Transgender Healthcare: Definition, Gender Dysphoria & Coming Out

In the past years, there has been an outpouring of education and advocating for transgender people throughout many parts of the world. Never before in human history has there been so many resources available to someone who suffers from gender dysphoria or has a non-binary gender identity. 

Our Sioux Falls therapists provide support to all gender variant individuals seeking professional care and support. The information provided below serves as a resource for you and our community. If you should need further support, please contact our office directly. 

Defining Important Terms

Let’s get started by defining some important terms.

  • Gender Identity: the inner sense of being male or female, both or neither

  • Sex: physical characteristics of our body at birth (biological)

  • Gender: related to our social interactions and roles we take

  • Cisgender: sex and gender identity match; preferable to biological or natural male/female

  • Transgender: affirmed gender doesn’t match assigned gender

One of the most frequent questions we hear asked is whether a transgender person is gay or straight. Many people don’t understand that gender and sexuality are not the same things. 

Sexual orientation describes the gender or genders we are attracted to:

  • Gay: Attracted to the same gender

  • Straight: Attracted to the opposite gender

  • Bisexual: Attracted to both genders (male and female)

  • Pansexual: Attracted to all genders

  • Asexual: Not attracted to anyone

  • Queer: umbrella term of anyone who is not cisgender and heterosexual

And just to clear up any confusion around the alphabet soup, here is what LGBTQIA stands for:

  • LGBT (lesbian, gay, bisexual, transgender)

  • LGBTQ (+ questioning)

  • LGBTQIA (+ intersex and allies)


It is important to let each individual define what his or her gender identity is. Some gender identities are non-binary, meaning not male or female. This can also be known as: gender variant, gender queer, pangender, gender fluid, androgynous (having both male and female characteristics), non-gendered, gender-neutral and two-spirit (Native American).

Most transgender or gender variant people find the use of pronouns to be critical to the integration of their gender identity in a social context. It is important to use each person’s preferred gender pronouns: “he”, “she”, “him”, or “her”. For individuals who are gender-neutral, they may have a preferred pronoun of “they”.

Holding hands

Gender Dysphoria

People who are transgender or gender variant may experience anxiety and/or depression as a result of the disparity between who they are on the inside and who they are on the outside. This is referred to as gender dysphoria. 

The Diagnostic and Statistical Manual of Mental Disorders (5th Edition), defines Gender Dysphoria as a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months duration, as manifested by at least two of the following:

  • Incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

  • Strong desire to be rid of one’s primary and/or secondary sex characteristics

  • Strong desire for the primary and/or secondary sex characteristics of the other gender

  • Strong desire to be of the other gender

  • Strong desire to be treated as the other gender

  • Strong conviction that one has the typical feelings and reactions of the other gender

  • The condition is associated with clinically significant distress or impairments in social, occupational or other important areas of functioning

Section Break

A transition process, done alone or with the help of medical professionals, can treat gender dysphoria. When someone starts to identify with a particular gender they come out. Coming out is an important process in a transgender transition. 

When someone starts to physically alter their body and behaviors to align with their gender identity they transition. The transition process can vary depending on the person and what relieves gender dysphoria and creates congruence for them. Many times transition involves hormone therapy and sex reassignment surgery (SRS) or gender-affirming surgery (GAS). 

Top surgery is the changing of one’s chest. This can be a mastectomy or removal of the breasts on a female to male transgender person or hormone therapy to develop breast tissue or breast implants on a male to female transgender person. 

Bottom surgery is the changing of one’s genitals. This can be a vaginoplasty in male to female transgender people or a Phalloplasty in female to male transgender people. 

After a transgender transition, someone can choose to live as trans, some who pass may live as stealth. In the transgender community, pass is defined as the degree to which a transgender person will be seen as their gender. Stealth is defined as someone passing completely in their preferred gender in the public sphere.

Coming Out

The first step in the process is when someone comes out to themselves. Some transgender people have known since they were children, others say they knew something was different but didn’t know why, and others never realized anything until they were adults. 

Many times transgender people who always knew had a lot of pressure to conform and “act like a lady” or not be a “sissy”. Some will overcompensate or others cope by developing separate identities that later in therapy have to be shed. 

Coming out can be euphoric or also cause one to live in denial. There is a variation in how people decide to come out. Some make major changes and some continue to live as their assigned gender due to family or economic barriers. Coming out to yourself involves a deepening process of self-understanding. Many transgender people change the course of the transition as they develop a better understanding of who they are. It is important to have a lot of self-care during this time. 

Coming out to others is the process by which a transgender person knows who they are and they start to tell others. Everyone who goes through this has different circumstances to consider. Difficulties can range from fear of job loss or family security to shame and guilt. Many people are scared to come out to others, but it is an important step in the transition process

It is useful to create a coming out plan and decide who to tell first and how you will tell them. It is important to share feelings, set expectations about what you need, what name you’d like to be called and what pronouns to use.  

Not everyone in a transgender person’s life may support them. The coming out process is more than just personal relationships; it involves work and/or religious community or any other community to which that person is part of. It is important to negotiate transition depending on the circumstances of a person’s life. Some plans may change or a transgender person may delay aspects of the transition due to relationships or having young children.

It is generally more complicated to come out to family than to friends. Coming out to family may have an impact on financial stability, housing, marriage or parenting. For younger transgender people, it is difficult for parents to “lose” what they thought of as a son or daughter. There may be a period of grief and loss for the transgender person or their family members. The coming out process also involves coming out at work and the widening circles of casual acquaintances or people from someone’s past. 

Many transgender people reach a time when it’s optional whether they reveal that they are transgender. The biggest concerns of this outside of personal choice are safety and comfort. There are some situations where it’s appropriate to tell, e.g. a primary care doctor, attorney, therapist. Some places may not be appropriate or safe. Each situation should be considered for the individual.

Finding Support & Understanding

Our team of Sioux Falls therapists works closely with our LGBTQIA community. We specialize in supporting individuals with a host of specialties including evaluations for hormone therapy and gender confirmation surgeries, transition plans and advocacy and support.