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Burleton Education is not a healthcare provider, and we do not, under any circumstances, offer medical advice. This content is provided for informational purposes only. Always consult a physician.
Assigned Boy at Birth (ABAB) refers to a person who was designated male when they were born, based on the assumption that external anatomy or other physical characteristics observed by medical professionals correspond to the biological sex of the newborn. This is not always accurate.
Burleton Education uses the term (and acronym) ABAB to acknowledge that what is being assigned is stereotypical gender, not sex.
This designation happens as part of the standard process of recording a newborn’s sex assignment, typically labeled as male or female on birth records. The term "assigned sex" is misleading, because sex cannot be "assigned". Biological sex is established as a result of multiple processes that occur (or don't occur) during prenatal development. This results in biological sex configurations that are far more diverse than simply "male" or "female".
Christian Nationalist (anti-trans) motivated physicians, politicians and others opposed to the proven existence of biological sex and gender diversity frequently argue that "sex isn't 'assigned', it's given to us by nature (God)!". This argument, with relation to the 'nature' component, is technically true, however it's also dangerously essentialist. It's limited to a very narrowly defined scope of nature's ("God's?") establishment of almost infinite diversity. Christian Nationalists define any naturally occuring biological diversity beyond 'male XY/penis/masculine' as a disorder, perversion, ideology, or mistake that needs either correction, or social isolation.
It’s important to note that “assigned boy at birth” (or “assigned male at birth,” AMAB) describes only the initial classification, not a person’s gender identity. A person assigned boy at birth may identify as a boy or man (cisgender), or they may identify differently — for example, as a girl, woman, nonbinary, Two-Spirit, or other gender.
Assigned Girl at Birth (AGAB) refers to a person who was designated female when they were born, based on the assumption that external anatomy or other physical characteristics observed by medical professionals correspond to the biological sex of the newborn. This is not always accurate.
Burleton Education uses the term (and acronym) AGAB to acknowledge that what is being assigned is stereotypical gender, not sex.
This designation happens as part of the standard process of recording a newborn’s sex assignment, typically labeled as male or female on birth records. The term "assigned sex" is misleading, because sex cannot be "assigned". Biological sex is established as a result of multiple processes that occur (or don't occur) during prenatal development. This results in biological sex configurations that are far more diverse than simply "male" or "female".
Christian Nationalist (anti-trans) motivated physicians, politicians and others opposed to the proven existence of biological sex and gender diversity frequently argue that "sex isn't 'assigned', it's given to us by nature (God)". This argument, with relation to the 'nature' component, is technically true, however it's also dangerous and essentialist. It's limited to a very narrowly defined scope of nature's ("God's?") capacity for infinite diversity. Christian Nationalists define any naturally occuring biological diversity beyond 'female XX/lack of penis/feminine' as a disorder, perversion, ideology, or mistake that needs either correction, or social isolation.
It’s important to note that “assigned girl at birth” (or “assigned female at birth,” AFAB) describes only the initial classification, not a person’s gender identity. A person assigned girl at birth may identify as a girl or woman (cisgender), or they may identify differently — for example, as a boy, man, nonbinary, Two-Spirit, or other gender.
Anxiety is a natural emotional response to stress, danger, or uncertainty. It involves feelings of worry, nervousness, or fear about situations that may seem threatening or unpredictable.
For trans and nonbinary youth and adults, excessive anxiety can stem from fear of judgment from others if their gender feelings are revealed or discovered, as well as a sense of 'impending doom' about what the future holds, particular with pubertal changes to their bodies, which don't correspond to their gender identity.
From a psychological perspective, anxiety helps people stay alert and cautious, but when it becomes excessive or constant, it can interfere with daily life.
From a biological standpoint, anxiety triggers the body’s “fight-or-flight” response — releasing hormones like adrenaline and cortisol, which prepare you to respond to perceived threats.
There are also clinical anxiety disorders, where anxiety becomes chronic or disproportionate to the situation. Examples include:
Generalized Anxiety Disorder (GAD): persistent, excessive worry about many aspects of life.
Panic Disorder: sudden, intense fear leading to physical symptoms like a racing heart or shortness of breath.
Social Anxiety Disorder: fear of social situations or being judged by others.
Phobias: intense fear of specific objects or situations.
Co-occurring anxiety disorders can be effectively treated in conjunction with delivery of gender affirming care.
In short, anxiety is both a normal human emotion and, when excessive, a mental health condition that can benefit from treatment and support.
The areola is the circular, darker-colored area of skin surrounding the nipple on the chest or breast.
Here’s what to know:
Color: Usually darker than the surrounding skin; varies widely among people.
Function: Contains small glands (called Montgomery glands) that lubricate and protect the skin, especially during breastfeeding.
Appearance: Size and color can change with puberty, pregnancy, hormonal shifts, and age.
Location: Present on all sexes.
Atypical means not typical — in other words, unusual, uncommon, or not representative of the norm.
It doesn’t automatically mean something is wrong; it just means it differs from what is most common or expected.
Examples:
“An atypical symptom” → a symptom that isn’t usually seen with a condition.
“An atypical behavior” → behavior that’s different from what is normally expected.
“An atypical pattern of growth” → growth that doesn’t follow the usual timeline.
Axillary hair is the medical term for underarm hair—the hair that grows in the armpits.
It develops during puberty as a response to androgens (hormones such as testosterone and DHEA).
It typically appears after pubic hair begins to grow and is part of the Tanner staging used to track pubertal development.
Axillary hair helps with sweat distribution and may play a role in scent signaling (pheromones).
Growth patterns vary widely among individuals and are normal across all sexes.
The clitoris is a small, highly sensitive organ located at the top of the vulva, where the inner lips (labia minora) meet. Its primary function is sexual pleasure.
Here’s a clear overview:
The part you can see externally is usually a small, rounded glans—about the size of a pea, though size varies naturally.
Most of the clitoris is actually internal. It has:
Two internal legs (crura) that extend downward along the pubic bones.
Bulbs of erectile tissue on each side of the vaginal opening.
Like the penis, it contains erectile tissue, which becomes engorged with blood during sexual arousal.
The clitoris has thousands of nerve endings, making it one of the most sensitive parts of the human body.
Its sole biological purpose is to provide sexual pleasure; it is not involved in menstruation, pregnancy, urination, or childbirth.
Size, shape, and appearance vary greatly between individuals, and all variations can be completely normal.
Congenital Adrenal Hyperplasia (CAH) is a group of inherited genetic variations that affect how the adrenal glands make certain hormones. It can influence growth, development, and long-term health in a range of ways depending on the specific type and severity.
Most commonly, CAH is due to a deficiency of the enzyme 21-hydroxylase (about 95% of cases). Other, rarer enzyme forms also exist.
Because the adrenal glands can’t make enough cortisol (and sometimes not enough aldosterone), the pituitary gland signals them to work harder. This causes the adrenal glands to overproduce androgens, leading to many of the symptoms seen in CAH.
Low cortisol → fatigue, poor stress tolerance, low blood sugar
Low aldosterone (in salt-wasting CAH) → dehydration, salt loss, low blood pressure
Infants with XX chromosomes
May be born with atypical or ambiguous genitalia (a typical reason CAH is identified at birth)
Infants with XY chromosomes
Normal genital appearance
Salt-wasting crises may be the first sign
Children
Early pubic hair
Fast growth but early growth plate closure → short final height
Adolescents & Adults
Fertility challenges (in both women and men)
Hormonal imbalance can cause mood or energy issues
In nonclassic CAH: acne, hirsutism, irregular cycles, or PCOS-like symptoms
High androgens → virilization, early puberty, rapid childhood growth, short adult height
Congruence generally means agreement, harmony, or correspondence. The exact meaning depends on the field you’re talking about, but the core idea is the same: two things are congruent when they match in an important way.
Congruence refers to the alignment between a person’s inner feelings and their outer expression.
Coined by Carl Rogers, it describes being genuine or authentic.
Depression commonly coexists with other psychiatric conditions, particularly anxiety disorders. This frequent co-occurrence has led to a theoretical debate among researchers, with some arguing that depression and anxiety may not be entirely separate entities but rather different expressions on a shared spectrum of psychopathology.
For those experiencing Gender Dysphoria (GD) Major Depressive Disorder (MDD) is the most common co-occurring diagnosis, with prevalence rates ranging from 31% to 33.3% in transgender and gender diverse (TGD) adults in clinical settings, substantially higher than in the general population. The primary explanatory framework for this disparity is the 'Minority Stress Model,' which links external stressors—such as discrimination, rejection, and nonaffirmation of identity—to resulting negative mental health outcomes like depression and elevated suicide risk.
An endocrinologist is a medical doctor who specializes in the endocrine system—the network of glands that produce hormones. Hormones act as the body’s chemical messengers, coordinating many essential functions.
They diagnose, treat, and manage conditions involving hormone imbalances, including:
Diabetes (Type 1, Type 2)
Thyroid disorders (hypothyroidism, hyperthyroidism, nodules)
Pituitary and adrenal gland disorders
Growth and puberty conditions
Bone health (osteoporosis)
Reproductive hormone conditions
Intersex variations and gender-affirming endocrine care
Essentialism is the belief that certain categories—such as gender, race, or species—have an underlying, unchanging “essence” or set of characteristics that make members of those categories what they are.
In other words, essentialism assumes that:
Things (or people) have a fixed nature that defines them.
These defining traits are inherent rather than shaped by environment, culture, or experience.
Gender essentialism: The belief that men and women have innate, natural qualities (e.g., “men are naturally aggressive,” “women are naturally nurturing”).
Gender essentialism is the belief that men and women (or males and females) have inherent, natural, and unchangeable qualities that define their behavior, abilities, and roles in society.
It assumes that gender differences are biologically determined rather than influenced by culture, upbringing, or individual experience.
“Boys are naturally better at math and science.”
“Girls are naturally more caring and emotional.”
“Men are leaders; women are nurturers.”
These statements treat gender traits as fixed and universal, ignoring the social and cultural factors that shape them.
Non-essentialist (or social constructionist) perspectives argue that many differences—especially social ones—are culturally created rather than biologically fixed.
Scientific Evidence: Modern biology and psychology show wide variation within sexes and significant overlap between them.
Cultural Differences: Gender roles differ greatly across societies and historical periods, suggesting they are socially constructed.
Social Consequences: Essentialist thinking can reinforce stereotypes, justify inequality, and marginalize people who don’t conform to binary norms (e.g., transgender, nonbinary, and gender-nonconforming individuals).
Gender-Affirming Care (GAC) is a comprehensive, multidisciplinary model of healthcare that supports individuals whose gender identity differs from the gender role they were assigned at birth (transgender, gender diverse, and nonbinary individuals).
GAC is based on the philosophy of affirming a person's self-determined gender identity. Its primary clinical goal is to alleviate the psychological distress and discomfort (known as Gender Dysphoria or Gender Incongruence) that can arise from a mismatch between a person's internal sense of self and their assigned gender role at birth. This model follows standardized protocols from professional bodies like the World Professional Association for Transgender Health (WPATH) and is considered evidence-based.
The care is highly individualized and encompasses a broad spectrum of interventions, which can be categorized into four main domains:
This involve changes to a person's outward presentation and social role attributions, often serving as the first step in gender transition.
Identity: Using a preferred, affirming name and pronouns.
Expression: Changes in clothing, hairstyles, voice, and behaviors to align with gender identity.
Physical Contouring (Non-Medical Aids): Using items such as breast binders, genital tucking devices, or padding to adjust body shape.
This involves formal, administrative recognition of the individual's gender identity.
Documentation: Updating legal documents, such as driver's licenses, birth certificates, or passports, to reflect the affirming name and gender marker.
Use of pharmacological or procedural means to align secondary sex characteristics with the individual’s gender identity.
Hormone Therapy: Using gender-affirming hormones (estrogen or testosterone) to induce desired physical changes, such as fat redistribution, muscle mass changes, and body hair growth.
Puberty Blockers: In adolescents, medications may be used to temporarily suppress endogenous puberty, allowing time for further exploration and decision-making.
Other Procedures: This includes non-surgical services like hair removal (electrolysis, laser) or voice and communication therapy to develop vocal characteristics that better align with their gender.
These are procedures intended to modify physical anatomy to reduce dysphoria. Surgical options are diverse and personalized.
Chest Surgeries: Procedures like masculine chest reconstruction (mastectomy) or breast augmentation.
Genital Surgeries: Known as "bottom surgery," these include procedures like vaginoplasty or vulvoplasty for transfeminine individuals, or phalloplasty or metoidioplasty for transmasculine individuals.
Other Surgeries: Procedures like facial feminization surgery (FFS), tracheal shaves (Adam’s apple reduction), and hysterectomies.
It is important to note that surgical intervention is a complex decision, and procedures, while proven beneficial in most cases, are rarely provided to minors under the age of 18 as a result of anti-trans disinformation campaigns and executive/legislative intimidation of surgical providers.
“Gender diverse” is a broad, inclusive term used to describe people whose gender identity, gender expression, or lived experience does not fit neatly into traditional binary categories of “male” or “female.” It emphasizes natural variation in how people understand and express their gender.
Umbrella term: It includes many identities, such as nonbinary, genderqueer, genderfluid, agender, two-spirit (specific to some Indigenous cultures), and others.
Focus on diversity, not deviation: The term avoids implying that these identities are disordered or abnormal. Instead, it recognizes that gender exists along a spectrum and can be expressed in many ways.
Context-sensitive: In clinical, educational, and community settings, “gender diverse” is often used to affirm and validate individuals whose gender experiences differ from societal expectations.
Sometimes used for youth: In pediatric or adolescent settings, it can describe children or teens who show gender-expansive behavior or express a gender identity different from the one assumed at birth.
“Gender diverse” centers dignity, variation, and inclusion, and it allows people to describe themselves without being placed in narrow categories. It communicates that gender is not limited to two fixed options and that human experiences of gender are varied and valid.
Historically, “gender diverse” is used to describe people or cultures whose gender roles and identities did not fit binary Western categories, even if those cultures didn’t use modern terms.
Two-Spirit identities among many Indigenous nations (though each nation has specific roles and names; “Two-Spirit” is a contemporary pan-Indigenous term).
Hijra communities in South Asia.
Fa’afafine in Samoa.
Various gender-expansive roles in ancient Mesopotamia, Egypt, Greece, the Americas, and Africa.
Historians use “gender diverse” as a bridge term—a respectful way to discuss gender variance without falsely labeling past individuals with modern identities like “transgender” or “nonbinary.”
In law and policy, “gender diverse” is used to ensure protections or inclusivity beyond binary categories.
Anti-discrimination laws: Some jurisdictions include “gender diverse people” in protected classes, alongside transgender or nonbinary people.
Identity documents: Policies may state that they serve “transgender and gender-diverse individuals,” especially in areas with X markers or nonbinary recognition.
Employment and education policies: Schools and workplaces often use the term to cover anyone who doesn’t conform to gender norms, even if they don’t identify as transgender.
The term offers legal clarity by including all forms of gender variance without requiring individuals to use specific labels.
In everyday community use, “gender diverse” is an inclusive, broad, and often gentle way to describe gender identities and expressions that go beyond the binary.
Community programs: Support groups, youth organizations, and LGBTQ+ centers often describe themselves as serving “gender-diverse people.”
Affirming language: It allows people to be included without pressure to choose a specific identity.
Non-stigmatizing: It’s helpful for families, schools, and social workers who want terminology that is respectful, supportive, and culturally flexible.
Some people prefer more specific identities (nonbinary, genderfluid, etc.).
Others appreciate the privacy and inclusivity of “gender diverse,” especially when navigating unsupportive environments.
Gender dysphoria is a psychological term that describes the distress or discomfort a person may feel when their gender identity—their internal sense of being male, female, both, neither, or somewhere along the gender spectrum—does not align with the sex they were assigned at birth.
Emotional distress: People with gender dysphoria often experience anxiety, depression, or unease related to this incongruence.
Not the same as being transgender: Being transgender or gender diverse is not itself a disorder. Gender dysphoria refers specifically to the distress that may accompany the incongruence.
Diagnosis: The term is used in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a clinical diagnosis to help individuals access gender-affirming healthcare if needed.
Treatment: Support can include gender-affirming therapy, social transition (like name or pronoun changes), and/or medical interventions (such as hormone therapy or surgery), depending on the person’s goals.
The definition of gender dysphoria has changed significantly over time — reflecting shifts in medical understanding, cultural awareness, and respect for transgender and gender-diverse people. Here’s how it evolved:
In early psychology and psychiatry, being transgender was often pathologized.
1950s–1970s: Transgender identities were viewed as a type of “sexual deviation” or “disorder.”
The focus was on trying to explain or “correct” gender variance rather than support the person’s experience.
Trans people often faced stigma and barriers to care.
When the Diagnostic and Statistical Manual of Mental Disorders (DSM) included the term Gender Identity Disorder (GID) in 1980, it described people whose gender identity differed from their assigned sex.
The focus was on the identity itself being “disordered.”
This classification pathologized being transgender, which reinforced stigma.
However, it also allowed some individuals to access medical transition care by establishing a recognized diagnosis.
A major change came with the DSM-5 in 2013.
The diagnosis was renamed Gender Dysphoria to emphasize that the distress — not the identity — is what requires support or treatment.
This reframing aimed to reduce stigma and validate that being transgender is not a mental illness.
The diagnosis helps people access gender-affirming care while acknowledging the emotional distress that can result from societal rejection or body incongruence.
The World Health Organization’s International Classification of Diseases (ICD-11) went even further.
It replaced “Gender Identity Disorder” with Gender Incongruence, and moved it out of the mental disorders chapter into a section on sexual and reproductive health.
This change recognizes that gender diversity is a natural part of human experience, not a psychiatric condition.
| Era | Term Used | Focus | Perspective |
|---|---|---|---|
| Pre-1980 | None / “Transsexualism” | Identity seen as deviant | Pathologizing |
| 1980–2013 | Gender Identity Disorder | Identity itself as “disordered” | Medicalized |
| 2013–present | Gender Dysphoria | Distress from incongruence | Supportive / affirming |
| 2022–present | Gender Incongruence (ICD-11) | Health, not a mental disorder | Human-rights based |
Gender incongruence refers to a condition in which a person’s experienced or expressed gender does not match the sex they were assigned at birth.
It is the term used by the World Health Organization (WHO) in the International Classification of Diseases, 11th Revision (ICD-11) to describe what was previously called “gender identity disorder.” Unlike earlier definitions, gender incongruence is not classified as a mental disorder — it is placed under “conditions related to sexual health.”
Definition: A marked and persistent mismatch between a person’s internal sense of gender and the physical characteristics or social expectations of their assigned sex (i.e., assigned gender role).
Examples:
Someone assigned as a boy/man at birth who identifies as nonbinary or lives as a woman.
Someone assigned as a girl/woman at birth who identifies as nonbinary or as a man.
Diagnosis (ICD-11): May apply when this incongruence causes significant distress or difficulty functioning socially or personally.
Purpose of the term: The shift to “gender incongruence” aims to reduce stigma and recognize that gender diversity is part of human variation, not pathology.
The glans is the rounded, sensitive tip of a penis or clitoris. It contains a high concentration of nerve endings, which makes it an important structure for sexual sensation.
The glans forms the head of the penis.
It may be covered by the foreskin in those who are not circumcised.
It plays a key role in sexual arousal and pleasure.
The glans is the visible external part of the clitoris—a small, highly sensitive structure located at the top of the vulva where the inner labia meet.
Most of the clitoris extends internally, but the glans is the portion on the outside.
GnRH Analog Therapy (also called GnRH agonist therapy) is a medical treatment that affects the body’s hormone regulation system, specifically the hypothalamic-pituitary-gonadal (HPG) axis.
GnRH stands for Gonadotropin-Releasing Hormone, a hormone produced by the hypothalamus that controls the release of two other hormones from the pituitary gland:
LH (Luteinizing Hormone)
FSH (Follicle-Stimulating Hormone)
These hormones stimulate the gonads (testes or ovaries) to produce sex hormones like testosterone and estrogen.
A GnRH analog is a synthetic version of this hormone that can either stimulate or suppress the body’s natural hormone production depending on how it’s used.
When given continuously (rather than in the body’s natural pulses), GnRH analogs desensitize the pituitary gland. This leads to:
Decreased LH and FSH secretion
Reduced estrogen and testosterone levels
This effectively “pauses” puberty or sex hormone production.
Precocious Puberty:
To stop or slow down early puberty until an appropriate age.
Gender-Affirming Care:
To temporarily halt puberty in transgender or nonbinary youth, allowing more time to explore identity and decide on further treatment.
Prostate Cancer:
To reduce testosterone levels that fuel cancer growth.
Endometriosis or Uterine Fibroids:
To reduce estrogen and control symptoms like pain or bleeding.
Leuprolide (Lupron)
Histrelin (Supprelin)
Triptorelin
Goserelin (Zoladex)
Hot flashes
Headaches
Mood changes
Decreased bone density (especially with long-term use)
Temporary changes in growth or development if used during puberty
GnRH analog therapy is often referred to as puberty blocker treatment when used for transgender or nonbinary youth.
The goal is to pause the physical changes of puberty that do not align with a young person’s gender identity.
This provides time to:
Reduce psychological distress (gender dysphoria)
Allow for continued emotional and cognitive development
Give youth and families more time to make informed decisions about future care (such as hormone therapy or social transition)
The GnRH analog suppresses the brain’s signaling to the gonads (testes or ovaries).
This stops the release of testosterone or estrogen, halting puberty-related changes such as:
Breast development
Voice deepening
Facial/body hair growth
Menstruation
Leuprolide acetate (Lupron Depot): given as monthly or quarterly injections
Histrelin acetate (Supprelin LA): a small implant placed under the skin, lasting 12–24 months
Triptorelin: injection lasting several months
All work by maintaining a steady, continuous level of GnRH analog, which suppresses the pituitary response.
Reduces gender dysphoria related to unwanted body changes
Can prevent the need for later, more invasive surgeries (like chest reconstruction or voice modification)
Supports better mental health and quality of life outcomes
Allows for gradual, informed transition planning
Bone health: Because sex hormones affect bone density, doctors monitor bone growth and may recommend calcium, vitamin D, or weight-bearing exercise.
Fertility: The treatment doesn’t cause permanent infertility, but discussions about future fertility preservation are encouraged before starting.
Emotional health: Ongoing mental health and family support are important parts of care.
GnRH analog therapy is a safe, reversible, and effective way to give transgender or gender-diverse youth time and control over their development. It’s typically managed by a pediatric endocrinologist (or other physician in consultation with a pediatric endocrinologist) as part of a broader, affirming healthcare plan that includes psychological and social support.
Homosexuality is a sexual orientation characterized by enduring emotional, romantic, and/or sexual attraction to people of the same sex or gender.
Sexual orientation refers to patterns of attraction—whom someone tends to form relationships, bonds, desire, or intimacy.
Homosexual individuals may identify with terms like gay, lesbian, or simply queer, depending on personal preference.
Orientation is not a choice and is understood to arise from a complex mix of biological, developmental, and environmental factors.
Homosexuality is a normal and natural variation of human sexuality and has been seen across cultures and throughout history.
Hormones can be grouped into three main types based on their chemical structure and how they act in the body:
Examples:
Examples:
Examples:
treatment and support.
The labia are folds of skin that form part of the external genitalia (vulva) in people with female anatomy. There are two pairs:
The outer folds.
Typically larger, with more fatty tissue.
Help protect the inner structures of the vulva.
Can have hair after puberty.
The inner folds.
Usually thinner and hairless.
Surround the vaginal opening and urethral opening.
Their size, shape, and color vary greatly from person to person.
Together, the labia help protect the genital area, provide sensation, and play roles in sexual arousal and comfort.
Informed consent is a foundational ethical and legal principle in medicine and research. It means that a person has the right to receive clear, accurate information about a treatment, procedure, or study — and then freely decide whether to proceed.
Most definitions include these core parts:
Disclosure
The clinician or researcher explains:
What the procedure or treatment is
Why is it being recommended
Expected benefits
Possible risks and side effects
Alternatives (including the option of doing nothing)
What might happen without the intervention
Understanding
The patient must comprehend the information. Providers should explain things in accessible, non-technical language and confirm understanding.
Voluntariness
The decision must be made freely — without pressure, coercion, manipulation, or undue influence.
Capacity
The person must have the ability to make medical decisions. This usually refers to legal and cognitive capacity to understand and weigh choices.
Consent
The patient affirms their decision. Consent may be:
Explicit (written or verbal, documented)
Implied (in some low-risk situations, such as offering an arm for a blood draw)
Medical treatments and surgeries
Gender-affirming care
Mental health treatment
Clinical research or trials
Procedures with risks (e.g., anesthesia, imaging with contrast, biopsies)
Informed consent:
Respects personal autonomy
Builds trust between patient and provider
Protects legal rights
Ensures ethical medical practice
Informed consent models are commonly used for hormone therapy and some surgeries. These models emphasize:
Providing clear information about effects and risks
Supporting patient autonomy
Avoiding unnecessary gatekeeping
If you'd like, I can also explain assent for minors, how decision-making capacity is assessed, or informed consent in gender-affirming contexts specifically.
For minors, informed consent is paired with assent and parental/guardian consent.
The adolescent must understand the treatment and agree to it.
Providers evaluate:
Emotional maturity
Consistency and persistence of gender identity
Ability to understand risks and benefits
Clinics generally require at least one parent's consent for:
Puberty blockers
Hormone therapy
Rules vary by state and country.
No medical interventions (puberty blockers, hormones, surgery) are provided.
Informed consent applies to:
Social transition decisions
Mental health care
Planning for future care
Reduces unnecessary psychological evaluations that were once required
Centers patient autonomy
Improves access without sacrificing safety
Aligns with WPATH SOC8, which emphasizes collaborative, individualized care
Recognizes that patients are experts in their own gender identity
Palpate means to examine a part of the body by touch, usually with the hands or fingers.
Healthcare providers palpate to:
Feel the size, shape, or firmness of an organ or body part
Detect tenderness or pain
Check for swelling, lumps, warmth, or texture changes
Assess pulse or circulation
For example, a doctor might palpate the abdomen to check for tenderness or palpate the neck to feel the lymph nodes.
The earliest widely recognized use of passing comes from the United States, where it described racial passing—most commonly, Black individuals of mixed ancestry who were able to present themselves as white in a legally segregated society.
Post-Reconstruction era: Jim Crow laws enforced racial boundaries, and the concept of passing became central to racial identity, legality, and survival.
Early literature and journalism: Newspapers and social commentary used “pass” or “passing” to describe crossing the racial line.
Nella Larsen’s novel Passing (1929) is one of the most influential early literary works exploring the emotional, social, and psychological aspects of racial passing.
Key features: secrecy, safety, mobility, and societal oppression.
This early usage established the basic structure: an individual is perceived as belonging to a dominant or socially safer category, often for survival or access to rights.
By the 1940s–1950s, “passing” broadened to include other forms of identity presentation:
Ethnic passing: e.g., Jewish, Irish, or other European immigrants assimilating into Anglo-American norms.
Sexual orientation: Gay or lesbian people “passing as straight” to avoid discrimination.
Class passing: Presenting oneself as wealthier or more educated for social mobility.
By the mid-20th century, academic sociology began treating “passing” as a general sociocultural mechanism for navigating stigma, drawing especially onErving Goffman’s work on stigma (1963).
In early transgender medicine and community life, “passing” was adopted to describe whether a trans person was perceived as cisgender by the public.
Physicians and early gender clinics (e.g., Johns Hopkins, Stanford, Reed Erickson–funded programs) often judged surgical and social “success” by a patient’s ability to “pass.”
Surgeons like Georges Burou, Harold Gillies, and Harry Benjamin used the term informally to describe how well a person was recognized in their lived gender.
The concept became entangled with:
safety from discrimination or violence
gatekeeping in medical transition
social assimilation pressures
“Passing” became a widely understood colloquial term within trans communities:
Some trans people valued passing as a means of safety or privacy.
Others critiqued it as enforcing cisnormative beauty standards.
The term sometimes carried class and race implications, as access to medical and aesthetic resources shaped who could “pass.”
Beginning in the 2000s, many trans scholars and activists critiqued the term:
It implies deception or performance rather than authenticity.
It reinforces the idea that one must appear cis to be considered valid in their gender.
Alternatives grew in usage: “being read as,” “being recognized as,” “being perceived as,” and “stealth.”
Despite critique, “passing” is still widely recognized, especially in discussions of safety, discrimination, and gender expression.
Modern scholarship considers passing as a form of social navigation shaped by power structures:
Critical race theory examines how racial hierarchies created the original context.
Trans studies analyze how gender norms, medical gatekeeping, and visual culture influence who is “allowed” to be seen as their gender.
Queer theory frames passing as a strategy, not an inherent trait—constructed by societal expectations rather than individual identity.
Pediatrics is the branch of medicine that focuses on the health and medical care of infants, children, and adolescents, typically from birth up to about age 18 (though some pediatric specialists care for patients into young adulthood).
Pediatricians are doctors who:
Diagnose and treat childhood illnesses and injuries
Monitor growth and development
Give vaccinations
Provide guidance on nutrition, behavior, emotional health, and safety
Manage chronic conditions such as asthma, diabetes, or congenital disorders
Children aren’t just “small adults.” Their bodies grow and develop rapidly, and their medical needs are different from adults. Pediatrics requires understanding:
Age-specific diseases
Developmental milestones
Communication with children and families
Preventive care to support lifelong health
Precocious puberty is when a child’s body begins changing into that of an adult (puberty) too early—before age 8 in girls or 9 in boys. woman, nonbinary, Two-Spirit, or other gender.
In most cases, no clear cause is found (called idiopathic).
Sometimes it’s linked to:
Brain abnormalities (e.g., tumors, trauma, infections, or congenital malformations)
Radiation or injury to the central nervous system
Usually treated with GnRH analog therapy ("puberty blockers"), which pauses puberty until a more appropriate age.
Once treatment stops, puberty resumes naturally.
This type is less common.
It occurs without brain involvement.
Instead, sex hormones are produced directly by the ovaries, testes, or adrenal glands—independently of brain signals.
Focuses on stopping the source of excess hormones, such as removing a tumor or treating the underlying hormonal disorder.
Pre-compliance with bans on transgender health care refers to the practice in which clinics, hospitals, insurers, or individual providers change their policies or restrict care before a law actually requires them to do so. In other words, they “pre-comply” with anticipated bans or restrictions—sometimes months ahead of the law taking effect, or even before a law is formally passed.
Pre-compliance happens when a health-care institution:
Stops offering certain gender-affirming services (such as puberty blockers, hormone therapy, or surgeries for minors) before a legal deadline.
Stops accepting new patients or reduces availability of care because they expect legal risk.
Changes documentation or billing practices out of fear that these could later be interpreted as violating a restriction.
Tells patients they must discontinue or transfer care even before the law formally prohibits it.
Several factors drive it:
New laws or proposed legislation may be ambiguously worded, creating fear of civil or criminal penalties.
Administrative or legal teams sometimes recommend early changes to avoid:
Loss of licenses
Financial penalties
Professional disciplinary action
Insurers may preemptively exclude coverage if they anticipate legal exposure or administrative burdens.
Even before a bill passes, organizations sometimes react to political signals, assuming restrictions will inevitably be enacted.
Pre-compliance can have significant consequences:
Abrupt loss of access to gender-affirming care
Interrupted continuity of treatment, which can be medically harmful
Increased travel burdens as patients seek care across state lines
Emotional distress due to sudden uncertainty about ongoing treatment
In many states, pre-compliance has occurred months before bans took effect, creating disruptions even when laws were later challenged or blocked in court.
Prepubertal means before puberty.
More specifically, it refers to the stage of childhood before any physical signs of puberty have begun. During the prepubertal period:
The body has not yet started producing increased sex hormones (estrogen or testosterone).
Secondary sex characteristics such as breast development, testicular enlargement, pubic hair, or voice changes are not yet present.
Growth patterns and body proportions are typical of childhood, not adolescence.
Clinically, this corresponds to Tanner Stage 1.
Risk aversion is a concept from economics, psychology, and decision-making that describes a preference for certainty over uncertainty—even when the uncertain option could lead to a higher payoff.
The scrotum is a pouch of skin that hangs below the penis and contains the testes (testicles). Here’s a simple, clear explanation:
A loose sac of skin and muscle.
Located outside the body, between the penis and the anus.
Holds and protects the testes, which produce sperm and testosterone.
Helps control temperature, because sperm develop best at a temperature slightly cooler than the inside of the body.
The scrotum can tighten (pulling the testes closer to the body when it’s cold) or relax (letting them hang lower when it’s warm) to keep the temperature stable.
Usually has wrinkled skin.
Often covered with fine or coarse hair after puberty.
Contains a muscle layer (the dartos muscle) that helps with temperature control.
Sex hormones function as chemical messengers that regulate the development and maintenance of sexual characteristics, reproductive processes, and many other body systems. They are produced mainly by the gonads (ovaries in females and testes in males), but also by the adrenal glands and, during pregnancy, the placenta.
Here’s a breakdown of how they function:
The hypothalamus in the brain releases GnRH (gonadotropin-releasing hormone).
This signals the pituitary gland to release LH (luteinizing hormone) and FSH (follicle-stimulating hormone).
LH and FSH then act on the gonads to produce sex hormones.
Estrogen (primarily in females)
Produced mainly by the ovaries.
Regulates the menstrual cycle and reproductive system.
Promotes development of female secondary sex characteristics (breast growth, fat distribution, etc.).
Supports bone health, skin elasticity, and brain function.
Progesterone (primarily in females)
Produced after ovulation by the corpus luteum in the ovary.
Prepares the uterus for pregnancy and maintains it if fertilization occurs.
Helps regulate the menstrual cycle.
Testosterone (primarily in males)
Produced mainly by the testes.
Stimulates sperm production and sex drive (libido).
Promotes male secondary sex characteristics (muscle growth, body hair, deepening voice).
Supports bone density and red blood cell production.
Sex hormone levels are regulated through negative feedback:
High estrogen or testosterone levels signal the brain to reduce LH and FSH release.
Low levels trigger increased hormone production.
This keeps hormone levels balanced.
A biological process in which two parents contribute genetic material to produce offspring with a unique combination of genes. It involves the fusion of gametes — (sperm) and (egg or ovum) — during fertilization.
This process increases genetic variation within a species, which helps populations adapt to changing environments and resist diseases.
In a transgender context, “stealth” refers to a person choosing not to disclose their transgender status in everyday life and instead living socially as their affirmed gender without others knowing they are trans. Here’s a more complete explanation:
A transgender person is considered stealth when they do not share their transgender history at work, school, in social settings, or sometimes even in close relationships.
They are perceived by others simply as a woman, man, or nonbinary person—without the knowledge of transition being part of their background.
People choose to go stealth for many different reasons, including:
Safety: Reducing risks of discrimination or violence.
Privacy: Treating medical history as private, like any other health information.
Emotional comfort: Wanting to live without being defined by being trans.
Employment or housing security: Avoiding bias or unequal treatment.
A sense of closure: Feeling that transition is complete and wanting to move forward.
None of these reasons is “wrong”—each is valid and personal.
Going stealth is not the same as being “closeted.”
Closeted refers to someone not living publicly in their gender identity.
Stealth refers to someone living openly in their gender but without disclosing being trans.
Some people go semi-stealth, sharing their history only with trusted people or in specific spaces.
While stealth can offer safety and peace of mind, it can also come with challenges:
Worry about being outed.
Difficulty accessing trans-specific healthcare discreetly.
Emotional strain of maintaining privacy in a world that often expects personal disclosure.
Feeling disconnected from transgender community or support networks.
Stealth is a personal choice about privacy, safety, and identity. It doesn’t make someone “more” or “less” trans—it’s simply one of many ways transgender people navigate the world.
If you'd like, I can also explain:
“Passing” vs. “stealth”
The history of stealth culture
The ethics/debates around stealth within trans communities
How stealth intersects with race, class, and safety
Testes (singular: testis) are organs in the male reproductive system that have two main jobs:
The testes make sperm cells, which are the reproductive cells needed to fertilize an egg.
They also produce important hormones—especially testosterone—which supports puberty changes, muscle and bone growth, and sperm production.
In most people assigned male at birth, the testes are located in the scrotum, the pouch of skin under the penis. They develop inside the abdomen before birth and usually descend into the scrotum shortly before or after birth.
Each testis contains:
Seminiferous tubules – tightly coiled tubes where sperm are made
Leydig cells – make testosterone
Epididymis (attached to the testis) – stores and matures sperm
Risk aversion is a concept from economics, psychology, and decision-making that describes a preference for certainty over uncertainty—even when the uncertain option could lead to a higher payoff.
The scrotum is a pouch of skin that hangs below the penis and contains the testes (testicles). Here’s a simple, clear explanation:
A loose sac of skin and muscle.
Located outside the body, between the penis and the anus.
Holds and protects the testes, which produce sperm and testosterone.
Helps control temperature, because sperm develop best at a temperature slightly cooler than the inside of the body.
The scrotum can tighten (pulling the testes closer to the body when it’s cold) or relax (letting them hang lower when it’s warm) to keep the temperature stable.
Usually has wrinkled skin.
Often covered with fine or coarse hair after puberty.
Contains a muscle layer (the dartos muscle) that helps with temperature control.
Sex hormones function as chemical messengers that regulate the development and maintenance of sexual characteristics, reproductive processes, and many other body systems. They are produced mainly by the gonads (ovaries in females and testes in males), but also by the adrenal glands and, during pregnancy, the placenta.
Here’s a breakdown of how they function:
The hypothalamus in the brain releases GnRH (gonadotropin-releasing hormone).
This signals the pituitary gland to release LH (luteinizing hormone) and FSH (follicle-stimulating hormone).
LH and FSH then act on the gonads to produce sex hormones.
Estrogen (primarily in females)
Produced mainly by the ovaries.
Regulates the menstrual cycle and reproductive system.
Promotes development of female secondary sex characteristics (breast growth, fat distribution, etc.).
Supports bone health, skin elasticity, and brain function.
Progesterone (primarily in females)
Produced after ovulation by the corpus luteum in the ovary.
Prepares the uterus for pregnancy and maintains it if fertilization occurs.
Helps regulate the menstrual cycle.
Testosterone (primarily in males)
Produced mainly by the testes.
Stimulates sperm production and sex drive (libido).
Promotes male secondary sex characteristics (muscle growth, body hair, deepening voice).
Supports bone density and red blood cell production.
Sex hormone levels are regulated through negative feedback:
High estrogen or testosterone levels signal the brain to reduce LH and FSH release.
Low levels trigger increased hormone production.
This keeps hormone levels balanced.
A biological process in which two parents contribute genetic material to produce offspring with a unique combination of genes. It involves the fusion of gametes — (sperm) and (egg or ovum) — during fertilization.
This process increases genetic variation within a species, which helps populations adapt to changing environments and resist diseases.
In a transgender context, “stealth” refers to a person choosing not to disclose their transgender status in everyday life and instead living socially as their affirmed gender without others knowing they are trans. Here’s a more complete explanation:
A transgender person is considered stealth when they do not share their transgender history at work, school, in social settings, or sometimes even in close relationships.
They are perceived by others simply as a woman, man, or nonbinary person—without the knowledge of transition being part of their background.
People choose to go stealth for many different reasons, including:
Safety: Reducing risks of discrimination or violence.
Privacy: Treating medical history as private, like any other health information.
Emotional comfort: Wanting to live without being defined by being trans.
Employment or housing security: Avoiding bias or unequal treatment.
A sense of closure: Feeling that transition is complete and wanting to move forward.
None of these reasons is “wrong”—each is valid and personal.
Going stealth is not the same as being “closeted.”
Closeted refers to someone not living publicly in their gender identity.
Stealth refers to someone living openly in their gender but without disclosing being trans.
Some people go semi-stealth, sharing their history only with trusted people or in specific spaces.
While stealth can offer safety and peace of mind, it can also come with challenges:
Worry about being outed.
Difficulty accessing trans-specific healthcare discreetly.
Emotional strain of maintaining privacy in a world that often expects personal disclosure.
Feeling disconnected from transgender community or support networks.
Stealth is a personal choice about privacy, safety, and identity. It doesn’t make someone “more” or “less” trans—it’s simply one of many ways transgender people navigate the world.
If you'd like, I can also explain:
“Passing” vs. “stealth”
The history of stealth culture
The ethics/debates around stealth within trans communities
How stealth intersects with race, class, and safety
Testes (singular: testis) are organs in the male reproductive system that have two main jobs:
The testes make sperm cells, which are the reproductive cells needed to fertilize an egg.
They also produce important hormones—especially testosterone—which supports puberty changes, muscle and bone growth, and sperm production.
In most people assigned male at birth, the testes are located in the scrotum, the pouch of skin under the penis. They develop inside the abdomen before birth and usually descend into the scrotum shortly before or after birth.
Each testis contains:
Seminiferous tubules – tightly coiled tubes where sperm are made
Leydig cells – make testosterone
Epididymis (attached to the testis) – stores and matures sperm
