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Coming Out to Doctors

Coming Out to “Everyone”:
Understanding the Average Sequence of Transgender Identity Disclosures Using Social Media Data

What was done? Gender transition is a complex life change, and transgender identity disclosures are pivotal moments that delineate the gender transition process. Transition is a process, not one defined moment. People were faced with balancing a desire for authenticity with demands of necessity. They weighed their internal gender experience with considerations about their available resources, coping skills, and the consequences of gender transitions. Previously, we lacked data on the average sequence of people to whom transgender people disclose. Knowledge of this sequence may help health care providers contextualize these disclosures, and react to them appropriately. This study sought to understand the sequence in which people disclosed their transgender identity to different audiences? Where do health care professionals fall within this sequence? What were the emotional implications of transgender identity disclosures to health care professionals?

What was new, innovative, or novel? On the social media website Tumblr, transition “blogs” are a common genre in which people document their gender transitions. These blogs include diary-like entries discussing social, medical, and legal aspects of transition. The blogs discuss the coming out process and resulting acceptance, support, and/or rejection. They also discuss the physical and mental changes, medical procedures, and name and document changes that take place. 

Researchers, Oliver L. Haimson and Tiffany C. Veinot, used mixed methods to identify 362 transgender identity disclosure social media posts within 41,066 total posts from 240 Tumblr transition blogs. Posts were manually assigned one of twenty audience types. This revealed the average sequence in which transition bloggers disclosed their transgender identity to people in their lives. Researchers also noted that disclosures to self and to one’s spouse/romantic partner did not appear in the posts because for most these disclosures happened before they started their transition blog.

What was learned? Based on the blog  analysis, Haimson and Veinot, created a timeline of relative audience disclosure sequence on average. Health professionals, such as therapists and physicians, were often some of the very first people to whom transgender people disclosed their transgender identity. Friends came next, followed by close family and extended family. Mass disclosures, such as on Facebook, usually came late in the process. Bloggers described both voluntary and involuntary disclosures, and anxiety associated with both types.

What does this mean for our community? Quantifying the average transgender identity disclosure sequence provides evidence that gender transition is  a process that happens over time. Longitudinal social media data enabled Haimson and Veinot to analyze a sample of people’s disclosure experiences, written in their own words at the time of the disclosure. This type of data is potentially more accurate than previous work that has captured similar information using retrospective reporting. These methods enabled the research team to analyze people’s rich, real-time descriptions of their emotions around transgender identity disclosures, such as the anxiety that often accompanied disclosures to health care professionals. Several additional observations include:

  • Health care providers are, a positive, affirming, supportive response to a patient’s transgender identity disclosure. 
  • The disclosure sequence timeline could help therapists understand what to expect during gender transition and how to best support transgender patients.
  • The fact that transgender people often disclose to health professionals so early distinguishes transgender identity disclosure from lesbian, gay, bisexual, and queer (LGBQ) sexual identity disclosures, which typically do not begin with disclosures to health professionals.

What’s next? Although disclosures are important transition milestones for many people, they should not be considered requirements or measures of transition success.

The results provide evidence that gender transition consists of different types of disclosures to different audiences, rather than a single event. Bloggers described distress surrounding voluntary and involuntary disclosures to health care providers. Health care providers should practice extra sensitivity in these situations, and should be supported in accessing resources and developing skills to enhance their sensitivity. Transgender people may also benefit from supplemental support to ease the anxiety of disclosures to health care providers.

Take Action: Access the published paper entitled Coming Out to Doctors, Coming Out to “Everyone”: Understanding the Average Sequence of Transgender Identity Disclosures Using Social Media Data
 by Oliver L. Haimson and Tiffany C. Veinot. The Open Access publication is in Transgender Health published April 2, 2020. After reading the article, take part in our discussion. Social transition was an important topic discussed at our Capstone Collaborative Learning Summit.


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John Oeffinger is Director, eLearning and Training for Texas Health Institute and Co-Director of TransFORWARD: Texas Transgender Health, a collaboration between Texas Health Institute and Equality Texas Foundation. He has 39 years’ experience in project management, distance education and eLearning in for-profit, association, and non-profit organizations. John currently leads or co-directs four eLearning or transgender health projects for THI developing collaborative partnerships with national, state, and community based partners. He has been project lead for thirty-three online courses including twenty-five that are currently online. John earned his Bachelor of Arts in Anthropology from Texas A&M University in 1976 and was named to Marquis Who’s Who in America in 1996. His primary research interests are in culturally competent transgender health, 3D immersive learning, web and mobile applications in health, and developing organizational knowledge.

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