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Transsexualism is a phenomenon experienced by individuals who transition between either of the two major sexes, male and female, not due to social pressures or mental disorders, but due to an acute feeling of fundamental discontent with the sex to which they have been assigned (gender dysphoria).
Neuroscience studies of transsexuals in recent years are increasingly suggesting that transsexuality is a biological phenomenon rather than a purely psychological one, as transsexuals' brain structures tend to have a strong resemblance to the brains of their identified gender, even before beginning sex reassignment therapy.
Although definitions of "transsexual" and related terms like "transgender" are currently in something of a state of flux, the general tendency is for "transgender" to refer to all gender-variant people, and for "transsexual" to refer to the more specific cases of women who were assigned male at birth (transsexual women) and men who were assigned female at birth (transsexual men). Note also that "transsexual" is preferably used as an adjective rather than as a noun.
Within those two broad categories, there is as much room for variation as there is for any other group of people. Transsexual people can have any sexual orientation that cissexual people can; just bear in mind that transsexual people define their orientation in terms of their preferred gender, not the one they were assigned at birth. There are many reasons that a transsexual person may pursue medical transition, and it is not always seen by the individual as a choice they would make in a social vacuum.
- Transsexual women are simply men who are so enamored with femininity that they go so far as surgery to emulate it ("autogynephilia") This is a recent point of view floated most notably by weirdos and trolls such as Ray Blanchard, Ann Lawrence and J. Michael Bailey, based largely on junk science and speculation. Aside from a great many criticisms of the concept that this is simply a love of women taken too far, it utterly ignores the existence of female-assigned-at-birth transsexual individuals. Although autogynephilia is widely rejected for rational reasons, some people do openly identify as autogynephiliacs as it describes their personal experience quite well. The more important thing is to remember that theories advancing this idea assert that all transsexual people are either homosexuals or autogynephiles. Also of note is that some radical feminists assert this same idea, and feel that transsexuals are the male 5th column coming in to literally rape the last sacrament of femininity, their very bodies.
- Transsexual people are really homosexuals who wish to avoid social stigma by actually becoming the "opposite" sex This is often presented together with the above AGP concept, and is no more well founded. Proponents tend to note though that "homosexual transsexual people" are so effeminate that they are unable to function in life as men, and are typically able to pass so well, that they can live in "stealth" afterwards. Again, it does not recognize the existence of trans men, but further suggests that homosexual men would try to escape the social stigma of homosexuality by embracing the far greater stigma associated with transsexuality. Further, this misconception suggests that a homosexual male would go through a process that by definition would make him impotent, and thus unable to have homosexual sex. This is a bizarre concept at best. Why a person would flee a socially stigmatised identity to take up an even more stigmatised identity is a question as yet unanswered.
- A little therapy or a good fuck is all they need to snap out of it. This misconception ignores that the psychiatric community requires transsexual people to have extensive therapy in order to receive treatment, and many who transition later in life have led a fairly successful sexual life. This view is commonly shared about homosexual people too, as people believing this misconception have difficulty distinguishing the two subjects of transsexuality and homosexuality. Medical treatment for transsexual people is typically dependent upon a course of therapy. Whilst originally introduced to hinder trans people, this now serves to prevent harm due to misdiagnosis and to help transsexual people through the process of transition. It should be noted that recently there is a trend for informed consent[wp] clinics that provide hormone replacement therapy without requiring psychological evaluation. This is widely seen as a good thing among trans rights activists.
- Gender and physical sex are the same thing. There is a distinction between a person's identification and personality (gender), and their physical features and properties (sex). Most people perceive them to match enough that they assume they match for everyone else. Transsexual people undergo procedures to alter their sexual characteristics to bring them in line with their gender identity.
- Transsexual people may satisfy their urges with occasional role-playing or crossdressing. This is often akin to reparative therapy in homosexual people, where the individual suppresses natural urges or identification in order to appear "fine". This can be due to a number of reasons, such as fear, family pressure, or simple uncertainty about the concept or transitioning. However, many find they cannot maintain this false front, and proceed to transition at some later date. It is also notable that crossdressers are seldom transsexual, though some crossdressers may later realize that they are better served by transitioning.
- Transsexual and transgender are interchangeable terms. Like LGBT, transgender is an umbrella term, whose exact definition is subject to much debate, but generally covers any person whose gender expression or identity is considered abnormal by society. Transsexual, on the other hand, has a more defined and restricted meaning, and does not cover gender expressions which are recreational or do not involve medical transition, such as drag queens. Some transsexual people do not wish to be identified under the "transgender" umbrella and find it highly offensive to be referred to as "transgenders" or "trans," though others accept umbrella terms for the purposes of political alliance and do not find them offensive.
- Transsexual persons are gender variant. Many transsexual people prefer to conform to gender norms. Even those that have criticisms of their cultures gender norms often would prefer not to have to assert their gender to every individual they encounter 24/7, or to risk violence and street harassment for their transgressions. In the past, medical professionals actually required transsexual patients to dress and act in an extremely stereotypical way for their target sex in order to qualify for treatment, though currently such standards are relaxed so that transsexual people do not have to adopt an exaggerated presentation.
- "Tranny" is an endearing and acceptable term for transsexual people. The term "tranny" is very often used as a slur for transsexual people, and as such, many find it highly offensive, on the level of calling a gay person a "faggot." Some trans people reclaim the term and use it for themselves, but as with other minorities that reclaim slurs in this way, it is not a polite or universally-acceptable term for non-trans people to use.
 Relationship to homosexuality and bisexuality
A transsexual man attracted to other men is showing a homosexual orientation, despite assigned sex. A transsexual woman attracted to men, on the other hand, shows a heterosexual orientation. It's quite simple.
Due to oppression, violence, lack of legal protections and misunderstanding, most people in these rarer sexual sub-categories tend to try to work together for legal rights and social acceptance, hence the LGBT (etc.) umbrella "label". The symbol of the Rainbow Flag indicates the range of healthy expression of sexuality in humans, and the political need for us to accept each other equally.
However, despite the symbolism of the Rainbow Flag, transsexual people are often not afforded the same inclusion as other groups under the umbrella. One recent example of this in the USA is the Human Rights Campaign's willingness to jettison demands for transsexual rights in order to ensure passage of a bill ensuring rights for gays and lesbians. During the same situation, the Lesbian and Gay Task Force explicitly said that they are not supporting protection for "gender identity and expression" for transsexual or transgender individuals, but rather solely for the personal goal of ensuring that there would be no loophole for discriminating against gay or lesbians for the way that they act, when incongruous to the stereotypes of their sex.
Also, Washington HB 2661 which granted discrimination protection to the GLBT community, only added protection for "sexual orientation", which was defined to include "gender identity and expression." While whatever argument can be made to justify this action, it still shows an ignorance of the gay and lesbian community about what motivates transsexuals to change.
 Sex reassignment therapy
Sex reassignment therapy involves generally three stages, therapy, hormones and then surgery. This three tier approach is designed to keep a person from going further than they would be comfortable with in their life. Recently their is a trend for informed consent[wp] clinics providing hormones without prior therapy, although surgery continues to require diagnosis.
 Phase 1: Psychiatric therapy
In some instances the therapy is designed in a way almost like reparative therapy. The first stance that the therapist is to take is skepticism, and attempting to help the patient resolve their feelings without hormones, transition, or surgery. A patient is informed that transsexuals face a real threat of harm, and death simply from being transsexual. There should not be any intent to dissuade genuine individuals from transition, but rather to ensure that transition happens only when medically necessary, and not on whim or pretense.
If the therapist's skepticism is satisfied, they will usually recommend that the transgender person spend some "practice" time living as the opposite gender before undergoing hormone therapy or surgery. This may involve some combination of; formally or informally changing their name to a name of the opposite gender, "coming out" as transgender to society at large, and making changes to their gender expression.
There are a number of hypothetical examples that demonstrate individuals for whom transition would be the wrong treatment to take:
- A woman who had been sexually abused, and viewed transition as the only way to regain control over her sexuality.
- Crossdressers may originally approach a therapist seeking sex reassignment surgery, but such a surgery would actually cause negative psychological impact.
- Crossdressers may also become complacent with their erotic fantasies, and begin to suspect that this means they should transition, even though this surgery would still cause negative psychological impact.
- Felons fleeing from justice, and view transition as a way to evade prosecution.
None of the preceding patients should be encouraged to transition, as they have a distinct gender identity conforming with their biology, and actual transition will result in serious negative consequences. Thus patients are originally recommended to find expressive, non-permanent ways to express themselves and relieve the stress caused by their transgender feelings. This gives the therapist time in order to evaluate and review the indications and counter-indications of whether medical intervention is actually medically necessary.
A (somewhat) famous example of an individual for whom sex reassignment was not the right thing to do, but who went through with it anyway and later regretted it, was Dan/Danielle Bunten[wp], the author of M.U.L.E.. It didn't help that, in her case, the surgery ended up making her incapable of achieving orgasm, as can happen when the surgeon isn't extremely careful about preserving the nerves intact.
 Phase 2: Hormone replacement
In cases where psychiatric therapy leads to the conclusion that a person is genuinely transsexual and should undergo physical gender transition, the Standards of Care used internationally suggest hormone therapy be given. Some people undergoing the therapy seek maximum feminization/masculinization, while others will experience relief with an androgynous presentation resulting from hormonal minimization of existing secondary sex characteristics (Factor & Rothblum, 2008).
Hormone therapy can provide significant comfort to patients who do not wish to make a social gender role transition or undergo surgery, or who are unable to do so (Meyer, 2009). Hormone therapy is a recommended criterion for some, but not all, surgical treatments for gender dysphoria.
 Physical Effects of Hormone Therapy
Feminizing/masculinizing hormone therapy will induce physical changes that are more congruent with a patient’s gender identity.
In FtM patients, the following physical changes are expected to occur:
- Deepened voice
- Clitoral enlargement (variable)
- Growth of facial and body hair
- Cessation of menstruation
- Atrophy of breast tissue
- Decreased percentage of body fat compared to muscle mass
In MtF patients, the following physical changes are expected to occur:
- Breast growth (variable)
- Decreased erectile function
- Decreased testicular size
- Increased percentage of body fat compared to muscle mass
Most physical changes, whether feminizing or masculinizing, occur over the course of two years. The amount of physical change and the exact timeline of effects can be highly variable.
In female to males, the effects of testosterone on menstruation and fat distribution will generally revert if stopped within a few weeks. For male-to-females, the effects of hormone treatments become irreversible only after about 3 months.
Within the transgender community there's a considerable amount of debate over the value of gatekeeping protocols; self-medicating with hormones is surprisingly common for those who feel that they're being forced to jump through hoops, and quite a few transgender people have felt forced to overpresent as their target gender -- to express what to them seems to be unacceptable levels of bimbosity or machismo, frequently -- in order to be taken seriously as transgender by their doctors and to continue receiving hormone therapy. As a result, there's a number of clinics that will provide hormones to those who ask for them, given a statement of informed consent and medical clearance.
 Phase 3: Reassignment surgery
Reassignment surgery is a form of cosmetic surgery which changes aspects of a transgender person's body to make them physically resemble the opposite gender. In transsexual men, this is usually limited to a breast reduction, as the results of creating genitalia for them are typically poor. However, significant work has been done in creating realistic genitalia for transsexual women. transsexual women may also receive a breast enlargement if hormone therapy has not led to the growth of full breasts. Both forms of genital surgery are generally irreversible; reversing surgeries for transsexual men may find some success, but reversing MtF surgeries is impossible.
Some countries, like France, make undergoing this phase mandatory before being able to petition for an official identity change, so before being able to insert in society (good luck finding a mainstream job presenting as female while your ID says you're a man). That is often viewed by LGBT activist as an effort to "punish" fully committed trans by making sure they will be sterile.
 Prejudice and violence
“”One father described the challenge of empathizing with his child’s fear this way: How would it feel if someone told him that one day soon he would start growing breasts and a vagina?
“I’d try to stop that from happening,” he said.
Until 2010 and the passage of the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, the FBI did not collect information to determine the prevalence of hate crimes against transgender or transsexual people. So it is difficult to guess at how common they are out of the entire population, although most are certain that the violence rate is significantly higher than any other group. Combined with a substantially higher-than-normal suicide attempt rate (41%, more than 25 times the rate of the general population), and the rarity of the condition in the first place - the number of successful transitions is often outweighed by those who do not transition.
The common value given by trans advocates is that a transsexual has a 50% chance to have a successful transition, and the rest primarily die, commit suicide, or are killed before they have the chance to transition completely. Go team, eh?
The transsexual community abounds with tragic stories of individuals killed by others simply for being transsexual persons, and police or health care providers refusing to treat. Of particular note, one transsexual woman involved in an accident was laughed at and mocked once the police and rescue personnel learned that she was a preoperative transsexual; the delay in her care and treatment was the primary cause of her death. Gwen Araujo is a well-known transsexual woman, who was brutally murdered by bludgeoning force when some men, who committed statutory rape against her and forced her to give them oral sex, found out that she was either transgender or a preoperative transsexual woman. Another heartbreaking story, is of a trans woman, who was run over repeatedly by her former boyfriend with his car immediately after their break up. The police later classified this tragedy as an accident, even when witnesses insisted that it was deliberate. Trans men also face significant discrimination by doctors when they are diagnosed with cervical, uterine, or ovarian cancer, there may be refusal by the doctors or even the insurance company to treat that cancer.
 Notable transsexual people
- Leelah Alcorn, American transgender teen who committed suicide because her parents ostracized her.
- Thomas Beatie, the "pregnant man"
- Kristin Beck, former United States Navy SEAL
- Chaz Bono, son of Sonny & Cher and LGBT activist
- Wendy Carlos, composer of music for two Stanley Kubrick films and Tron
- Laverne Cox, actress and transgender advocate
- Sasha "Scarlett" Hostyn, a professional gamer and a world champion in Starcraft 2
- Caitlyn Jenner, formerly known as Bruce Jenner, an Olympic gold medalist in track and field.
- Chelsea Manning, WikiLeaks leaker
- Geena Rocero, model and transgender activist.
- Lana Wachowski, formerly known as Larry Wachowski, co-director of The Matrix and Cloud Altas
- Laura Jane Grace, lead singer of anarcho punk band Against Me! Was known as Tom Gabel until announcing a transition in 2012.
- ↑ "Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus", The Journal of Clinical Endocrinology & Metabolism, May 2000.
- ↑ Jessica Hamzelou, "Transsexual differences caught on brain scan", New Scientist, 26 January 2011.
- ↑ Critique of The Man Who Would Be Queen, a landmark book regarding AGP, at TS Roadmap
- ↑ The most important example being Anne Lawrence, a medical doctor who is also one of the main proponents of this theory
- ↑ Originally advanced by Janice Raymond in The Transsexual Empire; popularly pushed in the UK press by Julie Bindel.
- ↑ Review of The Man Who Would Be Queen
- ↑ See above reference at TS Roadmap
- ↑ See "Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity", by Julia Serano
- ↑ One of our well-meaning editors had to be schooled on this
- ↑ Green, Jesse. 2012. "S/He" New York Times Magazine
- ↑ Southern Poverty Law Center on transgender murders
- ↑ 
- ↑ Hate Crimes: Causes, Controls, and Controversies by Phyllis B. Gerstenfeld
- ↑ What's On Tonight
- ↑ Philadelphia Police Fail To Investigate Suspicious Death of a Transgender Woman