I'll second Yurei's position that "intent" in magic matters. A ton of spells let you choose exactly how you want to execute a specific command when casting it, letting you exclude or include certain targets in the area. Hell, there are certain spells that completely revolve around an "ally" being within the AoE, which entirely depends on whether or not you consider someone your friend/ally or not. I see no reason why healing magic would make unwanted changes to the person the spell is being cast on. 

If someone wants a good example similar to this in popular fantasy media, there is a transgender character in Brandon Sanderson's Stormlight Archive that gets access to healing magic and is able to change their biological sex because of who they feel they are on the inside. I would definitely let a character in one of my campaigns choose to do the same thing with healing magic powerful enough (Resurrection, Regenerate, Reincarnate, and similar spells).

Quote from greyowl1999 >>

I had a related question to this; if a trans character or NPC used IRL methods to transition and were exposed to healing magic, would it undo/reverse the surgery?

D&D healing magic only regenerates lost body parts when it explicitly states it does, which is why cure wounds will *not* fix any of these:

Circumcision 

Missing limbs, organs, etc.

Shaving (nor will it remove hair)

Tattoos

And so on ad infinitum.  Likewise, you can't use (normal) healing magic to counter true polymorph.  Special exceptions may exist, per both spell wording and DM fiat.

Seeing as this thread has had Raise Dead cast upon it, I'm going to repeat what I said earlier

I would like to remind everyone to speak with kindness and forethought if you can, and to not speak at all if you can't. Issues surrounding sex and gender can strike home for a lot of people, so speaking to an experience you don't have with ill informed opinions can be hurtful and harmful to others.

I'm firmly in the "this should be discussed in session 0" camp.  Ultimately the whole swapping gender thing in the game would be flavour only (no actual change to rules or effects), so comes down to a purely roleplay result. This being the case, you need to know that the players are happy to roleplay it without making it either personal to them or it becoming an issue.

Honestly feel like this sort of thing may be better off left out, unless it's actually relevant. My concerns would fall not so much on whether it becomes a trigger or uncomfortable subject for a player, but on what it will prompt from the roleplay. Should someone act differently because they changed their gender? Should they not act differently? Will it take the whole campaign down an exploratory sidetrack which I don't want to have to narrate?

Before including anything, I will consider "Why". If it is something which shows that perhaps the BBEG has two personas (one male, one female) and that links a whole bunch of stuff together to form a clue, then I might include it. But I would make it optional (hold the item and say the activation words) not sprung (you drank the water - surprise, you're a woman now!).

For the most part though, it sounds like something intended to alter how the players act, which itself is liable to incur stereotypes and -isms, which I would prefer to avoid. 

There's an argument that flippant/memey sex-change magic, a'la the original purpose of necro-resurrectreborn thread, is almost more of a 'Know Your Table' thing than a Session Zero thing.  Knowing the people at your table, knowing their moods and whims on the subject, and knowing whether the specific people you're playing with are likely to laugh off a "drag" episode or whether they're going to take such things amiss.  After all, it's possible to crack the funnies without being dismissive of the plights and identities of real-life trans folk, though doing so can take some work and some familiarity with the trans folk in question.

There's also a world of difference between, say...a mischievous fey prank and "a dire curse inflicted on the unworthy".  One can potentially be amusing, the other is gauche as hell.  I am a trans/trans-adjacent individual who nigh-exclusively plays female characters, and if a DM were to hit me with a spell that turned my character male and treated it as a blessed gift saving me from my own feminine weakness, I'd have some Words for that DM and that situation.

If, on the other hand, I found an ancient mask that turned me into a pillar of mankind, regardless of my original gender, for a time/until I completed a specific task, complete with a strange urge to adopt ridiculously over-dramatic poses and indulge in megalomaniacal speechmaking?  Provided this wasn't coming out of left field in the midst of an otherwise serious and dramatic story, I'd be delighted to lean into that for a while.  At that point the joke isn't any kind of commentary on gender identities, but is instead an excuse to chew the scenery whilst leaning into hypermasculinity so drastically over-the-top it almost circles back around to feminine again in a strange way.

But that's me, specifically.  Someone else might very easily be turned off by the entire idea regardless of pageantry or melodramatics, while a third individual might be rolling their eyes and wondering why we all always gotta be so sensitive.  Session Zero might catch some of that, but I can say from painful personal experience that bringing the issue up at all is sometimes enough to start fights.  Bad ones.  

If you don't know the people at your table and have a good, solid idea of what they're willing to tolerate?  Maybe keep gender hijinks in your pocket for a while until you have a better grasp on your table's dynamics.

I wouldn't include anything that forcibly changed a character's sex, gender, identity, or sexuality, unless it was at the instigation of a player character. Regardless of my table's outward facing demographics, the truth is you just don't know how someone feels, and secondly What purpose does it serve?  

Firstly, gender identity can be something that people either hide or are unsure of for decades of their life. And perhaps the last thing they want in a game about battles and dragons to suddenly bring it to the table. No matter how sure you think you are of your players' identity, you could be badly mistaken.

Secondly, you have to really ask what the reason for including this is. Items that force biology or identity switches could be either used for comic effect (whether or not someone thinks it is funny or not) or is it to allow characters to switch gender identity, e.g. a replacement for technology that doesn't exist in the world? For a cis het player the change might be an inconvenience.

In one game world I ran, all genasi were non-binary. None of my PCs were playing genasi, and there was a storyline where the genasi were all driven from their homeland and were refugees, but a power change led to the refugee-receiving nation falling under totalitarian control, and there were factions who hated them for being outsiders. I have also seen a game world where elves regularly use magic to change their gender identity and it was globally accepted to be part of their culture. These inclusions can be an interesting way of differentiating your game world from the real world. But the important thing was that the players always had control over their characters.

The way I see it there are two options:

1) This is discussed in a Session 0 that there could be magic in the world that would alter a PC's gender/sex, and ask if this would be ok with the players and what they would believe the outcome would be for their characters.  If an agreement could not be made or this makes players uncomfortable, then this magic is not at the table.

2)  The magic exists, however it is purely consensual.  The affects of the magic do not happen to a character unless the player agrees.  In which case the effect is whatever the player chooses for their character.  

I would argue that the spell True Polymorph (creature into creature) could be used to cause a change of gender along with species. It doesn't specify in the spell description anything about gender and since there is also creature into object and object into creature options, it seams that gender can be introduced. It's also one of the few spells with a level of permanence if cast correctly.

Quote from Curissa >>

I would argue that the spell True Polymorph (creature into creature) could be used to cause a change of gender along with species.

 I would assume that alter self is sufficient, though gender is not specifically mentioned as something that can change. In any case, I would tend to avoid involuntary gender-change effects in games because the purpose is usually to make the player uncomfortable.

In any case, I would tend to avoid involuntary gender-change effects in games because the purpose is usually to make the player uncomfortable.

Agreed 100%

Quote from Curissa >>

I would argue that the spell True Polymorph (creature into creature) could be used to cause a change of gender along with species. It doesn't specify in the spell description anything about gender and since there is also creature into object and object into creature options, it seams that gender can be introduced. It's also one of the few spells with a level of permanence if cast correctly.

My message alert said this post was written in response to me and I think while you may well be right about True Polymorph and Pantagruel may be right about [spell[Alter Self[/spell] and their relationship to gender manifestations, I think you're missing the context of my post and I really don't see how it responds to what I wrote.  I was writing specifically to the thread necromancer who asked about "healing" magic applied to character who has undergone transitional surgery or procedure may have the consequence of "undoing" the surgery. or procedure.  As I think at least 99% of "healing" magic in D&D is in some way divinely or at least "higher power" derived, it's a very problematic question on top of the more apparent ramification of transitional surgery or procedure being construed as an injury.  It implies "healing" is "correcting" the transition, and as I said in my original post, I can't tell someone how to play but playing this way seems problematic on a number of levels the question doesn't seem to consider.

It does seem we agree that any instance of gender changing or sexual identity changing magic needs to be with care.  The response to which I think you're responding was written out of a feeling that that care wasn't present in the thread necromancy.  I don't want to criticize theologically derived perspectives, because those discussions rarely result in converts, but I feel it's more important to point out the potential harm of playing with the idea of trans identity and presentation and transitional procedures being something that can be "healed" via divine magical means. 

I don't think that body-modification surgery of any kind would really be much of a thing in most D&D settings.  You'd need to have a fanatically anti-magic society for it to make sense to bother with stuff surgically.

But for the most part, healing magic doesn't do anything about old scars or missing body parts unless the spell or magic item description specifically says so: if you're missing an arm thanks to an encounter with a Sword of Sharpness when you get a Cure Wounds spell, the arm doesn't grow back.  So any deliberate body modifications, not just gender alterations, should probably be treated the same.

I guess the question then lies in what is considered "wrong" or "missing". Does greater restoration bring your body in line with your mental body image (regrowing limbs which your mind considers should be there) or does it work off some cosmic blueprint?

Could be the ruling in your world is that Greater Restoration restores you to being whole and as you see yourself, rather than how you happened to be.

This is a warning to anyone who decides to participate in this thread to be very careful about how they talk about matters such as transitioning and the trans experience. For example, referring to, or implying, that transitioning is something you could have undone through "healing" is very offensive.

Everyone who elects to contribute to this thread should do so after having thought very carefully about what they are saying. If you are unsure, do not post. If you do post and what you post proves to be harmfully ignorant (or just plain harmful), you should expect to face consequences of this per the site rules and guidelines.

This will be the final warning.

Quote from Kotath >>

Quote from 6thLyranGuard >>

I don't think that body-modification surgery of any kind would really be much of a thing in most D&D settings.  You'd need to have a fanatically anti-magic society for it to make sense to bother with stuff surgically.

But for the most part, healing magic doesn't do anything about old scars or missing body parts unless the spell or magic item description specifically says so: if you're missing an arm thanks to an encounter with a Sword of Sharpness when you get a Cure Wounds spell, the arm doesn't grow back.  So any deliberate body modifications, not just gender alterations, should probably be treated the same.

 

A regenerate spell, which does grow things back, might reverse it though. 

 If you got your cancer removed, would you want Regenerate to put it back? I'd say it can work this way if and only if the character wants it to. Maybe their medical transition was forced upon them by an evil wizard. Which like, I'm not even going to get into that. Not touching it.

Anyway, to OP's original question, I can only speak on my own little non-binary experience and say that if I walked through a magic sex-change door, I'd be like, "huh." Like I don't think I'd be bothered at all, except for practical reasons such as "periods seem sucky." If I instead walked through a magic gender-change door, my gut tells me that I'd turn into a very macho bro guy. Because I'm the type of enby who would simply present female if I could manage it.

Respectfully, Davyd, I don't think anyone here is attempting to incite or further any harm.  A discussion of the effects of specific magic in unusual circumstances feels in line for the board so long as people understand that the process of transition itself is net-positive for those undergoing it.  I can state with confidence that despite my own issues with identity and my sharp dislike of my current body, the process of physical transition terrifies me.  That, combined with my area being notably and markedly hostile to anyone undergoing physical transition, effectively ensures I never will.  There's a lot of representation and positive support for people undergoing transition, and I have nothing but respect for their courage and the best of hopes for their success.  But there's also an undercurrent of "if you're not undergoing transition, you're not 'trans' at all, you're just a poser" in a lot of circles I interface with, and a lot less support for people who dislike their assigned gender identity but do not have the freedom, either societally or financially, to alter that identity.

Discussion of the effects of magic on transition, or the ability of magic to aid/replace conventional medically-assisted transition, shouldn't be squelched.  Rather than burning someone for even asking the question, perhaps it would be better to inform a person on why transition does not count as "injury" for the people undergoing it.  Seek understanding rather than censure.  After all, sewing a wound closed is itself 'injuring' the wounded party further - the body doesn't come with little holes in it you can use for thread, you have to make them.  And yet, sutures are a livesaving tool absolutely no one would rule is undone by healing magic save through the restoration of the originally sutured wound itself.

It's why I brought up the intent behind magic, and how the system in D&D, both mechanically and in-world, is aligned with the idea that the caster's intent is a critical and irreplaceable part of the spell.  The intent of curative magic is to restore a body to working order and undo injuries that threaten its integrity.  Transitional surgery does not interfere with a body's working order nor threaten its integrity, and would very likely be as invisible as tattoos, piercings, sutures, or anything else a person does to modify themselves without threatening their health.

The other thing to remember is that the D&D spell list is not an exhaustive list of all magic in the realms of D&D.  There are spells NPCs know that adventurers do not, because  those NPCs do jobs that adventurers do not do.  In a world where magic is real and understood enough to be used as a tool in combat and other high-risk situations where reliability is paramount?  There will be civillian, noncombative spells that do things 'Adventuring' spells do not simply because adventurers are not expected to need or want to learn those spells.  Keith Baker's Exploring Eberron specifically calls out the existence of high-level magical cosmeticians and 'beauty mages' who learn ways to alter and enrich a creature's appearance as their profession.  The most skilled and accomplished of these mages can permanently alter a person's biological sex, and some book space is devoted to the idea that these mages can connect with therapists who can aid a person through the process of transition.  It's expensive but not unobtainably so, especially for an adventurer, and one can obtain temporary changes for far lower costs.

Healing magic, in D&D, is CLS magic.  Combat lifesaving.  Cure Wounds is a literal stopgap measure - it's a spell you cast when you need to stop a gap in someone's flesh from leaking all their living-juice out onto the floor.  Thinking of these spells as emergency first-aid measures helps frame them in the proper light, as does remembering that the 5e spell list is the "Adventurous Spells for Adventurers" spell list rather than an Exhaustive List of All Magic.

...anyways.  Hopefully my point was made somewhere in that stream-of-consciousness ramble.  If you figure out what it was, lemme know?

Quote from Yurei1453 >>

Respectfully, Davyd, I don't think anyone here is attempting to incite or further any harm. 

Oh, I wasn't saying anyone was, I was just making sure moderator presence, and the desire to ensure everyone is being respectful, was crystal clear and unambiguous. If I, or any other moderator, thought that actual bad actors were at work, stronger action would be taken.