Step-by-step educational guides designed to help navigate transition, legal processes, healthcare systems, advocacy, and everyday life. Whether you are changing your name, updating documents, starting HRT, or learning how to support a trans loved one, these guides aim to make complex topics easier to understand.
Wait, what’s binding? In short, binding is the practice of compressing one’s chest to have a flatter and traditionally masculine appearance. It’s considered standard practice amongst the transgender community, similar to packing and tucking, since it is a non-medical alternative to alleviating gender dysphoria. If you want to know more about binding basics, read this post instead.
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More than any other season, summer presents additional challenges. Binding should never be painful, but you’d be hard-pressed to find anyone who would call binding physically comfortable. The issues that make binding unpleasant year-round intensify with heat, which is why extra caution is advised during the summer.
No matter what, remember the golden rule of binding: Always listen to your body. If you feel pain or begin to feel light-headed, stop binding immediately and take a solid break. A properly sized binder should feel like a tight hug, it should never cause you pain.
Consider how your preferred binding method will combine with summer heat.
Full-length and tank-style binders are notoriously hotter since they compress the entire torso compared to half-length and racerback binders. More guys experiment with K-tape during the summer, as it is cooler than half-binders and can be easily used for swimming. In contrast, traditional binders aren’t always swim-safe and can deteriorate over time due to excess water exposure. However, remember you should NEVER use ACE bandages, duct tape, or other non-recommended items to bind.
Try Sports Bras and Compression Tops
If your emotional health and gender dysphoria permit it, try binding with sports bras or compression tops instead of traditional binders. These garments are easier on the body and will prevent heat exhaustion with looser compression than your regular binder. Even if you don’t generally use sports bras, it’s best practice to carry an emergency one during the summer to change into if you have to take off your binder. Binding is a tool that many transgender people use, but it’s not a requirement – the practice of binding (or the lack thereof) doesn’t define your gender. Taking care of yourself and your body is gender-affirming care in its own right.
I want to note here that while I advise my fellow trans peers to take off their binders when it’s hot, it isn’t always feasible. If you are an adult and worried about a transgender youth binding during the summer, do not force them to take off their binder. Offer them spaces to cool off instead. Even if you are a PE instructor or coach, it’s no less appropriate to ask a transgender youth to remove their binder than to ask a cisgender girl to remove her bra. Binders are essentially underwear and allow transmasculine individuals the ability to survive despite gender dysphoria.
Take (extra) Breaks throughout the day
If you bind regularly, you’re likely no stranger to “binder breaks.” It’s best practice to give yourself breaks throughout the day via stretching and limiting binding to eight hours per day. Make these breaks more frequent during warm weather and stay mindful of your physical health while outside.
Material matters!
If you’re prone to sweating (which increases with HRT usage), remember that material matters. A moisture-wicking fabric will keep you drier than non-breathable fabrics. Linen, muscle tees, jerseys, and button-down shirts are summer staples since they conceal curves better than other fabrics. Some individuals wear a tank undershirt under their binder to soak excess moisture. Regarding overshirts, remember that white colors reflect heat – so if you dress emo or goth, be prepared for intense heat. While most folks worry about their binder possibly showing, don’t forget that cisgender people are largely clueless – few cis folks know what binders are, so they’re quick to assume your binder is an undershirt or accessory.
Powders exist – so use them!
Whether you sweat a lot or experience skin irritation, there are numerous powders available on the market that prevent chafing. Just consider purchasing talc-free if you have a family history of ovarian or similar cancers. Similarly, you can also apply regular antiperspirant deodorant under your binder to decrease sweat and odor, although this won’t lower chafing as powders would.
Hydrate, Hydrate, hydrate
Drink more water. Make an effort to drink water when outside in the heat, since hydration both reduces overheating and prevents skin irritation.
Juices and sodas are great in a pinch, but water is best when you’re sweating a ton. Relatedly, commit to at least one salty meal a day to replenish the sodium lost from sweat.
Keep it clean!
Wash your binder. This is basic advice in general, but you should wash your binder at least once or twice a week regardless – and more often when you’re sweaty, like during the summer. Binders are essentially underwear and compress heat and moisture. With the added effects of HRT causing increased sweat and acne, don’t add to the mix with an unwashed binder.
Cool off (When you can)
If you’re able to, consider taking a cold shower partway throughout the day – at the very least, stay in air conditioning and other cool spaces. If you’re outside a lot and unable to access air conditioning, look into cool packs – you can purchase them online and slide them under your binder for immediate heat relief. Another technique is wetting a cloth with cold water and wrapping it around your neck.
Binding, or the practice of compressing one’s chest to have a flatter and traditionally masculine appearance, is a pretty standard practice amongst the trans community, similar to packing and tucking. Anyone can bind – even if you’re not transgender, there might be moments when it’s beneficial, like if you’re cisgender but engage in cosplay or drag.
In the transmasculine community, binding is one of the first steps in transitioning. Being assigned female at birth, breast tissue naturally forms during natal puberty and creates distress from gender dysphoria unless preventative measures are taken, like puberty blockers. When trans men begin testosterone through prescribed hormone replacement therapy, breast tissue no longer forms – but HRT cannot reverse tissue already created.* Since few transgender people have the fortune to have supportive parents and the ability to access puberty blockers as youth, binding is the norm.
*Technically, testosterone-based hormone replacement therapy CAN impact breast tissue, but it cannot get rid of it entirely. It’s all extremely anecdotal, but you might experience breast tissue shrink in size. More commonly, HRT affects the composition of breast tissue and makes it less firm, similar to breast tissue cisgender men have. However, these changes are rarely enough to override the need for binding.
Q: DO I HAVE TO BIND? A: Nope! While binding is common, it is not a requirement to be transgender, and there are many reasons transmasculine folks may choose not to bind, such as having a chest too large for traditional binders, disability, or comfort. Generally, you should talk with your doctor before binding if you have asthma, scoliosis, lupus, COPD, arthritis, Hypermobility Joint Disorder, GERD/IBS/IBD, migraines, TMJD, or fibromyalgia.
Q: HOW OLD DO I HAVE TO BE TO BIND? A: Anyone who has breast tissue is old enough to bind, although this statement might make people queasy. American youth are entering puberty earlier than ever, so it’s reasonable to say that if breast tissue is causing them significant discomfort, they should have access to binding. While binding can have long-term consequences, preventing kids from binding safely will only make them more likely to DIY, which can be dangerous. On the other end of the spectrum, there’s no upper age cap for binding.
Q: WAIT, DID YOU SAY THERE ARE LONG-TERM CONSEQUENCES TO BINDING? A: Yes, but those consequences come with caveats. Long-term binding can impact the density of your breast tissue, which can potentially limit your options for chest surgery later. However, these effects (which are common at 10+ years of binding) do not bar you from chest surgery – and it’s worth stating that the average transmasculine person gets chest surgery way before this deadline.
There are plenty of anti-trans parents who will rant on how chest binding will impact children’s bone development during puberty, so youth shouldn’t be allowed to bind. While it is a possibility, there isn’t research to back up this claim: there is little long-term research on transgender people as a whole, and even less on minors. Chest binding, when done safely, isn’t dangerous – a binder should feel like a relatively tight hug and should never cause pain. You should also never wear two or more binders, since the added compression can cause a lot of pain. Exceeding safety recommendations puts you at actual risk of developing skeletal issues, and as mentioned above, barring safe binders from youth pushes them to resort to DIY methods with higher risk.
Always get the right size.
Yes, a smaller binder will give you a flatter chest – but the right size vastly minimizes your risk of common side effects. Keep in mind that cisgender men don’t have completely flat chests, and everyone has some breast tissue. Don’t strive for a perfectly flat chest.
DON’T KNOW YOUR BINDER SIZE? FOLLOW THESE STEPS.
Wrap a tape measure around the fullest part of your chest. This is the part that comes out the farthest from your body. Do this while you are dressed.
Write down the measurement. You might want to measure more than once to check it.
Wrap the tape measure around your chest, right under your breasts. This is where the crease is.
Write down the measurement.
Add the measurements together and divide by 2. This is your chest size.
Put the end of the tape at the outside edge of one of your shoulders. Measure across your body to the outside edge of your other shoulder. Make sure you are standing up straight. Avoid tensing up, hunching your shoulders, or wrapping the measuring tape around your shoulders.
Write down the number you get. This is your shoulder size.
If your shoulder measurement is 1.5 inches bigger than the shoulder measurements listed for your chest size… Buy a larger size, usually the next size up.
If your shoulder measurement is smaller than the shoulder measurements for your chest size… Buy the size that matches your chest measurement.
If you have a larger chest or broad shoulders… Consider a tank binder. This might be the most comfortable style for you.
If you buy a binder that is smaller than your measurements… Return it for one that fits. The effect on your chest is probably not enough to notice, and the wrong size puts pressure on your back and ribs.
Wearing the correct binder size MATTERS. Over time, using the incorrect size can restrict breathing, irritate the skin, break skin around the edges of the binder, cause overheating, and bruise/fracture the ribs.
TYPES OF BINDERS
Full-Length Tank As one of the two main classics, the full-length or tank binder has a long panel of compression and can be tucked into your pants. They compress more than just the chest – they also flatten the hips and stomach, which is why these are the most common binders used by cisgender men.
Full-lengths are best suited for individuals with large chests or folks who want additional compression around the stomach and hips. Newer tank binders are made to look like casual shirts, which is a benefit you won’t find with other binder styles. On the other hand, I’ve been told that the more a binder resembles a regular tank top, the less compression it offers. They’re also far less comfortable – from personal experience, full-tanks are hotter and irritating to wear, and I was never able to get the hang of tucking them in, so it would always roll back up.
Half-Length The other classic binder is the half-length, which is identical to the full-length, other than the lack of material. These stop above the ribs, so they’re cooler and allow for a greater range of motion.
Half-lengths are ideal for individuals with smaller chests compared to full-length, but they can work for folks with larger chests if you’re okay with less compression. They offer better breathability, so they’re more comfortable for all-day use and sports. On the other hand, half-lengths are the most well-known – people will know you’re wearing a chest binder unless you cover it up with a shirt.
Racerback The racerback binder came into style within the last decade, offering even more range of motion than the half-tank. They’re identical to the traditional half-tank other than the back support design resembling the same ‘x’ pattern that racerback sports bras use. The same pros and cons apply to these as half-tanks, but their strap design is easier to conceal for folks who don’t want to possibly out themselves for wearing a binder.
Strapless Strapless binders are the most commonly portrayed in film when depicting transmasculine characters, but they’re far from the most commonly worn by actual transgender people.
These are often the cheapest since they’re made in mass production for cosplay, but they offer significantly less compression and support than other binder styles. You have to be precise with strapless measurements, too, since the wrong size could mean the binder falling off. These are also difficult to find by major binder brands due to their association.
I’ll also note that strapless binders like these are considered less safe than other styles – they’re created for cosplay purposes and worn for a day or two at a time, not regular long-term binding. They’re easy to access, but always use with caution.
Pullover & Zipper These aren’t binder styles themselves, but refer to another aspect of all of the above types. A pullover binder will be pulled over your head, similar to a t-shirt, whereas a zipper binder uses a zipper, clasps, or hooks to put the binder around your chest.
Both are good options! Pullover binders are more commonly produced by binder brands since they’re associated with better compression, but they’re difficult to put on in the beginning when you’re new to binding. Zipper binders are common for strapless and cosplay binders, but they’re a better option if you struggle to get pullovers on. However, always opt for zipper binders that attach in the center of your chest or back – zipper binders that attach on just one side will cause uneven compression that can harm your body over time.
Kinetic Tape Kinesiology tape, or K-tape, is a thin elastic tape that uses adhesive, and it’s become fairly popular for binding amongst smaller chested individuals. You should NEVER use other forms of tape to bind, such as duct tape, since K-tape is made specifically for athletic purposes and provides a range of motion and breathability that other tape does not. Duct tape is especially dangerous since it constricts your breathing after application.
K-tape struggles to provide the same level of binding as traditional binders, but many folks find it empowering since it gives a more natural look compared to binders. You can even safely sleep and shower with it since the tape is relatively waterproof and takes a few days to naturally lose its grip.
If you have the funds, there are a number of K-tapes now produced with chest binding in mind – like Trans Tape. While the function is the same, I’ve heard that the quality of Trans Tape is significantly better, BUT regular K-tape is pretty accessible since anyone can purchase it in their local Walmart.
Despite this, kinetic tape isn’t for everyone. The compression level isn’t feasible for many, but more often, it’s the adhesive. Kinetic tapes, regardless of brand, can cause significant irritation to the skin even if you don’t have any adhesive allergies. Later on, I’ll be talking about the importance of binder hygiene, and the same applies here. K-tape is used in a sweaty and hot part of the body that creates a LOT of friction. While I was pleased with the compression K-tape provided me, the tape chafed me pretty badly, and I *don’t* have any adhesive allergies.
Sports Bra A good sports bra can provide a decent level of compression, so it’s a great alternative to regular binding to give your body breaks. In essence, sports bras are similar to racerback binders. Unlike binders, you can find sports bras sold pretty much anywhere, so they’re more accessible.
Unlike the above binding options, sports bras are the ONLY style that I would okay “double-binding.” Since sports bras offer less compression than actual binders, the compression level achieved from double-layering won’t cause significant harm, like if you layered traditional binders.
Keep it clean!
Binders are underwear. Seriously, they can get gross – they’re directly compressing your body and creating hot and humid spaces. Regardless of season, binders should be washed at least weekly, but you should move to every three days if it’s summer or you’re a naturally sweaty person. Even if the binder doesn’t smell too bad, poor binder hygiene causes rashes, skin irritation, acne, fungal infections, and other conditions.
Each binder manufacturer will provide specific instructions on how to best care for your binder. Follow their advice to prolong the life of your binder! However, if you lost the instructions, these are the most common suggestions.
Wash your binder in cold water on a delicate cycle, OR wash it by hand in the sink with laundry detergent and warm water. Avoid hot water and putting your binder in the dryer.
Hang the binder up to dry.
Keep your binder on a hanger when you are not wearing it. This helps it keep its shape.
Have more than one binder, if possible. This allows you to wash and dry them regularly.
Stay flexible and give your body breaks.
Listen to your body – what works for your friend won’t inherently work for you. The following are general guidelines, but always listen to your own body first. If you’re in pain, stop.
Keep binding for eight hours at a time and never bind more than twelve consecutive hours. This can be difficult to navigate if you’re in public often, but it’s best practice to have off days when you do not bind.
Take at least one day completely free of binding per week, and take more break days if you can manage.
Never sleep in your binder. Breathing becomes more shallow while you’re unconscious, so binding while asleep poses an increased risk.
Take precautions if binding while working out or swimming. There are binders available to purchase to use while swimming, since chlorine exposure can shorten traditional binders’ lifespans, and exercise binders that provide greater mobility. If these aren’t options for you, your dedicated workout or swimming binder should be at least one size larger than what you typically wear.
Stay hydrated and keep cool when binding, especially during summer months. Even if you feel fine, it’s pretty easy to develop heat stroke – from personal experience, I got heat exhaustion once while on a summer field trip because I thought it was a myth.
Never use any material to bind that was not listed here. Do not use duct tape, plastic wrap, belts, or ACE bandages. These constrict as you breathe, which can bruise you or potentially suffocate you.
Consider wearing a cotton undershirt or tank top under your binder if your skin is prone to irritation. Binders won’t help any existing skin conditions. An undershirt or the use of body powder also helps during warm weather to limit excess sweating.
Learn exercises and stretches to ease pain in your back, shoulders, and chest. Try stretching every few hours while binding.
Looking for binder suggestions?
The following prices are based on the current price at the time this article was published. Verify with the merchant before buying.
Wait! I want a new binder, but there are too many options! Yeah, and there are plenty of binder brands that I don’t cover below – if you hear good things about a binder company from friends or those you trust, go for it and don’t let my lack of review stop you. Otherwise…
Generally overwhelmed and just need a good quality binder? Get GC2B.
Unable to find a binder size that fits? Get Origami Customs.
Have severe dysphoria and need high compression? Get Underworks.
Looking for something special to be proud of? Get ShapeShifters.
Can’t deal with sensory overload? Get GenderBender or Amor Sensory.
GC2B @ gc2b.co / $42 USD Founded in 2015 as a trans-operated binding brand, GC2B is the premier binder today. After using an Underworks binder, I found GC2B much more comfortable in comparison – although it provided slightly less compression. There’s talk that GC2B binders have gone downhill in quality after they changed textile suppliers, but I’m still a strong supporter of the brand as a whole.
GC2B has a bit of everything, including K-tape. They specialize in everyday binders, so you’ll find a variety of nude binders designed to be concealed under shirts. Before GC2B, binders were only available in white, black, and a limited number of “nude” binders – but the binder color matters significantly if you’re wanting to wear a white shirt. Their binder utilizes both the front and back panels to provide medium compression.
FLAVNT @ flavnt.com / $55 USD This streetwear brand has a larger range of nude binders than GC2B and has a pretty good selection of pride apparel. Their binders are all pullover style and offer medium compression via the front panel. Tired of hideous rainbow merch from retailers like Target and Walmart? Try FLAVNT.
For Them @ forthem.com / $55-$64 USD This brand specializes in underwear, including binders. For Them produces two types, one labeled “MAX” to offer high compression and “All-Day” that prioritizes comfort.
The MAX binder will provide compression similar to other brands, but the All-Day line is unique: it’s made with sensory issues in mind. It won’t make you as flat as other binders, but it’s super comfortable.
Peecock Products @ peecockproducts.com / $31-$34 USD Based out of Singapore, Peecock has been producing chest binders since 2010 and also has one of the best quality of entry-level prosthetic packers out there. Zippers, pullovers, v-necks, swimming binders, you name it – Peecock probably has what you’re looking for. However, their binders won’t be as comfortable or sensory-friendly as GC2B.
TomboyX @ tomboyx.com / $49 USD Although TomboyX caters to femme-identified people, they have a decent binder selection since a large chunk of their customer base is butch. Their selling point is their adjustable binder, which uses straps to allow the user to modify the level of compression. On the other hand, TomboyX binders have lighter compression compared to other brands.
UNTAG @ untag.com / $61-$69 USD Preferred by folks living overseas, UNTAG has a diverse binder selection that offers lower shipping rates compared to some American brands. In addition to the regular selection of binders, UNTAG also offers binders specifically made to exercise and unique designs like lace.
Urbody @ urbody.co / $45-$55 USD These binders were created to further expand binding beyond masculine-identified folks, so they generally offer less compression than other binders. Despite that, Urbody binders are preferred with folks with compression or sensory issues since the lack of compression means increased comfort.
Underworks @ underworks.com / $32-$38 USD As the oldest brand on this list, Underworks is a classic alongside T-Kingdom – they’ve been around since 1997. Originally, their target audience was cisgender men who wanted to compress their torsos, but they transitioned to make an array of trans-friendly binders since Underworks was the easiest place to purchase online.
If you’re looking for high compression, Underworks is for you. Seriously, their compression is INTENSE – but this means their binders can also be uncomfortable. The material is also rougher than brands like GC2B and Origami.
GenderBender @ genderbenderllc.com / $49-$59 USD These guys are relatively new, but they have a great selection that makes them distinct from other brands, like their own brand of K-tape, pride-themed binders, and plus-sized binding swimwear. Their company is disability-centered, so their products are made with various disabilities in mind, like sensory issues, anxiety, adhesive allergies, and the like.
Origami Customs @ origamicustoms.com / $64 USD In addition to the regular selection of binders, Origami Customs is unique because they can and will make custom binders on order. If you are too large for other binder companies, Origami Customs should be your go-to. Without them, people would be barred from binding due to weight or breast size – but Origami Customs can provide anyone with a binder.
Origami Customs also has ready-to-order binders, but I wouldn’t really recommend them if you don’t require a custom size.
Shapeshifters @ shapeshifters.co / $85-$115 USD Most binders are boring since they cater to everyday wear and stealth. Not Shapeshifters binders – they don’t actually have any nude binders unless you’re ordering from their “Make Your Own Binder” sewing kit. Shapeshifters specialize in fashionable designs, offering a refreshing alternative to bland options and asking, ‘Why can’t binders be fun too?!’
However, Shapeshifters is pricier than other brands, so I wouldn’t recommend them as your first binder unless you have money to burn.
Amor Sensory @ amorsensory.com / $79 USD Similar to GenderBender, Amor Sensory is a disability-first binder brand that centers on Autistic experiences. Binding can be a sensory nightmare, so Amor’s binders are sewn with those issues in mind. Even though they cost a bit more, Amor Sensory binders offer trustworthy moderate compression like mainstream brands.
Reddit and Online Spaces @ r/ftm / FREE to ∞ If you don’t mind used binders, check out virtual spaces like r/ftm – they host recurring spaces to allow guys to buy, sell, and trade items and you’ll likely find a used or free binder faster than the binder programs I suggest below. You can find these types of spaces on any forum, including Facebook groups and trans-related Discord servers.
I can’t afford a binder, what should I do?
Fret not, because there’s still options out there! Before continuing with my suggestions, read my last point on binder brands – in my experience, you’ll get a binder faster from online spaces like r/ftm when there’s availability. The companies and organizations I list below give binders as donations, which means they have limited resources and funding and MASSIVE waitlists.
Generally speaking, the larger the organization, the longer the waitlist. My very first binder was a donation from Point of Pride, but I had to wait nine months on their waitlist before it was shipped. These resources are national, but if possible, you should check with any local LGBTQIA+ organization in your area to see if they have a binder program. CenterLink hosts a (incomplete) directory of LGBTQIA+ nonprofits throughout the country, so start there if you don’t know where to begin.
Keep in mind that the following programs are active at the time this article was published. In my experience, binder programs tend to be unstable since they rely on donation funding – so some might be no longer active by the time you’re reading, or there might some missing that you expected to see.
Point of Pride @ pointofpride.org With a variety of funds, Point of Pride has given nearly $4 million dollars to financial aid programs to benefit transgender folks.
They were created in 2016 by Point 5cc, a trans clothing and apparel company to become the first and largest international chest binder donation program. Check out their website for details on their binder program, femme shapewear and gaff program, electrolysis support fund, HRT access fund, trans surgery fund, and Thrive fund. Their binder program is open to all, regardless of age or where they live in the world.
Trans Essentials @ ftmessentials.com Similar to Transguy Supply, Trans Essentials is an online megastore for trans needs. They sell binders, tucking tape, packers, gaffs, dilators, STPs, books, buttons, etc. They also operate Early to Bed for adult goods.
TE provides free Underworks binders to individuals ages 24 and under anywhere in the United States, shipped out on a quarterly basis.
TOMSCOUT @ tomscout.com The Freedom Binder Program provides binders to “storytellers,” determining eligibility based on your personal story and need for a binder.
Make sure to read all of TOMSCOUT’s rules before applying, since missing one will automatically disqualify you. There is no upper age cap, but applicants must be at least sixteen to qualify. Additionally, you’ll have to cover the shipping costs of the binder once you’ve been selected.
The Queer Trans Project @ queertransproject.org Based out of Florida, QTP is a Black-led organization that donates binders, packers, and packing underwear to individuals in need.
QTP has high demand, but they cover a lot of needs – including flight assistance to help transgender folks flee hostile states like Florida for safer havens.
Black Trans Men Inc @ blacktransmen.org The Brother 2 Brother Binder Grant allows Black Trans Men Inc to give free binders to low-income transgender men of color throughout the US.
To qualify, you must be at least sixteen years old, identify as transmasculine, demonstrate financial hardship, and identify as Black. There are no upper age cut-offs for their program. If you don’t identify as Black, they can still help if you reach out by referring you to other applicable programs.
Health Care Advocates International @ hcaillc.com Healthcare access isn’t equal to everyone, which is something marginalized people know well. HACI believes every patient deserves their best chance at a health life.
You must be at least eighteen years olds to qualify for HACI binders. Individuals must be in the United States or Puerto Rico to receive a binder from their services.
Thriving Transmen of Color @ thrivingtransmenofcolor.org TTMOC is a national grassroot nonprofit with chapters in Virginia, Georgia, District of Columbia, California, Florida, Illinois, and Nevada. Like Black Trans Men Inc, TTMOC centers on uplifting Black and Brown transgender individuals.
TTMOC binders are provided based on eligibility and are reserved only for transmasculine individuals who cannot afford to purchase their own binder. Applicants must be following TTMOC on social media and have attended at least one virtual or in-person event to qualify.
Phoenix Transition Program @ phoenixtransitionprogram.org PTP offers direct assistance to transgender folks in need, such as their binder program, care packages, utilities assistance, opening businesses, and crises.
To qualify, you must be at least eighteen years old and live in the United States. Other programs beyond binder assistance are functioning, but are limited based on time of year.
Last week, I posted about five of the most common myths spread about transgender people. Misinformation sells – media has always benefited from spreading fake news, but current politics have heightened its spread. Here’s five more common myths spread about transgender people.
Myth #6: Transgender women are a threat to women’s spaces.
That’s a broad generalization that isn’t backed by any research. Transgender women are no more a threat to women than cisgender lesbians “threaten” fragile heterosexuality. Due to stereotypes and stigma, most transgender women already enter spaces rather timidly because they don’t want to push that narrative. Women’s bathrooms? Transgender women are just there to do their business and be on their way like any other woman. Domestic and sexual violence shelters? Maybe it sounds unbelievable, but transgender women are actually harassed more often than their cisgender counterparts – and they’re just looking for safe resources when at those centers.
At its core, this myth relies on the belief that transgender women are predators. Homophobes have labeled LGBTQIA+ people as dangerous for decades despite more accurate allegations against stereotypically conservative professions like law enforcement and religious officials. The myth centers transgender women as inherently masculine, often taking it a step further to imply that masculinity is always dangerous and transgender women are unable to lose this status due to being assigned male at birth. It also works on the flip side, since individuals who advocate for this myth don’t view transgender men as threats – due to being assigned female at birth, transgender men are unable to hold the same predatory status and are therefore welcomed in women’s spaces. It asserts that biological sex and mythical masculine-born energy dictate one’s ability to harm others.
Two comics from Assigned Male on the topic, by Sophie Labelle
Myth #7: All gender-affirming care is medical. All transgender people seek surgery, and children are being pushed into getting serious operations.
“Gender-affirming care” refers to any service that benefits transgender people, especially if that service helps to affirm our chosen gender identity. Medical services like hormone replacement therapy and surgery are classified as such, but so do non-medical services like binders, gaffs, haircuts, clothing style, pronouns, names, etc. There is not a single transgender person out there who engages with medical gender-affirming care before being well-acquainted with non-medical services. Before the normalization of informed consent, it was legally required to socially transition to access HRT – but it is still required for some transgender Americans who have insurance coverage that dictates letter approval as a prerequisite for HRT. Beyond HRT, individuals have to prove they’ve been on HRT for several years in addition to being socially transitioned to have surgical procedures, and many states require certain surgeries, usage of HRT, or documentation to allow transgender folks to legally change their gender documents.
Many transgender people do seek surgical procedures (often referred to as top or bottom surgery), but there is no single “one-size-fits-all” surgery for us. Not all transgender people can undergo or afford surgery, especially if they are disabled, live in a hostile or rural area, or have medical coverage that purposely doesn’t include transgender care. Lastly, not all transgender people want surgery, and that doesn’t make them less transgender. Anyone who identifies as a gender identity other than the one assigned to them at birth qualifies as transgender, but the label does not require folks to feel a certain way about their body. Most often, transgender people forgo bottom/genital surgeries since they have high complication rates and can have less-than-satisfactory results. And as mentioned above, it takes a lot of work to access these surgeries compared to other aspects of gender-affirming care.
Regarding any stories on minors being pushed into serious transgender procedures, I would kindly ask you to reconsider the validity of their publishers. It is already difficult enough for transgender adults to access surgeries or for transgender minors to be prescribed puberty blockers. The possibility of a transgender minor accessing surgery before age 18 is nearly zero. Minors have numerous barriers to gender-affirming care in addition to the ones transgender adults face – even the international WPATH guidelines require minors to have multiple healthcare providers recommend services. The only trans-related surgery minors can have feasible access to is transmasculine top surgery, since any other procedure would be paused until the individual turns 18. And I say feasible because transgender minors cannot reliably access top surgery since it’s extremely barred.
Myth #8: Transgender people are mentally ill.
In my previous post, I wrote about how cisgender people struggle to understand transgender experiences. Since they have never had to think critically about their relationship with either gender identity or sexuality, cisgender people come to the assumption that rebelling against their natural worldview means transgender people must hate their bodies, since anything else wouldn’t make sense. This assumption fueled and twisted research on transgender identity for decades – and it accompanied many other problematic ideas.
For reference, during these early years, you would also be labeled as mentally ill if you were a woman who cried too much, refused to be a servant to her husband, or stood firm that women ought to be equal to men. Queer individuals were also considered mentally ill, as were anyone else that failed to conform. Calling transgender people mentally ill purely based on their identity is as faulty as saying women still experience hysteria because they’re unwed.
Today, it’s a bit complicated: transgender identity itself was internationally removed as a mental illness in 2018 via the World Health Organization, and the current psychiatric diagnosis is gender dysphoria. The disconnect between one’s biological sex and internal gender identity is the only part of transgender identity classified as a mental illness today. There’s still stigma with that association, but mental illness does not hold any inherent goodness or badness to it. Before the classification change, transgender identity itself was labeled as illness, whereas today only the distress experienced from being misgendered, unaffirmed, and otherwise not respected as ourselves is classified as illness, and that distress can be a lot.
By making that move, the World Health Organization, American Psychiatric Association, and DSM also links gender-affirming care as a cure for gender dysphoria as a mental disorder: it has been well-documented that gender-affirming care eliminates gender dysphoria, and such care is internationally recommended as the best practice for transgender patients. Once a transgender person is affirmed as their gender, they generally experience little distress due to their sex assigned at birth – and that lack of distress qualifies as a lack of illness.
There is one more reason why gender dysphoria is still classified as a mental illness, and it essentially boils down to capitalism. Due to the American health insurance industry, individuals must have a diagnosis that qualifies care as “medically necessary” for companies to cover services. Without any diagnosis, American corporations would be quick to deny transgender Americans access to gender-affirming care unless they were willing to pay out-of-pocket, which is why WHO, the APA, and the DSM left gender dysphoria in the DSM rather than removing it entirely. However, it is predicted this might change – the field of psychology is leaning into classifying gender dysphoria as a medical condition rather than a psychiatric one, similar to how obesity was classified as predominantly a medical issue. This would remove some of the leftover stigma of being a “mental disorder” and allow transgender individuals to continue accessing gender-affirming care via health insurance coverage, since it would be diagnosed by a medical professional. The only potential issue with this route is that few medical professionals are adequately trained on transgender issues, similar to their lack of training on mental health as a whole. Unless folks live in a region with plentiful trans-friendly and knowledgeable providers, they may be further limited since doctors are generally unwilling to diagnose if they feel unconfident.
Myth #9: There are only two genders/sexes.
Gender is real, but it’s still a social construct. Social constructs are ideas that affect us as humans because of their perceived importance, but have little to no impact naturally.
The two comparisons I commonly use as alternative social constructs are money and race, since they are, in fact, social constructs. Without money, you wouldn’t be able to convince someone to build you housing or be paid for work, so money is real, but it doesn’t have any natural value since you’re not going to commonly find wild animals trading currency. Race matters because it identifies groups of people with each other (for better and worse), but it doesn’t have any natural meaning since, again, you’re not going to find animals identifying based on fur patterns, skin textures, or any other feature.
Gender roles, expression, and identity are all socially real but lack actual natural value. Western society traditionally emphasizes two genders, but that’s just one among thousands that have existed across human history. Other societies have held three or more genders for centuries, and western society is rapidly moving to a three gender system as nonbinary identities become socially accepted and legally recognized.
Stating there are only two sexes is more accurate than claiming there are only two genders, but it’s still not fully true. Frankly, it’s over simplistic: sex is complicated, which is why we’re taught there are two sexes while early in our educational journeys, but that view expands if you continue to learn about biology. Biological sex is composed of chromosomes, gonads, hormone levels, internal genitalia, external genitalia, and a mess of “secondary sex characteristics” like body hair distribution, breast tissue, vocal pitch, body fat, bone structure, muscle mass, etc. Most people align with one end of the sex spectrum, but intersex people can be born anywhere along it – and there are countless ways intersex conditions are expressed, meaning there are vastly more than just two sexes if you account for each possible intersex condition.
Myth #10: All transgender people are a little gay, and it’s at least a little bit gay to be attracted to a transgender person.
Statistically, transgender people are more likely to identify as queer compared to cisgender people – but that’s more attributed to the fact transgender people have already critically thought about their relationship with gender, so they’ve very likely thought about their sexuality. While cisgender heterosexual people hate to consider it, most people float somewhere along the straight-gay binary – but unless they have taken the time to reflect on their sexuality, few identify as queer when it is more convenient to be straight.
The other half of this myth is a lot to get into. Attraction is complicated, and sexual anatomy matters in some relationships – but I’ve always been of the opinion that gender and identity labels need to matter more. If you are a woman dating a transgender man, you are in a straight relationship; you can be bisexual and date him, but you’re not in a lesbian relationship. Stating otherwise demeans that partner of his gender for your own comfort – and people being obsessed with the comfort of previous sexuality labels is the most common I’ve come across. Hearing your partner call themselves a lesbian while they’re dating you as a man hurts, even if they don’t think it’s harmful, since it devalues your gender. A cisgender man dating a transgender man is a gay relationship, and it’s messed up how many times I’ve come across men who say transgender people are the nice little stepping stone between being gay and straight.
A cisgender woman dating a transgender woman is a lesbian relationship, and a cisgender man dating a transgender woman is a straight one. Doing mental gymnastics with this to defend your sexuality puts transgender people in danger – it is predominantly transgender women who are assaulted and murdered because straight men cannot bear being thought of as gay after being with a transgender woman, leveraging trans panic when brought to court – although it does happen the other way around, such as in the murder of Brandon Teena.
On one hand, labels shouldn’t have to matter that much – it’s why so many people just refer to themselves as queer since it avoids getting into a whole mess of other labels. But if your identity as a lesbian, gay man, or straight person matters that dearly to you, realize that our gender identity matters just as much to us as transgender people.
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I was 14 when I realized I was transgender, back in the year 2014. Not much later, to my dismay, Caitlyn Jenner came out to the world – her novel identity fascinated the world, and that extended to my hometown in rural America. Suddenly, peers at school were talking about what they supposedly knew about transgender people, and my parents, who wouldn’t know I identified as trans for another year.
I’m well-versed in trans misinformation. Frankly, most transgender people are: it comes with being a marginalized person, expected to educate every single person you meet with unwavering patience. I don’t fault folks who get exhausted and frustrated after years of educating their friends, family, and strangers – that exhaustion led to the rise of Buzzfeed-like “Dear Cis People,” “100 Questions for White People,” and similar articles, videos, and posts during the 2010s that tried to rephrase that expectation. I always wondered when I would become frustrated and exhausted, likely to lash out like a stereotypical “blue-hair liberal.” Yet, eleven years later, I haven’t gotten to that point even though I’ve spent a decade in activism and educating cisgender people throughout those years. I can still manage patience, under one condition: I do not educate for bad faith. Many individuals purposely spread disinformation and “want to ask questions” to trans folks with the express purpose of being the Devil’s advocate. Those individuals are not open to actually learning and come with an agenda to demean or “convert” trans people. You cannot change them in one conversation, and they are not worth the effort. Anyone actually interested in understanding transness, that is not coming from a place of hatred, is worth teaching – even if they stumble on their journey.
Today, there’s more disinformation online than misinformation. There is a semantic difference: misinformation is false info spread, regardless of whether the person sharing knows if it’s true or not, while disinformation is purposely shared with knowledge that the info is false. All disinformation is misinformation, but disinformation is more nefarious. A family relative who shares a misleading post on Facebook about transgender people might not know its facts are wrong – that’s misinformation. If that relative knows that the post is incorrect, it becomes disinformation. There’s another conversation to be had on how to correct people with misinformation, since people hate being told they’re wrong and take corrections as a personal attack. Misinformation wasn’t that big of a deal ten years ago when flat-earthers and autism moms against vaccines were laughingstocks.
Misinformation is a big deal, and I don’t mean to be an alarmist. It truly holds the potential to cost human lives. We are more familiar with current events, such as the effects of misinformation about the COVID vaccine pushing more Americans to forgo the vaccination, leading to more immunocompromised people dying and more healthy Americans suffering from “long COVID.” Or, when Russia hacked American media during the past election cycles to spread disinformation and seat Republican candidates better suited to their interests.
Even before the 20th century, transgender people have always been around. If you look hard enough, you can find traces of gender-diverse people spanning centuries and Roman emperoress Elagabalus. Transness was only recently documented, and it’s only entered the public subconscious and mainstream in the past couple of decades. People claim the same about how many queer people exist today compared to fifty years ago, or how autism is supposedly on the rise. When identities are no longer criminalized and it becomes okay for people to publicly identify themselves, people incorrectly assume there’s an “explosion” of people suddenly queer, autistic, or transgender. The same belief was held on a sudden rise years ago of people identifying as left-handed or folks being diabetic. There was never a real increase, but there was a perceived explosion of left-handed individuals because they weren’t being burned at the stake for writing differently, and people were able to survive diabetes with the discovery of synthetic insulin, creating a “spike” of diabetic people.
This myth is fairly easy to dispute, for now. In some countries, information is regulated: when governments censor topics in published books, movies, and content on the internet, it’s easy to convince people that transgender people don’t exist. We are not at that point yet in the United States, but the GOP does want to move towards that future, evidenced by forced removals of transgender people mentioned in history, research, and educational curricula. Thus, trans history matters.
Myth #2: Transgender regret is common.
Compared to other medical procedures, transgender services like hormone replacement therapy and surgery actually have astonishingly low regret rates. Every surgery has a regret rate, whether it’s from complications, lack of satisfaction, or another reason entirely. The average knee surgery has a regret rate upwards of 30%, breast implants maintain a regret rate of up to 47%, and successful pregnancies have a regret rate around 17%.
The reason transgender people have an astonishingly low regret rate is because of these hoops, but it also deters people from getting care when it could benefit them. Trans regret only gets media coverage because detransitioners become viral on the internet from their sob stories. It’s unfortunate when it actually happens, but stories from detransitioned folks of how they were tricked are made up: even in “fast” informed-consent, you have a barrage of questions to answer from doctors to access prescriptions, changes take weeks to show even minor things, and you have people with you throughout the process to check in. Despite this reality, the belief that medical professionals are diabolically trying to force people to be transgender gets clicks.
Another way to think about trans regret and medical care is to compare it to other services. All procedures have risks and there can always be complications. Those risks are not worth denying the service as a whole. It’d be impossible to fathom a world where cancer treatments are banned because a small percentage of people have negative experiences on a life-saving treatment; the same should be applied to transgender procedures since they are documented as life-saving, too.
Myth #3: Transgender people want to trick cisgender people.
This myth has numerous layers, but at its core, it’s the insecure and paranoid belief that transgender people want to trick cisgender folks into having sex or that transgender people get some joy out of “tricking” people into perceiving us as our affirmed gender. Transgender people want to be respected as their authentic selves, but we don’t get joy from “tricking” others like our identity is a prank.
Trans people tricking poor cisgender folks into having sex is a real problem – and it’s been used as the punchline trope in comedy for decades. It even has legal recognition in most states, referred to as “trans panic defenses,” where cisgender people accused of murdering a transgender person can legally claim they were so angry, upset, or shocked that someone was transgender that they just had to assault them. The legal procedure comes from the underlying fragility of cisgender people’s sexuality, since there’s nothing worse than being thought of as flirting (or worse) with a transgender person, and gives cis judges and juries a reason to excuse anti-transgender hate crimes.
Disclosure is the process of telling a person that you’re transgender, and it’s a very personal decision that comes with inherent safety risks. Every trans person knows there is some risk in telling someone new, ranging from a new possible ally to a barrage of insults to even being hate-crimed. Some people prefer being out because they feel safe to do so, while others remain stealth – but not because they’re hoping to trick someone.
The transgender community advises sexually active folks to have that tough conversation with a prospective partner before you’re in the bedroom. Each person is different: a transgender woman who has had bottom surgery might not need to disclose her transgender status during a one-night stand because there’s nothing actually distinguishing her from other women compared to the safety risk of telling a stranger that you’re trans; a transgender man might feel inclined to tell a women he’s been seeing that he’s trans because aspects of his transness could affect their potential future together.
Cisgender people get frustrated about disclosure: they feel entitled to know whether someone is transgender. Some cis folks believe they “always know” when someone is trans, too. Yes, it is ideal for transgender people to be open about their identities, but cisgender people cannot be entitled to that knowledge as long as we exist in a society that is dangerous to live in. In comparison, there are so many other things you might want to know when having a one-night stand or going on a date with someone, like whether they’re infertile, if they have a stable job, if they have a disability, or already have children. But we all understand we are not entitled to automatically get that knowledge, and it completely upends how humans socially interact with each other via the social script.
On the other end of the spectrum, there is a community of cisgender folks who want to have sex with trans individuals because they fetishize us as a kink. Chasers (or “admirers,” as they call themselves) actively seek us out for sex. Any porn website will have a transgender category. Trans-specific dating apps exist purely for chasers’ convenience. We do not need to “trick” cisgender people into having sex with us. Should transgender people like chasers? That’s another topic for a different post – the ultimate point is no, we don’t trick cisgender people.
Because of the above, there is actually a subsection of the transgender community that identifies as T4T, or “trans for trans.” These trans folks only date other transgender people – but unlike chasers, they do so because they feel safer and better understood by other transgender people. We don’t have to explain our transness or the complications of gender theory to another transgender person to feel heard; we don’t have to fear that they might believe we’re going to hell for being trans or go into a violent rage because of who we are.
Myth #4: Transgender people are sexually aroused by their bodies. / Transgender people hate their bodies.
I combined two common myths for this one because both relate to how cisgender people fail to empathize with trans experiences. The first part, or the belief that all transgender people get turned on by their bodies, relates to Freudian-era pseudoscience and confusing transvestites with transgender people.
There are individuals who are sexually aroused by their bodies: the scientific terms are autogynephilia and autoandrophilia. But unlike transvestites, transgender people do not transition because they seek sexual pleasure. Generally, transvestites just stop at crossdressing (aka not continuing transition by seeking hormones or surgery) because they don’t actually want to identify as another gender. Yet transvestites were infinitely more interesting to research during the early years of sexology, so research papers were written for years with this base assumption that transgender people transition out of kink.
Are transgender people allowed to be sexually aroused by their bodies? Cisgender people are allowed to feel confident or sexy when looking at themselves in the mirror. It would be hypocritical to say transgender people do not deserve that same right. To feel comfortable in our bodies, that includes having the capacity to feel sexual in them, too. But that’s more a philosophical question outside of the realm of this myth.
The second part, or that transgender people must hate their bodies, also dates back to early research on transgender people. Cisgender people have always struggled to grasp what causes a person to want to be a different gender – very few cis people think critically about their relationship with their sex assigned at birth, so gender isn’t something they’ve really considered. To rebel against their natural worldview, they believe transgender people must hate their bodies – anything else wouldn’t make sense.
These assumptions permeated the very beginning of transgender researchers, and even trans-friendly providers held these stereotypes. It became quickly obvious that to transition socially, medically, or legally, transgender people had to adhere to these stereotypes since cisgender people held the power to prescribe medicine or affirm legal changes that transgender folks did not. To allow trans people to transition, doctors wanted them to fit their rigid boxes of what they believed transness to be – and that always included the stereotype that transgender people absolutely hate their biological bodies.
Today, there’s a decent understanding within the scientific community that transgender identity does not come from a hatred of one’s body but rather a disconnect between one’s internal versus outward gender. That disconnect can include feelings of hatred, but it doesn’t have to. The term “gender dysphoria” refers to that disconnect, ranging in feeling just uncomfortable to more extreme disgust or hatred. There is also a community of individuals promoting the idea that gender euphoria is just as important as gender dysphoria when discussing the need for transition – transgender people should not be expected to hate themselves. To be happy and fulfilled people, we need to be allowed to feel content in our bodies.
Myth #5: Transgender people want to dominate in sports, prisons, schools, etc.
We aren’t asking for unlimited access to dominate sports, we want the right to play fairly as ourselves. Until the past year or so, transgender people have been playing small roles within sports without issue: most leagues have written rules on how transgender people may participate, which usually requires two to three years of documented hormone replacement therapy. HRT is the key factor on supposed “advantages,” since hormones dictate muscle growth, strength, and stamina in all human bodies. A transgender woman who has been on prescribed estrogen for five years has no biological advantage over a cisgender woman – and quite frankly, cisgender women do hold an advantage if they compete with naturally high testosterone or a hormone disorder. Other aspects of transition, like surgery or legal status, have zero bearing on competitive performance.
For emphasis, transgender people have been officially allowed to compete in the Olympics since 2004. The exact rules have varied, but the general consensus to be allowed to participate is hormone replacement therapy. And the standards used by the Olympics are used in countless other sports and minor leagues.
Some folks might still get up in arms about other “advantages” transgender may have, but none of them warrant barring a group of people from fair play. A transgender woman who is six foot might have an advantage at basketball, but so does a cisgender woman who is also six foot. It’s those small advantages that drive people to play sports based on what they’re good at. It’s the nature of competition and sports. Getting up in arms about bone structure or child socialization is just as nonsensical as barring people based on race, ethnicity, disability, and even class.
This myth is more ludicrous in school settings. It’s difficult to argue against the benefits of school sports: they provide exercise while giving youth crucial team building skills while they socialize in a structured setting. But due to the stigma transgender people automatically get from participating in sports, very few of us do – and even fewer participate in school sports. Even in the most liberal states, transgender students still have to adhere to established protocols, which almost always relate to documented hormone replacement therapy. Out of the thousands of students that participate in school sports each here, only one or two of them identify as transgender. If they’re playing by the rules, it’s hardly fair to ban them based on identity alone.
Lastly, transgender people don’t go to prison to use taxpayer dollars for gender-affirming care. It’s way easier to transition beyond prison, and the dangers transgender people are exposed to in prison are never worth it: compared to cisgender adults, transgender people are roughly 10 times more likely to be assaulted by both fellow prisoners and prison staff. Most transgender people are forcibly detransitioned while incarcerated, so the reality is closer to transgender people asking if they can access or continue medical care while incarcerated.
Looking for more educational guides?
Browse Trans Solidarity Project’s guides, or check out these posts:
Most people have never considered the difference between “gender” and “sexuality” – unless you’re questioning or identifying as LGBTQIA+, there’s little reason for folks to give it a second thought. However, understanding these two concepts is key when discussing many oppressions, like sexism, heterosexism, and cissexism, and helps make you a better ally to transgender folks.
Looking for more educational guides?
Browse Trans Solidarity Project’s guides, or check out these posts:
In the simplest sense, gender identity (or just “gender”) is who you ARE or how you view yourself. Everyone has a gender identity, even if it is the same one as they were assigned at birth. You might identify as a boy, a woman, as genderqueer, agender, or nonbinary – but you still identify as something. GLSEN breaks up gender even further into three parts: gender expression, gender attribution, and sex assigned at birth.
Gender expression refers to how you display your gender or lack thereof. It’s a combination of hairstyles, fashion choices, behaviors, and habits that reflect your inner gender identity. Most people choose expressions that match their gender, such as dressing masculinely as a man or femininely as a woman, but expression doesn’t dictate gender. Women can have masculine expressions, men can be feminine, and nonbinary people can be androgynous or have a gendered expression. Expression is also the pronouns you state you use to match your gender and titles like mister, miss, and mx.
Gender attribution is how your gender is perceived by others, for better and worse. Gender very rarely occurs in an isolated bubble, and due to being a social concept, gender is both real and fake: people take aspects of your gender expression and sex to make quick assumptions about your inner gender. Attribution is most annoying when those assumptions are wrong, resulting in misgendering and deadnaming, but it’s one of many natural instincts people have when meeting individuals. When attribution goes well, it has positive benefits – being affirmed as your gender is a spectacular feeling as a transgender person, just like being misgendered is a miserable experience. Attribution is the pronoun and gender that others assume you are, such as a man, woman, nonbinary person, or other identity. Like expression, gender attribution does not dictate your gender identity. Other people assuming you are nonbinary does not make your gender identity nonbinary. However, it does often have an impact on your mental well-being and how you visualize your gender/passing ability.
Sex assigned at birth (SAAB) refers to the label medical professionals gave you upon birth, such as male, female, or intersex. SAAB is a “historical term,” unlike “sex,” which is used as a whole. Sex accounts for your current biology, but most aspects of biological sex are malleable, despite what anti-transgender activists claim. SAAB refers strictly to the sex you were perceived at birth, reflecting a part of your personal history but not necessarily reality. After high school, biology becomes complicated: science well-establishes sex is more than just a male/female binary and biological sex is instead composed of chromosomes, gonads, phenotype, and behavior. Modern science allows three-quarters of biological sex to be changed. SAAB refers ONLY to the state you were at birth and accounts for gender identity since SAAB determines whether you identify as cisgender or transgender. And like gender expression and gender attribution, SAAB does not dictate your gender identity – although all three parts can influence your overall gender.
The most common examples of gender identity are man and woman, although plenty of others exist. Technically, “cisgender” and “transgender” are descriptors of gender identity – everyone is either cisgender or transgender based on whether they identify as the gender assigned to them at birth. Cisgender means “same,” referencing folks who identify as the same gender they were assumed as at birth. Transgender means “different,” referencing those who identify as a gender identity other than the one assigned to them at birth.
Where do nonbinary folks fit in? Nonbinary is an identity associated with anyone who falls outside of the male/female gender binary. Currently, most nonbinary individuals are classified as transgender since they weren’t labeled as nonbinary growing up. Eventually, as more people are raised as nonbinary or without traditional gender, there will be folks who were raised as nonbinary and still identify as such – those people will be both nonbinary and cisgender. There are a few people today who fall within those categories, but it’s relatively rare.
What is Sexual Orientation?
If gender is how you view yourself, sexual orientation is who you’re attracted to. For most folks, it’s pretty straightforward – and like gender identity, everyone has a sexual orientation. Individuals who are attracted to the “opposite” gender as themselves are straight or heterosexual, like a man who is attracted to women. Those who identify as gay or homosexual are attracted to people who are the same gender as themselves. Queer, bisexual, pansexual, asexual, and other labels often reflect folks who don’t fit within that strict straight/gay binary – such as people who are attracted to one or more genders, or none at all.
Attraction can be further broken down: most people are familiar with romantic and sexual attraction, but it’s valuable to learn the inner workings of sexuality and attraction to better understand queerness and asexuality.
Romantic attraction happens when you want to be romantic with another person, like feeling the desire to date, kiss, hold hands, etc.
Sexual attraction is the desire you feel to be sexual with another person, like wanting to have any type of sex with someone.
Platonic attraction happens when you feel an emotional magnetism to someone, like feeling the desire to know someone better or become their friend.
Aesthetic attraction comes from appreciating someone’s look or fashion, like when you admire someone’s style but don’t necessarily want to date them.
Sensual attraction is the desire to hug or cuddle someone in a non-sexual tactile way.
Intellectual attraction is an attraction caused by wanting to engage or debate someone in conversation.
It’s perfectly normal to experience multiple types of attraction, and it’s also normal not to experience attraction. Most people experience a number of attractions all the time – many friends feel platonic, aesthetic, and intellectual attraction without romantic or sexual attraction; some folks might feel all forms of attraction when they’re in love with someone.
The key point is that gender identity is YOU, while sexual orientation pertains more to who you’re attracted to. As mentioned before, everyone has both a gender identity and sexual orientation – even if you don’t think about it very often, you still have labels like gender, sexuality, race, ethnicity, religion, class, etc. A straight man has a straight sexual orientation and a masculine gender identity, just as an asexual nonbinary person has an ace sexuality and nonbinary gender. Gender and sexuality matter to some folks and not others, just like how other identity labels matter more to some individuals ,like race and class. Gender and sexuality are also pretty fluid – you’re allowed to experiment and explore these identities, so what you find works now may not be what you identify as in ten years, and that’s alright!
Extra Credit: Historical Gender & Sexuality
I think it’s also worth noting that our modern definitions for gender identity and sexual orientation are reversed from what they used to be just 50 years ago. During the post-WWII sexology renaissance, there was a lot of research into gender and sexuality in the United States and Europe. However, this research was heavily dominated by straight white men inspired by pseudoscientists like Sigmund Freud and didn’t account very well into humanistic or people-first approaches. Many of these early researchers supported gender-affirming care, but they still fundamentally believed sex and gender were combined – in their view, LGBTQIA+ people existed due to anomalies and disorders of “regular” functioning.
This resulted in papers that documented folks who were assigned male at birth and identified as women (known as transgender women today) as “transgender/transsexual men,” and folks assigned female at birth and identified as male (known as transgender men now) as “transgender/transsexual women.” The distinction between gender and sex didn’t become widespread in academic settings until feminist scholarship found its roots during the 1970s, so these men used labels based on biological sex. Further, they applied sexuality based on this understanding: an individual assigned male at birth, identified as a woman, and was attracted to men would be classified as a gay/homosexual transgender man since, according to their standards, the individual was attracted to the same sex as themselves. Today, that same individual would be classified as a straight transgender woman. These differences can become confusing very quickly, but they’re important to remember if you delve deeper into transgender history or the history of gender.
Previously, I wrote about the basics of HRT – the process of taking prescribed synthetic testosterone or estrogen to align one’s physical body and sex characteristics with their gender identity. Despite the GOP’s war on transgender people, HRT has been firmly backed by medical science for nearly a century as the best treatment to prescribe. No amount of conversion therapy or repression is as effective nor humane as accessible trans-affirming care – and ‘trans regret‘ and ‘social contagion‘ theories have been repeatedly debunked by scientific research.
DISCLAIMER:This post is for informational purposes only and does not provide professional advice. Always seek the advice of a qualified healthcare provider with questions regarding medical conditions or treatments.
What’s the difference between HRT 1.0 and HRT 2.0?
My previous post explained the basics of hormone replacement therapy, puberty blockers, common myths, and recommended routes to accessing legal HRT via informed consent and written letters.
In today’s political climate, it may not be possible to access HRT through traditional legal routes. In contrast to my previous post, HRT 2.0 provides an overview of alternative routes – but remember the above disclaimer and be mindful of the legal risks involved. When possible, always get HRT prescribed through traditional legal routes. Don’t take risks when they aren’t necessary. For American adults, we are currently still at a point where it is feasible – and safer – to obtain HRT through mainstream doctors. Even when there are no local doctors physically available, telehealth now offers transgender folks the ability to get legal prescriptions online.
“DIY HRT” is the practice of obtaining and administering hormone replacement therapy without a licensed medical provider or prescription. Today, it’s fairly rare within the United States as long as individuals have physical and financial access to a provider, but it was the most common method for transgender folks decades ago when most healthcare professionals were unwilling to prescribe HRT. Beyond the US, DIY is still a common practice in countries where transgender identity is strictly regulated or criminalized.
By nature, DIY HRT communities are difficult to find on the mainstream internet, but they aren’t impossible to find. In addition to the medical disclaimer, DIY HRT communities are not open to minors. You might be able to find basic information, but these communities are already on high alert due to their potentially illegal nature and therefore generally unwilling to have open discussions with individuals under the age of 18. DIY HRT and its legality vary drastically by country – even within the United States, synthetic estrogen and testosterone have different laws applied to them. Throughout most of the world, possession of HRT isn’t a criminal offense, unlike the trade of unprescribed medication. To circumvent this, this article uses the same logic as most DIY communities on the clear web – this article is for purely informational purposes, and I do not endorse DIY HRT. As mentioned above, I actually advise getting your hormones from a licensed provider when possible.
Is DIY HRT Dangerous?
Anecdotally, it’s generally safe. All medicines and procedures carry some inherent risk, and hormone replacement therapy is no different. Traditional HRT carries no substantial medical risk compared to cisgender people, although there are (often discredited) doctors who will attribute unrelated issues to being on HRT.
DIY HRT isn’t much different as long as you know the potential risks and benefits of basic hormone therapy. The largest health risks associated with DIY are reduced by monitoring and appropriately adjusting your hormone levels through regular blood work – a process you’d normally do with a licensed provider, too. Blood tests are not negotiable; most external signs cannot feasibly identify whether you’re on a safe or unsafe dose. Monitoring your levels protects your long-term health.
Where do I learn more about DIY HRT?
For clear web users, there are two sources: r/TransDIY and The DIY HRT Directory. The Directory provides details on medication levels, distributors, and blood work, whereas r/TransDIY offers an open forum for discussions and questions in addition to general guides. The Directory currently does not offer any contact feature, so you should visit r/TransDIY for support.
The most common form of synthetic testosterone is injection-based, usually as testosterone propionate, testosterone cypionate, or testosterone enanthate. Both cypionate and enanthate have long half-lives (which determines the length of time the testosterone will last in your body). Gels are rare, but occasionally possible to find – although it is difficult to source the amount of gel needed for appropriate hormone levels.
For all forms of HRT, you begin on a much lower dose initially and progress to a stable regular dosage based on your blood work. Most medical providers mimic the natural hormone cycle of cisgender men, putting individuals on a low dose before increasing over the first few years, and then slightly lowering to a long-term level.
DOSAGE
Low Dose
Initial Dose
Typical Maximum
Testosterone Cypionate
20 mg per week IM/SQ
50 mg per week IM/SQ
100 mg per week IM/SQ
Testosterone Enanthate
20 mg per week IM/SQ
50 mg per week IM/SQ
100 mg per week IM/SQ
For more info on dosages, mainstream providers have guides available online for informed consent purposes.
Do NOT try to achieve a higher dose than what is needed. In addition to long-term health risks, high hormone doses are subject to the possible ‘spillover effect’ (clinically known as aromatization), where excess HRT will convert to your naturally produced sex hormone (aka estrogen).
Vials of injectable testosterone are often compounded as 200 mg/mL, 250 mg/mL, or 300 mg/mL. In common language, in a 200 mg/mL vial, there is 200 mg of testosterone in each milliliter. If the vial contains 10 milliliters of liquid testosterone, there are 2,000 milligrams of total testosterone in that vial.
Due to this, you will have to do math to calculate exactly how much liquid to inject to achieve your target dosage. Medical providers would calculate this for you, but you’ll have to do so when calculating for DIY. The formula used is:(amount you want to inject) ÷ (concentration of the vial) = amount to inject per dose in mL.
EXAMPLE: John has acquired a 200 mg/mL vial of testosterone and wants to have a 50 mg per week dose. (50) ÷ (200) = 0.25 Based on the above formula, John should inject 0.25 mL per injection.
Since injectable testosterone is fairly thick, it requires a thicker needle for proper injection. For intramuscular injections, it is recommended to use needles between 1″ to 1.5″ in length and 23-25g gauge (needle thickness). Subcutaneous injections should use needles between 1/2″ to 5/8″ in length and 25-30g gauge.
Compared to transmasculine DIY, which usually only requires injecting and monitoring testosterone levels, effective transfeminine HRT requires both synthetic estrogen and testosterone blockers.
Additionally, estrogen can be ‘homebrewed’ rather than purchased through a pharmaceutical company unlike testosterone (which cannot be produced at home). Within the DIY community, estrogen is commonly ‘homebrewed.’ Homebrewed estrogen is produced by individuals through raw estradiol ester/bicalutamide/etc powder. Pharmaceutical-grade estrogen is produced by legitimate pharmaceutical companies – these forms of estrogen are widely considered safer, but they are more expensive than homebrewed sources.
The most common form of estrogen is pill-based – they’re the most prescribed by licensed doctors and also the easiest to DIY. Synthetic estrogen does not harm the body the same way testosterone does in pill form, which is why transmasculine folks opt for injection routes. Always use bioidentical estrogens such as estradiol hemihydrate or estradiol valerate. Never use non-bioidentical estrogens for HRT. Estrogen can also be taken as a gel, patch, or injection – pills are cheapest per month, while injections are cheaper annually or long-term.
The most common testosterone blockers (antiandrogens) are pills that must be swallowed, which include spironolactone, cyproterone acetate, and bicalutamide. Spiro is the most famous, but is considered a weak (but much safer) antiandrogen. Cypro and bica are considered strongly effective but must be used with caution due to harsher health risks.
DOSAGE
The following guidance is considered a higher-than-average regimen than what most individuals may use. Adjust accordingly based on blood testing.
REGIME 1
Cyproterone acetate | 6.25-12.5 mg per day
Estradiol | 3 mg twice per day
REGIME 2
Bicalutamide | 50 mg per day
Estradiol | 3 mg twice per day
For DIY cypro, you will need a pill cutter to create the above dosage. If your testosterone levels are not adequately suppressed, increase your estrogen dosage.
Bica may cause blood testosterone levels to INCREASE slightly, so make sure your T is adequately blocked. 50mg is advised as generally adequate for testosterone suppression when combined with estradiol.
For more info on dosages, mainstream providers have guides available online for informed consent purposes.
Do NOT try to achieve a higher dose than what is needed. In addition to long-term health risks, high hormone doses are subject to the possible ‘spillover effect’ (clinically known as aromatization), where excess HRT will convert to your naturally produced sex hormone (aka testosterone).
Sourcing & Supplies
How do you find DIY HRT? Considering its legal status, it can be difficult to find – the following information and links are from major sources like r/TransDIY and the Directory. The Directory has not been updated in a few years, but r/TransDIY continues to be moderated – check its information for the most current verified distributors.
Injection Supplies
It’s fairly easy to get syringes and injection equipment – you don’t need a prescription to access them. Most countries allow you to purchase needles from any pharmacy, although you may need to speak directly with a pharmacist. Online, Amazon is the most popular source for American DIY users.
Amazon states needles are ‘not suitable’ for human use – but this is untrue and put to skirt around American Amazon regulations that prohibit the sale of medical supplies.
Medications
Listed below are the most common and reputable pharmaceutical distributors for DIY HRT. Use extreme caution if using a source that is not listed below or on either r/TransDIY or the Directory. Most in the DIY community purchase legitimate pharmaceutical-grade medication from foreign companies that permit the sale of these drugs internationally. To use these companies, you will have to learn how to buy cryptocurrency like Bitcoin or utilize an international system like Zelle or MoneyGram.
When purchasing HRT internationally, it is best practice to buy small amounts in case it is confiscated by customs. Individuals are rarely prosecuted or arrested for attempting to order international HRT, but your shipment can be seized. By ordering in small amounts, you reduce the amount lost when seized. Domestic purchases are not screened like international shipments, so there is little to no risk of losing your order.
Another route for DIY-ish HRT is stockpiling, which works well alongside informed consent and other methods of obtaining legal HRT. Since hormones are prescribed at an exact dose by providers, there are two ways to stockpile HRT from stockpile-adverse providers (although there is a growing number of providers that understand the volatile political climate transgender Americans are facing and why folks want to stockpile). Both methods described below are slow processes – you’re not going to be able to stockpile overnight through your provider.
By purposely taking less than your prescription in the days leading up to blood testing by your provider, your hormone levels will show up as low. In response, most providers will prescribe an increased dose to stabilize your levels. Once prescribed, individuals return to their former dosage regime and save the excess for future use.
Some individuals purposely take a lower dose regularly than their prescription to save the excess for stockpiling. This method is used when an increased prescription cannot be received but will result in slower transition, similar to the effects of low-dose HRT.
If possible, do not travel with DIY HRT – especially testosterone. Testosterone is strictly regulated compared to estrogen, and unprescribed medication can be charged as possession of a controlled substance if found by airport security. If you MUST travel, clearly label your testosterone in a large clear Ziploc bag and throw in over-the-counter medication like aspirin and allergy meds alongside in the bag. Airport security will be less likely to hound you for a prescription. If you are arrested, do not say anything to the police and contact a lawyer as soon as the opportunity is presented.
Blood Testing
Especially when beginning HRT, blood testing is recommended every three months – although every six months becomes more common later on. For DIY, you should get a blood test after one month on HRT and then every three months. It is advised to find a healthcare facility local to your location for blood testing, although you may have to ask to manually see your results. For accurate results and monitoring purposes, ALWAYS get your estradiol (E2) and total testosterone (T) tested every time. Additional information from blood tests are useful for monitoring potential side effects of HRT, but not as mandatory.
Transfeminine
Testosterone levels should range at 50 ng/dL or lower and estradiol should range at 100 pg/mL or above.
Transmasculine
Testosterone levels should range between 300-1,000 ng/dL and estradiol should range between 10-50 pg/mL. Unlike transfeminine HRT, testosterone hormone therapy naturally lowers naturally produced estrogen more easily.
Surgery can be an important step in the journeys of many transgender people in their pursuit to live comfortably and authentically as themselves. The ability to get necessary medical care is integral for democracy, and the ability for transgender folks to choose when, how, and why they get gender affirmation surgery is important for bodily autonomy. Learn about the basics of related surgeries in this post.
DISCLAIMER: It is still common for people to believe transgender people must get “the surgery” or at least be actively pursuing it. There are even people who believe you must get “the surgery” before identifying as transgender – while “the surgery” usually refers to bottom surgery, also known as genital surgery or sex reassignment surgery, these notions are both false. Surgery is a personal choice, and there are many reasons why a transgender person may want or not want a procedure – it doesn’t make them less transgender.
Glossary
The following are frequently used terms that will help guide your understanding of this article. It isn’t comprehensive, but it’s a great starting point.
GENDER AFFIRMATION SURGERY
The most modern term for any surgery done to affirm the gender of a transgender person – which includes all of the surgeries in this article. There is no single surgery all transgender people seek to get, which is why “gender affirmation surgery,” or GAS, fits in today’s language. Other terms include gender confirmation surgery, gender reassignment surgery, and sex reassignment surgery – while they have different connotations, they generally mean the same thing.
The only term not advised to use is “sex change.” This term is usually considered offensive due to its negative connotation and usage.
PRE-OP/POST-OP/NON-OP
These terms are all short-hand and slang used within the transgender community to describe surgery status.
Pre-op, or pre-operative, refers to a transgender person who seeks a gender affirmation surgery of some sort but has not received it due to a variety of reasons, like medical barriers, cost, physical health, safety, etc.
Post-op, or post-operative, refers to a transgender person who sought a gender affirmation surgery and has received it.
Non-op, or non-operative, refers to a transgender person who does not seek a certain gender affirmation surgery and does not plan to pursue it out of personal choice, rather than the barriers mentioned for pre-op individuals.
It is possible to be pre-op, post-op, and non-op at the same time – these terms are usually used within the community for specific surgeries as well as surgical status as a whole. Someone can consider post-op for having a chest reconstruction surgery, pre-op for seeking bottom surgery like metoidioplasty, and non-op for not wanting to pursue a procedure like facial surgery.
MEDICALLY NECESSARY
This term is often used within healthcare and insurance to describe whether a treatment will be covered by your insurance provider. Medically necessary treatments are services that are deemed as important for diagnosing, treating, or preventing an illness or injury. To qualify as medically necessary, treatment must be regarded as effective for your condition and must be done per generally accepted medical practices.
At the end of the day, transgender healthcare is considered medically necessary because it’s supported by all major medical institutions and is backed by decades of research proving the positive impact of trans-related treatments. Not all treatment options are considered medically necessary, though, and this article will point out which are and which are not.
Requirements for Gender-Affirming Surgery
Any surgeon who performs gender affirmation surgeries should follow the standards of care guidelines by the World Professional Association for Transgender Health (WPATH), which has produced these standards based on best healthcare practices since its founding in 1979. For historical context, WPATH was originally known as the Harry Benjamin International Gender Dysphoria Association – named after Harry Benjamin, who worked with Magnus Hirschfeld to provide healthcare to transgender and queer folks in pre-Nazi Germany.
WPATH has recently gotten negative media attention, sparked by the executive order by President Donald Trump “Protecting Children from Chemical and Surgical Mutilation.”The order, fueled by Project 2025, falsely accuses WPATH of being “junk science” despite decades of peer-reviewed research and being internationally agreed as the best treatment standard for gender dysphoria. Ordering all government agencies to rescind any policies that use WPATH, Trump and Project 2025 use actual junk science to fuel their anti-transgender claims.
The 8th edition of the Standards of Care was released in 2022, and research and guidelines on surgery are detailed in Chapter 13.
“In appropriately selected TGD individuals, the current literature supports the benefits of GAS. While complications following GAS occur, many are either minor or can be treated with local care on an outpatient basis. In addition, complication rates are consistent with those of similar procedures performed for different diagnoses (i.e., non-gender-affirming procedures)… The efficacy of top surgery has been demonstrated in multiple domains, including a consistent and direct increase in health-related quality of life, a significant decrease in gender dysphoria, and a consistent increase in satisfaction with body and appearance. Additionally, rates of regret remain very low, varying from 0 to 4%… Although different assessment measurements were used, the results from all studies consistently reported both a high level of patient satisfaction (78–100%) as well as satisfaction with sexual function (75–100%). This was especially evident when using more recent surgical techniques. Gender-affirming vaginoplasty was also associated with a low rate of complications and a low incidence of regret (0–8%).”
“If written documentation or a letter is required to recommend gender affirming medical and surgical treatment (GAMST), only one letter of assessment from a health care professional who has competencies in the assessment of transgender and gender diverse people is needed…
Criteria for Surgery: a. Gender incongruence is marked and sustained; b. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care; c. Demonstrates capacity to consent for the specific gender-affirming surgical intervention; d. Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options; e. Other possible causes of apparent gender incongruence have been identified and excluded; f. Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed; g. Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).”
There are two main takeaways from WPATH’s standards on surgery: the main qualifier to be eligible for gender affirmation surgery and have it be considered medically necessary is identifying with having gender dysphoria for a substantial length of time – usually between six to twelve months; most additional requirements like letters and use of hormone replacement therapy are optional.
Just like I explained regarding HRT, you are not going to find a licensed provider that would be willing to operate on someone who just suddenly ‘decided’ they are transgender – they must firmly believe that you understand the gravity of gender-affirming surgery, that you can fully consent to the procedure, and you are aware of its potential benefits and risks. Any media outlet or online personality that states otherwise is purposely lying to garner attention. While letters are not necessarily required according to WPATH guidelines, written documentation from a healthcare professional or mental health provider establishes the first requirement under WPATH – it gives proof to both your prospective surgeon and insurance company that you have experienced gender dysphoria for a set amount of time.
A decade ago, it was common for surgeons to require additional hoops for transgender people to access gender-affirmation surgery. Most often, surgeons required their prospective patients to have written documentation proving they had been on hormone replacement therapy for up to three years before they would consider them eligible for surgery. These HRT requirements weren’t usually pushed by insurance providers but existed as an additional safeguard for surgeons to lengthen the process of care – but it also served as a method of gatekeeping. Hormone replacement therapy is still a requirement for select surgeries where the effects of HRT have a direct positive impact on the result of a surgery, like testosterone and metoidioplasty. Other surgeries, like vaginoplasty or phalloplasty, may require electrolysis or laser hair removal. Going back further in time, surgeons also commonly required patients to have “real-life experience,” or proof that they were living as their chosen gender “full-time” – these requirements disproportionally barred individuals who were unable to transition out of safety, which is why they fell out of favor, although today’s societal acceptance of transgender people means more folks can live as themselves before surgery.
These requirements are not the same as those placed on transgender minors – WPATH has different guidelines for youth procedures:
“Criteria for Surgery: – A comprehensive biopsychosocial assessment including relevant mental health and medical professionals; – Involvement of parent(s)/guardian(s) in the assessment process, unless their involvement is determined to be harmful to the adolescent or not feasible; – If written documentation or a letter is required to recommend gender-affirming medical and surgical treatment (GAMST), only one letter of assessment from a member of the multidisciplinary team is needed. This letter needs to reflect the assessment and opinion from the team that involves both medical and mental health professionals (MHPs).
a. Gender diversity/incongruence is marked and sustained over time; b. Meets the diagnostic criteria of gender incongruence in situations where a diagnosis is necessary to access health care; c. Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment; d. Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally. e. Informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility; f. At least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.” – Standards of Care Version 8, WPATH summary requirements for youth surgery.
Some of the requirements are the same – but there are important distinctions. WPATH has a longer length for HRT usage than adults, and their standards also dictate the requirements for HRT and puberty blockers in transgender youth. They must have reached Tanner stage 2 of puberty to be eligible for either treatment and have their parents or legal guardians involved in the process. Written documentation has a higher bar set on who can write it for it to be valid for surgery. Youth must also demonstrate emotional and cognitive maturity in addition to proving they fully understand their treatment options. Combined, these standards make surgery incredibly difficult for transgender youth to pursue and push them to wait until after they turn 18, and the requirements lessen. These requirements also firmly debunk false accusations by anti-transgender individuals who claim minors are getting these surgeries en masse – the only surgery trans youth tend to have access to is top surgery or chest reconstruction, which still has all of the above requirements associated with it.
Financing Gender-Affirming Surgery
Surgery is expensive – especially in the United States, which makes money one of the primary barriers in whether transgender folks can pursue gender affirmation surgery. The first step towards financing your surgery is to deep-dive into your insurance coverage. Federal law prohibits most commercial and government insurance programs from discriminating against transgender-related care – but it still happens.
Before continuing, here are some main legal points to keep in mind:
Insurance providers cannot place blanket exclusions. Any plan that states something akin to “all care related to gender transition is excluded” violates federal law.
Insurance providers cannot place categorical exclusions on specific transition-related treatments deemed medically necessary. Plans that purposely exclude coverage for procedures like facial feminization surgery or voice surgery would violate this part of the law.
Insurance providers cannot place discriminatory limits on transition-related care. Any treatment covered for cisgender people must be covered for transgender people, too. For example, plans that cover breast reconstruction for cancer treatment in cisgender women cannot deny transgender people also seeking chest reconstruction for their gender dysphoria.
Insurance providers cannot cancel your coverage, refuse to enroll you, or charge you higher rates because of your transgender status.
Insurance providers cannot deny coverage because it is typically associated with one gender. If a healthcare professional recommends a procedure that is traditionally gendered, like prostate exams or pap smears, insurance providers cannot deny coverage simply because that individual is listed as the “wrong gender” on their paperwork.
If you believe you are experiencing discrimination, there are several steps you can take. Firstly, appeal any insurance denials you receive and keep in mind that you should apply for preauthorization before undergoing any procedures to ensure you know your standing regarding coverage. If your appeals do not go through, you may need to talk to an attorney or legal professional – like the National Center for Lesbian Rights, Lambda Legal, the Transgender Law Center, ACLU, or local organizations. You can also report anti-transgender discrimination with the United States Department of Health and Human Services and state agencies – check out Advocates for Trans Equality’s page for more information.
Confused by the American healthcare system and don’t know where to start with insurance? Click here.
Public Health Providers
Medicaid is the largest public insurance provider in the United States, run as a joint federal and state program to provide free medical coverage to low-income Americans based on income. Each state and territory has its own requirements for Medicaid, so you have to look into the specific policies relevant to where you live. In the majority of the country, transgender-related care is covered by Medicaid for adults – either explicitly by state protections or implicitly by the above protections in federal law. However, Trump’s executive order “Protecting Children from Chemical and Surgical Mutilation” currently bans any transgender-related coverage to minors through government programs like Medicaid, Medicare, and TRICARE. This order is being sued in court, but it has not yet been paused by federal courts – until then, the order causes immense harm as it shuts down gender-related care at major hospitals.
At the time of this article, 10 states ban transgender-related coverage in their Medicaid programs: Idaho, Arizona, Texas, Nebraska, Missouri, Kentucky, Tennessee, Florida, Ohio, and South Carolina. However, as mentioned in this post, it’s worth remembering that not all adults are eligible for Medicaid since 10 states also ban single adults from applying entirely, regardless of income.
Medicare is a federal program that provides medical coverage to people with disabilities as well as older adults ages 65 and older, regardless of income status. Since it is run federally and not controlled by individual states, Medicare offers less flexibility than programs like Medicaid but is less discriminatory as a whole. Since 2014, Medicare has covered transition-related surgery, and there is no national exclusion for transgender treatments. In practice, Medicare deals with trans-related healthcare the same as it does other forms of coverage – each individual is covered on a case-by-case basis based on whether the care is deemed clinically necessary. Learn more here.
The US Department of Veterans Affairs provides free healthcare to anyone who has served in the armed forces and did not receive a dishonorable discharge, while active service members are covered by TRICARE until their service is complete. The VA will cover most transgender-related procedures, including hormone replacement therapy, binders, prosthetics, mental health care, and voice coaching – but the VA still prohibits any coverage of transition-related surgery regardless of medical need.Read more about VA coverage here.
Due to Trump’s executive order “Prioritizing Military Excellence and Readiness,” transgender people are again banned from serving in the United States armed forces. It is unclear whether this ban will dishonorably discharge American servicemembers, similar to the previous Trump ban, but a similar act would bar transgender people from using VA health services despite their service. Since transgender individuals are banned from the military, TRICARE does not offer transition-related services to its active members – although it still currently provides limited treatment coverage to family members of active members as long as they are at least 19 years old.
All Native Americans recognized by a Federally recognized tribe are eligible for free healthcare coverage through Indian Health Services within their official IHS district or reservation. While IHS provides gender-affirming coverage for treatments within their scope, there is no information about their procedures due to the Trump directive to purge government health websites of data – including transgender issues and other unrelated topics. While the federal courts have ordered the administration to restore the data, this story is still developing.
Incarcerated individuals are one of the few groups in the United States entitled to healthcare protected as a constitutional right – although there are no standards of what minimum healthcare must be provided for free since it is not codified or elaborated in law. Gender-affirming care, including hormone replacement therapy and surgery, are supposedly protected rights – but most prisons have barriers in place, like requiring proof of care before arrest. These barriers are what cause a quarter of transgender inmates to be denied healthcare, even though accrediting organizations like the National Commission on Correctional Health Care recommend transgender procedures.
Commercial Providers
The majority of Americans use commercial insurance through the Healthcare Insurance Marketplace or their employer when they do not meet the criteria for other providers like Medicaid, CHIP, Medicare, IHS, VA, TRICARE, etc. Anyone at least 18 years old and not currently incarcerated is eligible for the Marketplace as long as they are lawfully living in the United States and are not eligible for Medicare – individuals eligible for Medicaid are recommended to use the Marketplace since it also issues coverage for those meeting their state guidelines. Out2Enroll is the best national resource for researching care guidelines – their information is entirely free and user-friendly, and their Trans Health Insurance Guides page has up-to-date data for transgender coverage in each state.
Historically, these laws focus on whether commercial providers are allowed to deny transgender-related care. Zero laws intend to outlaw transitional treatments entirely and prevent providers from opting to cover them – in Arkansas, there are still insurance companies that cover transgender treatments even if they’re ‘allowed’ to deny coverage. While there are entities that seek to outlaw transgender care entirely (ex. Project 2025 and the Heritage Foundation), it’s exceedingly unlikely to take that jump – and if it did, the crisis in the United States would cause an international precedent of allowing transgender Americans to flee as refugees due to the depth of that jump. Instead, it is more likely that anti-transgender organizations and people in power will tear away at American healthcare protections in attempts to federally legalize coverage discrimination rather than outright banning coverage.
For information about commercial insurance that is not covered by Out2Enroll, check out Advocates for Trans Equality’s Trans Health Project – their site goes in-depth on legal rights regarding commercial coverage and how to navigate its systems.
Crowdfunding & Grants
In the age of the internet, crowdfunding is a common route many transgender folks use to finance transgender-related surgeries when their primary insurance provider fails them, or they lack coverage entirely. The most commonly used platforms are GoFundMe, Donorbox, and Facebook – although all of these sites take a percentage of the money raised. GoFundMe is the largest crowdsource site, but it’s known to take the largest cut compared to alternatives. Non-personal organizations and nonprofits have a larger variety of sources out there, like Givebutter, while individuals can raise money without losing a percentage through direct money transfer apps like Cash App, Venmo, Paypal, and Zelle.
This option is less advised compared to the above routes – if possible, use any insurance coverage you have and work your way down this list. Personal loans through online lenders and credit unions are the best route for borrowing money for gender affirmation surgery, with their own pros and cons. Online personal loans can be used for nearly any purpose, including medical costs, and range up to $100,000 but can be expensive if you don’t pay attention to your monthly payment and annual percentage rate. Credit unions offer similar personal loans at lower interest rates but use your credit score to determine whether you qualify for their funding.
The most common credit card associated with healthcare costs is CareCredit, which offers zero-interest financing for a designated term. However, the downside to CareCredit is that it defers interest after its promotional period if you fail to finish your payments within that period – and CareCredit’s standard APR is 29.99%. Depending on your credit score, other credit cards offer alternatives with lower interest rates than CareCredit.
Lastly, some surgeons and healthcare providers offer payment plans similar to credit financing that break up large medical bills into more affordable monthly payments. Make sure you read the terms before signing and negotiate with your provider to understand additional billing fees associated with using a payment plan.
Associated with: Any/All Genders. Set of surgical procedures that uses liposuction, fat grafting, and skin excision techniques to sculpt the body to appear more feminine, masculine, or androgynous. Can be covered as medically necessary on a case-by-case basis with sufficient documentation of gender dysphoria. Recovery time of two to three weeks, average cost of $8,500 to $19,500 without coverage.
Associated with: Transfeminine. Surgical procedure that utilizes breast implants to create a female breast contour, especially when combined with estrogen-based hormone replacement therapy. Can be covered as medically necessary, especially if breast contour from HRT is insufficient to alleviate gender dysphoria. Also known as MTF top surgery. Recovery time of four to eight weeks, average cost of $5,000 to $10,000 without coverage.
Associated with: Transmasculine. Surgical procedure that removes the breasts through a variety of techniques to create a male chest. Widely considered medically necessary and is the most common gender-affirming surgery for transmasculine individuals. Also known as FTM top surgery or a mastectomy. Recovery time of six to eight weeks, average cost of $3,500 to $10,000 without coverage.
Associated with: Transfeminine. Non-surgical technique that permanently removes hair regardless of hair type or skin color but is slower than laser hair removal (which works best for dark hair and light skin and does not work on blonde, gray, white, or red hair). Widely considered medically necessary and commonly covered with prior authorization. Recovery time of two to three weeks per session, average cost of $30 to $150 per session without coverage.
Associated with: Transfeminine. Surgical procedures that transform traditional male facial features into shapes, sizes, and proportions associated with female features. Considered medically necessary. Also known as FFS. Recovery time of six to twelve months, average cost of $4,500 to $100,000 without coverage.
Associated with: Transmasculine. Surgical procedure that masculinizes facial features, especially in individuals who do not receive sufficient masculinization from testosterone through hormone replacement therapy. Can be considered medically necessary with sufficient documentation of gender dysphoria. Also known as FMS. Recovery time of six to twelve months, average cost of $1,000 to $20,000 without coverage.
Associated with: Any/All Genders. Surgical technique that creates hairlines associated with male or female stereotypes and restores hair loss. Can be deemed medically necessary but not commonly covered by most insurance providers without sufficient documentation for gender dysphoria. Recovery time of ten days per session, average cost of $4,000 to $15,000 without coverage.
Associated with: Transmasculine. Surgical procedures that remove the uterus or womb. Total hysterectomies remove the cervix, although the removal of the ovaries varies based on patient preference and medical need. The three main procedures include laparoscopic, vaginal, and abdominal – while abdominal is the most common, it is the most invasive and has the most associated complications. Widely considered medically necessary. Also known as masculinizing lower surgery or hysto. Recovery time of six weeks, average cost of $16,000 to $17,000 without coverage.
Associated with: Transfeminine. Surgical procedure performed as a type of facial feminization surgery to reduce the size of the Adam’s apple by removing thyroid cartilage. Can be considered medically necessary. Also known as a tracheal shave. Recovery time of two to four weeks, average cost of $3,000 to $10,000 without coverage.
Associated with: Transmasculine. Surgical procedure that creates a small phallus from existing genital tissue formed from clitoral enlargement from testosterone-based hormone replacement therapy. Widely considered medically necessary when accompanied by medical documentation. Also known as meta. Recovery time of six weeks, average cost of $4,000 to $60,000 without coverage.
Associated with: Nonbinary. Surgical procedure that reroutes the urethra to the perineum to create a gender-neutral appearance to the genitals. Compared to other genital surgeries, gender nullification is relatively new and was introduced as an option due to the growing number of medical professionals well-versed in nonbinary identities. Can be considered medically necessary, although you may have to combat your insurance provider due to it being considered more experimental than other genital surgery options. Also known as nullo or eunuch surgery. Recovery time of six to eight weeks, average cost of $15,000 without coverage.
Associated with: Transmasculine. Surgical procedure that removes the ovaries, halting the natural production of estrogen. Considered medically necessary and often done alongside hysterectomies. Recovery time of two to six weeks, average cost of $7,000 without coverage.
Associated with: Transfeminine. Surgical procedure that removes the testicles/testes, halting the natural production of testosterone. Widely considered medically necessary and can be done alongside other gender-affirming genital surgeries. Recovery time of two to four weeks, average cost of $2,000 to $8,000 without coverage.
Associated with: Transfeminine. Surgical procedure that removes the penis and relocates the urethra to allow the individual to urinate more freely. Considered medically necessary. Recovery time of four weeks, average cost of $8,000 without coverage.
Associated with: Transmasculine. Surgical procedure that creates a penis using tissue grafted from another part of the body, such as the forearm or hip. Widely considered medically necessary when accompanied by medical documentation. Also known as phallo. Recovery time of twelve weeks, average cost of $25,000 to $50,000 without coverage.
Associated with: Transmasculine. Surgical procedure that creates a scrotum using skin from the labia and a silicone implant, often done in conjunction with other genital surgeries like metoidioplasty or phalloplasty. Considered medically necessary. Recovery time of eight weeks, average cost of $3,000 to $5,000 without coverage.
Associated with: Transmasculine. Surgical procedure that repairs and lengthens the urethra during gender-affirming genital surgery to allow the individual to urinate while standing using their new anatomy. Widely considered medically necessary. Recovery time of six weeks, average cost varies based on accompanying procedures.
Associated with: Transmasculine. Surgical procedure that removes the vaginal lining and closes the vagina, reducing the complications associated with other genital surgeries like metoidioplasty and phalloplasty. Widely considered medically necessary. Recovery time of six to eight weeks, average cost varies based on accompanying procedures.
Associated with: Transfeminine. Surgical procedures that transform male genitals into functional and aesthetic vaginas and vulva. Widely considered medically necessary. Recovery time of six to eight weeks, average cost of $20,000 to $30,000 without coverage.
Associated with: Transfeminine. Surgical procedure that alters the voice to better fit traditional male and female stereotypes. While possible for transmasculine and nonbinary individuals, it is more commonly associated with transfeminine transitions since testosterone-based hormone replacement therapy naturally alters the voice, whereas estrogen-based HRT does not. Can be considered medically necessary. Recovery time of six months, average cost of $5,500 to $9,000 without coverage.
Associated with: Transfeminine. Surgical procedure that removes the penis, scrotum, and testicles while also creating a labia, clitoris, and urethral relocation – but unlike vaginoplasty, it does not create a vaginal canal and instead has a zero/shallow-depth dimple constructed. Can be considered medically necessary. Recovery time of six to eight weeks, average cost of $20,500 to $22,000 without coverage.
Curious about the basics of gender-affirming care? The use of HRT has been foundational and approved as the best form of treatment for transgender people for nearly a century. Learn the facts about hormone replacement therapy and its importance in this week’s post.
HRT, also known as hormone replacement therapy, is the use of synthetic hormones to mimic traditional sex hormones. Hormone treatments were originally invented in the early 1900s, related to when researchers discovered how to isolate and synthesize testosterone and estrogen, and became widely prescribed to cisgender folks by the 1960s.
Even though HRT is commonly associated with transgender people and our transitions, it’s utilized more often by cisgender individuals – these hormone treatments were created to help with the lower levels of sex hormones cisgender men and women experience as they age. The use of hormone replacement therapy as gender-affirming care and a means to allow transgender people to medically transition began in the 1950s through the John Hopkins School of Medicine, Harry Benjamin, and Christian Hamburger. Gender-affirming hormone therapy (GAHT)/hormone replacement therapy (HRT) is the use of prescribed synthetic hormones to align one’s secondary sex characteristics with their gender identity – which ranges from body fat, breast growth, muscle mass, vocal range, hair, Adam’s apple, etc.
What are Puberty Blockers?
Puberty inhibitors and blockers suppress the natural production of sex hormones like testosterone and estrogen, created and approved by the FDA to treat precocious puberty in cisgender children. Due to the growing trend of children starting puberty earlier than normal, puberty blockers became more commonplace for doctors to prescribe to cisgender patients. Around the same time, puberty blockers were being used experimentally abroad to help transgender children explore their gender identity more thoroughly by the 1990s via the Dutch Protocol. The primary purpose of puberty blockers is to pause cisgender-associated puberty in youth wanting to explore their gender identity without the use of HRT. After spending an ample amount of time solidifying their gender identity, they can continue their medical transition through hormone replacement therapy to mimic puberty aligned with their internal gender; if they change their mind regarding their gender identity, puberty blockers can be stopped at any time and puberty will begin/resume as normal.
Before continuing, I cannot stress enough that puberty blockers and hormone replacement therapy are widely considered safe by the scientific community. Both treatments have been used to treat gender dysphoria for decades and it’s been established blockers are the best and most humane way to allow gender-diverse children to explore gender since blockers are entirely reversible. The only genuine negative side effect associated with blockers is lower bone density that is created by bone mineralization during puberty – but this is easily managed with exercise, calcium, and Vitamin D. There is not much high-quality research on the long-term effects of puberty blockers, just as there is little long-term research on transgender people as a whole – but information available supports that the use of puberty blockers. Even if all parents/legal guardians approve of a child receiving puberty blockers, many additional steps are required to ensure they are the best option for the child’s health and well-being. Despite this consensus, many bad actors intentionally lie to harm transgender people: it has been leaked and proven that anti-trans politicians are purposely using funds to back pseudo-scientific research against gender-affirming care in their bills. It is incredibly easy for institutions and figures to create misleading research to support inaccurate beliefs; the foundations that host their findings are non-profit, using governmental 501(c)(3) status to legitimize their work even though anyone can create a non-profit by filling the appropriate paperwork. Many organizations have tried to ‘debunk’ puberty blockers and the Dutch protocol out of a political agenda – but none of them can debunk the actual use of blockers in trans children, which is to simply pause puberty temporarily (not ‘cure’ gender dysphoria, force children to take cross-sex hormones, etc.) As such, there are no reputable organizations, institutions, or research groups that dispute the effectiveness of gender-affirming care.
Puberty blockers are most often prescribed for gender-diverse youth between the ages of 9 to 16, but this can vary based on your needs since bodies vary. Once prescribed, blockers come in two forms: the histrelin acetate rod can be inserted under the skin in your arm and lasts for one year, while the leuprolide acetate shot can work up to 1, 3, or 4 months at a time. However, puberty blockers and gender-affirming care for minors are currently highly controversial for reasons stated above – as of 2025, there are six states that make it a felony crime to provide gender-affirming care to transgender youth.
On January 28th, 2025, President Donald Trump signed the executive order “Protecting Children from Chemical and Surgical Mutilation,” which prohibits federal funding and research on gender-affirming care for all individuals under the age of 18 in the United States. On paper, this bans the use of Medicaid, TRICARE, and other government programs from prescribing puberty blockers, hormone replacement therapy, and other well-supported forms of care until age 19. However, this order has long-reaching effects which is why it is being challenged in court – hundreds of hospitals and clinics are preemptively stopping gender-affirming care entirely out of fear, and even more facilities have stopped providing gender-affirming care entirely to all transgender people regardless of age since they rely heavily on federal funding.
I would normally try and insert an information video about puberty blockers – but YouTube is infested with anti-transgender content on the topic due to recent news from both the Trump administration and overseas in the United Kingdom.
Mythbusting HRT: Fact-Checking Gender-Affirming Care
MYTH: GENDER-AFFIRMING CARE IS UNSAFE. FACT: As I mentioned above, gender-affirming care is supported by every major medical and mental health association. Age-appropriate transition care is considered both medically necessary and life-saving for individuals who experience gender dysphoria, or a disconnect between their internal gender identity and sex assigned at birth. While there are some negative health risks associated with hormone replacement therapy that I will cover later, they are immensely manageable and outweighed by the positive impacts of gender-affirming care. Over 1.3 million licensed doctors in the US support gender-affirming care, as well as leading organizations like the American Medical Association, American Academy of Pediatrics, and American Psychological Association.
MYTH: ONLY EXTREMIST LEFTIST DOCTORS SUPPORT GENDER-AFFIRMING CARE. FACT: In the United States alone, over 1.3 million licensed doctors support gender-affirming care. That’s because transgender healthcare is overwhelmingly backed by research! That’s essentially every single registered physician considered active by the American Medical Association. Not every doctor agrees on gender-affirming care, and there are plenty of physicians that are not well-informed on how to interact with transgender patients – but the underlying consensus no matter what is that gender-affirming care is necessary.
MYTH: BUT [INSERT STUDY HERE] SAYS GENDER-AFFIRMING CARE IS DANGEROUS! FACT: Also mentioned above, there is a growing wave of anti-trans pseudoscience being funded by politicians with bigoted and nonscientific agendas. We live in a universe where you can purchase a degree from nonreputable sources, and astroturfing proves how widespread fake movements are in funneling money to bad science. If someone lacks integrity, it is not hard to manipulate research into creating “proof” that supports your claim – most commonly, these individuals will manipulate the data gathered in their research by deleting objecting evidence and using misleading questions. The amount of junk science that opposes transgender rights and healthcare is overwhelmingly outweighed by real researchers and associations – which have real relevant experience, qualifications, peer-reviewed work, and publications by reputable journals.
Lastly, federal law states that insurance providers can limit care, even if it’s deemed medically necessary – but they are not allowed to deny care based on patients. If a provider covers mastectomy for cancer or genetic predisposition, they must also cover it for gender dysphoria. Providers that cover hormone treatments for cisgender people cannot deny HRT for transgender individuals. Doing so is considered discrimination and blatantly against the law.
MYTH: MOST PEOPLE THAT TRANSITION REGRET THEIR DECISION! FACT: Any “research” you read regarding this, I invite you to reread the above section on junk science. Detransitioning, or the act of reverting to your sex assigned at birth, is exceedingly rare and studies report “transition regret” as low as 1% to 2% of all cases – although these numbers vary drastically due to the political slant in the research. In reality, gender-affirming care actually has the lowest regret rates in the medical field – your average major surgery has a 5% to 10% regret rate, knee replacement surgeries have rates up to 30%, and pregnancies have roughly a 7% rate of regret. You wouldn’t dream of preventing someone from having knee surgery or a baby because they might regret it later.
Potential regret is why puberty blockers exist for trans kids. Blockers allow transgender youth to explore their gender identity before medical transition since they’re reversible. Even for adults, gender-affirming care is not someone people just wake up and decide one day. Surgery requires letters of approval from mental health professionals, which can take three to twelve months of appointments to get. While informed consent clinics make it easy for transgender adults to access hormone replacement therapy, they’re still not going to prescribe hormones for someone who “decided” they were trans that same day – they’re going to make sure you have fully thought through your decision and can give medical consent.
MYTH: PEOPLE ARE ONLY BECOMING TRANSGENDER NOW BECAUSE IT’S TRENDY. FACT:Transgender people have existed as long as humanity has existed. We will continue to exist no matter what laws are passed, even if we are forced back into the closet. While more people are open about their transgender identities, it’s not because it’s suddenly trendy – it’s just safer and more socially acceptable to be open about it. Language changes, so more people are able to become familiar with words like transgender to describe their experiences – in the past, people who would identify as transgender today might have identified as drag performers, crossdressers, transsexuals, transvestites, or even butch women and femme men.
The right-wing “social contagion” theory has been repeatedly debunked. The theory asserts that “rapid onset gender dysphoria” occurs in today’s youth due to social media – but there is zero empirical evidence to support this claim. This conspiracy theory is used by lawmakers to justify anti-trans legislation, and most medical associations have made official statements to eliminate this term from being used.
MYTH: CHILDREN SUBJECTED TO GENDER-AFFIRMING CARE HAVE MEDICAL PROCEDURES THAT WILL PERMANENTLY ALTER THEIR LIVES. FACT: News articles that claim this are sensational and intentionally trying to mislead you. Before puberty, transition is entirely social for children – as well as for most adults in the beginning processes of exploring their gender. Social transition involves no medical interventions and therefore is completely reversible, such as using a new name, pronouns, clothing, or hairstyle. The only possible negative consequence of social transition is potential bullying and discrimination – but it is in no way that person’s fault they are being bullied or harmed due to a society that is adverse to exploration.
If a child is exploring their gender identity at the onset of puberty and they have supportive parents, they might have access to puberty blockers to pause puberty temporarily while they continue to explore. Blockers have been approved as the gold standard by the FDA since 1993 to pause puberty. Complications like bone density are easily remedied with supplements and existing research on puberty blockers used on cisgender youth with precocious puberty shows normal fertility and reproductive functioning after reversing their blockers.
There are no young children who are being subjected to transgender-related surgeries. In extremely rare cases, 16 and 17-year-olds can get specific surgeries like chest/top surgery only if they have been consistent in their current gender identity for years, have been taking gender-affirming hormones for an extended amount of time, and have approval from all parents/legal guardians and doctors. Once all of those factors are achieved, they still have to get additional approval from multiple mental health providers and physicians to determine that surgery is the best course of action. By the time that process is done, that young person is most likely 18 – which is why the overwhelming majority of transgender youth wait until that age to pursue gender-affirming care.
The only form of “mutilating” sex surgery performed on children is perpetrated by conservatives. Intersex medical interventions, or genital mutilations, are performed on intersex infants to align with stereotypes on how male and female genitals should look – with or without parental knowledge.
MYTH: ANTI-TRANS BILLS ARE ALL ABOUT PROTECTING KIDS! FACT: Politicians who insert partisan debates in private conversations never genuinely care about science, medicine, or evidence. If these bills were about protecting kids, anti-abortion politicians would ensure the United States has an immaculate foster care system, education program, and policies to uplift youth. Instead, those same politicians have zero empathy for new mothers, purposely try to destroy public education, disavow sexual education entirely, attempt to dismantle foster care systems, create higher costs for giving birth and parenthood, and penalize youth at every possible chance. Anti-trans bills and their lawmakers are fueled by bad faith – politicians that regularly try to defund services like mental health cannot be taken seriously when they try to claim they are “protecting kids.”
There have been clear, well-established, and evidence-based standards of care for transgender people for nearly a century – the World Professional Association of Transgender Health (WPATH) has maintained these standards for decades. These standards advocate that gender-expansive youth have access to socially explore their gender before anything else.
How Do I Get HRT?
There are two primary routes to get prescribed hormone replacement therapy: letter approval and informed consent. Both are acceptable ways to legally get access to hormones – but the path you should take will depend on your needs and local laws.
INFORMED CONSENT
The informed consent model of care is the most modern and reduces gatekeeping that bars many folks from receiving healthcare. The idea behind informed consent is that most adults can make decisions about their own healthcare when given accurate and in-context information. After finding a provider that uses the informed consent model, they’ll educate you on the possible benefits and risks to HRT before having you sign off on the paperwork needed to state you are officially consenting to the medication plan.
To be able to use informed consent, you will need to be your own legal guardian. Most people automatically do this upon turning 18, although your situation may vary. Upon meeting that standard, your provider must feel confident that you understand the information given to you, so they’ll likely break down medical terms and videos, photographs, and guides.
Wanting to find an in-person informed consent provider? Erin Reed has a detailed map and Planned Parenthood is one of the largest providers in the United States. Due to the current administration, it is advised to find a provider you can see in person – political attacks on trans-related telehealth make online options less viable for the immediate future. However, FOLX and Plume are the best telehealth HRT providers that prescribe hormones online.
The greatest pro to informed consent HRT is the speed of the entire process. Some clinics will prescribe you hormones the same day that you make your appointment. A common complaint about the traditional route where you’re required to get a letter from a mental health professional is that trans folks feel like they’re performing their transness for their provider – giving a long story on when they first realized they were transgender, often embedded with many of the stereotypes cisgender people have about transness to get their medication. By removing that barrier, trans people are more free to be themselves.
LETTER APPROVAL
Until 2012 upon the release of WPATH’s 7th edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, the approval letter model was the only way to access hormone replacement therapy – the 7th edition officially opened the path for providers to prescribe HRT through informed consent.
The letter approval model requires transgender people to acquire a letter from a therapist or other mental health professional stating that gender-affirming care like HRT is medically necessary for their well-being. This method is becoming less common since it encourages negative stereotypes about transgender people as they’re forced to cater to the understanding (or lack thereof) of transness that a mental health provider has to receive their letter of approval.
The process can take anywhere from three to twelve months since it requires the therapist to feel fully confident that gender-affirming care is medically necessary for their client before signing the letter. However, the letter approval model is more stable and tends to offer more financial stability – most insurance companies will put up a fight on covering any sort of medical care, and this is definitely the case within transgender healthcare. It’s also worth noting that since the letter approval model is more traditional and has been used for decades, it’s less likely to be impacted by anti-transgender laws or executive orders in the years to come.
Providers that offer gender-affirming care through the letter approval process often work on a much smaller scale and are significantly more common in rural settings. While large gender clinics have specialized staff to prescribe informed consent HRT, these providers may be primary care physicians, endocrinologists, gynecologists, urologists, psychologists, or psychiatrists.
Feminizing Hormone Therapy (FHT)
Feminizing HRT uses a combination of several hormones to create physical changes in the body typically caused by female puberty. Gender-affirming hormones stimulate nearly all of the same changes that occur during puberty for cisgender girls. Most individuals take a combination of estrogen (estradiol) and antiandrogens (spironolactone) since a testosterone-blocking medication is required to ensure the synthetic estrogen works best. While it’s not as common, some providers also prescribe progesterone to aid FHT.
Estradiol is prescribed as a pill, injection, and skin patch. Throughout your healthcare journey, your provider will regularly check your hormone levels with blood tests to ensure they’re in an optimal and healthy range. The effects of FHT vary from person to person – puberty is different for cisgender and transgender people alike, and the best way to predict what your results will be is to look at women you’re immediately related to. The combination of testosterone blockers and estrogen causes breast growth, softer skin, less facial and body hair, decreased muscle mass, and more – but FHT can’t change the pitch or sound of your voice, which is why some people opt for voice feminization surgery or voice therapy.
There is a lack of substantial research on the long-term effects of hormone replacement therapy on transgender bodies – however, it’s important to note in any research that you read regarding the risks that HRT makes your body medically female. Women are more at risk of developing conditions like osteoporosis and osteopenia. Current information about transgender healthcare will reflect this, but older studies are often cited with bad intentions without including this. Genuine risks associated with gender-affirming care include things like infertility and erectile dysfunction. In the event that you wish to pursue parenthood, some transgender people pause their FHT temporarily to increase their fertility – but it’s not guaranteed since the longer you are on HRT, the more likely you are to become permanently infertile. Complications with HRT can be lowered and managed by regularly seeing your healthcare provider.
Masculinizing Hormone Therapy (MHT)
Masculinizing HRT primarily uses testosterone to create physical changes in the body typically caused by male puberty. Gender-affirming hormones stimulate nearly all of the same changes that occur during puberty for cisgender boys. Compared to FHT, only one medication is prescribed – testosterone does not need additional medication used since it naturally overpowers the effects and production of estrogen. That process is the exact reason why FHT tends to require both estrogen and testosterone blockers to have a noticeable effect.
Transgender people are most commonly prescribed testosterone as a shot, skin patch, pellet, or gel. Testosterone also comes in a pill form, but it is not often prescribed as gender-affirming care since its pill variant is harsh on the body long-term. Throughout your healthcare journey, your provider will regularly check your hormone levels with blood tests to ensure they’re in an optimal and healthy range. The effects of MHT vary from person to person – puberty is different for cisgender and transgender people alike, and the best way to predict what your results will be is to look at men you’re immediately related to. Testosterone generally causes facial hair, body hair, voice changes, greater muscle mass, oily skin, possible hair loss, and more – like with FHT, you can’t choose which effects of hormone replacement therapy you’ll receive since it’s based on genetics.
As mentioned above regarding feminizing hormone therapy, there is a lack of substantial research on the long-term effects on transgender bodies. Despite this, gender-affirming care is considered medically necessary and important to provide since it alleviates gender dysphoria and allows transgender people to live as their authentic selves. Many of the associated risks documented in older research on HRT are common health risks that cisgender men are generally more likely to have than women – like high blood pressure, male-pattern baldness, acne, and diabetes. The most typical genuine risk associated with gender-affirming care is infertility; while testosterone may decrease the chance of pregnancy, it is not an effective birth control method and does not fully prevent it. In the event that you wish to pursue parenthood, some transgender people pause their MHT temporarily to increase their fertility – but it’s not guaranteed since the longer you are on HRT, the more likely you are to become permanently infertile. Complications with HRT can be lowered and managed by regularly seeing your healthcare provider.
Nonbinary Hormone Therapy (NHT)
There is no one way to be nonbinary – but some nonbinary people pursue hormone replacement therapy as part of their journey to live comfortably in their own bodies. Compared to FHT and MHT, nonbinary hormone treatments aim to balance the levels of estrogen and testosterone in the body to create an androgynous appearance. The most common route is microdose HRT, or when hormone replacement therapy is prescribed at a much lower dose than traditional levels. Changes take significantly longer to occur but allow the individual to stop more immediately when they are satisfied with the changes. Since it is impossible to directly choose what changes will occur on HRT, this gives a small level of control since the changes associated with HRT are gradual like cisgender puberty.
For individuals assigned female at birth, testosterone is often prescribed at a low dose for a short period of time. Those assigned male at birth may choose to use a low dose of both testosterone blockers and estrogen or opt for just estrogen. In both cases, it is important to remember that not all changes caused by HRT are permanent – some, like voice changes, breast growth, and clitoral growth are permanent while others like fat redistribution, acne, and periods are not.
Further Reading: Learn More About HRT
Cleveland Clinic is a major academic medical center based in Ohio, ranked as one of the best hospitals in the United States. Its site hosts comprehensive information about gender-affirming care for both feminizing hormone therapy and masculinizing hormone therapy.
FOLX Health is the largest HRT telehealth provider in the United States and offers prescribed medication to registered members. Since FOLX has in-person facilities in major cities, it is available in all states – including ones that are banning transgender telehealth like Florida. Learn about their programs for feminizing hormone therapy, masculinizing hormone therapy, and nonbinary hormone therapy.
GoodRx is a free website and mobile app that provides users with discounts on prescription drugs at over 75,000 pharmacies across the United States, including major retailers like Walmart, CVS, Costco, and Kroger. These discounts also apply to medications prescribed for gender-affirming care – GoodRx is the primary alternative for individuals needing prescription medications but does not have insurance coverage to pay for those medications. Due to this, GoodRx is a valuable resource if Medicaid or commercial insurance bans transgender-related healthcare coverage. It also hosts information about both masculinizing hormone therapy and feminizing hormone therapy.
Johns Hopkins Medicine is a teaching hospital and biomedical research facility based in Baltimore’s Johns Hopkins School of Medicine, most well-known for being one of the first gender clinics in the United States. Its Center for Transgender and Gender Expansive Health offers information on a variety of gender-affirming services like hormone replacement therapy, surgery, fertility, voice therapy, primary care, etc.
Planned Parenthood is an American nonprofit reproductive and sexual healthcare provider, which continues to be the largest single abortion provider in the United States. Planned Parenthood is also one of the largest national HRT providers, although not all of their locations offer HRT services. Learn more about some of the gender-affirming services Planned Parenthood provides.
Plume is another large HRT telehealth provider and takes a large range of commercial insurance plans. While Plume operates throughout the majority of the United States, their lack of in-person facilities means they are not able to prescribe HRT to states banning transgender telehealth like Florida. Its site contains a great deal of information on both estrogen hormone therapy and testosterone hormone therapy.
Trans Health Project is a site maintained by Advocates for Transgender Equality (A4TE) to educate transgender people about their legal rights and better access to gender-affirming healthcare. The project contains information on medical insurance, state laws, HRT providers, etc.
University of California San Francisco Transgender Care, also known as UCSF’s Gender Affirming Health Program, is a multidisciplinary program that provides gender-affirming care out of the research university and hospital. Its site contains information on hormone therapy as well as other forms of gender-affirming care like surgery, sexual health, sexual health, and voice therapy.
University of Virginia Health is an academic healthcare center based in Charlottesville and maintains a transgender health clinic. Its site has information on hormone replacement therapy, although its content is not as in-depth as other resources on this list.
We live in dangerous times – when does it become time to move from the United States to another country? What is the correct phase during a genocide to finally decide it’s too unsafe to remain in the US? This post outlines the best countries for transgender rights and the easiest countries to immigrate to, as well as what is required for each country.
As of the time of this article, there are no countries that have opened their refugee immigration paths for transgender Americans – although this may change. In the event refugee paths open, an update to this post will be made; until then, this post outlines non-refugee paths. Immigration is a complex process that varies drastically from country to country – refugee status grants you faster routes to move, find work, and become a permanent resident.
It is ultimately up to you when and why you leave the United States. I advise you to self-reflect and seriously consider what types of laws, actions, and policies would be your determining point for immigration so you are not caught entirely off-guard if that time comes. Not everyone can immigrate – children, disabilities, criminal history, and wealth can all impact your ability to move. However, it is not selfish to consider your own best interests. It’s not selfish to immigrate or become a refugee to survive, even if people are trying to continue the fight at home. Use your personal determining point to decide when it is no longer safe for you to continue your work and activism at home.
Looking for more information?
Browse Trans Solidarity Project’s guides, or check out these posts:
Legal immigration to the United States is complicated and expensive – but that isn’t the norm elsewhere in the world. The United States uses a lottery system to randomly select 675,000 applicants each year to immigrate without a US sponsorship or green card refugee status. Additionally, only 55,000 individuals can be approved from each country – this places individuals coming from large countries at a disadvantage compared to others. If you are not selected among the 55,000 people who were approved that year, you have to wait until next year for the next lottery – and you are no closer to getting legal immigration status due to your wait time.
Barriers to Immigration
The most common barriers that transgender Americans will experience while attempting to immigrate relate to their identity documents – the current administration has already made moves to halt gender-affirming changes on federal legal documents, requiring transgender individuals to use their sex assigned at birth on new passports for the next four years. While we wait for this executive order to be blocked by the courts, it prevents transgender Americans from freely moving throughout the world safely. Documents that do not match your gender identity or expression can put you at additional risk when traveling, since the chance of discrimination increases when immigration agencies are not well-versed in transgender issues. On the plus side, transgender Americans still have the right to a passport and travel documents – although we are barred from updating our gender markers on them, we can still legally leave despite the increased risks that will appear due to gender marker discrepancies.
The documents you will need to legally immigrate will depend on the country you are immigrating to. At the very least, you will be required to present a passport or similar travel document – but you may also need proof of language proficiency, education, medical examination, criminal history, work experience, job offer, and funds to immigrate.
Future decisions by the current administration and Congress will determine whether other countries open refugee paths for transgender Americans. As mentioned above, refugee status allows you to move more easily than traditional immigration routes – and this concept applies everywhere in the world. Compared to the documents required for traditional immigration, refugees typically just need a travel or identity document – they don’t need to prove language proficiency, education, funding, or any of the other mentioned factors to be permitted. However, refugee status is granted to groups in desperate need – until the political situation in the United States is seen as hostile enough by the international community, transgender Americans will have to use traditional immigration.
Trans Right Havens
There are 195 different countries recognized by the United Nations – this post does not list out the rights of each country since that would be lengthy and distract from the point. Instead, I have used various research put out by other entities on LGBTQIA+ travel safety and combined it with the easiest countries for American citizens to immigrate to – the table below gives you some of that data, and I’ll be going into detail later.
The countries are not in any particular order – each has its pros and cons, and it is your personal decision on which is the best path for you. Numerous countries have high scores for transgender rights and safety not included in this post because they are more difficult to immigrate to – such as France, Belgium, and Cuba. Some countries are easy for Americans to immigrate to but do not have great track records for transgender rights – like the United Kingdom, Japan, and Mexico. Instead, this post combines both to guide you to trans-affirming countries with simple immigration policies.
COUNTRY
ASHER & LYRIC
EQUALDEX (AVG)
EQUALDEX (LEGAL)
Canada
247 / A
78
95
Iceland
200 / A –
94
98
Malta
250 / A
76
100
Spain
222 / A –
83
100
Portugal
248 / A
76
93
Greece
224 / A
66
93
Australia
173 / B +
76
90
Ireland
200 / A –
72
85
Germany
200 / A –
81
100
Switzerland
224 / A
69
74
Thailand
117 / C
72
75
Asher & Lyric is a travel research site that utilizes publicly available information to rate countries on LGBTQIA+ inclusiveness based on transgender-related murder rates, legal identity laws, hate-based violence criminalization, legal discrimination protection, and queer worker protections. I specifically use their data from their global trans rights index, but their general LGBTQIA+ travel safety guide is also useful. On the other hand, their data was last updated in June 2023 – it’s become exponentially outdated regarding US laws (ranking the US at #40 for trans rights and #25 for LGBTQIA+ travel safety), but it is still a great starting point despite how quickly the political landscape can shift.
The other two columns of data I use are from Equaldex, an international collaborative project that provides information about LGBTQIA+-related laws and public opinion around the world. Equaldex’s data is extremely up-to-date – their website even includes recently changed laws before making mainstream headlines and information about upcoming laws set to take effect around the globe. The average column, which they refer to as their equality index, combines the average from their legal index and public opinion index. I believed it was worth knowing whether a country has a good combined total compared to general public opinion – although I recommend reading their data further if you’re interested. The legal Equaldex column focuses only on the legal rights of LGBTQIA+ people in a given country – Equaldex rates countries on thirteen different legal aspects based on the most current laws.
Best Countries for Transgender Americans
Canada
As the United States’ northern neighbor, Canada is the most common choice for any American to move to. It’s the most culturally similar to ours, and it’s one of the few countries Americans can drive through rather than deal with TSA and airport immigration other than Mexico.
The largest cons associated with immigrating to Canada relate to the weather and high taxes. Since Canada is so far north, most of its citizens live close to the southern border it shares with the United States. All American citizens are expected to continue paying taxes to the United States, even if they do not live or work in the US unless they renounce their citizenship – but doing so means you’ll lose access to permanently return without citizenship elsewhere and you won’t be able to vote.
Canada is renowned for its universal healthcare, but it’s also infamous for long wait times for certain healthcare services – but not to the extent as the UK’s. Depending on the province, you’ll be looking at a combined tax rate of 23% to 31% – but since Canada has a good index score for its cost of living, these expenses are mitigated by excellent wages. Similarly, the argument can be made that Canada’s quality of life score overshadows its healthcare wait times since residents can get the care they need despite occasionally having to wait.
IMMIGRATION PATHS There are three federal programs for Canada’s Express Entry system, which is the easiest and fastest way to legally immigrate to Canada. These programs are competitive and score-based, so they use your submitted criteria to determine your eligibility among other candidates.
If you have at least one year of skilled work experience, meet the minimum fluency requirements in either French or English and score at least a 67 out of 100 on their selection grid, you can be eligible for the Federal Skilled Worker (FSW) Program. Skilled work is determined by occupation field – you’ll want to look up your occupation on Canada’s National Occupation Classification (NOC) system to see where you fall since most programs will require you to be at least TEER 3 or more. For the FSW Program, you will have to be TEER 0, 1, 2, or 3. The FSW Program has a job seeker visa option, which allows you to find work after arriving in Canada without an existing job offer – although you’ll still have to wait for your ITA. However, the FSW Program has a higher income requirement needed to prove you have the funds to support yourself.
If you have at least two years of skilled trade work experience, meet the minimum fluency requirements in French or English, and have a certificate approving your trade to be practiced in Canada, you can qualify for the Federal Skilled Trades (FST) Program. The FST Program applies to specific occupations like industrial, electrical, construction, and other related trades. To be eligible, you have to either have a certificate that proves you are qualified to practice your trade in Canada or have a job offer of at least 12 months of full-time employment in Canada. Like the FSW Program, FST Program applicants must have at least CAD 14,690 in their bank accounts to qualify.
The last Express Entry federal program is the Canadian Experience Class (CEC) for individuals who have at least one year of skilled work in Canada at NOC 0, 1, 2, or 3 on a valid work permit and meet the minimum language requirements in French or English. Compared to FSW and FST, the CEC requires you to already be working and present in Canada – but once you are, it’s significantly easier than the other paths.
Generally, the largest barrier to Canadian immigration is securing work. US citizens can get employer-specific work permits as well as CUSMA work permits. CUSMA permits allow workers to find work faster via the International Mobility Program compared to traditional permits. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Individuals between the ages of 18 to 35 can work under International Experience Canada (IEC), which has three additional permit categories: working holiday open work permit, international co-op internship, and young professional employer-specific permit. However, the US is not a full member of the IEC agreement, so you will have to be approved by a Recognized Organization.
Canada is one of several countries that offer a Golden Visa program, which provides residency to foreigners looking to make investments, start a business, or buy a business in Canada. There are multiple options available, so you’ll need to determine which best suits your situation.
Spouses, common-law partners, and dependent children can be sponsored once you have permanent residence status in Canada.
Prospective students can apply for a study permit, but you’ll need a provincial attestation letter (PAL) or territorial attestation letter (TAL) and a letter of acceptance from a designated learning institution.
Iceland
Iceland has a slightly higher cost of living than the United States, but it severely outranks America in every other major category. It is one of the safest countries in the world and is a beacon for transgender rights. Although English is not the native language of Iceland, over 90% of the population speaks it fluently.
It has a lot in common with the other Nordic countries, but Iceland has a reputation for being a trailblazer for LGBTQIA+ rights. On the other hand, Iceland is admittedly more expensive – and since it’s even further north than Canada, you’ll be dealing with even colder weather. While Iceland is further from the US than Canada, it’s still significantly closer than elsewhere in the world.
IMMIGRATION PATHS Since US citizens do not qualify under Iceland’s EEA/EFTA permits, you will have to obtain a residence permit to stay for longer than three months. However, like Canada, you won’t need a visa to enter. Traditional immigration paths all require a signed employment offer showing your contract to government officials for both the residence and work permit required to move to Iceland. The Multicultural Information Centre is a great resource that outlines the basics of Icelandic immigration.
One of the issues regarding Canada is that all employers must do additional paperwork to hire foreign workers, so you’re not able to just apply for any job you see. Iceland doesn’t have this – while there are fewer routes outlined compared to Canada, the process is more straightforward. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS While technically not a retirement visa, the Financially Independent Person Permit allows individuals who have sufficient passive income to get a visa in Iceland. This permit is eligible for anyone at least 18 years old and makes 239,895 ISK per month.
The Family Reunification Visa applies to married spouses and cohabiting partners to get an Icelandic visa once a traditional visa is secured. Children under the age of 18 as well as adult parents over 67 can also get this visa.
Prospective students can apply for an Icelandic student residence permit, which requires both proof of the financial support you will be using to live in Iceland as well as confirmation of your study program admission.
Malta
If the weather in Canada and Iceland is a deterrent for you, Malta is the next suggested choice – it’s less heard of, but Malta has the best scores for transgender rights in all metrics. The country has a perfect 100 for its legal rights and protections and has a public opinion rating of LGBTQIA+ people on par with Canada and Australia.
Approximately 88% of Malta’s population speaks English fluently, which is why it’s one of its official languages alongside Maltese. Since it is Mediterranean, it has a warm and sunny climate – so it draws in a lot of retiring Americans who want to experience Europe’s high quality of life at a lower cost than other European countries.
IMMIGRATION PATHS United States citizens are considered Third Country Nationals (TCNs) since we are not part of the EU or EFTA. All TCNs must go through the single permit procedure to work and reside in Malta unless they qualify for an exception. Malta requires applicants to submit a copy of a valid employment contract among other documents – if approved, foreign workers are allowed to reside for at least one year. Malta is notably difficult to immigrate to – it’s a small country, so they have limited resources. Like Canada, Malta requires employers to prove they have sufficiently tried to fill their open job vacancies with domestic workers – but unlike Canada, you are free to apply to any job openings. Use the buttons below to view common job openings to foreign workers.
OTHER EXCEPTIONS Individuals aged 55 and older can utilize the Malta Retirement Program, which gives residency to anyone receiving a pension income seeking to live in Malta.
Malta has a Golden Visa program for potential foreign investors looking to gain residency as well as citizenship. The main route for this is the Malta Permanent Residence Program – although the program also works for non-investors with enough funds since you just have to prove you have sufficient funds in your EU accounts.
Since 2021, Malta has also had a Digital Nomad Visa available to remote foreign workers to reside in the country for up to one year as long as their employer is based outside of Malta. Digital nomads must have proof of a salary of at least €3,500 per month or €42,000 per year.
The Malta Family Reunification Visa allows legally married partners to obtain an additional visa once a traditional option is secured. Children under the age of 18 may also get this visa as well as financially dependent adult children.
Students can pursue higher education in Malta via a Schengen visa if they can prove they have enough income to support themselves for each month of their studies in addition to their admission letter. Malta has a specific requirement that you must have at least 75% of the minimum wage to meet the international student income requirement.
Spain
While the cities of Spain have a higher cost of living, it’s a much cheaper alternative than other Western European countries – when coupled with its famous laid-back culture, inclusive policies, and public programs, Spain is a solid choice. Its quality of life index score is only a couple of points behind the US, but it outranks America elsewhere – such as its trans-inclusive laws, cost of living, and safety.
Spain does have one drawback compared to many of the other countries that made my list: you will have to speak Spanish. Spain has one of the lowest English proficiency scores in Europe, with about 20% of its population knowing English. While you’ll be able to survive in its major cities without knowing Spanish, you won’t get very far – and the type of Spanish you likely know as an American (Latin American Spanish) isn’t the same as Castilian Spanish.
IMMIGRATION PATHS Spain allows for job seeker visas for anyone wanting to search for work for up to twelve months at a time, as long as you can prove you can provide for yourself in the meantime. This means that you can obtain a Spanish visa without having an existing job offer, unlike the above countries. However, to get a job seeker visa, you will have to apply at a Spanish consulate or embassy in your home country by booking an appointment and bringing all the required documents. One of the reasons for the job seeker visa is that Spain has a heavy tradition of networking for finding and offering employment, so it gives future employees time to make connections.
Once a job offer is secured, you can get a regular work visa that is valid for up to five years max with renewals before pursuing permanent residence. Seasonal visas also exist for individuals with short-term employment contracts of up to nine months in specific industries like retail, hospitality, and construction. Lastly, Spain offers a special visa for freelancers and self-employed individuals who wish to reside in the country. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS The retirement D7 program allows retirees eligible to reside in Spain if they can demonstrate they have enough passive income to support themselves – unlike Malta’s retirement program, there is no minimum age requirement.
Individuals who invest in a Spanish business can secure indefinite residence via their Golden Visa program – although the Spanish Congress is working to eliminate the program. There are similar routes for foreign entrepreneurs looking to start a business in Spain without the immensely heavy investment requirement.
Digital nomads can work online while residing in Spain for up to two years if they can prove they have a monthly income of at least €3,040 and savings of €36,500.
Individuals can also obtain a visa if they are married or partnered with an individual with a visa or residence in Spain. Immediate children can be given this visa if they are under 18 years old as well as adult parents if they are older than 65.
The student visa allows for international study for up to three months, six months, or longer – but you’ll need an offer letter before you can apply. Folks with a long-term student visa can work up to 20 hours per week after applying for a foreign identity card.
Portugal
Considered one of the more affordable countries in Western Europe, Portugal is affordable even in its major cities. Like Spain, Portugal has a great work-life balance and healthcare system that attracts plenty of Americans. Unlike Spain, Portugal has better transgender rights and is significantly more proficient in English – they’re ranked #6 in the world, making them the most English-fluent on this list for a country whose native language isn’t English.
These factors are why Portugal maintains a large expat community, so you’d likely find yourself among many other American newcomers upon arrival. The majority of goods, housing, and other general expenses are significantly cheaper in Portugal than in the United States – although they do have higher prices on imported goods.
IMMIGRATION PATHS Non-EU residents like American citizens must secure both a residence permit and a work visa to live and work in Portugal. Akin to Spain, Portugal has a job seeker visa available for individuals to search for job opportunities within Portugal for up to 120 days before getting a traditional work visa with an offer of employment.
For a work visa, you must have a job offer from a Portuguese employer – but like in Spain, your employer will apply for your work permit on your behalf to the Portuguese Labor Authorities. Similar to Iceland, you are free to apply for any job openings since the paperwork required is put upon the employer if they are interested in hiring you. After securing your permit and job offer, you then must apply for a work visa at the Portugal Embassy. All visas and permits, including all exceptions listed below, must be applied to at a local embassy. Your residence permit will be applied for when you enter Portugal at the Portuguese Immigration and Borders Services. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Portugal has a very similar retirement or D7 program to Spain – if you can prove you have the passive income to support yourself, the only requirement associated with the visa is that you must be at least 18 years old to qualify.
Young people between the ages of 18 to 30 are eligible for the youth mobility program since Portugal has an agreement with the United States to allow citizens to work and study for up to twelve months.
Like other countries, Portugal has a Golden Visa program for foreign investors wanting to live full-time in Portugal. Similar to the Golden Visa, prospective entrepreneurs can use the D2 Startup Visa to expand or start new business projects within Portugal.
The Portugal digital nomad visa is known as the D8 Visa, which authorizes residence permits for remote workers and freelancers who want to work within Portugal. The D8 Visa requires individuals to make at least four times the minimum wage, which totals at least €3,480 per month.
If you have family in Portugal, you can use the D6 Visa to obtain residency. Commonly, the D6 is used to bring immediate family and partners with you after obtaining another visa.
For student visas, you must be accepted to study at one of Portugal’s fourteen universities or polytechnic education institutions. The Type D student visa allows for long-term students over 90 days.
Portugal has a special visa for individuals trained in the tech industry outside of the European Union. Applicants must be at least 18 years old and have a Bachelor’s degree in a relevant field.
Greece
Most people wouldn’t think of Greece when considering trans-friendly countries to immigrate to, but it’s a much stronger contender than other countries. Even though it marks the entrance to Eastern Europe, Greece is progressive – especially so when compared to its neighbor Italy. About half of its population speaks English fluently, but English is so innate to Greek life that it sits #8 in the world for English proficiency.
One possible drawback to Greece is that due to its progressive nature, you’ll experience more strikes and demonstrations that can interfere with daily life – while they’re generally peaceful and not to the size of France, they still have the same spirit.
IMMIGRATION PATHS Anyone seeking to reside in Greece longer than 90 days must get a long-term D visa, which is used for both work and students. You will need either an official offer of employment from a Greek business or an admission letter to be approved for a type D visa. Applications are only received by in-person appointment at the Consular Office of the Embassy of Greece in Washington DC. After seven years of residency in Greece, you can apply for naturalized citizenship if you demonstrate basic fluency in Greek. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Like other European Union countries, Greece offers a Financially Independent Person visa similar to a retirement visa. Applicants must be at least 18 years old and make €3,500 per month from passive income sources like rent, pension, and investments.
Foreign investors can use Greece’s Golden Visa program if they can pass the minimum checks alongside purchasing real estate or investing in Greek businesses.
The Greek Digital Nomad Visa was launched in 2021 to provide travel work visas to remote workers who have employers outside of Greece. These visas authorize you to work for up to 12 months and permit you to bring immediate family members. To be eligible, you must meet the minimum financial requirement of €3,500 per month.
If you are a spouse or child under the age of 18 of an individual living in Greece under another visa, you are eligible for a family reunification visa. Like all Greek visas, it must be submitted in person.
Non-EU students must get a type D long-term visa, which can be renewed annually and allows them to apply for a residence permit as well as work part-time for any Greek employer.
Australia
As one of two countries on this list to beat the United States on all major key points, Australia is a great choice – there are plenty of good salaries to go around, and the country maintains both a lower cost of living and a higher quality of life than the US. You’ll only find high costs of living in Sydney and Melbourne, but Australia’s economy and environment make up for it. Like Canada and Ireland, English is Australia’s primary language.
Compared to other entries, there are fewer locations further from the United States than Australia. It experiences geographical isolation, so it’ll be difficult to return home to see friends and family – as well as for them to visit you. It’s also worth mentioning that one of the major reasons Australia has its fantastic environment is because it’s so climate conscious – the country experiences more extreme weather events than elsewhere in the world, although this might not be a major factor if you’re living in a weather-extreme region in the US.
IMMIGRATION PATHS Australia has a LOT of visas – so I recommend using the Australian government’s online matching service to find which is best suited for you. Most individuals seeking work will want to look into the Skilled Employer Sponsored Regional Provisional Visa (Subclass 494). The 494 is similar to Canada’s work visa since it requires you to have an employment offer from an Australian company – but you are only eligible if you are under the age of 45. The similar Skilled Regional Provisional Visa (Subclass 489) has no age limitation and does not require an employment offer, but you have to get a nomination from a state or territory government – but the 489 is currently only available as an extension of short-term visas like the 475, 487, 495, and 496. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Since 2018, the Australian government has remodeled its retirement visa program as a pathway to permanent residency – there is not a ton of information on how to apply under their program as a prospective retiree, but allowed individuals aged 55 and older to immigrate through the Investor Retirement Visa (Subclass 405) or Retirement Visa (Subclass 410).
Australia has a youth mobility work holiday agreement with the United States, which allows American youth between the ages of 18 and 30 to work in Australia for up to three years through the Work and Holiday Visa (Subclass 462).
While Australia does not have a proper digital nomad visa, their general tourism and visitor visa allows individuals to stay up to twelve months as long as they have the funds to support their stay and leave once their visa expires. This visa allows you to work remotely for a non-Australian employer, but you won’t be able to formerly work or sell goods or services within Australia without an additional work permit.
Visa holders are entitled to bring partners and family members when moving to Australia. For family members other than parents or children, you must get either an alternative visa or go through the sponsorship system if your Australian connection is an official citizen or permanent resident.
Students with an official admission letter to an Australian university can apply for a Student Visa (Subclass 500), allowing them to legally reside for up to five years and work part-time while studying.
Ireland
For transgender-related rights and immigration, Ireland makes this list while the United Kingdom does not. The UK falls just short of making it, largely due to growing anti-trans sentiment copied from the United States. Ireland is known for its friendly culture, natural beauty, and high standard of living which makes it on par with other countries in the European Union.
Similar to Greece (and many of the countries on this list), Ireland’s progressive spirit means demonstrations are commonplace and an integral part of the country’s history. Compared to elsewhere, Ireland has a poorer housing market – while Ireland is one of the safest places in the world, you’ll likely have trouble finding an apartment to rent.
IMMIGRATION PATHS Due to Americans being non-EEA/Swiss nationals, you will need to obtain an employment permit or atypical permission to work in Ireland. You’ll also need to register with immigration, assuming you plan to stay in the country for over three months. The long-term Type D Employment Visa issued by the Department of Enterprise, Trade, and Employment covers most occupations, although there are a couple of other visas for specific fields like the Atypical Working Scheme Visa and Scientific Researcher Visa. Like most countries, you must have a job offer from an Irish employer to be granted work visas – but the process is pretty straightforward and can be done entirely online well in advance before flying to Ireland. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Anyone, regardless of age, can retire to Ireland under a Type D Visa with Stamp 0 as long as they have a passive or non-working income of €50,000 per year and can prove they have enough savings to cover any sudden major expenses.
Ireland has a unique agreement with the United States for its youth mobility program – unlike other programs that are purely based on age, the working holiday program for Americans seeking to travel to Ireland for work and travel has no age limit. Instead, it requires you to be a recent graduate of any third-level education within the past 12 months. These include any educational degree or certificate program after high school, such as community college, university, graduate school, etc.
Married and civil partnered couples can use family reunification to apply for a second visa in addition to traditional working visas, as long as your partner is at least 18 years old. Ireland also recognizes proxy marriages and extends family reunification to immediate family members, according to the traditional understanding of the nuclear family, and elderly dependent parents.
Students wanting to remain in Ireland longer than three months to pursue their education must get a long-term visa, which requires a letter of acceptance at an Irish school.
Germany
Even though Germany does have an alt-right party, Germany is an extremely progressive place to live compared to the United States – Alternative for Germany (AfD) exists on the outskirts of German society since Germans have no tolerance for neo-Nazis. Equaldex rates Germany’s LGBTQIA+ laws and protections as nearly perfect, similar to the laws in Spain and Malta. It’s also the other country on this list that beats the US on every major metric on the key data listed below.
Germany’s social welfare system is a magnet that draws many Americans abroad, including its strong job market, work-life balance, and healthcare system. Like Greece, about half of Germans know English fluently – knowing German will make your experience better, but it’s not required.
IMMIGRATION PATHS Germany has two routes for its job seeker visa, which explicitly allows you to come to Germany without an existing job offer for one year. The first route requires you to show vocational or academic qualification that is recognized by Germany, while the second route uses a variety of factors like education and language proficiency to determine your eligibility – for both methods, you’ll have to prove you have enough funds to support yourself while you search for a job.
Individuals with a job offer from a German employer can be granted either a Visa for Professionally Experienced Workers or a Work Visa for Qualified Professionals – the first is for more general employment while the latter is used for specialized occupations that require certification to practice. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS While Germany does not have a Golden Visa program, it does offer several visas for foreign investors and entrepreneurs considering moving to Germany – as well as its self-employment visa. Their investment visas require less funding than Golden Visa programs and the amount varies by region. Since Germany does not have a retirement visa, many people use these visas to secure long-term residency if they are unable to get a work visa before retirement for a later settlement visa.
Germany’s self-employment visa, as mentioned above, is used frequently in place of a digital nomad visa seen elsewhere in the world. The freelancer aspect of the visa allows for remote work as long as you can prove you have the funding and income to support yourself.
The German Family Reunion Visa allows non-German residents to bring family members once they have settled in the country, even if they do not have permanent residence status. Americans are classified as TCNs, so you will need a settlement permit, long-term European Union residence permit, German residence permit, or EU Blue Card to sponsor family members’ visas. Germany has a lax approach to its family visa, allowing adult children, siblings, cousins, and other extended family members to use the system if you attest that they need your support to avoid hardship.
Unsurprisingly, Germany also has several student visas available. The Student Applicant Visa allows students to lawfully reside in Germany if they are waiting for admission confirmation, related to the fact that German universities have several steps required like interviewing and testing before confirmation is given. The applicant visa is only granted if you have a genuine chance of being admitted and you are required to have already applied to the university beforehand. Once confirmed, you can receive the Student Visa for full-time study. Lastly, Germany offers a German Language Course Visa to reside in Germany while taking language courses without requiring you to enroll in full-time study.
Switzerland
It stands similarly to Nordic countries like Norway, Finland, and Sweden, Switzerland is a strong enough contender to be included on this list – although the entire Nordic region further north has good laws protecting transgender folks. Switzerland is most well-known for its incredibly high quality of life, job security, and political stability.
On the other hand, Switzerland is one of the more expensive countries to live in and has the highest cost of living on this list. Major cities will have high rent, grocery prices, utilities, and everyday expenses. While the country has multiple official languages, being an English-speaking American won’t hold you back – but there is a limited job market available to foreigners.
IMMIGRATION PATHS Even though Switzerland is not part of the European Union, it uses many of the same trade and immigration agreements as its neighbors – so non-EU/EFTA citizens like Americans will need a long-term visa to work in the country. You are only eligible for a Switzerland Work Visa if you have an existing job offer that could not better be performed by an EU/EFTA citizen – once you have a job secured, you can apply for a work visa while your employer applies for your residence permit. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS The Switzerland retirement visa allows financially stable adults to reside if they are at least 55 years old if they can prove they have the passive income required to not become dependent on Swiss social security benefits.
At the end of 2024, Switzerland agreed with the United States for a youth mobility program to grant visas for young people seeking working holidays abroad. The program allows Americans to work and live in Switzerland for up to 18 months, as long as they are between the ages of 18 to 35, and have completed any post-secondary education.
The Swiss Golden Visa grants residency and citizenship to foreign investors through the Swiss Residence Program and Swiss Business Investor Program, but you must be between the ages of 18 to 55 to be considered eligible.
Switzerland does not have a digital nomad visa program, although non-Swiss nationals are permitted to work remotely if they have a contract with a non-Swiss employer and can prove they have the income to support themselves. You will not be able to sell goods and services non-remotely within Switzerland without a valid work permit. However, most people seeking remote nomad work use the Golden Visa program instead.
Family reunification is granted based on your residency permit and the nature of your marriage and family unit. The C permit gives individuals the right to bring their married or registered spouse and dependent unmarried children or grandchildren, while the B permits leave family reunification to the discretion of authorities looking over your case.
For Student Visas, you are required to submit proof of acceptance from a Swiss education institution. Non-EU/EFTA nationals must contact the Swiss embassy or consulate in their home country to apply for their student visa and the requirements associated with it.
Thailand
There are several Americans that move to Asia when immigrating, like Singapore and Japan. Unlike other Asian countries, Thailand has more trans-inclusive laws – although Thailand is not perfect, it’s on a similar path to queer success as Japan but ranks better on LGBTQIA+ laws than other common Asian countries Americans immigrate to.
While Thailand has a fantastically low cost of living, it has a large income inequality gap – which is why so many Americans flock there like Mexico. However, you’ll experience significantly more pollution (about twice as much), and you will have to know Thai since only 20% of the country knows fluent English.
IMMIGRATION PATHS For Thai work permits and visas, you must have a Thai company or related entity file an application for your permit on your behalf, which allows you to get a work visa valid for one year. Once you have a job offer, you should consult with the Ministry of Foreign Affairs and the Royal Thai Embassy in Washington DC. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Thailand allows foreigners to obtain a retirement visa if they are at least 50 years old and have a steady income that comes from outside of Thailand. Applicants must either have a regular income of 65,000 THB per year or a savings account of at least 800,000 THB.
The Thailand Privilege Visa is the country’s version of the golden visa, which grants long-term residency to foreign investors. This visa option has a very high price since you must have at least $1,000,000 USD in assets and have made at least $500,000 USD in Thai investments.
Since 2024, the Destination Thailand Visa (DTV) has become a more doable option that replaces other countries’ digital nomad visas. Remote workers and freelancers are allowed to work up to five years if they can produce a certificate or professional portfolio showcasing their work or employment contract. Workers must also prove they have at least 500,000 THB in total to support themselves in an emergency.
Non-Thai nationals may bring spouses, parents, and children to live in Thailand under the Type O Visa if they currently hold a valid work or residency permit in Thailand.
Frequently Asked Questions
What is an expat? I keep seeing that word around when I research options. Expat is short for expatriate, referring to anyone who lives in a country other than their own. Generally, expats expect to live in another country for a limited time while immigrants seek to settle permanently – but expat resources are immigrant resources and vice versa.
What about the countries not included on your list? My list is extremely condensed, so there are lots of countries that just fell short – but that doesn’t mean you shouldn’t consider them. Use sources like Equaldex and ILGA to determine how queer-friendly a prospective country is, and consider how much power anti-trans and fascist groups have there (if any). Japan, the United Kingdom, Norway, Argentina, and many other countries are decent options based on both their transgender rights and the process of immigration.
Getting a job is hard! How do I immigrate without a work offer? Technically, I am supposed to advise you to either search for jobs online before moving overseas, look into countries with established job-seeker visas, or use other visa programs available like youth mobility and digital nomad work.
Americans have a unique advantage compared to elsewhere in the world – we don’t often need visas to travel abroad for short trips lasting up to 90 days. The only exception to the countries I listed above is that the European Union will begin requiring American citizens to apply for travel authorization via their new ETIAS screening process, which gets linked to your passport once filed. It’s not quite a visa, but similar and meant to enhance EU border security. That being said, there’s nothing technically stopping an individual from considering foreign jobs while staying abroad on a tourist visa as long as it’s within the three-month time frame. Job seeker visas generally last up to twelve months to give you ample time for your search – just be prepared to potentially fly back to the US if you don’t have a job offer and work visa by 90 days or risk becoming an illegal immigrant.
How does sponsorship work? I heard that’s another way to immigrate! If you have family living in another country, you can use their citizenship status to get a visa granted if they agree to be your financial sponsor while you’re looking for work. Non-immediate relatives like cousins and in-laws will take a longer time to process your visa, but it still grants you a visa.
Under certain conditions, private individuals who are not related to you at all can also sponsor immigrants – but you’ll want to look up the exact laws for the country you have in mind. Sponsorship works the same way, so they’ll have to sign documentation that they are financially responsible for you until you are self-supporting.
Why aren’t transgender Americans able to have refugee status? This might change soon, but humanitarian-focused countries have not deemed the political climate in the United States dangerous enough yet to give refugee status solely based on trans identity. In the event something drastic happens in the US, that will likely change – refugee and asylum seekers get a variety of benefits in addition to their visa, like financial support, healthcare, case management, housing, etc. If transgender Americans are granted refugee status anywhere in the world, that would be a better route than any of the countries listed for traditional immigration.
While pursuing equality, it’s important to make efforts to protect your digital safety – especially when hostile groups or the government can target your activism. It’s nearly impossible to exist without connecting to the internet. Save yourself the headache now by learning about what you can do to become safer online.
Author’s Note: Digital security becomes outdated extremely fast. This article will become obsolete at some point, so make sure to review the advice given here and apply it with updated ideas.
The more your movement wishes to change the status quo, the more likely you will be targeted by cyberwarfare. In fascist and conservative societies, simply being marginalized is seen as opposing the status quo – even if it is not something that can be changed. Being vocally and visibly out puts you at risk, but it’s also where you can create the most change. Online harassment and doxxing are commonplace for non-activists that merely upset the wrong people, but targeted surveillance and hacking are weaponized if your movement is deemed an ideological threat.
The largest real-world examples are the actions taken by the United States Federal Bureau of Investigation against the civil rights movement, which spied on figures like Martin Luther King Jr., Malcolm X, Elijah Muhammad, and Aretha Franklin. COINTELPRO was the official series operated by the FBI, which covertly and illegally surveilled, infiltrated, discredited, and disrupted groups they deemed subversive like Black power, civil rights, the American Indian Movement, Brown Berets, United Farm Workers, and numerous feminist, environmental, and left-wing organizations. COINTELPRO is the most notable example, but similar programs most certainly exist today to allegedly secure national security. Even when the government is not involved, ill-intentioned individuals and organizations put energy into disrupting equality.
Watch It! Do Risk Assessment!
Before you get the conspiracy hats on, it’s important to note that most people will not be targeted by large-scale operations or the government. By nature, activists are at a higher risk, but simply being transgender won’t land you under increased surveillance unless you’re part of a group that can feasibly undermine others.
Risk assessment refers to identifying potential hazards so you can plan to avoid them as much as possible. Digital security is complicated, long-winded, and limiting – the more secure you become, the less freedom you’ll have online. For those reasons, not everyone needs to have a high level of security if it’s unneeded. Before continuing, think about these five questions:
What do I need to protect?
Who do I need to protect it from?
How much do they want that information and how easy is it for them to get it?
What happens if they get it?
What am I willing to do to stop that from happening?
The Secure Communications Framework
The SCF is an open-source model that was created to help activists, human rights researchers, and other individuals interested in security determine the best tools and practices for their situation/work. The following chart is the secure communications framework, but I’ll break down the lingo used.
The “x” axis, or spectrum going rightward, represents your work:
Limited Impact: The item or work is not publicly available. Becoming public or taken might reduce the speed or impact of your work, but your message and strategy would be safe.
Public: The item or work is publicly available information. There are no inherently negative consequences of it being publicly available, so it doesn’t need security.
Significant Impact to Research/Organization or Limited Impact to Individuals: Confidential information and work being publicly exposed would likely need organizational strategy revision. Individuals are impacted in non-physical ways.
Significant Impact to Individuals: The unplanned public release of this information would result in an individual being physically detained, arrested, or harmed.
The “y” axis, or spectrum going upward, represents who you are targeting with your mission:
Interest Groups and Individual Actors: Interest groups are organizations and communities that share a common interest or goal. Individual actors refer to any single person who plays a role in your work – these are often regular people who can be persuaded to work with or against you.
Governments, Corporations, and Non-State Actors: Organizations that can use passive or untargeted methods to monitor your work. Most entities fall here until you have drawn their attention.
Highly Capable and Motivated Adversaries: Organizations that are taking active/targeted steps to learn or interfere with your work.
Using the bullet points on the SCF above, you can tell there is a significant difference in the risk involved. A draft press release wouldn’t require any changes, even if it was annoying if it got exposed early, but a list of projects might need alteration if it got leaked. Personnel information being exposed might lead to online harassment, but a testimony being leaked might cause an individual to be detained.
Work that falls in the purple sectors requires regular basic security practices. Individuals should use an encrypted email and device, and should only use organization-issued computers and phones if part of a larger group.
Work that falls in the orange sectors needs to use end-to-end encryption for all communications and border crossing security.
Work that falls in the red sector should consult with a trusted security expert in addition to the previous guidance. It’s also recommended to only work from devices disconnected from the internet and not use any closed systems communications.
As I’ll get into below, digital security is extensive – there is little reason to use top-tier safety mechanisms for work that does not need protection. The more secure something becomes, the more tedious it is to use. The more your work is guarded, the fewer people will hear your message.
Back to Basics: Safety Anyone Can (and Should) Do
Browsers Matter!
Regularly update your operating systems (OS), browsers, and apps. More than 90% of software updates are security patches – forgetting or refusing to update your devices is more likely to put you at a data breach than your device just becoming slow. This is especially important on organizational computers and devices you use for your work!
Speaking of browsers – not all internet applications are created equally. Google Chrome stands as the industry leader, which is incredibly fast and the default for most users – but they’re one of the worst browsers for data security, going to great lengths to obtain and sell user information to the highest advertising bidder. Microsoft Edge is forcibly installed on all Windows devices, the modern version of Windows Explorer – it consumes less power and battery resources than Chrome and sets the precedent for in-browser AI. Apple-based devices use Safari, which boasts robust privacy protections that separate it from its competitors – but it’s difficult to trust one of the tech industry’s leaders at face value. Arc is a new face on the scene, released in 2023 using Chromium to focus on user productivity and multitasking.
The two most secure internet browsers that actually provide digital safety are Firefox and Brave. Opera used to claim this title too, flaunting its free VPN feature built into its programming, but it’s come under fire for selling user data to advertisers. Both Firefox and Brave prioritize user privacy, but it’s personal preference between the two. Supposedly, Brave is better at privacy out-of-the-box, while Firefox requires more set-up – but in turn, Firefox is more customizable.
Special Feature: Tor
Occasionally known as the “dark web browser,”Tor (which stands for The Onion Router) is an open-source overlay network that takes user privacy to an extreme by using numerous networks to encrypt information multiple times. This makes it nearly impossible for entities to track you, making your internet browsing anonymous. Compared to other internet browsers, Tor takes more user knowledge since it’s complicated and has fewer features than mainstream browsers like Chrome, Safari, or Firefox. Tor also hides your IP address (discussed below in VPNs) – but despite the sketchy reputation the dark web has, Tor is fully legal to use. It’s used for tons of legitimate purposes like journalism and activism! However, Tor is not lawless – if you get caught engaging in criminal activities, you can still get in trouble.
HTTPS What?
All websites use either HTTP or HTTPS – it’s included at the very beginning of a web address like https://transsolidarityproject.wordpress.com/. HTTP (Hypertext Transfer Protocol) transfers data over your network, but your information can be read by anyone monitoring that website’s connection. For that reason, HTTP sites are more likely to expose user data like passwords, credit card numbers, and other important details.
HTTPS (Hypertext Transfer Protocol Secure) encrypts HTTP transfers. When someone tries to monitor an HTTPS website, they’ll only get random encrypted characters instead of private user information. HTTPS is considered vastly safer, so websites that utilize it are boosted in search engines to steer users. That doesn’t mean HTTP sites are bad – it just means you should be wary when using them and consider additional security protections if you don’t fully trust the site.
Secure Your Network: VPNs
Virtual private networks, or VPNs, are always brought up quickly when discussing digital privacy. VPNs establish a digital connection between your device and a remote server, encrypting your personal information and masking your IP address. Both of these functions serve important purposes:
Your IP (Internet Protocol) address is a unique number given to your device while using the internet, allowing it to communicate and connect with the rest of the world. If someone obtains your IP address, they can pinpoint your location up to the postal code you live in – IPs don’t show exact locations, but combined with other information hackers can obtain like birthdates and Social Security numbers, fraud can occur under the right circumstances.
Information that has been encrypted can only be unlocked through a unique digital key since the encryption process scrambles the data into a secret code. Even if someone gets access to your network, they won’t be able to unscramble the encryption placed on your devices or cloud storage – keeping data confidential.
People use VPNs for a variety of reasons – while I’m focusing on data privacy, many users have VPNs to bypass regional content locks. Once your IP is masked, your location can be set to anywhere in the world – allowing you to access websites and content in other countries. Others use VPNs to simply block internet service providers from logging and tracking their search history, and some users have VPNs to get around government censorship and surveillance. While VPN usage and IP masking can look suspicious to police, there is no way to track live encrypted VPN traffic – and you can’t get in trouble just because your internet usage looks a bit suspicious.
Most people don’t need to use a VPN. Digital privacy feels great, but it’s a lot of steps that most people don’t need if they’re unconcerned with their browsing data being sold to advertisers since most people aren’t worried about being censored or surveilled. At the end of the day, regular folks only need a VPN if they’re connected to a public or otherwise untrusted internet network – which is when you’re at the most risk of having your data stolen. Otherwise, members of the general public can get by using an ad blocker like Privacy Badger – a browser extension available on Chrome, Firefox, Edge, and Opera that stops third-party trackers.
If you have never used a VPN ever, I recommend Tunnelbear – it’ll get you used to the mechanics of how VPNs work for free and has a user-friendly interface. That’s important because VPNs can get complicated if you’re unaccustomed and don’t have high data privacy literacy, which is most people.
For the majority of people, Proton VPN is the best choice. There are hundreds of VPN providers that all promise specialized features and user security. It’s not terribly hard to use, and it’s free. Entirely free, with a connection speed similar to premium versions – the only downside to Proton is that you can only connect their free VPN service to one device at a time. Proton also hosts a secure email service, cloud storage, password manager, calendar, and wallet for users, too.
If you really want to pay someone for a VPN (and it’s not Proton), NordVPN is an industry-standard. It has a little bit of everything, providing slightly more encryption than Proton, and has built-in antivirus protection among its many tools. It has something to offer for everyone – but it’s definitely more pricey than other VPN providers. If you’re curious about other VPNs, the r/VPN subreddit has a datasheet comparing major providers.
Why would I use a VPN and not Tor?
User-friendliness, mostly. You don’t need both – if you have Tor, you don’t need a VPN, and if you have a VPN, you don’t really need Tor unless you’re going for the freedom and anonymity that Tor provides. Generally, VPNs are more user-friendly and significantly faster than Tor but it’s personal preference. Like Proton, Tor is entirely free to use.
Interested in More Activism?
Check out these posts for guides based around mutual aid and equality.
Two-step or two-factor authentication (2FA) requires two forms of identification to access an account, which protects your devices and information even when passwords are leaked. With standard single-factor authentication (SFA), a user just inserts one password to access their account – but if their password becomes compromised, all of their account data is at risk. With 2FA, users provide that same password but also have to provide a different second item like a security token, fingerprint scan, facial recognition, or pressing a button on an additional device.
You don’t need 2FA on everything, but you should enable it where possible – especially on password managers, finances, and social media profiles. It’s a simple step that saves you a lot of hassle! It’s rumored that the 2016 Hillary Clinton campaign actively rejected security advice to use 2FA on its accounts, leading to the thousands of emails that were leaked by Russian hackers – if they had used 2FA, we might be living in a very different America.
Most 2FA apps are entirely free, but it’s up to you which one to go with. GoogleAuthenticator is the go-to for most folks, followed by 2FA Authenticator, Microsoft Authenticator, and Duo Mobile. However, I’d actually recommend 2FA out of the above options since it allows for cloud back-ups and provides protection that Google doesn’t.
Don’t Dox Yourself, Use an Alias
You have the power to determine how much of yourself is online. Make an effort to review what information is publicly available so you don’t accidentally dox yourself. Doxxing refers to when personally identifiable information about an individual or organization is released without their consent, and it can be done maliciously by all sides of the political spectrum. A handful of US states have criminalized doxxing, but assuming the perpetrator has taken steps to not get doxxed themselves, it’s difficult to tackle.
By using an online alias or alternate name, you can protect your real-life identity since your actual name and contact information aren’t readily available. However, aliases are less common today outside of certain communities and forums.
Do You Trust Meta?
Just like internet browsers, not all social media sites equally value your personal information and privacy. Some of the most privacy-friendly sites used in the US include Reddit and Snapchat – Reddit is filled with anonymous accounts used for their forums, and Snapchat deletes messages after being read while also notifying users if someone tries to screenshot their content. Similarly, Amazon, Grindr, Pinterest, Spotify, and Lyft all collect minimal data compared to other major sites. Not on the below list, Bluesky is a growing platform and alternative to Twitter/X that does not sell data – they’re an open-source network with a focus on privacy meant to resemble what Twitter used to be like before its takeover by Elon Musk.
Some of the worst offenders for digital security include Meta, YouTube, LinkedIn, and Uber. Despite lobbying by Meta owner Zuckerberg, Meta sells insurmountably more user data than supposedly dangerous sites like TikTok – which is why its sites are poor choices for privacy, including Facebook, Instagram, WhatsApp, Threads, and Messenger. Since it’s owned by Google, YouTube is slow to delete its user data even after account deletion. Uber obtains a large quantity of user information, which can be used to target individuals seeking criminalized services like gender-affirming care and abortions if given to the wrong entities. Lastly, while LinkedIn isn’t as malicious as other sites, they’ve suffered the greatest number of data breaches.
Protect Your Messages
The use of artificial intelligence is growing – which means privacy theft, scams, and blackmail schemes are becoming more complicated. There are very real people willing to buy private chat logs, photos, and videos from your phone. One step you can take towards protecting yourself online is switching messaging platforms.
For secure messaging, there is no better alternative than Signal. All messages are secured with end-to-end encryption and it’s used by government agencies as well as activist groups. While you must have a phone number to sign up for a free Signal account, your information is secure and isn’t sold.
After Signal, WhatsApp is an internationally used platform that automatically deletes messages and images – but many users don’t inherently trust its privacy claims since WhatsApp is owned by Meta. Most messaging platforms are more secure than direct SMS or texting since texting generally lacks encryption, although this varies depending if you’re using mobile data or a local internet connection.
Messages aren’t the only thing you should keep secure – Jitsi is the most recommended platform for video calls and conferencing. Unlike Zoom, Jitsi actually uses end-to-end encryption and passwords to protect users. Zoom has been targeted by numerous security threats and data breaches.
While I am recommending Signal and Jitsi for digital privacy, the same rules apply to everything else I’ve mentioned. Most people do not need everything on this list – targeted ads are mildly annoying but worth the freedom and ease that comes with mainstream browsers like Chrome. Even if you’re transitioning to these sites, it’s impossible to get all of your contacts to stop using their preferred messaging platform like Facebook for something like Signal instead. For those reasons, this means digital security in practice is ‘use what you need, as needed.’ The majority of your messages don’t necessarily need tons of protection since they shouldn’t contain sensitive information – so I recommend using platforms like Signal as needed for sensitive topics and contacts, kept separately from your other messages.
Protect Your Device (Physically)
It’s essentially impossible to exist in modern society without a cell phone or similar device. They store our credit cards, identification, maps, contacts, and photos – you can hardly apply for a job without having a reliable phone number. Some people believe that old phones (or dumb phones) are safer than modern cell phones – this is untrue. The information you likely want to protect from the SCF can’t be secured with dumb phones because they cannot encrypt data and cannot use encrypted apps like Signal or VPNs. True dumb phones can’t operate in most places since they lack the modern VoLTE required, and modern dumb phones are just lobotomized smartphones without the capability to use apps or security updates.
It is remarkably easy to get caught up in data breaches in the cloud when discussing digital security, but you can have your data stolen just as easily IRL.Physical and external devices like your phone, USBs, and micro USBs can leak your information if stolen – having your devices encrypted is vital for this possibility. The most dangerous information you can have on your device is photos, contacts, recordings, and login information – especially if you are part of a sensitive movement or organization. In those cases, that data should only be stored on select devices that just a few people can access. When your device is stolen by thieves or law enforcement, it’s more than just your information they’re accessing if they can see your entire contact list.
Out of all the security options available, facial recognition is one of the worst since it allows your device to be accessed easily – if someone looks too similar to you, it’ll automatically unlock. Worse yet, it’s entirely possible for someone to use your face while you’re restricted or unconscious to unlock the device for them. Following that, finger sensors are only slightly more secure since it is easy for police to force individuals to unlock their phones through their fingerprints. Six-digit passcodes and complex patterns are the most secure way to lock your phone since they are the hardest to hack – as long as you aren’t using a code that’s overtly generic like your birthdate or home address. Beyond passcodes and patterns, the strongest passwords are ones that use a combination of different characters or make up a passphrase that you can memorize.
Create a Paper Trail
In the event that your data is exposed or stolen, document it. Failing to do so means you can’t track the incident – just make sure to shred physical paper copies once you’re done. Documentation allows you to think more carefully about how and why a breach occurred, regardless of whether it was an error on your end or a breach in a remote server like Google. This is exponentially more important when other people are involved, such as in an organization, group, or movement, so all affected individuals can verify their data and reset security protections. Further, you’ll be able to take legal action later on if you find the perpetrator of your leak.
High-Level Security
The following guidance is not for most people – it’s for individuals and organizations at high risk of being targeted and surveilled by opposing groups or the government. The majority of people will only need the following protections sparingly when they engage in high-risk work.
License plates trace your identity, allowing people to find your home address, criminal history, and accident history just by searching online or calling their local DMV. SIM cards work the same way – they can be searched to find out your phone number, contacts, text messages, location, and other identifying information. When engaging with high-risk work, such as going to a protest, it’s better to purchase a burner SIM with cash. Burner phones do not inherently make your digital information more private unless you have a generic SIM you buy to later discard. With as little information on the device as possible, you minimize your risk even if your phone is taken by law enforcement.
Not everyone can be on the front lines at a protest. To maintain security, you should limit high-value individuals from going to actions like protests and demonstrations – if they are detained, their data is the most at-risk. This includes admins and anyone who has login details, contacts, and sensitive messages for your group. Best practices advocate having these individuals stay back and message others remotely during a demonstration through the burner devices people IRL should have, since that both protects your data from possible exposure while also giving your activists access to data as needed by messaging you.
Speaking of which, law enforcement in the United States must have a warrant to search your phone – including if they’ve already seized it after arrest or if they believe they have probable cause for evidence of a crime. Your cell phone is covered under the Fourth Amendment from unreasonable searches and seizures, backed by the 2014 Supreme Court decision inRiley v. California. However, police are allowed to force you to unlock your phones in certain states if you use biometric logins like fingerprints or facial recognition. The courts are especially conflicted about this since it should fall under the Fifth Amendment’s right to not testify against one’s self, but it hasn’t reached the Supreme Court.
Additional Resources
Access Now has information about censorship, surveillance, and data – “A First Look at Digital Security” runs you through what exactly needs protecting and how to do it based on your needs. They even have a free 24/7 digital helpline available in English, Spanish, French, German, Portuguese, Russian, Tagalong, Arabic, and Italian.
ActionSkills has some pretty cool websites worth checking out – like the Commons Library, which hosts educational resources that you can browse for free. The Library even has information on digital security.
Association for Progressive Communications’ Digital Security First Aid Kit for Human Rights Defenders is a collection of tools and links for better online safety. The site is geared towards activists, covering how to send information without being tracked, hacks, abuse, and surveillance.
Digital Defenders has several online publications, ranging from digital support for civil rights, internet blockages, and related topics.
Digital First Aid gives you advice on how to best handle common digital security issues, like losing access to your device or account, viruses, hacking, impersonation, harassment, and surveillance.
Electronic Frontier Foundation is another large digital privacy and free speech group, which hosts tools for activists like the Surveillance Self-Defense (learn the basics on data surveillance), Privacy Badger (a tracking blocker for those who don’t want VPNs), Certbot (enables HTTPS on manually-administered websites), Atlas of Surveillance (documents local police technologies for users to search), Cover Your Tracks (check how well you’re protected from digital tracking), and Street Level Surveillance (which explains how various technologies are used to spy on the public).
Free Software Foundation believes in software freedom, but one of their best resources is their email self-defense guide for individuals wanting to secure their personal email from surveillance but don’t want to move to a platform like Proton.
Front Line Defenders has numerous projects worth looking at, including Security-in-a-Box – an open-source tool that teaches users how to protect their passwords, communication methods, devices, internet connections, and files. Read their entire digital security section here.
Medium has a good article about digital privacy for normal people who don’t need to be overly concerned with security.
Mozilla, which owns and operates Firefox, actually has a ton of information about digital security – including best practices for digital activism.
Oregon State University has a free book on cryptography, a key focus on cybersecurity since it relates to encryption. The book explains why digital security matters and the history of both digital privacy activism and suppression in the United States.
Prism Break is a great reference tool for comparing various software and companies, giving you information on the best platforms for digital privacy.
Rise Up is an autonomous body that values digital liberation and hosts numerous projects for independent forums and media.
SAFETAG is an international network of white hat hackers for small organizations – auditors who intentionally try to penetrate your security to improve your framework.
Security Planner is another free beginner guide to digital security, which gives personalized advice for free based on your needs.
Tactical Tech is a major digital security organization – but they have just as many creative demonstrations and physical exhibitions as they have reference guides and projects. Some of their online projects include the Data Detox Kit (teaches basic digital health, AI, and misinformation), Digital Enquirer (self-paced modules for users interested in online media literacy), the Influence Industry Project (effects of data collection on politics), the GAFAM Empire (information on the monopolized empire by Google, Amazon, Facebook, Apple, and Microsoft), Our Data Ourselves (learn about data, activism, politics, and yourself), Holistic Security (approach to teaching digital security as an aspect of general wellbeing)
The Movement Hub hosts free online resources for grassroots activism, which includes digital campaigning. Digital Activism is a private website that supports verified organizers with tools after registering.
Watch Your Hack uses everyday language to explain simple internet safety to protect yourself from common hacking techniques.
