Transsexuality is a topic that has gained greater social visibility in recent years. However, this increased visibility has not always been accompanied by clear and accurate information. It is common to encounter concepts that are used as though they were interchangeable, contradictory messages in the media, or debates that generate more confusion than understanding.
We also see this in clinical practice. Some people seek therapy because they have questions about their own experiences; others are looking for support while navigating a gender transition; and sometimes family members need help understanding what a son, daughter, or partner is going through. Although every story is unique, they all share one common need: a safe space where they can talk openly, resolve their doubts, and feel heard without being judged.
From the perspectives of psychology and sexology, our role is not to tell anyone who they are or what decisions they should make. Our job is to provide support, offer information grounded in scientific evidence, and help each person better understand their own experience while addressing any difficulties that may arise throughout the process.
In this article, we explain what is currently meant by transsexuality, how this concept differs from other related terms, what scientific research tells us about the mental health of transgender people, and when psychological support may be beneficial.
What Does Transsexuality Mean and How Has the Term Evolved?
The way transsexuality is understood has changed significantly over the past few decades. This is not because transgender people are a new reality—they have existed throughout history and across many cultures—but because science has developed a better understanding of the diversity of sex and gender.
For much of the twentieth century, the term transsexuality was used to describe individuals whose gender identity did not correspond to the sex they were assigned at birth and who generally wished to undergo some form of medical transition, such as hormone therapy or gender-affirming surgery.
Over time, both scientific research and clinical practice have shown that this definition is too narrow. Not all transgender people wish to modify their bodies through medical treatments, and not everyone experiences their gender journey in the same way. As a result, terms such as trans people and transgender people are now more commonly used because they reflect a broader and more diverse reality that is less focused on medical interventions.
One of the most significant developments occurred in 2022, when the International Classification of Diseases (ICD-11), published by the World Health Organization (WHO), came fully into effect. In this classification, transsexuality was no longer listed as a mental disorder. Instead, the WHO introduced the diagnosis of gender incongruence, placing it within the chapter on sexual health.
This was more than a simple change in terminology. It reflects an increasingly broad scientific consensus that being transgender is not, in itself, a disease or a psychological disorder.
This does not mean that transgender people cannot experience psychological distress. As we will discuss later, some individuals experience significant discomfort related to their bodies or to the way they are perceived by society, while others develop anxiety or depressive symptoms as a result of rejection, discrimination, or a lack of social support. The distinction is important: the focus shifts away from a person’s identity and toward the circumstances that may affect their well-being.
In our clinical experience, this change has also transformed the way we support transgender individuals. Years ago, many people came to therapy fearing they would be considered “mentally ill” or that they would have to prove who they were to healthcare professionals. Today, the goal is different: to create a supportive environment where people can explore their questions, better understand what they are experiencing, and make informed decisions while respecting their own pace and autonomy.
Sex, Gender Identity, Gender Expression, and Sexual Orientation: Different Concepts
One of the most common misconceptions we encounter is the tendency to use these concepts as though they meant the same thing. In reality, they refer to different aspects of a person’s experience, and distinguishing between them is essential to avoid confusion.
In very simple terms, sex refers to the biological characteristics a person is born with; gender identity refers to a person’s internal sense of who they are; gender expression relates to the way someone expresses their gender socially; and sexual orientation describes the people to whom someone feels emotional or sexual attraction.
Understanding these distinctions helps dispel many common myths. For example, sexual orientation does not determine gender identity, and the way someone dresses or expresses themselves does not reveal how they identify.
We believe, however, that these topics deserve a more detailed explanation than we can provide in this article. For that reason, we have dedicated a separate article to explaining how these concepts relate to one another, what we mean by gender diversity, and what the transgender spectrum encompasses.
In this article, we prefer to focus on another issue that frequently raises questions in our work as psychologists and sexologists: how transgender people experience their journey and what scientific evidence tells us about their psychological well-being.
Trans Women, Trans Men, and Bodily Diversity
When discussing transsexuality, it is easy to adopt an overly simplified view without realizing it. People often imagine a single pathway: someone discovers their gender identity, begins hormone therapy, undergoes various medical procedures, and completes a transition. In reality, the experiences we see in clinical practice are far more diverse.
Some trans women and trans men wish to undergo a full medical transition. Others pursue only a social transition by changing their name, pronouns, or the way they wish to be addressed. Still others choose not to undergo any medical treatment because they do not feel it is necessary or because it does not form part of their personal life goals.
From a psychological perspective, it is important to understand that none of these choices is more valid than another. A person’s identity is not defined by their body, whether they receive hormone therapy, or whether they decide to undergo surgery. Every transition reflects different personal needs, life circumstances, and individual timelines.
In therapy, one of the beliefs we most often challenge is the idea that there is a “right” way to be transgender. Some people worry that they are “not trans enough” because they do not want certain medical interventions. Others believe they should have recognized their identity much earlier and feel guilty for having needed years to understand what they were experiencing.
Both scientific evidence and clinical experience consistently show that there is no single pathway. Some people are certain of their gender identity from early childhood, while others begin questioning it during adolescence or even adulthood. Likewise, some experience a strong desire to modify certain aspects of their bodies, whereas others achieve a sense of well-being without feeling the need to do so.
For this reason, we avoid imposing expectations about how a transition “should” unfold. Rather than directing the process, our goal is to support each individual in making informed decisions while respecting their own pace and personal needs.
Transsexuality and Gender Dysphoria: They Are Not Exactly the Same
One of the concepts that generates the greatest confusion is gender dysphoria. It is sometimes used as though it were synonymous with transsexuality, when in fact the two refer to different aspects of a person’s experience.
Transsexuality describes an experience related to gender identity. Gender dysphoria, by contrast, is a clinical concept that refers to the significant distress some individuals experience because of the incongruence between their gender identity and the sex they were assigned at birth.
The distinction may seem subtle, but it has important implications.
Not all transgender people experience gender dysphoria. Some describe profound distress related to specific physical characteristics or to the way they are perceived by others. Others, however, describe a general sense of discomfort or a lack of identification with the gender role expected of them, without experiencing clinically significant distress.
The opposite is also true: distress may decrease considerably when a person finds an accepting environment, begins the changes they consider necessary, or simply has a safe space where they can express their feelings without fear of judgment.
In clinical practice, we often explain that having doubts does not necessarily mean someone is experiencing gender dysphoria, just as experiencing distress does not automatically mean that a person should pursue a medical transition. Every situation requires an individual assessment that takes into account the person’s life history, family and social context, expectations, and the impact these experiences are having on their daily life.
From a psychological perspective, our work focuses on understanding what is causing the distress. Sometimes it is related to the person’s body; in other cases, it stems primarily from fear of rejection, social pressure, or difficulty expressing one’s identity. Distinguishing between these factors is essential for providing genuinely helpful support.
Research also shows that relief from distress does not depend solely on medical interventions. Family support, meaningful relationships, social acceptance, and access to knowledgeable professionals all play a crucial role in improving the psychological well-being of many transgender people.
For this reason, rather than asking whether someone is “trans enough,” we believe a far more helpful clinical question is: What does this person need in order to experience greater well-being and less suffering? That question often opens the door to a much more respectful and individualized approach to psychological support.
Mental Health and the Effects of Discrimination and Transphobia
One of the questions most frequently asked when discussing transsexuality is whether transgender people experience higher rates of mental health problems. As with many topics in psychology, the answer requires some nuance.
Scientific research shows that transgender people do, in fact, experience higher rates of anxiety, depression, self-harm, and suicidal ideation than the general population. However, current evidence consistently indicates that these difficulties are not caused by being transgender itself, but rather by the discrimination, rejection, and violence that many transgender people experience throughout their lives.
This phenomenon is well explained by the Minority Stress Model, which is strongly supported by psychological research. According to this model, belonging to a socially stigmatized group means being repeatedly exposed to additional sources of stress, such as fear of rejection, the need to conceal aspects of one’s identity, derogatory comments, workplace discrimination, barriers to accessing services, and experiences of violence.
When these stressors persist over time, it is understandable that the risk of developing anxiety, depression, or significant psychological distress increases. This is not because there is a mental disorder associated with gender identity, but because living in an unsafe or hostile environment has consequences for mental health.
We observe this regularly in clinical practice. Many people do not seek therapy because they are uncertain about who they are, but because they are exhausted from constantly having to explain themselves, anticipating negative reactions, or feeling they must remain vigilant in certain family, workplace, or social environments.
We also encounter very different experiences. Some people have supportive families from the beginning and are able to navigate their gender journey with greater confidence and emotional security. Others face significant rejection or endure long periods of misunderstanding. These differences often have a profound impact on emotional well-being.
For this reason, when discussing mental health, it is essential to look beyond the individual and consider the environment in which they live. Research consistently shows that family support, safe social relationships, and access to knowledgeable professionals are among the most important protective factors against psychological distress.
Gender-Affirmative Psychological Support
There is sometimes a common misconception that seeing a psychologist means someone will tell us who we are or what decisions we should make. Our experience is quite the opposite.
Gender-affirmative psychological support is based on a simple premise: gender diversity is part of human diversity and does not need to be corrected. The goal of therapy is neither to confirm nor to question a person’s identity, but to help them understand their experiences, reduce distress when it is present, and support them in making decisions that are consistent with their own needs and values.
In practice, this means creating a safe space where people can speak openly without fear of judgment. Some individuals arrive with many questions and few answers; others need support managing anxiety, strengthening their self-esteem, navigating family conflicts, or developing strategies for coping in environments where they do not feel safe. Every person’s journey is unique, and for that reason, psychological support must be individualized.
Within our team, we believe that psychological intervention is not about following a rigid protocol but about adapting to each person’s individual circumstances. Sometimes therapy focuses primarily on gender identity; at other times, gender identity plays only a minor role, and the main reason for seeking help is relationship difficulties, grief, low self-esteem, or an episode of anxiety—just as it might be for anyone else.
This approach also means respecting each person’s individual pace. Not everyone needs the same answers or reaches them at the same time. Having the opportunity to explore questions without external pressure and with reliable information is often one of the aspects people value most about the therapeutic process.
If you would like to learn more about this model of care, we invite you to read our article on LGBTQ+ Affirmative Psychology, where we explain its principles, objectives, and the scientific evidence that supports it.
When Can It Be Helpful to Seek Professional Support?
There is no single right moment to seek help. Some people consult a professional when they begin questioning aspects related to their identity; others do so when they already have a clearer understanding of themselves but need support in navigating the changes they are experiencing.
Psychological support can be particularly helpful when:
- questions arise that cause ongoing distress
- anxiety, sadness, or stress begin to interfere with daily life
- there is fear of rejection from family, social circles, or the workplace
- difficulties emerge within a romantic relationship or family relationships
- a person needs a space to reflect before making important decisions
- discrimination or previous experiences of rejection have affected self-esteem or emotional well-being
It is not necessary to wait until things become overwhelming before seeking professional support. In many cases, having a space to reflect, resolve questions, and feel accompanied can help prevent greater distress and support a calmer, more positive personal journey.
As psychologists and sexologists, we understand our work as respectful support based on scientific evidence and adapted to each person’s individual needs. We do not begin with predetermined answers, but rather with active listening and the belief that every person’s story deserves to be understood within its own context.
Conclusion
The way transsexuality is understood has evolved significantly over recent decades. Today, we know that being transgender is not a mental disorder and that most psychological difficulties described in research are related to the impact of rejection, discrimination, and lack of support rather than to gender identity itself.
Understanding this distinction is essential for providing high-quality psychological care. Beyond labels or social debates, behind every consultation there are people seeking to better understand themselves, reduce their suffering, or feel supported during an important moment in their lives.
Our team believes that psychology and sexology can play a valuable role when they are practiced through listening, respect, and scientific knowledge. Supporting someone does not mean directing them; it means offering a safe space where each person can explore their experiences, address their questions, and make decisions freely and with reliable information.
References
- World Health Organization. (2019). International Classification of Diseases (ICD-11). WHO.
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
- Gómez-Gil, E., Esteva de Antonio, I., Fernández Rodríguez, M., et al. (2020). New models of healthcare for transgender people in the Spanish Healthcare System: demands, controversies and reflections. Revista Española de Salud Pública.
- Ministry of Health / Carlos III Health Institute. (2024). Transaludes. Health in transgender and/or non-binary people in Spain.
About the author
Paola Obrador Pellicer
General Health Psychologist and sexologist · Registered B-1815
Paola Obrador Pellicer is a general health psychologist, sexologist and director of Instituto Psicología-Sexología Mallorca. She specialises in sex therapy, couples therapy, psychotrauma, EMDR and psycho-oncology.