One definition is that a transsexual (TS) is a person that is born with the anatomical body of one sex, but the brain of the opposite sex.  TS's fall into two categories: male to female or female to male. This marked difference between anatomical sex and brain structure has been shown in scientific studies of post mortems on TS's. That is to say that a MtoF TS has the primary sex characteristics of a male . but the brain is female. This physical makeup sets up a terrible conflict within a TS. In the case of a MtoF, the brain has been looking for estrogen all of it's life and has been given testosterone instead.

This awry body chemistry plays havoc with a TS's life. As soon as hormone therapy is started, the TS begins to experience a greater joy and peace, as the brain became 'bathed' in estrogen.

There is great debate about the cause of transsexualism. Is it a result of nature when the TS was in the womb or the result of the TS's nurturing and upbringing or some combination of 'nature' and 'nurture'? There is no solid answer. The American Psychiatric Association accepts it as a psychological disorder GID (Gender Identity Disorder) and there is no cure except to allow true TS's to transition to the perceived gender to the extent that the TS chooses.

All TS's face the difficult decision as to what path they should take. Therapy is the recommended first step, including the TS's family if possible. It is vitally important that the TS research therapists and find one that has experience with TS's and is not opposed to hormone therapy or surgery. If the therapist follows the Harry Benjamin Standards of Care, that is a good indication. It is also important for the TS to have  rapport with the therapist, so that the deeply buried feelings can be brought out and discussed in a safe environment. While the Standards may seem like so much red tape or hoops to jump through, they are promulgated to primarily protect the TS and secondarily, the medical professionals. It is important to note that as experience with TS's broadens, the Standards are updated to be more realistic. Two recent important changes are, first, the minimum time required for psychological therapy before starting hormone therapy has been reduced from twelve months to three months at the discretion of the therapist. Secondly, living full time in the desired gender is not absolutely required. If one's job is lost due to premature transitioning on the job, the Standards became problematic and meaningless.

For many TS's, the butterfly is our symbol. A TS was once a "caterpillar", but having found the true self, the TS is a "butterfly", finally free.

No matter what a TS chooses, every path is fraught with terrible difficulties. The choices run the spectrum from doing nothing (continuing to suppress one's female or male characteristics) to a full transition, including surgery so that the TS's body is congruent with the perceived gender.

Most TS's choose some degree of transition and in so doing run the very high risk of losing their families and their jobs. Yet, for the sake of inner peace, most of us choose some level of transition no matter what the cost. Some even pay with their lives as in the movie "Boys Don't Cry". Society's perceived "rules" of gender are very rigid, so bigotry against TS's is built in for most people, especially the religious right.. 

For society at large, gender and sex are synonymous, a black and white issue: either you are male with male sexual characteristics or you are female with female sexual characteristics. Anything that falls outside of this "norm", is suspect. It is also widely assumed that TS's sexual orientation is "suspect". In fact, it has been definitively shown that gender and sexual orientation are completely separate issues.

After psychological therapy, hormone therapy may be indicated. Medical supervision is strongly recommended and is required by the Standards of Care. However, some TS's choose to take hormones on their on without medical supervision. This can unknowingly endanger the health of the TS. Liver damage and cancer are just two of the potential problems. Plus, once started, changes in the body occur that are not irreversible (breast growth for the MtoF or, for FtoM,  body hair and voice tone that becomes more bass or male like). Then hormones are indicated for the remainder of the TS's life.

Surgery or SRS/GRS (Sex/Gender Reassignment Surgery) is the next step along the transition path. This is a step that each TS that desires surgery must study and consider thoroughly. Across the world, there are many surgeons performing SRS. Some require that the TS have followed the Standards of Care, others only care if you have enough money. Because SRS is such a drastic step, each TS should seriously consider the Standards of Care, if for no other reason than to be absolutely sure that she/he as a candidate for surgery is being honest with themselves. SRS is relatively straight forward for the MtoF TS, but significantly more difficult and expensive for the FtoM. In addition, there are other secondary cosmetic surgeries that can be elected to enhance the desired gender appearance.

During all of these physical changes, the TS is moving, one step a at a time, to living completely in the role of the desired gender. Key elements include: A) A legal name change, B) A subsequent gender change, C) The very difficult decision of  deciding whether and when to approach the employer. This can be chancy and scary, especially in light of today's job market. Employers simply do not have any policy regarding TS's. Many times he TS's supervisor or manager will fire the TS in a knee jerk reaction. It is best to work through Human Resources, if the employer is large enough to have a separate HR department. The best way of losing one's job is just to show up at work one day dressed in the desired gender. Larger employers are more apt to be receptive to the TS's desire to transition on the job for two reasons. First, many companies pride themselves on the diversity of their work force and a transitioned TS adds to that diversity. Second, they are concerned with discrimination law suits. Legislation regarding gender preference is lagging way behind the real world. Many activist organizations like It's Time America are working to get legislation passed that eliminates discrimination based on gender preference.

I approached my employer's HR department by first making an appointment convenient to the HR director, stressing that confidentiality was important. I went dressed in a nice man's suit and I started off by explaining to her that what she saw me as was a lie! I quickly explained that I was TS and what that means, showing her my three letters from my therapist, hormone doctor and primary care physician.. In addition, I showed her my new driver's license, stressing that my home state legally recognized me as a woman. I had been strongly advised not to ask what corporate policy on TS's was, but to instead politely and quietly ask how we could best facilitate my transitioning on the job from the man that I wasn't, but appeared to be to the woman I truly was. I also gave her a copy of "Transsexual Workers: An Employer's Guide". She was most receptive and promised to take it up with her manager. All of this moving up and down the corporate ladder, of course, took time. But six months later, with my employer's 100% backing, I was at my same factory job as a woman. My coworkers could not have been more gracious about it, whether they agreed with me or not.

"Transsexual Workers: An Employer's Guide" turned out to be such an important tool for HR, that I bought more copies for HR to give to my managers.

All in all, there is much to consider a person that thinks she/he may be TS. Taking one's time and being patient are key elements.