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Definition Transsexualism or transsexuality is a condition in which a transsexual person self-identifies as a member of the gender opposite to the one assigned to them at birth. Transsexual people are stereotypically described as "women trapped in male bodies" or vice versa, although some members of the transsexual community, as well as some outside the community, reject this model. 
Most transsexual men and women desire to establish a permanent social role as a member of the gender with which they identify. Many transsexual people also desire various types of medical alterations (sex reassignment therapy) to their bodies. These physical alterations are collectively referred to as sex reassignment therapy and often include hormones and sex reassignment surgery. The entire process of switching from one physical and social gender presentation to the other is often referred to as transition, and usually takes several years.
To obtain sex reassignment therapy, transsexual people are usually required to receive psychological therapy and a diagnosis of gender identity disorder. They must also live as members of their target sex for a period of time, known as the Real-life test, prior to surgery, and meet other requirements specified by protocols known as Standards of Care. These requirements are intended to prevent individuals from transitioning and later regretting doing so; however, their effectiveness is questionable.
Currently, the causes of transsexualism are unknown, and estimates of prevalence vary substantially.
Transsexualism is a complex condition that is defined differently by different people. Many terms have been proposed through the years to describe transsexual people and the processes they go through. Some of these terms are controversial, among the transsexual community as well as society at large.
The definition of "transsexual" is debated. Many within the trans community feel that a person is transsexual if they personally identify as such. However, some, especially health care providers and some transsexual people, believe there is a certain set of procedures that must always be completed for a person to be called "transsexual". The general public often defines "a transsexual" as someone who has had or plans to have "sex change" surgery, although this term is considered inaccurate by many people who believe that sex cannot really be changed. The term currently in widest use for modification of primary sex characteristics is sex reassignment surgery (SRS), a term which reflects the belief that transsexual people do not consider themselves to be changing their sex, but to be correcting their bodies. However, some feel that the term "sex change" is appropriate and that it stresses that transsexual people are not castrated members of their original sex. 
Description It is accepted in the Diagnostic and Statistical Manual of Mental Disorders that expression of desire to be of the opposite sex, or assertion that one is of the sex opposite to the one with which they were identified at birth, constitutes being transsexual.  The ICD-10 also states that transsexualism is defined by "the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment." In contrast, some transgender people often do not identify as being of or desiring to be the opposite sex, but as being of or wanting to be another gender.
Transsexualism (also known as transsexuality) is one of a number of behaviours or states collectively referred to as transgender, which is generally considered an umbrella term for people who do not conform to typical gender roles. However, some in the transsexual community do not identify as transgender, or see transsexualism not as a sub-division of transgender. Often, those people complain that non-transsexual transgender people are somehow "degrading" transsexual people by first describing them as "just tranvestites" (this refers to the assumption, that gender variant people can neatly be divided into "transsexuals" and "transvestites") or "perverts" or similar, and then claiming that this is not what transsexual people are. This is usually accompanied by demanding that medical treatment and legal change of name and legal gender should be reserved only for transsexual people. Some also see the term 'transgender' as subsuming and erasing their identity, rejecting it for themselves because to them it implies a breaking down of gender roles, when in fact they see themselves as fitting a gender role -- just not the one they were assigned at birth. Those contesting this view point out that the idea of a more inclusive "Gender identity disorder" has long replaced the idea of dividing gender variant people into "transsexuals" and "transvestites", that classifying transsexualism as a sub-division of transgender does not automatically erase any transsexual identity, that not all transgender people wish to break down gender barriers, and that any marginalized group trying to gain acceptance of those opposed to them by trying to oppress another group has not only never been successful, it is also ethically questionable according to certian individuals and faiths.
Transsexualism should not be confused with cross dressing or with the behaviour of drag queens, which can be described as transgender, but usually not transsexual. Also, transvestic fetishism usually has little, if anything, to do with transsexualism.
Gender terminology for transsexual people
Transsexual people are usually referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was identified as female at birth on the basis of his genitals, but who identifies as a man and is transitioning or has transitioned to a male gender role and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" gender terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc. These terms help to prevent confusion, as some people are oblivious as to whether a "transsexual woman" is a female transitioning to become a male or a male transitioning to become a female. Transsexual men and women are also sometimes referred to as transmen and transwomen.
Transsexual people are often construed as belonging to the LGBT or the Queer community, and many identify with the community; others do not, or prefer not to use the terms. It should be noted that transsexualism is not associated with or dependent on sexual orientation. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual (cissexual) people do. They almost always use terms for their sexual orientation that relate to their target gender. For example, someone assigned to the male gender at birth but who identifies as a woman, and who is attracted solely to men, will identify as heterosexual, not gay; likewise, someone who was assigned female sex at birth, identifies as a man, and prefers male partners will identify as gay, not heterosexual. Transsexual people, like other people, can be bisexual or asexual as well.
Older medical texts often referred to transpeople as members of their original sex; in other words referring to a male-to-female transsexual as a "male transsexual". They also described sexual orientation in relation to the person's assigned sex, not their gender of identity; in other words, referring to a male-to-female transsexual who is attracted to men as a "homosexual male transsexual." This dwindling usage is considered by many to be scientifically inaccurate and clinically insensitive today, and such a person would now be called and most likely identify herself as a heterosexual transwoman. Some medical textbooks still refer to transsexual people as members of their assigned sex, but many now use "assigned-to-target" terms.
A number of people outside the transsexual community still refer to transsexual people with terms associated with their birth sex (for example calling a male-to-female transsexual "him"). This usage, generally considered insensitive, has been (though not exclusively) based on biological arguments such as the unchanged karyotype, which is usually consistent with the sex assigned to the person at birth, or the absence of reproductive capability after transition and sex reassignment surgery. Arguments for this usage have also been based on religious dogma. Conservative groups such as the Traditional Values Coalition are among those to refer to transsexual people as members of their original sex.
Among the transsexual community, the short form trans is sometimes used, e.g. trans guy, trans dyke, trans folk. Some use the controversial terms tranny and/or trans, though others consider these terms to be offensive. Those who use these terms claim that they are diminishing the power of the term as an insult. Others feel that the terms are insulting or inaccurate regardless of the context.
Some people prefer to spell transexual with one s, in an attempt to divorce the word from the realm of psychiatry and medicine and place it in the realm of identity, but this trend is most common in the United States and, for example, is almost never used in the United Kingdom.  Some consider this usage to be silly and/or incorrect.
Some prefer the term transsexed over transsexual, as they believe the term sexual found in transsexual is misleading and implies that transsexualism is a sexual orientation. Another justification made for this preference is that they feel it is more in line with the term intersex, as more transsexual groups are welcoming them because they feel both groups have much in common. It is, by some definitions, possible to be both intersexed and transsexed. Other attempts to avoid the misleading -sexual have been the increasing acceptance of transgender or trans* and in some areas, transidentity.
It is often assumed, particularly by transsexual people, that transsexualism is simply a subset of intersex. "Intersex" previously referred only to those who are genitally intersexed, i.e., with genitals that don't look classically male or female (in spite of the fact that human genitals show an extremely wide variation in general). However, since sex in humans is composed of many different attributes, such as genes, chromosomes, regulatory proteins, hormones, hormone receptors, body morphology, brain sex, and gender identity, any variation among any of those attributes falls under the rubric of "intersex." Transsexualism, in this view, simply becomes neurological intersexuality. (See below for research of physiological causes of transsexualism).
Some people feel that both 'trans' and 'sexual', are misleading. A large variety of other terms exist, though almost all of them are somewhat controversial.
Some people also refer to transsexualism as Harry Benjamin's Syndrome, or simply Benjamin's Syndrome, named for Harry Benjamin, a pioneer in the field of sex reassignment. They feel that this term is more medically accurate than transsexualism or gender identity disorder, to describe what they believe to be an intersex condition. 
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