LGBTQ+ Health - Coming out
Telling someone about your gender or sexuality doesn’t only happen once. You could ‘come out’ to lots of different people at different times. Or you might not want to come out to anyone. There’s no right or wrong time to come out to someone about your sexuality or gender identity. Only you can say when the right time to come out is and how you come out is your choice.
Remember, discovering your identity is a journey. You can choose the labels that feel right to you at this moment. But, they can also change as you become more comfortable with who you are.
If you decide to come out to someone, you might worry about
- How they’ll react
- Whether they’ll understand and support you
- Them telling anyone else
- Discrimination or bullying
Here’s some things to think about before you come out:
- Who you trust to tell
- When to have the conversation
- Whether to tell someone face-to-face, over the phone or in a letter or message
- How to stay safe and take care of yourself if someone has a negative reaction
- What you’d like to say
- If you want to tell one person or more
Coming out is something to feel proud of. But it can also be difficult to know what to do next. If you’re confused or worried after coming out, try:
- Talking about it with someone you trust. This could be a friend, family member or a mental health professional.
- Giving it time. Even if someone doesn’t know how to react at first, they might still be able to support you later.
- Distracting yourself. Doing something you enjoy or keeping yourself busy can help you to feel less anxious.
- Celebrating. You’ve done a brave and brilliant thing! You could celebrate with other people or spend some time by yourself. Do whatever makes you feel happy and comfortable.
What happens if you’re not accepted?
A lack of acceptance after you’ve come out to someone can make you feel isolated or scared. Especially if they are homophobic, transphobic or it’s against their beliefs. You might worry about whether you’ve made the right decision and are not sure what to do next. It’s important to remember:
How to keep safe
It’s never okay for someone to hurt you because of your sexuality or gender identity. If you’re worried about your safety now or in the future, it’s important to get help. In an emergency you should always phone 999.
If you need to, make a safety plan. This is a list of important numbers, people and places to go if anything goes wrong. Having a safety plan can help if you’re worried about what will happen after you come out.
Make sure your safety plan is somewhere you can find it. Writing it on paper can help to make sure you’ve got it if your phone battery runs out or you can’t take your phone. Write down:
Important numbers to ring if something goes wrong
Places you can go if you’re feeling unsafe, and information on how to get there
Things to take with you if you need to leave quickly, make sure you include things like a phone charger.
Supporting Someone Who Has Come Out:
It’s important to try and support someone when they come out. It can be a daunting and scary thing to do. Although it may be hard to accept, the person you care about will be much happier when they can be themselves.
Remember, every situation is different, but here are a few tips that may help you
- Take it seriously. It’s a positive thing that they can place their trust in you and want to be honest with you.
- Give yourself some time to think things through.
- Think about their feelings.
- Be aware of your own values and judgements.
- Ask questions and find out if they need anything from you.
- Let them educate you: ask questions, be curious. You can even do your own research!
- Keep talking to them. They might not open-up fully at first but in time they may want to confide in you.
- Try to avoid saying phrases like “It’s a phase” or overly questioning if they are “sure” that they are LGBTQ+. Dismissing or disrespecting their feelings could push them away at a difficult time.
- Avoid reacting with confrontation or anger. Try to relax, it should become normal to be able to talk about this – and anything else.
- Their identity isn’t everything they are. They’re still the same person.
- Thank your friend for having the courage to tell you.
- Don’t judge your friend. If you have beliefs about LGBTQ+ communities, keep them to yourself for now. There will be plenty of time in the future for you to think and talk about your beliefs.
- Respect your friend’s privacy. Allow them to share what they want, when and how they want to.
- Be ready to include your friend in more of your plans. They may have lost the support of other friends and family. Your time and friendship will be even more precious to them.
- Do what you have always done together. Your friend probably feels like coming out will change everything in their life. It can be frightening for them. Don't change any plans you've already made!
If you’re an LGBTQ+ parent, or the parent of an LGBTQ+ child, then you can also get support from your local Family Hub. Find out more about Sandwell Family Hubs here.
Gender Dysphoria
Gender dysphoria is a sense of unease that a person may have because their biological sex doesn’t match their gender identity.
This sense of unease may be so intense it can lead to depression and anxiety and have a harmful impact on daily life.
Signs of Gender Dysphoria
People with gender dysphoria may change their appearance, behaviour or interests to express their chosen identity.
They may also show signs of discomfort or distress, including:
- Low self-esteem
- Becoming withdrawn or socially isolated
- Depression or anxiety
- Taking unnecessary risks
- Neglecting themselves
Treatment for Gender Dysphoria- Children and Young People
If your child is under 18 and may have gender dysphoria, they would have been referred to the Gender Identity Development Service (GIDS).
GIDS are no longer accepting referrals. The NHS is building new services for children and young people with gender dysphoria.
You can find out more about this by visiting:
Treatment for Gender Dysphoria- Adults
Adults who may have gender dysphoria are referred to a gender dysphoria clinic (GDC).
You can find your nearest NHS gender dysphoria clinic by visiting:
GDCs have a team of healthcare professionals, who offer ongoing support. Including:
Adults who may have gender dysphoria are referred to a gender dysphoria clinic (GDC).
- Psychological support, such as counselling
- Cross-sex hormone therapy
- Speech and language therapy (voice therapy)
For some people, support and advice from the clinic are all they need. Others will need more extensive treatment. Surgery and hormone therapy are optional. You can live as your chosen identity without them.
Hormone Therapy for Adults
The aim of hormone therapy is to make you more comfortable with yourself. The hormones usually need to be taken for the rest of your life, even if you have surgery. The decision to have hormone therapy is a discussion between you and your clinic team.
It can take several months for hormone therapy to be effective, which can be frustrating. It’s also important to remember what it cannot change, such as your height or how wide or narrow your shoulders are.
The effectiveness of hormone therapy is also limited by factors unique to the individual, such as genetic factors. These cannot be overcome by something like adjusting the dose.
Risks of Hormone Therapy
There is some uncertainty about the risks of long-term cross-sex hormone treatment. The clinic will discuss these with you and the importance of having regular blood tests with your GP to track the effects of hormone treatment.
The most common risks or side effects include:
- Blood clots
- Gallstones
- Weight gain
- Acne
- Dyslipidaemia (abnormal levels of fat in the blood)
- Elevated liver enzymes
- Polycythaemia (high concentration of red blood cells)
- Hair loss or balding (androgenic alopecia)
There are other risks if you’re taking hormones bought over the internet or from unregulated sources. It’s strongly recommended you avoid these.
Long-term cross-sex hormone treatment may also lead, eventually, to infertility. This will happen even if treatment is stopped.
The GP can help you with advice about gamete storage. This is the harvesting and storing of eggs or sperm for your future use.
Gamete storage is sometimes available on the NHS. It is not provided by the gender dysphoria clinic.
Read more about fertility preservation by visiting:
Surgery for Adults
Some people may decide to have surgery to permanently alter body parts associated with their biological sex.
Based on the recommendations of doctors at the gender dysphoria clinic, you will be referred to a surgeon outside the clinic who is an expert in this type of surgery.
You can find out the types of surgeries available to trans men and women on the NHS website:
It's important to note some surgeries are not available through the NHS.
As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.
Life after Transitioning
After treatment, your health needs are the same as anyone else's with a few exceptions:
- You'll need lifelong monitoring of your hormone levels by your G.
- You'll still need contraception if you are sexually active and have not yet had any gender surgery.
- You'll need to let your optician and dentist know if you're on hormone therapy as this may affect your treatment.
- You may not be called for screening tests if you've changed your name on medical records. Ask your GP to notify you screenings that are relevant to your biological sex.
Find out more about screening for trans and non-binary people by visiting:
How to get Help and Support
You may have to wait some time for a referral for an assessment at a gender dysphoria clinic. But, there are things you can do to help.
For children and young people:
If your child or teenager needs help, ask your GP to refer them to the local Children and Young People’s Mental Health Service (CYPMHS). CYPMHS may be able to offer psychological support while they wait for their first appointment at the GIDS.
Their school or college may be able to offer support as well.
For adults
While you’re waiting for your first appointment at a GDC, or waiting for treatment, there are several things you can do.
If you are struggling with your mental health, speak to your GP about getting support and treatment. We also have some tips for managing your feelings of gender dysphoria here.
- Quit smoking if you smoke. Smoking can increase the risks of side effects of hormone treatment and surgery.
Get advice on stopping smoking by visiting our Stop Smoking page.
- Lose weight if you are overweight. Certain risks from cross-sex hormones are increased if you are overweight.
You can find support for this on our Healthy Weight page.
- Do not self-medicate with hormones. You do not know what you're being sold, and you could harm yourself without regular monitoring.
- Use contraception if you are sexually active. Ask your GP or sexual health service for contraceptive methods to suit your needs.
Find out more about your local sexual health services on our Sexual Health page.
Live in your preferred gender (social transitioning)
For some, this is an important part of managing gender dysphoria at home, work and socially.
You would need to do this before you can have gender surgery. Gender dysphoria clinics need to know the changes you want to make will improve your life and be sustainable over time.
As part of social transitioning, most gender dysphoria clinics recommend you change your name by deed poll. You can do this for free and then use it to change your name on your passport and other personal documents, at your bank, work and at the GP surgery.
Once the GP has a copy of your deed poll, they should contact Primary Care Support England to change your name on medical records and issue you with a new NHS number.
Non-binary identities are not officially recognised, but the GP can make a note of your chosen name and preferred pronouns.
Tips on Managing your Gender Dysphoria
Managing your feelings of gender dysphoria can be hard. Especially while you are waiting for an appointment with a Gender Dysphoria Clinic.
Here are some tips to support you and help your mental wellbeing:
- Express your feelings in a notebook or blog, or express how you feel through an art, craft or music project.
- Talk to someone who understands. Talk to a supportive friend or find an online trans community you feel connection with. If you have a counsellor or therapist you feel safe talking with about your gender dysphoria, make time to bring this up
With them.
- Find/use items that help you express your gender and makes you feel more confident in yourself.
- Affirm your identity. Do small or big things. Whether it's re-styling your hair, or emailing your teachers or employers to tell them your preferred name and pronouns.
- Make plans, research, or take small steps towards your long-term transition goals.
- Tell yourself, out loud, that your body does not define your gender.
- Take a moment to point out a few positive things you love about your body more generally. Things you are great at, or things you like about yourself.
- Remember to be easy on yourself and on your personal image.
- Take time to explore what feels right for you when it comes to your identity and expressing yourself.
- Focus on the five ways to wellbeing. Connect with people, be active, take notice, keep learning and give back.
- Avoid spaces or people that will bring you down.
- Escape - to your favourite playlist, game, or show, or a long luxurious bath or shower.
- Practice self-care! Wear comfy clothes, eat your favourite meal, and switch off from social media. Schedule it in if you have to!
- Connect with nature - go for a walk outside, do some gardening, watch the birds, trees or stars, care for an animal, wade in a river or ocean, bask in the sunshine.
- Take time out or stay busy - whichever works best for you at the time.
Safe Binding and Packing
Binding and packing are two of the many things you can do to make your physical appearance align with your chosen gender identity.
What is Binding?
Using a binder to reduce the apparent size of breasts and give the appearance of a flatter chest. The effects of binding only last whilst wearing the binder. Binders are a tight, elastic type of underwear that compresses the chest into a different shape. This flattens breast tissue, making it less visible.
How do I stay safe while binding?
It’s important to note that the health risks of binding are almost entirely unstudied and unknown. It is also associated with many health problems.
Use of a binder is almost always accompanied by some undesirable symptoms. The most common ones are:
- Back, chest or shoulder pain
- Overheating
- Shortness of breath,
- Itching
- Bad posture
Rarer but more serious effects of binder use include:
- Scarring
- Swelling
- Rib fractures
- Respiratory infections.
Here are some things you can do that may reduce the risk
- Make sure your binder is the right size. There are lots of guides to help you measure your chest and find the right binder for you.
- Avoid binding for more than eight hours in a day
- Never sleep in your binder
- Take rest days where you do not bind as much as you can
If you start to feel pain, especially chest pain, take off your binder. If you suspect something is wrong, see a doctor as soon as possible.
Only use binders from reputable brands. Ask others if you’re unsure if a brand is reputable or not. It’s also important to do your own research on what sort of binder is right for your body.
The full risks and consequences are currently unknown. This is because there have been few medical studies about it. Before deciding to use a binder, think about whether the benefits outweigh the risks.
What should I be aware of?
What should I be aware of?
Long-term binding for several years can affect skin elasticity. This can increase the risk of complications if you wish to surgically remove your breasts with an operation.
Are there other options?
Safer but less effective alternatives to binding are wearing a sports bra or multiple layers of clothing to hide your chest shape.
Surgery which permanently remove breasts also eliminates the need to bind.
How do I bind?
The safest way to bind is to use a binder.
You can get different styles of binders depending on where you get them from and your needs:
- Full length binders are in a tank top style. The compression is mainly in the chest area but there is some in the stomach area too.
- Tri top binders are in a crop top style. The compression is in the chest area and the stomach area is left free.
How do I put on my binder?
There are two main methods to put on a binder:
- Pulling it over the head, like a sports bra
- Turning it inside out, stepping into it and pulling it up over your hips
Which of these is the best method for you will depend on the shape of your body and the type of binder you have. If your binder came with any instructions, these might tell you the best method.
You may need to adjust binder once it is on to get the flattest look possible. Make sure that the resulting fit is comfortable enough for you to wear it and avoid stretching or creasing your skin.
What is Packing?
Wearing padding or an object (‘packer’) in the crotch to create a bulge. This is a temporary technique that works while the packer/padding is being worn. Some ‘prosthetic’ packers are designed to continue working when clothing is removed.
How do I stay safe?
If you are using a packer as part of sex, be aware that it may transfer sexually transmitted diseases from one partner to another. You may want to use a condom over the packer or sterilise the packer between uses. Remember that only packers made from silicone can be sterilised.
How do I pack?
You may need something to hold the packer in place:
- Tight/sports underwear: wearing tight underwear or multiple layers of underwear can often be enough to hold the packer in place.
- Packer pouches: these are fabric pouches with Velcro on one side that attach to the inside of your underwear
- Packer harnesses/straps: a strap that goes around your hips which attaches to the packer to hold it in place.
- Boxer harnesses: boxer shorts with a built in ring or pouch that the packer fits in to hold it in place.
- Professional alteration can add a built-in packer pouch to many types of underwear
- DIY options: such as modifying an existing pair of underwear by stitching in a pocket
What kinds are there?
There are many different kinds of packers are available, including:
- DIY packers
Using home made packers such as rolled up socks, or condoms filled with hair gel or “gak”.
- Packers with built in STP
These packers are designed with a built in funnel and tube that allows you to urinate out of them while standing (“standing to pee”). You can also buy devices to do this which are not used for packing, normally called STP devices.
- Packers with built in STP
These attach to your body using surgical glue so that they stay in place even when underwear is removed.
- packers designed for use in penetrative sex.
These packers contain a bendable rod, or which can be inflated.
Are there other options?
If you find that you are still unhappy when packing, there are the more risky and permanent surgical options of phalloplasty or metoidioplasty.
Local Support Services
- LGBTQ+ Peer network
- Weekly sessions, Friar Park Millennium Centre, Wednesbury WS10 0JS
- Social activities, sports, crafts, chat, peer support and signposting.
- For adults 18+ from LGBTQ+ community living in Friar Park but welcomes anyone from Sandwell.
- Call 0121 556 0139 or email fpmccentremanager@gmail.com
- 1:1 Counselling service
- Sessions at Pride House, Wolverhampton.
- Counselling sessions for Sandwell residents.
- Adults 18+ from LGBTQ+ Community living in Sandwell .
- Email info@wolverhamptonlgbt.org
- 1:1 Counselling service
- Sessions at Holloway Circus, Birmingham.
- Counselling sessions for Sandwell residents.
- Adults 18+ from LGBTQ+ Community living in Sandwell.
- Call 0121 643 0821 or email Hello@blgbt.org
- LGBTQ+ Football team, training sessions and tournaments.
- WBA Community Sports Hall, West Bromwich Friday football training sessions 7pm- 8pm and additional weekly training for team members.
- Football training sessions and LGBTQ+ & Allies Football team.
- All age and all ability levels.
- Email info@proudbaggies.com
- LGBTQ+ Peer Support
- Weekly session at range of venues across Sandwell.
- Coffee mornings for LGBTQ+ carers, offering signposting, supporting issues and needs and providing a listening ear.
- Adult carers age 18+ living in Sandwell.
- Email info@crossroads-caringforcarers.org or call 0121 553 6483
