The word transsexual has a precise medical definition. It was defined by Harry Benjamin in his seminal book "The Transsexual Phenomenon". In particular he defined transsexuals on a scale called the "Benjamin Scale". Which defines a few different levels of intensity of transsexualism. Listed as "Transsexual (Nonsurgical)", "True Transsexual (moderate intensity)", and "True Transsexual (high intensity)". Many transsexuals believe that to be a true transsexual one needs to have a desire for surgery. However it is notable that Benjamin's moderate intensity "true transsexual" needs estrogen medication as a "substitute for or preliminary to operation. "Therefore the desire for SRS is not what scientifically determines if one is transsexual or not. What defines someone as transsexual is that living in the gender role assigned at birth causes psychological distress.
The two terms of sex and gender have become popularly used as one concept, which blurs distinction, but they have different meanings. Physical sex refers more to one's biology and anatomy (that is, male or female) where gender is a more socio-cultural term of how a person presents or is taken (that is more at man or woman, or "like" a male or female" (see Milton Diamond, Ph.D. 2001 or U.S.S.C. Justice Antonin Scalia saying "The word gender has acquired the new and useful connotation of cultural or attitudinal characteristics (as opposed to physical characteristics) distinctive to the sexes. That is to say, gender is to sex as feminine is to female and masculine is to male.")
When genital surgery is undertaken it is commonly referred to as sex reassignment surgery or genital reconstructive surgery or even gender reassignment surgery by some 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. 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, transgenderists 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 physical disability, a condition, trait, disease, behavior, desire, mental illness, perversion, paraphilia, political identity, and lifestyle. The term perversion is 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 such a grouping 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, where some of the beliefs of modern day transsexual people that they are not transgender, is reflective of this historical division (Denny 176), other transsexual people state that someone choosing to retain their former physical sex (no SRS) is very different from someone who needs to be of "the other sex", that the groups have different issues and concerns and are not doing the same things. The latter view is rather contested, with opponents pointing out that merely having or not having some medical procedures hardly can have such far-reaching consequences as to put those who have them and those who have not into such distinctive categories. Notably Harry Benjamin's original definition of Transsexual does not require that they need to have had SRS
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