The term “transgender” is not a psychiatric diagnosis. It is used to refer to a person whose sex assigned at birth (usually based on the appearance of external genitalia) does not align with their gender identity (one’s psychological sense of their gender). Some people who identify as transgender do experience “gender dysphoria,” a DSM-5-TR psychiatric diagnosis that refers to the psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. Though gender dysphoria can sometimes begin in childhood, some people may not experience it until after puberty or much later.
There are many different ways that people who are transgender seek gender affirmation. This might simply involve a social transition (changing one’s name, pronouns or the kind of clothing they wear); a legal transition (e.g., changing gender markers on one’s government-issued documents); medical transition (e.g., pubertal suppression or gender-affirming hormones); and surgical transition (e.g., vaginoplasty, facial feminization surgery, breast augmentation, masculine chest reconstruction, etc.). Not all people who are transgender desire all domains of gender affirmation, as these are highly personal and individual decisions.