[Originally published: March 15, 2022. Updated: March 21, 2022]
An entire vocabulary has evolved around people who are transgender, and if you’re not familiar with the latest terms, you can easily hurt someone’s feelings, even if that’s not your intention. Figuring out a person’s terms can be challenging—the lexicon includes words with meanings that have changed over time and could change again. And because each transgender person is navigating their own path, the best words to use in a conversation with them could vary depending on their circumstances.
No one is expected to get this right at first, but you could make a huge difference to a transgender person by being knowledgeable and sensitive about language, says Christy Olezeski, PhD, director and co-founder of the Yale Pediatric Gender Program, which cares for transgender and nonbinary people up to the age of 25.
"It’s really about respect," Olezeski says. “This isn’t anything new. Transgender and nonbinary people are everywhere.”
Olezeski and other Yale Medicine experts who care for transgender patients weighed in on a short guide to understanding terms related to the transgender experience, especially if you are a doctor or a transgender patient.
Which pronouns should you use?
If you are not sure which name or pronouns a transgender person identifies with, you could introduce yourself and provide the pronouns you use to describe yourself. Then ask: “What is your name? Or what pronouns do you use?”
Once you know, make sure to use their pronouns even when you are referring to an event that took place before they decided to make a transition. If you can’t get confirmation, use “they” as a singular pronoun when describing a transgender person. The bottom line is to avoid making assumptions about a person’s gender or pronouns.
- He/Him/His and She/Her/Hers: These refer to the pronouns a person uses for themselves, whether or not they have made a transition.
- They and Them: These pronouns are considered third-person singular when used to refer to someone who doesn’t fit the strict definitions of male or female. These can also be used as nonbinary pronouns for individuals who identify outside of the gender binary (defined below).
- Ze/Hir/Hirs: Pronouns that correspond with the traditional pronouns mentioned above (e.g., he/him/his, or she/her/hers). While not commonly used, they may be used to describe a person who doesn’t identify within the gender binary.
- Mx (pronounced "mix"): Used in place of Ms. or Mr. (People have used this term when they don’t want to call attention to their gender, whether they are transgender or not.)
Gender identity terms to know
A person’s gender identity reflects their deeply felt, internal sense of self as far as their gender, whether or not it aligns with the one assigned to them at birth. It applies to all people, transgender or not.
- LGBTQIA+: Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more.
- Gender: Behavioral, cultural, and/or psychological ideas associated with a particular gender identity.
- Gender binary: The idea that there are only two genders, male and female, and everyone must fall into one classification or the other.
- Nonbinary: A person whose gender identity doesn’t fit into the traditional gender binary structure of man or woman.
- Agender: Adjective that describes someone who identifies as having no gender or who does not experience gender as a primary component of their identity.
- Bigender: Adjective used to describe a person whose identity combines two genders or who may be sometimes male and sometimes female.
- Cisgender: Adjective used to describe a person whose gender identity is congruent, in a traditional sense, with the sex assigned to them at birth.
- Queer: An umbrella term for those who think of their gender identity or sexual orientation as being outside of societal norms. Once considered a derogatory term, “queer” has been reclaimed by many within the LGBTQIA+ community as a term of empowerment, but still may be considered offensive by some, especially if used by a person who is not in the community.
- Gender expression: Ways of expressing and interpreting one’s gender through clothes, hairstyles, mannerisms, body modifications, or name. Gender expression varies, depending on culture, context, and historical period.
- Gender affirmation: The process of making changes to recognize, accept, and express one’s gender identity. This might include any combination of social, legal, and/or medical changes that might range from changing one’s way of dressing and hairstyle, to having gender-affirming surgery, to changing one’s name and sex designation on legal documents.
- Transgender (sometimes shortened to “trans”): Describes the full range of people who identify with a different gender than the sex assigned to them at birth. A trans person may or may not identify on the (traditional male or female) gender binary. They may or may not use hormones or undergo surgery to achieve a new gender identity.
- Deadnaming: The practice of calling or referring to a transgender person by the name they used at a previous time in life and are no longer using, whether or not calling them by that name is intentional. The best practice is to use the name the person has chosen.
Terms for making a medical or surgical transition
Every person’s gender journey is unique. Some people make the transition with medical or surgical treatments, while others make the transition socially, changing the external expression of gender (hairstyle, clothing, etc.).
Here are a few terms that can help.
- Gender-affirming hormone therapy: Treatments that lead to the development of certain secondary sex characteristics. Depending on what the person is trying to achieve, they might include anti-androgens, estrogens, progestogens, or testosterone.
- Gender-affirming surgeries: Surgical procedures that help people align their bodies to more closely match their gender identity. They may include chest and genital surgeries, body sculpting, facial feminization, and hair removal, among other treatments.
- Gender-affirming genital surgery: A number of procedures that can be done to align the genitals and reproductive organs with a person’s gender identity. (“Bottom surgery” is slang for gender-affirming genital surgery.)
- Gender-affirming chest surgery: Surgery to either remove or construct a person’s chest, depending on what they want to achieve. (“Top surgery” is slang for gender-affirming chest surgery.) One surgical procedure used to masculinize the chest—called a bilateral mastectomy—involves removing most of a person’s breast tissue; it is often accompanied by repositioning of nipple areola and chest contouring.
- Facial surgery: For a transgender woman, treatments may include Adam’s apple reduction and procedures to reshape the nose or other areas of the face. Surgeries for a transgender man might include jaw augmentation or enhancement of the Adam’s apple.
- Breast augmentation: Using implants to enlarge the breasts.
Other words to know when talking to a doctor about transgender care
Using appropriate terms can help medical providers discuss transgender care with their patients, as well as diagnose and treat transgender patients with more accuracy. This applies whether the patient is seeking gender-affirming treatment or routine ongoing medical care.
- Assigned male or female at birth: The sex assigned to a newborn based on the physical structure of their genitals and other biological characteristics at birth, including everything related to reproduction, such as hormones, chromosomes, and certain internal organs.
- Gender dysphoria: Distress experienced by some people whose gender identity and sex assigned at birth don’t match. When this distress becomes significant, both the American Psychiatric Association (APA) and the American Medical Association (AMA) recognize it as a psychological diagnosis.
- Intersex: From a medical perspective, the term describes a group of congenital (or at-birth) conditions in which the reproductive organs, genitals, and/or other sexual anatomy do not develop according to traditional expectations for females or males. Intersex can also be used as an identity term for someone with one of these conditions.
- Transition: The process of moving from the gender assigned at birth to becoming aligned with another gender identity (which could be anywhere along the gender spectrum). This happens over time and the trajectory is unique to each transgender person. Some may make a “social transition,” taking personal and legal steps such changing their name, pronouns, and gender expression, as well as telling family and friends, but undergo no medical interventions. Those who do make medical transitions may use hormone treatments to change their voice and distribution of body fat, among other characteristics. Some will have surgery to add or remove body parts related to the male or female genders.
- Trans man (or transgender man): Someone assigned female sex at birth but now identifies as a boy/man/male, regardless of whether they have had surgery. Avoid using the term female-to-male (FTM).
- Trans woman (or transgender woman): Someone who was assigned male sex at birth but now identifies as a girl/woman/female, regardless of whether they have had surgery. Avoid using the term male-to-female (MTF).
- Transsexual: A term used sometimes in the medical literature or by some transgender people to describe people who have gone through the process of medical gender affirmation treatments (i.e., gender-affirming hormones and surgeries).
- Chosen name/Name used: The name a person chooses to use for themselves and wants others to use. This name may be different from the name on that person’s identification or insurance documents.
Transgender terms to avoid
There are other words that confuse the issue, including words in the LGBTQIA+ world that denote sexual attraction, and that some people mistakenly confuse with gender terms. These include gay, lesbian, bisexual, and pansexual (meaning attracted to people of all gender identities and biological sexes)—and they apply to transgender people in the same way they apply to cisgender people. In other words, a cisgender man who is attracted to other men is gay, and so is a transgender man who is attracted to other men.
In addition, as experts learn more about the nuances of transgender issues, new terms have emerged to replace old ones that have come to be considered derogatory, disrespectful, or otherwise inappropriate. It may be best to simply ask people what terms they choose to use.
Below are words to avoid:
- Transvestite: A person who dresses in clothes of the opposite sex. A transgender person or cisgender person may or may not cross-dress. "Cross-dresser" is the preferable term.
- Hermaphrodite: Once used to describe conditions some people are born with in which reproductive organs, structures, or tissue don’t fit clear male or female definitions. The term "intersex" should be used instead.
- Sex-change operation: Once used to describe a surgery that alters the body for a person transitioning from the sex they were assigned at birth. Better terms to use are "gender-affirming surgery," "sex reassignment surgery," or "gender confirmation surgery."
- Tranny: Considered a slur. Instead, use “transgender people” or “transgender person.”
Special thanks to John Encandela, PhD, associate professor of psychiatry and member of the Dean’s Advisory Council (DAC) for LGBTQIA+ Affairs at Yale School of Medicine, and a contributor to the DAC’s LGBTQIA+ Glossary of Terms for Teaching in Health Care.
Note: This glossary is not designed to be a complete list. Some terms may not be included due to space constraints. Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.
[Correction: An earlier version incorrectly listed "transsexual" in the "transgender terms to avoid" section. The term is now located in the "other words to know when talking to a doctor about transgender care" section.]