Gender Confirmation: Meaning, Process, and Types

In recent years, gender confirmation has become one of the important medical, legal, and social topics in most countries around the world. Many individuals feel throughout their lives that their sexual and gender identity does not match their physical body. This incongruence causes confusion, anxiety, and depression, disrupting their normal lives. In such a situation, the individual decides to confirm their gender to align more closely with their gender identity. This process is called gender confirmation (or gender transition). Gender confirmation does not only mean surgery; it involves various stages and different types. Stay with us to fully familiarize yourself with this topic, its types, and its process.

What is Gender Confirmation?

As mentioned above, some individuals feel a sense of incongruence with their physical body. For example, a person is physically female but psychologically and mentally has masculine traits and temperament. In this situation, gender confirmation is performed to return to the person's true self. Gender confirmation refers to all actions an individual takes to align their appearance, behavior, social role, body, and legal documents with their true gender identity. This path includes several different stages, from changing one's name and clothes to hormone therapy or surgery. Some individuals undergo all these stages, while others only perform a few of them.



Signs and Symptoms of Being Transgender

The signs of being transgender often emerge during childhood and adolescence in most of these individuals, although in some cases, the emergence of these symptoms may take until adulthood and middle age. The important point is that these symptoms must be deep, permanent, and unchangeable. In fact, a transient period of these symptoms, especially during adolescence, cannot be considered a sign of being transgender. Some of these signs and symptoms include:

• A deep and persistent feeling that the inner gender is different from the physical body.
• A strong desire to wear clothes of the opposite sex.
• Lack of connection with the traditional social roles assigned to the person.
• Severe and persistent anxiety and depression due to gender incongruence.
• Continuous fantasizing about living with the other gender.
• Preference for being addressed by names of the other gender.

Is Gender Confirmation a Disease or an Identity?

Until a few years ago, gender confirmation and trans individuals were considered a disease or individuals with a disorder, but according to the new standards of the WHO in ICD-11, being transgender is not considered a mental illness or a disorder. Gender confirmation is currently considered a condition related to sexual health and emphasizes the concept of gender identity. Also, the American Psychological Association (APA) clarifies that gender is a spectrum, so trans individuals are not sick. These individuals suffer from stress and depression due to social pressure and are rejected by society. The APA also believes that treatment is not for correcting the individual but is done to help reduce the trans person's gender distress and improve their quality of life.

The Difference Between Gender Transition and Gender Reassignment

Many people often confuse these two concepts and use them in the wrong place. Gender Transition refers to the entire process of gender confirmation, from hormone therapy, psychiatric counseling, and changes in the individual's social and legal roles. Whereas Gender Reassignment refers only to medical and surgical interventions. In fact, Gender Reassignment can be said to be one of the stages and a subset of Gender Transition.

The Difference Between Sex and Gender Identity

There are two other different concepts here that should be accurately separated. Sex (or biological sex) refers to the individual's biological characteristics such as genitals, chromosomes, and hormones. These characteristics are usually determined from birth. Gender Identity refers to the internal feeling of being a man or a woman. This feeling is a stable psychological experience, and the individual may feel incongruent with their physical body. Although most people in society consider sex and gender to be the same, scientific research has proven that the two are separate and follow different paths.

Types of Gender Confirmation

As mentioned above, gender confirmation is a process and is performed in several stages and in several forms. In fact, individuals decide which type of gender confirmation to pursue based on their circumstances.

Social Gender Confirmation (Social Transition)

In this stage, the individual chooses a new gender role in their social environment without any medical intervention. They change their style of dress and appearance. They choose a new name and inform friends, family, and workplace. If necessary, they change their field of study or job and choose a new social role. Many psychologists believe that this stage is one of the most effective parts of gender transition, as it leads to increased self-confidence and reduced stress for the individual. It also helps the person to confirm whether they truly want to live with the new gender identity.

Medical and Surgical Gender Confirmation

This type of gender confirmation is one of the complex and time-consuming types. Gender confirmation surgeries must be performed by specialist and experienced physicians. Medical gender confirmation can be done in two ways: hormone therapy or surgery.

• In hormone therapy, trans women receive estrogen and anti-androgen hormones, and trans men receive testosterone in various forms such as injection, oral medication, or gel. These hormones cause changes such as breast growth, voice change, increased facial and body hair, or changes in body shape.
• Some individuals prefer to undergo surgery after hormone therapy. Depending on the individuals' needs, surgeries such as mastectomy (breast removal), removal of the ovaries and uterus, phalloplasty, or vaginoplasty are performed. In surgery, the male genitalia is converted to female genitalia, and vice versa. This surgery is considered one of the complex and difficult operations in the medical world.

Legal Gender Confirmation

In this type of gender confirmation, the person's identity documents, including the birth certificate, passport, national ID card, and educational certificates, are completely changed and issued with the new gender and new name. Each country has its own specific law for this stage of gender confirmation. Some do it only with a doctor's letter, some require a court order, and others require surgery. In Iran, both surgery and a court order are mandatory for legal gender confirmation.

Internal or Emotional Gender Confirmation

This stage is more of a psychological treatment than any of the stages above. With the support and guidance of a specialist and experienced psychologist, the person accepts the real gender in their mind and emotions and establishes a connection with it. This stage will be done even before the start of social or medical stages.

Psychological Stages Before Gender Confirmation Approval

According to the guidelines of the WPATH and APA, a person must go through the following psychological stages before gender confirmation:

• Initial psychological evaluation to check the actual gender identity in the individual.
• Diagnosis of gender dysphoria, if present.
• Discussion about the person's goals and expectations from life with the new identity.
• Discussion about the various stages of treatment.
• Assessment of mental health and management of potential disorders.
• Continuous sessions for decision stability.
• Providing a confirmation letter to start hormone therapy or surgery.
• Psychological support during the process and afterward.



Conclusion

Gender confirmation is a multi-stage process that starts internally and includes various social, psychological, legal, and medical changes. In this process, individuals whose gender identity and physical body do not align will experience life with a new identity. According to the most reliable global sources, being transgender is neither a disease nor a disorder. Individuals who undergo gender confirmation and live with their true gender identity experience increased self-confidence and reduced stress.

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Frequently Asked Questions

How do I know if I am transgender?

When the inner gender identity does not align with the physical body, and this feeling of incongruence is permanent and stable.

Can I officially change my gender?

Yes, the documents and process are different depending on the laws of each country.

What is the impact of gender confirmation on mental health?

In most cases, it leads to a reduction in anxiety and depression and an improvement in the quality of life.

Why are some individuals transgender?

Various factors, including biological, hormonal, brain development, and the person's environment and upbringing, are influential.

Do I need court permission to confirm my gender?

The law is different from country to country. In Iran, gender confirmation requires court permission.

Is gender confirmation permissible in Islam?

Based on the fatwa of most Shia Marja' al-Taqlids (Sources of Emulation), gender confirmation is permissible in Islam with medical conditions and specialist confirmation.

What is the difference between being trans and being homosexual?

Being trans relates to the individual's gender identity—the feeling a person has about their gender identity. Homosexuality refers to individuals who are congruent with their gender identity but have a sexual orientation towards the same sex.

How long does it take to get permission for gender confirmation?

Depending on the city and country, it may take a few months to a few years.

Is psychological counseling necessary before the operation?

Yes, psychological counseling is one of the mandatory stages for confirming gender identity and psychological readiness.