Introduction

Trans people are those people whose sex assigned at birth does not align with their gender identity – a condition that can cause marked distress. Consequently, many trans people seek to change their gender, often permanently. Most usually that change is to male or female although sometimes the change is to a non-binary gender form. However, as the last of these is less usual this commentary will consider only trans people who identify as male or female.

The options available to trans people vary according to cultural context and so this commentary considers such matters from a context in which hormonal and surgical assistance is comparatively readily available. Within such contexts, people who choose to transition often use hormones and surgery to create a body that is more congruent with their perception of themselves as men or women.

Thus people assigned as female at birth who identify and live as men (trans men) may take testosterone in order to grow facial hair and thicker body hair, increase musculature, create a deeper voice and ensure the cessation of menses. If they have the genetic propensity they will go bald. They will commonly have surgery to remove their breasts and produce a male chest contour and, less commonly, to have a surgically constructed penis. They will also be likely to have a hysterectomy and oophorectomy.

Those people assigned as male at birth who identify and live as women (trans women) may have androgen suppression as well as estrogens in order to develop breasts and a more female body contour. Body hair may lessen, but facial hair will need removing by electrolysis. Scalp hair loss will stop, but hair will not regrow and hairpieces may therefore be used. The masculine voice is not affected by estrogens and speech therapy and sometimes surgery can …