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The goal of this guide is to provide a brief overview of LGBTQIA+ history and culture as well as point towards resources for further reading.

What Does Transgender Mean?

A transgender person is someone whose gender identity differs from the sex they were assigned at birth. A person's gender identity is their internal sense of gender, such as identifying as a man or a woman. For someone who is transgender, their internal sense of their gender does not match what was assigned to them at birth. As they become comfortable with their identity, a transgender person may decide to transition, which is the process in which they bring their body into alignment with their gender identity. However a person's decision whether or not to transition, should not be seen as a basis for a person's gender identity. 


When talking about transgender people, refer to the gender they identify as:  

  • A transgender (trans) man is someone who identifies as a man, regardless of the sex he was assigned at birth. 
  • A transgender (trans) woman is someone who identifies as a woman, regardless of the sex she was assigned at birth. 

When writing about trans people, use “trans man” and “trans woman” rather than “transman” and “transwoman.” 


Gender identity and sexual orientation are separate segments of a person's identity. Sexual orientation refers to a person's romantic and sexual attractions, while gender identity refers to a person's sense of self. So a trans person can be gay, lesbian, straight, bisexual, pansexual, etc. An individual who transitions from female to male and is exclusively attracted to men would be considered gay just as someone who transitions from male to female and is exclusively attracted to women would be a lesbian. 

**At all San Antonio Public Library locations, patrons can use the bathroom with which they identify.


For someone who is transgender, transitioning is the process by which they bring their gender presentation in sync with their internal identity.  Gender presentation is what it sounds like: how a person presents their gender to the world. This covers a range of characteristics, from a haircut and clothing to body characteristics and behavior.

While many people are familiar with sex reassignment surgery (a.k.a gender confirmation surgery) there is much more involved in transitioning. It is a process that can take months or years. Everyone transitions at their own pace, but some of the steps can look like this:

Social Transition

  • Changing the pronoun one goes by
  • Changing one's name
  • Coming out as transgender to friends, family, and/or at work
  • Changing one's gender expression to align with one's gender identity

Legal Transition

  • Changing one's gender on legal documents
  • Changing one's legal name

Medical Transition (unimportant in terms of gender validity)

  • Hair removal
  • Hormone therapy
  • Sex reassignment or other gender reaffirming surgeries

Not all trans people transition medically!  There are a lot of reasons a trans person might not transition medically: they might have health problems that prevent it, they might not be able to afford it, or they might have personal reasons for choosing not to.  Medical transition doesn’t make a trans person’s gender more or less valid.

Gender Confirmation Surgery: Finances

As previously mentioned, not all transgender people want to undergo gender confirmation surgery, but for those who do, it can be an expensive process. Financing &Support for Gender Confirmation Surgery by Laura Dorwart provides information on the various costs of medically transitioning as well as financing options and support. Below is a summary of some of the information provided in the article.

Hormonal Transition

Average Cost: $20 - $350

For transgender individuals who wish to transition medically, hormone therapy is a relatively affordable and accessible option that allows them to achieve significant physical changes. Masculinization hormone therapy often involves the use of testosterone, while feminization hormone therapy uses estrogen, or testosterone blockers such as spironolactone or progesterone.

Gender Confirmation Surgeries

Average Cost: $5,000 - $50,000

Types of surgeries for Trans Men:

  • Facial masculinization surgery (FMS): FMS may include thyroid cartilage enhancement, cheek augmentation, forehead lengthening or augmentation, jaw and chin augmentation and nose reshaping.
  • Periareolar procedure: The areolas and nipples are resized and repositioned during this surgery. Two circular incisions around the areolas allow the surgeon to remove the “ring” of chest tissue.
  • Keyhole procedure: The keyhole procedure involves just one semi-circular incision below each of the nipples. Keyhole top surgery also allows most patients to keep the sensation in their nipple area.
  • Double incision: In double incision top surgery, the surgeon makes two incisions at the top and bottom of the pectoral muscles. The nipples and areolas are removed and replaced with nipple grafts.
  • Inverted-T top surgery: Inverted-T top surgery involves horizontal and vertical incisions and the removal of chest tissue but not nipples. Sensation is retained for most patients.
  • Metoidioplasty: Metoidioplasty involves releasing the clitoris from the ligament attached to it and repositioning it to create a penis. With this procedure, patients can also choose to undergo urethral lengthening and remove vaginal tissue.
  • Phalloplasty: Surgeons use skin grafts from other parts of the body (usually the thigh or forearm) to create a penis. A vaginectomy, or the closing of the opening in the front of the pelvis, as well as scrotoplasty, which creates a scrotum, can be included in some phalloplasty procedures. This is the most expensive of bottom surgery options for trans men, with price tags up to $150,000 in some cases.
  • Hysterectomy: A hysterectomy includes the removal of the uterus and ovaries

Types of Surgeries for Trans Women:

  • Facial feminization surgery (FFS): This surgery may include genioplasty, cheek augmentation, brow lifts, tracheal shave and lip lift or augmentation.
  • Breast augmentation/augmentation mammoplasty: Breast augmentation is one of the most common gender confirmation surgeries for trans women and nonbinary patients. It might involve saline or silicone implants or even fat transfers from other parts of the body.
  • Vaginoplasty: In vaginoplasty, a surgeon uses skin grafts from another part of the body (usually the scrotum or abdomen) to create a vaginal canal. The surgeon also uses existing genital tissue to create a clitoris. This allows most patients to have penetrative intercourse.
  • Orchiectomy: An orchiectomy is often a transfeminine patient’s first gender affirmation surgery. It involves the removal of the testicles.
  • Vulvoplasty: A vulvoplasty involves the external part of the vagina rather than the vaginal canal. Skin from the patient’s genitalia is used to create a vaginal opening, the inner and outer labia, a clitoris and an opening that allows the patient to urinate.

Medical Transitioning and Health Insurance

While it is illegal for the majority of private and public health insurers within the U.S. to discriminate against transgender people or deny transition-related care, financial and logistical barriers still remain.

  • Differences in state-by-state health insurance coverage: Each U.S. state has different policies regarding health insurance and trans-related care. Some U.S. states legally require health insurance providers to cover transition-related care while others do not.
  • Difficulty accessing up-to-date and accurate insurance information: The language in health insurance plan summaries can be out-of-date or vague. This can lead to discriminatory denials of care.
  • Discrimination and stigma: Discrimination against the LGBTQ community remains widespread, and transgender people may face health disparities and stigma in the context of medical care as a result, as well as other financial challenges. A 2015 study by the National Center for Transgender Equality revealed that about one-third of transgender patients said they were denied medical care or harassed by a medical provider.
  • Lack of training and cultural competency among health providers: Some healthcare providers haven’t had adequate training in healthcare for transgender patients, which can lead them to make questionable decisions.

Read the full article for suggestions on how to navigate health insurance and medical transitioning.

Financing Options

  • Loans: Taking out a personal loan to pay for transition-related care
  • Grants: Applying for a grant or scholarship designed to pay for some or all transition related costs
    • The Jim Collins Foundation: The Jim Collins Foundation is dedicated to funding gender-confirming surgeries for trans people who need them. Grants are awarded on an annual basis.
    • Genderbands Transition Grants: Genderbands offers transition grants to offset the expense of gender confirmation surgery for trans and nonbinary recipients.
    • Rizi Xavier Timane Trans Surgery Grant: Rizi Xavier Timane, DSW, established a grant program to aid in the costs of gender-confirming surgeries for trans and nonbinary individuals.
    • TransMission: The Loft LGBTQ+ Community Center’s TransMission is a small scholarship fund that helps trans and nonbinary recipients with medical, surgical and legal expenses.
    • Stealth Bros & Co. Surgery Support Fund: The Stealth Bros & Co. Support Fund offers financial aid to trans men and transmasculine people for surgery, hormone therapy and related expenses.
    • Black Transmen, Inc. Surgery Scholarship: Black trans men in the U.S. who have already been approved for surgery by a surgeon can apply for up to $1,000 in financial assistance.
    • Point of Pride: Point of Pride offers scholarship-like funding for gender-confirming surgeries on an annual basis with a competitive application process each November.
  • Fundraising: Reaching out to your community to help raise funds for transition-related costs
  • Line of Credit: Using a Home Equity Line of Credit if you own a home
  • Other: Some surgeons work with medical financing companies to help patients pay in installments over time

Advocacy Organizations

  • The Sylvia Rivera Law Project: In addition to impact litigation advocacy, the Sylvia Rivera Law Project offers legal services and resources to aid people in their journey toward gender self-determination.
  • Transgender Legal Defense & Education Fund: The Transgender Legal Defense & Education Fund is a nonprofit that fights for trans rights and against discrimination. The organization’s Trans Health Project helps transgender people access trans-confirming health insurance.
  • Transgender Law Center: The Transgender Law Center is a trans-led advocacy organization that offers educational materials and other resources around healthcare, immigration, incarceration and employment.
  • National Center for Transgender Equality: The National Center for Transgender Equality offers educational materials, self-help guides and other resources for the trans community.
  • SPARTA: SPARTA is a nonprofit organization dedicated to transgender, nonbinary and gender non-conforming people serving in the U.S. military.

Read the full article for additional expert insight on financing gender confirmation surgery as well as additional resources.

Being an Ally

It can be hard to know how to be an effective ally for someone in a minority population, especially when their experiences are far outside your own. To help you out, here are some Do's and Don't's of being an ally for transgender people.



  • Use the name that a transgender individual goes by. It is hurtful to insist on using their previous name (a.k.a deadname) if they have decided to change it.
  • Use the pronoun they prefer. If you are not sure, you can listen for what their associates use for them or introduce yourself and your pronouns to give them the opening to comfortably respond in the same way.
  • Be a supportive listener
  • Take the time to educate yourself about transgender issues and information. You can find a good resource here.
  • Be patient with individuals still navigating their gender identity, it is a process that goes at a different pace for each person.
  • Speak out against transphobia where you encounter it! For information on what transphobia looks like, go here.


  • Assume a person's gender identity or sexual orientation based on appearance
  • Use names, pronouns, or labels a trans person doesn’t describe themselves with
  • "Out" a person who is transgender unless they have given you express permission to share that information. This is not just an issue of privacy, it is an issue of safety for the trans person.
  • Use terms such as "it", "he-she", or "shim" to refer to a transgender individual as such terms are deeply disrespectful
  • Ask about a transgender person's body or genitalia. Aside from being rude, it has no bearing on their gender identity and its validity.