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Transgender people have a gender identity or gender expression that differs from their assigned sex. Transgender people are sometimes called transsexual if they desire medical assistance to transition from one sex to another. Transgender is also an umbrella term: in addition to including people whose gender identity is the opposite of their assigned sex (trans men and trans women), it may include people who are not exclusively masculine or feminine (people who are genderqueer or non-binary, including bigender, pangender, genderfluid, or agender). Other definitions of transgender also include people who belong to a third gender, or else conceptualize transgender people as a third gender. Infrequently, the term transgender is defined very broadly to include cross-dressers, regardless of their gender identity.

Being transgender is independent of sexual orientation: transgender people may identify as heterosexual, homosexual, bisexual, asexual, or may decline to label their sexual orientation. The term transgender is also distinguished from intersex, a term that describes people born with physical sex characteristics "that do not fit typical binary notions of male or female bodies". The counterpart of transgender is cisgender, which describes persons whose gender identity or expression matches their assigned sex.

The degree to which individuals feel genuine, authentic, and comfortable within their external appearance and accept their genuine identity has been called transgender congruence. Many transgender people experience gender dysphoria, and some seek medical treatments such as hormone replacement therapy, sex reassignment surgery, or psychotherapy. Not all transgender people desire these treatments, and some cannot undergo them for financial or medical reasons.

Most transgender people face discrimination in the workplace and in accessing public accommodations, and healthcare. In many places they are not legally protected from discrimination.

Evolution of transgender terminology

Psychiatrist John F. Oliven of Columbia University coined the term transgender in his 1965 reference work Sexual Hygiene and Pathology, writing that the term which had previously been used, transsexualism, "is misleading; actually, 'transgenderism' is meant, because sexuality is not a major factor in primary transvestism." The term transgender was then popularized with varying definitions by various transgender, transsexual, and transvestite people, including Virginia Prince, who used it in the December 1969 issue of Transvestia, a national magazine for cross dressers she founded. By the mid-1970s both trans-gender and trans people were in use as umbrella terms, and 'transgenderist' was used to describe people who wanted to live cross-gender without sex reassignment surgery (SRS). By 1976, transgenderist was abbreviated as TG in educational materials.

By 1984, the concept of a "transgender community" had developed, in which transgender was used as an umbrella term. In 1985, Richard Elkins established the "Trans-Gender Archive" at the University of Ulster. By 1992, the International Conference on Transgender Law and Employment Policy defined transgender as an expansive umbrella term including "transsexuals, transgenderists, cross dressers", and anyone transitioning. Leslie Feinberg's pamphlet, "Transgender Liberation: A Movement Whose Time has Come", circulated in 1992, identified transgender as a term to unify all forms of gender nonconformity; in this way transgender has become synonymous with queer.

Between the mid-1990s and the early 2000s, the primary terms used under the transgender umbrella were "female to male" (FtM) for men who transitioned from female to male, and "male to female" (MtF) for women who transitioned from male to female. These terms have now been superseded by "trans man" and "trans woman", respectively, and the terms "trans-masculine" or "trans-feminine" are increasingly in use. This shift in preference from terms highlighting biological sex ("transsexual", "FtM") to terms highlighting gender identity and expression ("transgender", "trans woman") reflects a broader shift in the understanding of transgender people's sense of self and the increasing recognition of those who decline medical reassignment as part of the transgender community.

Health-practitioner manuals, professional journalistic style guides, and LGBT advocacy groups advise the adoption by others of the name and pronouns identified by the person in question, including present references to the transgender person's past. Many also note that transgender should be used as an adjective, not a noun (for example, "Max is transgender" or "Max is a transgender man", not "Max is a transgender"), and that transgender should be used, not transgendered.

In contrast, people whose sense of personal identity corresponds to the sex and gender assigned to them at birth – that is, those who are neither transgender nor non-binary or genderqueer – are called cisgender.

Transsexual and its relationship to transgender

The term transsexual was introduced to English in 1949 by David Oliver Cauldwell, and popularized by Harry Benjamin in 1966, around the same time transgender was coined and began to be popularized. Since the 1990s, transsexual has generally been used to describe the subset of transgender people who desire to transition permanently to the gender with which they identify and who seek medical assistance (for example, sex reassignment surgery) with this. However, the concerns of the two groups are sometimes different; for example, transsexual men and women who can pay for medical treatments (or who have institutional coverage for their treatment) are likely to be concerned with medical privacy and establishing a durable legal status as their gender later in life.

Distinctions between the terms transgender and transsexual are commonly based on distinctions between gender (psychological, social) and sex (physical). Hence, transsexuality may be said to deal more with physical aspects of one's sex, while transgender considerations deal more with one's psychological gender disposition or predisposition, as well as the related social expectations that may accompany a given gender role. Many transgender people prefer the designation transgender and reject transsexual. For example, Christine Jorgensen publicly rejected transsexual in 1979, and instead identified herself in newsprint as trans-gender, saying, "gender doesn't have to do with bed partners, it has to do with identity." This refers to the concern that transsexual implies something to do with sexuality, when it is actually about gender identity. Some transsexual people, however, object to being included in the transgender umbrella. The definitions of both terms have historically been variable.

In his 2007 book Transgender, an Ethnography of a Category, anthropologist David Valentine asserts that transgender was coined and used by activists to include many people who do not necessarily identify with the term and states that people who do not identify with the term transgender should not be included in the transgender spectrum. Leslie Feinberg likewise asserts that transgender is not a self-identifier (for some people) but a category imposed by observers to understand other people. However, these assertions are contested by the Transgender Health Program (THP) at Fenway Health in Boston. It notes that there are no universally-accepted definitions, and terminology confusion is common because terms that were popular in at the turn of the 21st century may now be deemed offensive. The THP recommends that clinicians ask clients what terminology they prefer, and avoid the term transsexual unless they are sure that a client is comfortable with it.

Harry Benjamin invented a classification system for transsexuals and transvestites, called the Sex Orientation Scale (SOS), in which he assigned transsexuals and transvestites to one of six categories based on their reasons for cross-dressing and the relative urgency of their need (if any) for sex reassignment surgery. Benjamin considered a moderate intensity "true transsexual" to need either estrogen or testosterone as a "substitute for or preliminary to operation"; people who meet Benjamin's definition of a "true transsexual" but do not desire SRS include Miriam Rivera. There are also people who have had SRS but do not meet the definition of "transsexual", such as Gregory Hemingway.

Other categories

In addition to trans men and trans women whose binary gender identity is the opposite of their assigned sex, and who form the core of the transgender umbrella, being included in even the narrowest definitions of it, several other groups are included in broader definitions of the term. These include people whose gender identities are not exclusively masculine or feminine but may, for example, be androgynous, bigender, pangender, or agender—often grouped under the alternative umbrella term genderqueer—and third-gender people (alternatively, some references and some societies conceptualize transgender people as a third gender). Although some references define transgender very broadly to include transvestites / cross-dressers, they are usually excluded, as are transvestic fetishists (because they are considered to be expressing a paraphilia rather than a gender identification) and drag kings and drag queens (who are performers and cross-dress for the purpose of entertaining).

Genderqueer, including androgynous and bigender

Genderqueer or non-binary identities, which are not exclusively masculine or feminine but instead may be agender, androgynous, bigender, pangender, or genderfluid, exist outside of cisnormativity. Bigender and androgynous are overlapping categories; bigender individuals may identify as moving between male and female roles (genderfluid) or as being both male and female simultaneously (androgynous), and androgynes may similarly identify as beyond gender or genderless (postgender, agender), between genders (intergender), moving across genders (genderfluid), or simultaneously exhibiting multiple genders (pangender). Limited forms of androgyny are common (women wearing pants, men wearing earrings) and are not seen as transgender behavior. Androgyne is also sometimes used as a medical synonym for an intersex person. Genderqueer identities are independent of sexual orientation.

Transvestite or cross-dresser

A transvestite is a person who cross-dresses, or dresses in clothes typically associated with the gender opposite the one they were assigned at birth. The term transvestite is used as a synonym for the term cross-dresser, although cross-dresser is generally considered the preferred term. The term cross-dresser is not exactly defined in the relevant literature. Michael A. Gilbert, professor at the Department of Philosophy, York University, Toronto, offers this definition: "[A cross-dresser] is a person who has an apparent gender identification with one sex, and who has and certainly has been birth-designated as belonging to [that] sex, but who wears the clothing of the opposite sex because it is that of the opposite sex." This definition excludes people "who wear opposite sex clothing for other reasons," such as "those female impersonators who look upon dressing as solely connected to their livelihood, actors undertaking roles, individual males and females enjoying a masquerade, and so on. These individuals are cross dressing but are not cross dressers." Cross-dressers may not identify with, want to be, or adopt the behaviors or practices of the opposite gender and generally do not want to change their bodies medically or surgically. The majority of cross-dressers identify as heterosexual. People who cross-dress in public sometimes may have a desire to pass as the opposite gender, so as not to be detected as a cross-dresser.

The term transvestite and the associated outdated term transvestism are conceptually different from the term transvestic fetishism, as transvestic fetishist describes those who intermittently use clothing of the opposite gender for fetishistic purposes. In medical terms, transvestic fetishism is differentiated from cross-dressing by use of the separate codes 302.3 in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and F65.1 in the ICD.

Drag kings and queens

Drag is a term applied to clothing and makeup worn on special occasions for performing or entertaining, unlike those who are transgender or who cross-dress for other reasons. Drag performance includes overall presentation and behavior in addition to clothing and makeup. Drag can be theatrical, comedic, or grotesque. Drag queens have been considered caricatures of women by second-wave feminism. Drag artists have a long tradition in LGBT culture. Generally the term drag queen covers men doing female drag, drag king covers women doing male drag, and faux queen covers women doing female drag. Nevertheless, there are drag artists of all genders and sexualities who perform for various reasons. Some drag performers, transvestites, and people in the gay community have embraced the pornographically-derived term tranny to describe drag queens or people who engage in transvestism or cross-dressing; however, this term is widely considered offensive if applied to transgender people.

Intersex

Intersex people have genitalia or other physical sex characteristics that do not conform to strict definitions of male or female, but intersex people are not necessarily transgender because they do not necessarily disagree with their assigned sex. Transgender and intersex issues often overlap, however, because they may both challenge rigid definitions of sex and gender.

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