PREFACE: ESSENTIAL GENDER IDENTITY TERMS AND GUIDELINES
COMMON TERMS
Gender identity: An individual's feelings of identity in relation to societal and cultural conceptions of gender. Each individual has a unique relationship to their gender identity, and definitions will vary.
Assigned Gender At Birth (AGAB) refers to the sex assigned based on physical characteristics observed at birth. Assigned Female At Birth (AFAB) refers to an individual assigned a female sex at birth. Assigned Male At Birth (AMAB) refers to an individual assigned a male sex at birth. Intersex is defined as an individual who was born with a combination of male and female biological traits. Intersex individuals are often assigned a binary sex at birth, and may not discover their intersex status until adulthood.
The term cisgender or cis refers to an individual whose gender identity matches the sex they were assigned at birth.
Common labels that many gender-diverse individuals may identify with include:
Gender-diverse: An umbrella term used to describe individuals who are not cisgender, or are questioning their gender identity.
Transgender or trans: Identifying with a gender that does not align with the sex assigned at birth. Some transgender individuals identify as binary (male or female), others do not.
Non-Binary: Identifying outside the male/female binary.
Agender: Identifying as having little to no gender.
Demigender: Identifying partially, but not fully, with a certain gender. Individuals who identify as demigender may use identifying terms like demigirl (partially female-aligned) or demiboy (partially male-aligned).
Genderfluid: Identifying as having a gender identity that varies over time, such as in masculinity, femininity, neutrality, or intensity.
Genderqueer: Identifying as a gender identity that is fluid, non-normative, or exists between the binary categories of man and woman.
Two-Spirit: An Indigenous North American individual identifying as a traditional third-gender (or other gender-variant) social role in their community.
MtF: A transgender individual who is or has transitioned from AMAB to Female. (Male to Female)
FtM: A transgender Individual who is or has transitioned from AFAB to Male. (Female to Male)
Transfeminine (transfem): Identifying as a feminine-leaning transgender, non-binary, or gender non-conforming person, whether in identity, expression, or both.
Transmasculine (transmasc): Identifying as a masculine-leaning transgender, non-binary, or gender non-conforming person, whether in identity, expression, or both.
Transneutral: Identifying as a transgender individual who identifies fully or partially as a neutral, abinary, or any unaligned gender.
Gender Non-Conforming (GNC): Identifying as an individual who does not follow societal ideas or stereotypes about how they should look or act based on their assigned sex at birth.
Androgynous: Presenting neither specifically feminine nor masculine, or a blend of both.
Gender-diverse individuals may feel most comfortable being referred to with masculine language ("boy," "man," etc.), feminine language ("girl," "woman," etc.), and/or gender-neutral language ("child," "person," etc.). Some gender-diverse individuals may feel most comfortable being referred to with pronouns such as he/him, she/her, or they/them. Some individuals may prefer neopronouns, which are defined as pronouns not standardized in official dictionaries. Popular neopronouns include xe/xem/xemself, xe/xyr/xyrself, ze/zir/zirself, ze/hir/hirself, fae/faer/faerself, ey/em/eir, and ae/aer/aerself. Some individuals may have no preference for pronouns or prefer multiple sets of pronouns.
Common terms that many gender-diverse individuals may use include:
Coming Out: When a gender-diverse individual chooses to reveal their gender identity to others.
Outing/Outed: When someone tells others about a gender-diverse individual's identity without consent from the individual.
Deadname: A birth name of a gender-diverse person that is not their preferred name and may not reflect their identity. Mentioning or using a deadname can trigger dysphoria.
Questioning: When an individual is questioning or exploring their gender identity.
Passing: When a gender-diverse individual is perceived as the binary gender most aligned with their identity and presentation.
Clockable: An expression of feeling as though an individual is easily or quickly perceived as non-cisgender.
Closeted: An individual who has not "come out" as gender-diverse, or is concealing that information.
Stealth: An individual that passes as cisgender in daily life and chooses not to disclose that they are transgender.
Transitioning: The process of an individual actively changing their appearance or gender expression to outwardly express their gender identity. This process may be social (e.g. using a name other than their deadname or pronouns other than those associated with their AGAB), legal (e.g. changing their name and/or sex in legal documents), and/or medical (medical gender-affirming care).
Binding: When an individual uses a clothing garment or other material to make their chest appear smaller or flatter. See this link for a guide on safe binding practices.
Packing: When an individual without a penis or testicles uses padding or a prosthetic to achieve the physical shape of those genitals. Prosthetic packers are typically designed to closely resemble the detailed form of genitalia, whereas padding may simply create the appearance and feel of a bulge. Some prosthetic packers are Stand to Pee (STP), which signifies that wearers may urinate while standing, including using urinals. Additionally, some packers possess sexual functionality.
Tucking: When an individual with a penis and testicles uses a special form of tape, undergarment, or gaffe to minimize the outward appearance of the genitals. See this link for a guide on tucking.
HRT: Hormone Replacement Theory or HRT is a medical treatment which primarily includes taking sex hormones in order to alleviate gender dysphoria and/or trigger physical changes in sex (Testosterone/Estrogen, Male/Female). This can be in the form of shots, patches, gels, or pills. See this link for a guide on starting HRT.;
Puberty Blockers: A medication that suppresses the secretion of puberty hormones. Gender-diverse individuals in early-mid puberty may use this intervention to "pause" the physical changes of puberty that may worsen gender dysphoria. See this link for a guide on puberty blockers.
Gender Dysphoria: Discomfort or distress experienced by individuals because they feel their outward appearance or qualities do not properly reflect their gender identity.
Gender Euphoria: When an individual experiences joy, comfort, and/or fulfillment associated with feeling that their outward appearance or qualities properly reflect their gender identity.
Gender-Affirming Care: Care provided to a patient to further their transition goals regarding their gender identity. See this link for a guide on receiving G-AC.
GENERAL GUIDELINES FOR COUNSELING GENDER-DIVERSE INDIVIDUALS
It is a very common misconception that all gender-diverse individuals share the same set of experiences and goals, especially when it comes to the assumed end goal of coming out or passing as cisgender. It is also important to note that "coming out" is usually not a singular event but something that an individual may do selectively and repeatedly. Every gender-diverse client will have different life circumstances that could make coming out of the closet unnecessary or even dangerous. Listen to how your clients present their experiences, especially if what they say contradicts or expands on our definitions. Individuals may identify with multiple labels, no labels, or labels that have not been defined in this document. Be aware of how your clients' mental health needs and goals interact with their environment and physical safety. This guide is intended as a starting point, and is not intended to be comprehensive.
In many regions, individuals pursuing transition may be legally required to meet with mental health professionals, regardless of whether they want to seek counseling or whether they believe that counseling will benefit their specific desires and goals. Familiarize yourself with any such statutes in your region that apply to your practice, and consider how the regulations may affect clients.
The GIFI has been formulated by a team of gender-diverse psychology students with the goal of creating a widely applicable and inclusive resource for counselors, psychologists, and other client-facing mental health professionals.
Gender Identity Formulation Interview (GIFI) Guide
GUIDE TO INTERVIEWER
INSTRUCTIONS TO THE INTERVIEWER ARE ITALICIZED. TRANSITIONAL DIALOGUE IS IN "QUOTATION MARKS."
Possible questions and transitional dialogue will be found on the right side. It is important to use only the questions/dialogue that correspond with your client's situation and responses. The phrasing and order of the questions provided are suggestions, and may be changed to best suit your particular session.
The following questions aim to understand the client's gender identity, as well as their thoughts, feelings, and needs related to their experiences with gender. This may be used with clients who feel certain about how they identify as gender-diverse and clients who are questioning their gender identity.
INTRODUCTION FOR THE INDIVIDUAL:
"I would like to discuss your experiences with gender identity in order to support you most effectively. It is all right to be uncertain or to not have previously considered these aspects of your identity. Please take your time to answer however you feel most comfortable. There are no right or wrong answers."
SELF-DESCRIPTION AND EXPERIENCE
Initial questions (1-4) are intended to gather information about the client's personal definitions and experience. Gender diversity is deeply individual to each person who experiences it. Avoid making assumptions about the client's experience. Probe further if needed.
Use the client's own terminology going forward, especially the words they use for self-identification.
"I am going to start with some initial questions to help me understand your experience with gender. Feel free to answer these questions in as much detail as you like."
1. How would you describe your gender identity?
2. What kinds of feelings come up when thinking about your gender identity?
3. What do you do in your daily life to make yourself feel more comfortable with your gender?
4. What has the process of figuring out your gender identity been like?
PROBE AS NEEDED. This question is intentionally formatted to be open.
PERCEPTIONS AND GENDER DYSPHORIA
These questions (5-8) are connected to clinical definitions of gender dysphoria and experiences that most frequently cause gender-diverse clients distress. They are important to gathering an understanding of how an individual has been impacted and how to best support them, but should only be asked if the client is prepared to deal with thinking through them. Many gender-diverse clients deliberately avoid thinking about these concepts in order to avoid extreme distress.
"I have a few questions for you about dysphoria and perception. These questions are about how other people perceive you, and your potential experiences of distress. These questions can trigger a lot of dysphoria in some people. Are you comfortable discussing this topic?"
IF INDIVIDUAL IS NOT COMFORTABLE, SKIP QUESTIONS 5-8.
5. How do you think others tend to perceive you in regards to gender?
6. How do you feel about those perceptions?
7. What do you think your ideal self would look like?
8. What parts of living with your gender identity are the most difficult for you?
SAFETY AND SUPPORT IN COMMUNITY
Gender-diversity and transness are profoundly individual experiences and therefore can easily be isolating. It is important to understand how a client's community functions, and potential ramifications if they choose to begin or continue transitioning. For individuals who desire to come out and/or transition, there may be conflicting interests between safety and gender affirmation. Navigate these concerns with the individual. For many gender-diverse individuals, transitioning can result in extreme improvements to their mental health.
Questions 9-11 are intended to gather information about the client's environment, support system, and potential dangers in their environment.
"Support and a sense of belonging can be very helpful when you are struggling with your gender identity, since it can feel very isolating. Let's talk about support and community."
9. Do the people around you support you and your gender identity?
10. What would support look like to you?
11. Do you feel safe exploring your gender identity and presentation? Why or why not?
HELP SEEKING AND GOALS
Consider the client's specific wants and needs. Client goals for treatment may include social transition, reducing dysphoria and associated distress, coming out to family or community, improving self-esteem and self-image, working against internalized transphobia, or any other goal more specific to them. As always, it is crucial to be conscientious of the client's own treatment goals.
Questions 12-17 are intended to gather client-specific information that will be useful to you, including expansive phrasing. Probe as needed.
"Now, I would like to discuss more about how I can help you."
12. What kinds of help do you think would best support you with your gender identity?
13. Has anything prevented you from getting the help you need?
14. Do you have any specific transition goals?
15. What would you like to accomplish as we work together?
16. Do you have any concerns about working together?
17. Is there anything else related to your gender identity you would like to discuss?
References
American Psychiatric Association. (2013). Cultural Formulation Interview. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
Budge, S. L., Chin, M. Y., & Minero, L. P. (2017). Trans individuals’ facilitative coping: An analysis of internal and external processes. Journal of Counseling Psychology, 64(1), 12–25. https://doi.org/10.1037/cou0000178
Doernbecher Children's Hospital. (n.d.). About puberty blockers. OHSU. https://www.ohsu.edu/sites/default/files/2020-12/Gender-Clinic-Puberty-Blockers-Handout.pdf
Hedian, H. F. (n.d.). Gender-affirming hormone therapy (GAHT). John Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/gender-affirming-hormone-therapy-gaht
Human Rights Campaign. (n.d.). Get the facts on the gender-affirming care. https://www.hrc.org/resources/get-the-facts-on-gender-affirming-care
Trans Lifeline. (n.d.). A binding guide for all genders and gender expressions. Retrieved March 17, 2025, from https://translifeline.org/binding-guide/
Trans Lifeline. (n.d.). Tucking guide for trans femmes, trans women, & AMAB. Retrieved March 17, 2025, from https://translifeline.org/tucking-guide/
Document produced by University of Washington students Rowan Al-Ghosien, Morgan Fu-Mueller, and Natasha Gardner under supervision of Professor Jaki Yi. Published March 17, 2025.