Sexual health for trans, non-binary and gender diverse people

People whose gender identity (how you feel about being male or female) is opposite to their biological sex (the male or female parts of your body) are sometimes called transgender, or trans for short. Trans women are born with a penis and other male characteristics but identify as female. While trans men are born with a vagina and other female characteristics but identify as male. People who don’t identify as male nor female, or identify as both, are sometimes called non-binary or gender diverse.  

Being transgender or non-binary will mean different things to different people. And not everyone wants to use these terms to describe themselves, and that’s fine. 

Transitioning describes the changes that some trans and non-binary people make so they can live in a way that better reflects their gender identity. Not every trans or non-binary person transitions, and there is no right or wrong way to go about it. It’s different for everyone.  

Transitioning might include things like changing your name and pronouns (he, she, they). Or how you dress, talk or style your hair. It might include making temporary changes to your body, such as wearing binders or sports bras to flatten your chest, or using padded materials to enhance it.  

If it’s legally allowed, some people change their ID documents. 

Some people have gender-affirming hormone therapy. In general, people who want to transition to the male gender use testosterone and people who want to transition to the female gender use estrogen, progestogen or both.  

Some people have gender-affirming surgery. This permanently changes body parts associated with biological sex.  

Not everyone lives in countries where gender-affirming medical care is available. But if you do and you are considering either, you have the right to discuss the options with a doctor at a specialist clinic. 

Gender dysphoria are feelings of unease that some people get if their gender identity and their body don’t match up. This unease can also come from being treated as a certain gender by others when you don’t identify this way.  

Not every trans or non-binary person gets gender dysphoria. And for those that do, each experience is different. For some people, it can lead to mental health issues like depression and anxiety. But being transgender or non-binary is not in itself a mental illness.  

Lots of trans and non-binary people experience stigma, discrimination and transphobia (prejudice based on gender identity). This can be really tough, and it can make you feel bad about who you are. But you do not deserve to be treated this way. 

If you are feeling bad because of transphobia or gender dysphoria don’t suffer alone. It can help to reach out to people who are trans or non-binary or who understand the issues you are facing. If you don’t know any, you can search online for ‘trans support’ in your country.  

It might feel tempting to over use drugs and alcohol to feel better. But the next day you are likely to feel worse. And it might mean you end up in situations you regret.  

It’s really important to look after your body, however you feel about it, and your mind too. Here are some tips on how to do this. 

Wherever you are in your gender journey, you deserve a sex life that feels good. And to be in a healthy relationship if you want to be. Your gender-identity is different from your sexuality, which is about who you are attracted to. Understanding the difference between these two things can be helpful for working out how you feel. 

If you have gender dysphoria, sex can feel complicated. There are some steps to take that will help you deal with this. 

• Masturbation is a great way to safely explore what turns you on and what you might like to do with a partner. If you’ve had surgery, this is the best way to get to know your new body once you have healed.  

• Find ways to talk about your body parts that work for you. Then use them with your partner/s. 

• If some pronouns and other gendered language feel good to say during sex, try them out.  

• Wear what makes you feel like you during sex. Sex toys or prosthetics, like a strap-on or pack-and-play, can feel really good. And if you want to keep wearing certain items of clothes during sex, that’s fine too. 

• Have the sex that feels good for you. You don’t have to use any parts of your body that you don’t want to.  

If you are taking hormone therapy it can change your sex drive, especially if you have started taking testosterone. You might feel you want to try out new things with different people. Your sexual preferences might include being a receptive and/or penetrative partner in anal sex, oral sex or vaginal/frontal sex. 

But remember sex isn’t only about these things. It’s up to you to define what sex is for you, and even if you’re ready to have it. The most important thing is for you and your partner to consent and feel comfortable with what is happening so you can enjoy yourselves.  

Good sex is a great part of life. But trans and non-binary people have an increased risk of HIV and sexually transmitted infections (STIs) so it’s important to stay safe. 

Hormone therapy does not protect you from HIV or STIs. In fact, taking hormones can increase the risk of bleeding during penetrative sex, which makes it easier for you to get or pass on HIV. If you have lower surgery and have sex before you have fully healed, it can also be easier to get or pass on HIV. 

Luckily, there are more ways than ever to protect yourself and your partners. Here are your choices: 

Condoms are the only thing that protect against HIV and STIs. 

External condoms work for all penises, whether you’ve always had one or not. They come in different sizes so you can find the right fit for you. 

Internal condoms go inside the anus and the vagina/front hole. Not all trans women who’ve had lower surgery can use them, it will depend on the depth of your vagina. 

Use water-based or silicon lube with condoms. This will help to make sex feel great. It also helps stop condoms from breaking. And it can stop tears happening in your genitals. This is especially important if you’ve had lower surgery and the type you’ve had means your genitals don’t have natural lubrication. Taking testosterone can also reduce the natural lubrication of the vagina/front hole, so using lots of lube if you are having penetrative sex here is a must.  

If you are HIV negative you can take PrEP to protect yourself from HIV. But it won’t protect you from other STIs. PrEP still works if you are taking hormone therapy and will not stop hormone therapy from working. 

PEP is emergency treatment that HIV negative people can take if they think they have been exposed to HIV. PEP still works if you are taking hormone therapy and will not stop hormone therapy from working. 

This stands for undectable equals untransmittible. If you have HIV and are taking antiretroviral treatment (ART) you can become undetectable. This is when your medication reduces HIV to such a low level that it will not show up in blood tests. If you become undectable you cannot pass on (transmit) HIV through sex.  

Most ART is safe to take with hormone therapy. If you are already on ART or hormone therapy, tell your doctor before staring the other type of medication. 

It is easy to slip up when it comes to safer sex. That’s why it is so important to make regular HIV testing part of your life. If you feel uncomfortable going to a general clinic to test there are other options. You can take an HIV self-test which you can take at home or anywhere you feel comfortable. Or you may be able to search online or speak to a local LGBT+ (lesbian, gay, bi and transgender plus) group to find a testing service for trans and non-binary people.  

If you find out you have HIV, you should start treatment straight away. If you keep taking your treatment you have every chance of living a long and healthy life. But you’ve got to know your status to get that help.  

You might be worried about if and how to share your HIV status with other people. You don’t have to tell anyone. But if you choose to, it might help you deal with how you feel about it. Before you do, it’s a good idea to think through these questions. 

Hormone therapy can reduce your period or how much sperm your body makes. But it’s still possible to get pregnant or make someone pregnant if you’re taking hormones. If you want to avoid this, you need to use contraception.  

If you are taking testosterone, hormone-based contraceptives like the contraceptive pill, injection or implant are still safe to use. Gender-affirming surgeries for trans men can reduce the possibility of getting pregnant, but it depends on the type of surgery you have.  

It’s also okay to want children. You have the right to be a parent, just like anyone else. Speak to a trans-friendly reproductive health clinic about this if you are considering it. They can provide medical advice based on where you are on your gender journey. 

Anyone can feel embarrassed or fearful speaking to a doctor about sex. You may feel especially worried if you think they will judge you for being trans or non-binary. It can also be a difficult experience because a lot of reproductive healthcare is seen as a ‘woman’s health’ issue.  

But just like every other person, you have the right to sexual and reproductive healthcare. Here’s some things to know before you make that appointment. 

Nurses and doctors have made a professional commitment to respect and care for all patients, and that includes you. This means they should respect who you are, including using your chosen name and correct pronouns. It also means they should not judge or laugh at you. And they should keep all of your information private.  

If you experience disrespect, judgement or mocking, or your privacy is broken, then leave the situation as soon as you can. You can ask to see someone at the same facility or go to another one. And you have the right to make a complaint if you want to. 

If gender-affirming medical treatment is available where you live, you have the right to access it. A healthcare professional should help you make an informed decision about whether you want to explore this, not encourage or discourage you based on their personal values.  

The general rule is: honesty is the best policy. This means being honest if you have had unprotected sex. And if you have symptoms you think might be a sexually transmitted infection (STI), it means being honest about all of them and how long you have been getting them for. This will help the doctor work out what tests or treatments you need.  

The same goes for contraception. If you want to prevent pregnancy or are interested in planning for a family, it is okay to ask about it, no matter where you are on your gender journey. 

Remember, it’s okay to ask any question you want, even the ones that feel embarrassing or stupid. The most important thing is that you understand what the doctor is telling you.  

If you are transitioning or experiencing gender dysphoria tell the doctor about it so they can take this into account when they offer you advice and treatment. If they treat you badly consider finding a different doctor or clinic. 

Start by searching online for ‘trans-friendly sexual and reproductive healthcare’ in your country (or a version of this, like ‘trans-friendly sexual health clinic’ or ‘SRH service for trans people’). If you are struggling to find a health professional near you, try an anonymous helpline or online forum. They may also be able to connect you with a clinic that will treat you well.  

Every community has trans and non-binary people. Despite this, trans and non-binary people often face stigma, discrimination, harassment and abuse. If you are a cis-gender person (someone whose sex matches their gender identity), here are some ways to show your support: 

• ask someone what their pronouns are, then use them  

• if they are using a different name from their given name, make sure you use it 

• never assume you know what someone’s gender-identity (or sexuality) is just by how they look or act. Give them time to work it out – these things can be complicated and they can change over time 

• if someone opens up to you about their gender-identity or gender dysphoria, listen to them and take them seriously 

• don’t judge anybody for being who they are. Instead try to educate yourself on these issues (which you can do with the help of Be in the KNOW) 

• research trans and non-binary support groups, either in your area or online, which you can connect them with if they are ready to take this step.