Sex and Gender Diversity Among Transgender Persons in Ontario, Canada: Results From a Respondent-Driven Sampling Survey

Figures & data

Figure 1 Network structure for sample of 433 trans (transgender, transsexual, transitioned) persons in Ontario, Canada; triangle = female-to-male (FTM) spectrum; circle = male-to-female (MTF) spectrum; red = no transition; blue = social transition only; gray = some social and some medical transition; black = complete social and medical transition.

Table 1. Social Gender and Medical Sex Transition Status Among Trans ^a Ontarians

Transition Status	Gender Spectrum						Age				Ethnoracial Group
	Total (n = 433)		MTFs ^b (n = 205)		FTMs ^c (n = 227)		Adults (25+) (n = 309)		Youth (16–24) (n = 123)		Aboriginal (n = 35)		Racialized ^d (n = 62)		White ^d (n = 333)
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
No transition	30	(20, 35)	37	(23, 46)	23	(12, 32)	33	(21, 40)	24	(12, 36)	23	(8, 48)	27	(6, 34)	31	(21, 38)
Social only	23	(18, 33)	10	(4, 18)†	35	(27, 50)†	18	(10, 28)*	37	(25, 50)*	11	(3, 23)	26	(12, 52)	22	(16, 32)
Some social, some medical	24	(18, 31)	31	(22, 43)†	18	(11, 23)†	24	(18, 32)	24	(12, 35)	54	(20, 74)	17	(7, 32)	24	(18, 32)
Complete ^e	23	(17, 31)	22	(14, 33)	24	(14, 34)	26	(18, 36)	15	(8, 28)	13	(3, 29)	30	(12, 53)	23	(16, 31)

Table 2. Gender Identity Characteristics of Trans ^a Ontarians

Gender Characteristic	Male-to-Female Spectrum (MTF)										Female-to-Male Spectrum (FTM)
	All MTFs (n = 205)		No Transition (n = 52)		Social Only (n = 22)		Some Social and Some Medical (n = 64)		Complete Social and Medical (n = 62)		All FTMs (n = 227)		No Transition (n = 27)		Social Only (n = 59)		Some Social and Some Medical (n = 55)		Complete Social and Medical (n = 84)
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Gender identity
Female or feminine	73	(62, 84)	37	(19, 58)	67	(45, 90)	94	(86, 100)	100	(100, 100)	2	(0, 6)	9	(0, 22)	0	(0, 0)	0	(0, 0)	0	(0, 0)
Male or masculine	0	(0, 0)	—	—	—	—	—	—	—	—	84	(73, 92)	69	(59, 93)	71	(44, 91)	98	(95, 100)	99	(97, 100)
Fluid	27	(16, 38)	63	(42, 81)	33	(10, 55)	6	(0, 14)	0	(0, 0)	14	(7, 25)	22	(5, 34)	29	(9, 56)	1	(0, 5)	1	(0, 3)
Gender identity label*
Girl or woman	41	(30, 52)†	7	(3, 12)	43	(10, 75)	59	(45, 81)	73	(56, 90)	7	(1, 13)†	18	(0, 21)	8	(0, 21)	0	(0, 0)	0	(0, 0)
Boy or man	8	(2, 14)†	20	(3, 34)	13	(0, 31)	2	(0, 7)	1	(—, —)	64	(54, 74)†	56	(30, 80)	58	(39, 80)	75	(56, 90)	67	(47, 82)
MTF or FTM	45	(36, 56)†	34	(16, 53)	32	(12, 63)	58	(35, 71)	51	(32, 76)	58	(47, 68)†	61	(32, 89)	47	(30, 67)	62	(40, 79)	64	(41, 81)
Trans girl/woman	37	(27, 48)†	18	(5, 32)	30	(9, 58)	52	(29, 68)	35	(20, 57)	0	(0, 0)†	—	—	—	—	—	—	—	—
Trans boy/man	0	(0, 0)†	—	—	—	—	—	—	—	—	52	(39, 61)†	28	(5, 54)	48	(25, 66)	73	(51, 86)	55	(32, 73)
T girl	16	(8, 24)†	13	(2, 25)	24	(5, 50)	28	(11, 43)	10	(2, 23)	0	(0, 0)†	—	—	—	—	—	—	—	—
Shemale	8	(2, 14)†	10	(0, 19)	0	(0, 0)	12	(2, 27)	4	(0, 12)	0	(0, 0)†	—	—	—	—	—	—	—	—
Feel like a girl sometimes	12	(6, 20)	22	(7, 37)	29	(2, 52)	11	(0, 20)	1	(0, 2)	7	(3, 14)	14	(0, 16)	5	(1, 10)	2	(0, 4)	3	(—, —)
Feel like a boy sometimes	2	(1, 5)	—	—	—	—	—	—	—	—	14	(8, 24)	18	(1, 29)	16	(5, 32)	5	(0, 16)	2	(0, 9)
Cross-dresser	19	(9, 31)†	43	(21, 66)	16	(2, 33)	5	(0, 18)	0	(0,0)	5	(1, 9)†	—	—	—	—	—	—	—	—
Genderqueer	10	(5, 16)†	9	(2, 20)	28	(7, 56)	11	(1, 23)	9	(0, 22)	32	(22, 43)†	47	(23, 72)	41	(22, 63)	19	(6, 35)	8	(3, 16)
Two spirit	11	(4, 19)	18	(2, 34)	11	(2, 29)	11	(1, 22)	1	(0, 4)	5	(2, 10)	—	—	—	—	—	—	—	—
Bigender	7	(2, 13)	16	(3, 30)	22	(1, 50)	1	(0, 2)	0	(0, 0)	3	(1, 5)	—	—	—	—	—	—	—	—
Years since first aware of trans status
9 years ago or less	16	(8, 27)	20	(6, 42)	15	(0, 46)	16	(3, 31)	4	(0, 12)	24	(16, 36)	28	(8, 51)	35	(13, 56)	19	(3, 26)	11	(3, 23)
10–19 years ago	21	(12, 32)†	17	(4, 38)	5	(0, 28)	27	(12, 48)	10	(3, 27)	38	(26, 49)†	26	(5, 46)	38	(16, 58)	32	(18, 58)	35	(17, 57)
20–29 years ago	19	(13, 29)	4	(0, 11)	31	(12, 69)	20	(6, 42)	30	(11, 49)	15	(8, 23)	21	(13, 51)	11	(1, 30)	28	(8, 48)	22	(13, 44)
30 + years ago	44	(29, 55)†	59	(32, 77)	49	(5, 75)	38	(17, 53)	56	(31, 75)	23	(13, 34)†	25	(0, 32)	15	(4, 39)	21	(7, 43)	31	(7, 47)
Age first aware
9 years or under	60	(49, 70)	36	(15, 56)	52	(21, 85)	58	(41, 76)	88	(76, 95)	57	(44, 65)	55	(23, 79)	40	(20, 61)	61	(43, 79)	74	(59, 85)
10–14 years	23	(14, 32)	33	(13, 55)	11	(2, 33)	34	(17, 51)	7	(2, 15)	21	(14, 31)	17	(2, 39)	27	(11, 50)	23	(12, 48)	11	(5, 21)
15–19 years	10	(4, 18)	21	(3, 36)	5	(0, 18)	7	(0, 14)	3	(0, 10)	15	(9, 25)	19	(4, 50)	28	(9, 49)	9	(0, 16)	8	(2, 18)
20 years or older	7	(3, 14)	10	(2, 35)	33	(0, 63)	2	(0, 5)	2	(0, 8)	8	(3, 13)	9	(0, 23)	5	(0, 12)	7	(0, 8)	7	(0, 15)

Table 3. Social Transition and Gender Characteristics of Trans ^a Ontarians

	Male-to-Female Spectrum (MTF)										Female-to-Male Spectrum (FTM)
	All MTFs (n = 205)		No Transition (n = 52)		Social Only (n = 22)		Some Social and Some Medical (n = 64)		Complete Social and Medical (n = 62)		All FTMs (n = 227)		No Transition (n = 27)		Social Only (n = 59)		Some Social and Some Medical (n = 55)		Complete Social and Medical (n = 84)
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Living in felt gender
Full time	46	(37, 59)	—	—	52	(29, 86)	64	(51, 87)	100	(—, —)	49	(38, 61)	—	—	42	(27, 64)	76	(56, 91)	100	(—, —)
Part time	24	(13, 30)	17	(5, 28)	48	(14, 71)	36	(13, 49)	—	—	35	(25, 47)	38	(11, 64)	58	(36, 73)	24	(9, 44)	—	—
Not at all	30	(21, 42)†	83	(72, 95)	—	—	—	—	—	—	16	(7, 26)†	62	(36, 89)	—	—	—	—	—	—
Years since social transition ^b
1 year or less	20	(8, 25)†	—	—	43	(0, 72)	28	(8, 40)	7	(0, 15)	35	(25, 50)†	—	—	60	(53, 85)	42	(18, 60)	4	(0, 10)
2–4 years	39	(27, 52)†	—	—	17	(0, 49)	44	(29, 70)	36	(16, 52)	23	(16, 34)†	—	—	11	(3, 22)	34	(21, 57)	32	(27, 62)
5–14 years	31	(20, 46)	—	—	30	(0, 59)	16	(5, 37)	52	(37, 73)	31	(20, 42)	—	—	18	(2, 28)	19	(3, 35)	54	(26, 63)
15 + years	10	(3, 26)	—	—	10	(0, 74)	13	(0, 33)	5	(2, 12)	12	(2, 16)	—	—	11	(1, 13)	5	(0, 13)	10	(0, 21)
Using new name and/or pronoun	60	(50, 73)†	6	(1, 15)	89	(70, 100)	82	(67, 97)	100	(100, 100)	77	(66, 87)†	14	(3, 32)	97	(93, 100)	99	(—, —)	99	(98, 100)
Perceived as trans
Always or very frequently	18	(11, 28)†	6	(1, 17)	33	(0, 76)	28	(12, 48)	17	(5, 26)	7	(2, 12)†	7	(0, 21)	7	(0, 19)	4	(0, 11)	3	(0, 7)
Occasionally/rarely	41	(30, 51)	33	(16, 58)	49	(13, 80)	38	(20, 54)	45	(24, 68)	42	(33, 53)	18	(3, 32)	64	(49, 83)	62	(45, 82)	22	(13, 37)
Never or very rarely	42	(30, 52)	61	(34, 78)	8	(3, 46)	34	(17, 56)	39	(18, 63)	51	(40, 61)	75	(56, 94)	28	(12, 44)	34	(17, 51)	75	(59, 85)
Wants to be perceived as trans
Yes	18	(9, 26)	16	(3, 31)	12	(0, 22)	22	(5, 38)	1	(0, 2)	18	(10, 27)	27	(6, 56)	28	(12, 45)	12	(1, 27)	4	(1, 9)
No	54	(44, 66)	53	(25, 64)	52	(13, 85)	40	(28, 69)	79	(65, 92)	52	(41, 62)	30	(0, 47)	36	(19, 61)	48	(33, 71)	86	(76, 95)
Don't care	29	(19, 40)	31	(22, 61)	36	(12, 76)	38	(13, 53)	21	(8, 34)	30	(21, 41)	44	(23, 77)	37	(15, 53)	40	(18, 55)	10	(2, 19)
Legal name change	33	(23, 44)	0	(—, —)	5	(0, 15)	38	(21, 59)	86	(70, 98)	35	(25, 46)	4	(0, 14)	19	(7, 37)	56	(40, 80)	81	(59, 96)
Sex marker change
On all ID	11	(4, 19)	0	(0, 2)	0	(—, —)	2	(0, 5)	46	(15, 61)	10	(4, 17)	0	(—, —)	0	(0, 0)	9	(0, 34)	38	(20, 57)
On any ID	18	(10, 29)	0	(0,0)	34	(0, 73)	24	(8, 49)	33	(19, 62)	14	(8, 21)	0	(0, 0)	5	(0, 13)	18	(7, 34)	37	(18, 56)

Table 4. Medical Transition and Sex Characteristics of Trans ^a Ontarians

Medical Transition or Sex Characteristic	Male-to-Female Spectrum (MTF)										Female-to-Male Spectrum (FTM)
	All MTFs (n = 205)		No Transition (n = 52)		Social Only (n = 22)		Some Social and Some Medical (n = 64)		Complete Social and Medical (n = 62)		All FTMs (n = 227)		No Transition (n = 27)		Social Only (n = 59)		Some Social and Some Medical (n = 55)		Complete Social and Medical (n = 84)
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Medically recognized intersex condition
Yes	7	(2, 13)	3	(0, 9)	9	(0, 31)	3	(0, 11)	18	(2, 31)	5	(1, 10)	9	(0, 32)	4	(0, 10)	10	(2, 19)	1	(0, 4)
Unsure	17	(10, 26)	4	(1, 9)	40	(3, 67)	37	(16, 57)	3	(0, 7)	14	(7, 21)	18	(4, 52)	12	(1, 26)	15	(0, 22)	7	(1, 18)
Self-described medical transition status ^b
Completed	25	(17, 39)	—	—	—	—	10	(—, —)	100	(—, —)	25	(15, 35)	—	—	—	—	9	(—, —)	100	(—, —)
In process	32	(24, 44)†	—	—	—	—	88	(76, 99)	—	—	16	(10, 22)†	—	—	—	—	92	(76, 100)	—	—
Planning but not begun	15	(7, 22)†	27	(11, 47)	58	(29, 86)	—	—	—	—	38	(28, 49)†	75	(58, 95)	59	(37, 78)	—	—	—	—
Not planning	3	(1, 5)	6	(2, 12)	20	(2, 46)	—	—	—	—	6	(1, 14)	12	(0, 29)	12	(1, 26)	—	—	—	—
Not sure	13	(5, 21)	33	(—, —)	21	(—, —)	—	—	—	—	6	(2, 15)	1	(—, —)	11	(—, —)	—	—	—	—
Concept does not apply	11	(3, 15)	28	(9, 46)	5	(0, 12)	—	—	—	—	9	(4, 14)	17	(2, 29)	16	(6, 24)	—	—	—	—
Hormone use
Current	46	(35, 60)	—	—	—	—	69	(49, 92)	95	(80, 100)	39	(28, 49)	—	—	—	—	84	(70, 98)	100	(98, 100)
Past	7	(3, 13)†	—	—	—	—	3	(0, 9)	5	(0, 20)	1	(0, 3)†	—	—	—	—	6	(0, 15)	1	(0, 2)
Never	47	(34, 59)	—	—	—	—	28	(3, 48)	0	(0, 0)	60	(50, 72)	—	—	—	—	11	(1, 22)	0	(0, 0)

Table 5. Transition-Related Procedures: Male-to-Female Spectrum Trans ^a Ontarians

Procedure	All MTFs (n = 205)		Some Social and Some Medical (n = 64)		Complete Social and Medical (n = 62)
	%	95% CI	%	95% CI	%	95% CI
Hair removal	56	(42, 67)	75	(61, 93)	89	(75, 98)
Any surgery ^b	24	(14, 35)	13	(3, 26)†	72	(46, 86)
Vocal cord surgery	3	(0, 9)	0	(0, 0)	13	(0, 27)
Facial surgery	4	(1, 8)	3	(0, 10)	11	(1, 23)
Adam's apple shave	10	(2, 18)	2	(0, 0)	30	(4, 51)
Hair transplant	2	(0, 3)	1	(0, 4)	3	(0, 9)
Breast augmentation	12	(4, 22)	3	(0, 11)	43	(15, 62)
Orchiectomy	21	(11, 33)	10	(0, 27)	67	(41, 85)
Vaginoplasty	15	(7, 27)	0	(0, 0)	59	(32, 80)

Table 6. Transition-Related Procedures: Female-to-Male Spectrum Trans ^a Ontarians

Procedure	All FTMs (n = 227)		Some Social and Some Medical (n = 55)		Complete Social and Medical (n = 84)
	%	95% CI	%	95% CI	%	95% CI
Any surgery ^b	30	(21, 40)	38	(20, 60)†	88	(72, 96)
Breast reduction	5	(1, 8)	6	(1, 18)	5	(1, 12)
Mastectomy	25	(17, 36)	31	(14, 52)	83	(70, 94)
Hysterectomy	13	(6, 19)	20	(5, 40)	36	(17, 56)
Oophorectomy	12	(6, 19)	19	(3, 40)	35	(16, 55)
Metoidioplasty ^c	—	—	—	—	—	—
Phalloplasty	0.4	(0, 1)	0	(0, 0)	1	(0, 4)