Recent estimates suggest that as many as 1 in 200 adults may be trans (transgender, transsexual, or transitioned). Knowledge about dimensions of sex and gender in trans populations is crucial to development of inclusive policy, practice, and research, but limited data have been available, particularly from probability samples.

The Trans PULSE community- based research project surveyed trans Ontarians (n=433) in 2009–2010 using respondent- driven sampling. Frequencies were weighted by recruitment probability to produce estimates for the networked Ontario trans population. An estimated 30% of trans Ontarians were living their day-to-day lives in their birth gender, and 23% were living in their felt gender with no medical intervention. In all, 42% were using hormones, while 15% of male-to-female spectrum persons had undergone vaginoplasty and 0.4% of female-to-male spectrum persons had had phalloplasty. Of those living in their felt gender, 59% had begun to do so within the past four years. A minority of trans Ontarians reported a linear transition from one sex to another, yet such a trajectory is often assumed to be the norm. Accounting for this observed diversity, we recommend policy and practice changes to increase social inclusion and service access for trans persons, regardless of transition status.