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Transsexualism (also known as transsexuality) 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. As with any terms used by a group, or to refer to a particular group, some of these terms are controversial, or have become controversial, not only to society at large, but even among the transsexual community.

The definition of "transsexuality" is somewhat debated. One common definition is that a transsexual is a person who believes that his or her body does not reflect his or her true 'inner' gender. Another common definition is that a transsexual is a person who has had or plans to have medical or surgical treatments that alter his or her body to better reflect what the individual believes is his or her true gender. The first definition allows greater freedom for individuals to self-identify as a transsexual. The latter defines the term based on actual or planned operative status and makes it more an external label than a term of self-definition.

When surgery is undertaken it is commonly referred to as sex reassignment surgery by health care providers and community members. An older term, sex change surgery may be seen as disrespectful.

The Diagnostic and Statistical Manual of Mental Disorders accepts the expression of desire to be of the opposite sex, or assertion that one is of the sex opposite from the one with which they were assigned at birth, as sufficient for being transsexual.^[4] The ICD-10 states in a similar way 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 has been variously described as a trait, disease, behavior, desire, mental illness, perversion, paraphilia, political identity, lifestyle and sin. The terms perversion and sin are often used in a derogatory manner (especially by Western religions). People may consider the use of such labels offensive whether they are or are not transsexual, or involved with Western religions, themselves.

Transsexualism is often included within the broader term transgender, which is generally considered an umbrella term for people who do not conform to typical accepted gender roles, for example cross-dressers, drag queens, and people who identify as genderqueer. However, some transsexuals object to this inclusion. Historically the reason that transsexuals rejected associations with the transgender or broader LGBT community is largely that the medical community in the 1950s through the late 1980s encouraged (and in many ways required) this rejection of ones queer kin in order to be a 'good transsexual' who would thus be allowed to access medical and surgical care. The animosity that is present today is no longer fed by this same kind of pressure from the medical community (indeed, today many gender therapists actively encourage their clients to explore support within the broader community.) However the current animosity is reflective of this historical division. (Denny 176.)

Regardless of definition, transsexualism should not be confused with cross dressing or with the behaviour of drag queens and drag kings, which can be described as transgender but not transsexual. Also, transvestic fetishism usually has little, if anything, to do with transsexualism. As a general rule, transsexual people tend to dress and behave in a manner consistent with the gender they identify with, crossdressers tend to dress (and sometimes behave) in a manner consistent with stereotypical ideals of the opposite gender as opposed to the real-life behavior of that gender, and "drag queens" or "drag kings" tend to dress and behave in a flamboyant manner which parodies rather than emulates the opposite gender.

Transsexualism often manifests itself as a dysphoria toward one's biological birth sex, as well as conflict living in one's social role. If untreated, it can lead to mental and emotional problems, and sometimes, suicide. Dutch researcher Peggy Cohen-Kettenis estimates that 40% of untreated transsexual people are either institutionalized or die prematurely. However, with proper treatment, transsexual people often become fully functional members of society.^[1] The suicide statistics of treated transsexual people^[2] do not differ remarkably from non-transsexual populations.

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 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. The transition process can be highly traumatic and may involve the person being off work for a long period of time.^{[citation needed]}

To obtain sex reassignment therapy, transsexual people are usually required to receive psychological therapy and a diagnosis of gender identity disorder. Under the Harry Benjamin Standards of Care they are also required to live as members of their target sex for at least one year prior to surgery (so-called Real-Life Test or Real-Life Experience), although this time may be longer if the psychotherapist has concerns about the transsexual person's readiness. The intentions of the standard are to prevent people from transitioning when such a transition would be inappropriate (as a dramatic example, a person seeking to transition in order to veil their identity from police), or ill-advised (e.g., a strong crossdresser, who still identifies themselves as their assigned gender). These standards are open to the criticism of being ineffective, or being too strict, discouraging genuinely transsexual people from seeking treatment. It is claimed that Meta-reviews of post-operative transsexuals prior to 1991 reveal a rate of serious regrets of less than 1% for transsexual men and less than 2% for transsexual women, while studies published after 1991 have reported a decrease in the rates for both, likely due to improved psychological and surgical treatments.^[3]While such studies lend support for existing protocols concerning care of transsexuals, post-operative follow-up research is considered to be lacking. However a note on a report in the UK Guardian Newspaper states:

There is no conclusive evidence that sex change operations improve the lives of transsexuals, with many people remaining severely distressed and even suicidal after the operation, according to a medical review conducted exclusively for Guardian Weekend tomorrow.
The review of more than 100 international medical studies of post-operative transsexuals by the University of Birmingham's aggressive research intelligence facility (Arif) found no robust scientific evidence that gender reassignment surgery is clinically effective. [1]

Against the unreferenced note above of 1% and 2% the Report itself states:

Paradoxically, a growing number of post-operative transsexuals are scathing about their medical care. International research suggests that 3-18% of them come to regret switching gender. The Guardian Saturday July 31, 2004 [2]

Currently, the causes of transsexualism are unknown, and estimates of prevalence vary substantially.