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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.

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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." 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.

However, these assertions are contested by the Transgender Health Program (THP) at Fenway Health in Boston.

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.

who desire to transition permanently to the gender with which they identify and who seek medical assistance (for example, SRS) 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).

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, e.g. transgender people may identify as heterosexual, homosexual, bisexual, asexual, etc., or may consider conventional sexual orientation labels inadequate or inapplicable.

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