
athletic activities

situations

relationship/marriage

Other (please explain)

46

7. Compare how you felt before transition to how you feel now. How has transition
affected these areas of your life?
Significantly
BETTER

Somewhat better

No change

Somewhat worse

Significantly
WORSE

N/A

Overall quality of life

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sense of well being

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Physical health

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

School life

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual life

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Work life

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Religious / spiritual life

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Overal personality

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Openness to experience

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Being conscientious

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Social involvement

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Agreeableness

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Emotional stability

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Tendency to feel depressed

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Tendency to feel anxious

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Tendency to feel excessive

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

anger
Comments

8. How do you feel about each of the steps you've taken to affirm your gender?
Very SATISFIED Somewhat satisfied

Neutral

Somewhat

Very

dissatisfied

DISSATISFIED

N/A

Overall transition

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Hormone therapy

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Chest surgery

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Hysterectomy

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Genital surgery

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Electrolysis

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Facial feminization surgery

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Tracheal shave

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (please explain)

47

9. Do you have regrets about the steps you've taken to affirm your gender?
The results aren't perfect,
I have no regrets.

but I'd do the same thing

again

I would do this step again,

but I'd do it differently.

I wish I could undo this

step. I would NOT do it

N/A

again.

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Chest surgery

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Hysterectomy

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Genital

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Electrolysis

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Facial

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Hormone
therapy

surgery

feminization
surgery
Tracheal
shave
Other
Comments

10. Compare how you felt before transition to how you feel now. How has your transition
affected your experience of emotions?
Significant
INCREASE

Some increase

No change

Some decrease

Significant
DECREASE

N/A

Frequency of noticing my emotions

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Ease of accessing my emotions

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Ability to identify which emotions I feel

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Ability to express emotions

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

My level of interest in my emotions

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Desire to take action when I feel upset or

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Ease in my ability to cry

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of hope

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of joy

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of love

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of dispair

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of sadness

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of anger

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Feelings of fear

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

distressed
Desire to process my emotions when I feel
upset or distressed

Comments

48

11. Compare how you felt before transition to how you feel now. Has your transition
affected how you relate to emotions in close relationships?
Significant

How important I feel it is to talk about

Significant

Some increase

No change

Some decrease

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

INCREASE

N/A

DECREASE

feelings and process emotions with a close

friend or intimate partner
How often I seek out a friend or partner to
talk about emotions
How much I enjoy talking about emotions
with a friend or partner
How much satisfaction I get from talking in
depth about relationship issues with a friend
or partner
Comments

12. Has your preference for sharing emotions versus taking action changed?

Today: To feel supported

Some preference for

STRONG preference

taking action or

for taking action or

problem solving

problem solving

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

STRONG preference

Some preference for

for sharing emotions

sharing emotions

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

No Preference

when I'm upset or distressed

Before transition: To feel
supported when I was upset
or distressed
Today: To support
someone when they are
upset or distressed
Before transition: To
support someone when they
were upset or distressed
Today: To get a feeling of
trust, bonding, or closeness
to others
Before transition: To get a
feeling of trust, bonding, or
closeness to others
Today: To get a sense of
enjoyment when spending
time with others
Before transition: To get a
sense of enjoyment when
spending time with others

49

13. Compare how you felt before transition to how you feel now. How has your transition
affected sexual aspects of your life?
Significant
INCREASE

Some increase

No change

Some decrease

Significant
DECREASE

N/A

Sex drive

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Frequency of sexual thoughts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Arousal from visual stimulus

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Arousal from physical closeness

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Arousal from emotional intimacy

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Erotic experiences open me to tender

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Importance of sex in intimate relationships

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Interest in being in a monogamous

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Interest in being in an open relationship

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Interest in being in a polyamorous

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

feelings
Tender feelings open me to erotic
experiences

relationship

relationship
Comments

14. Has your sexual orientation changed?

Not
Male

Female

Male or
female

Trans men

Trans
women

Any gender

Other

attracted (I
was or am
asexual)

Before transition I was attracted to people

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

that I assumed were

Today I am attracted to people that I
assume are
Other (please specify)

15. What is your racial / ethnic identity? (select all that apply)
c American Indian or Native Alaskan
d
e
f
g
c Asian - Far East, SE Asia, or Indian subcontinent
d
e
f
g
c Black or African American
d
e
f
g
c Hispanic, Latino(a) or Spanish origin
d
e
f
g
c Native Hawaiian and Pacific Islander
d
e
f
g
c White
d
e
f
g
c Other
d
e
f
g
Other (please specify)

50

16. How old are you?

j Under 18
k
l
m
n
j 18-24
k
l
m
n
j 25-34
k
l
m
n
j 35-44
k
l
m
n
j 45-54
k
l
m
n
j 55-64
k
l
m
n
j 65 and older
k
l
m
n

17. What is your household income level? (US dollars)

j Less than $10,000 per year
k
l
m
n
j $10,000 - $24,999
k
l
m
n
j $25,000 - $49,999
k
l
m
n
j $50,000 - $74,999
k
l
m
n
j $75,000 - $99,999
k
l
m
n
j $100,000 - $149,999
k
l
m
n
j $150,000 or more
k
l
m
n

18. What is your highest level of education?

j Some high school
k
l
m
n
j High school diploma or equivalent
k
l
m
n
j Some college, no degree
k
l
m
n
j Associates degree
k
l
m
n
j Bachelor's degree
k
l
m
n
j Some postgraduate courses
k
l
m
n
j Master's degree
k
l
m
n
j Doctorate degree
k
l
m
n

19. Which US state or territory do you live in?

6
Other (please specify)

20. If you are comfortable doing so, please indicate your City.

51