These problems are alleviated by a change of gender role and/or physical characteristics.Many transgender and transsexual activists, and many caregivers, note that these problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-variant individuals. Some transsexual people reject the counseling that is recommended by the Standards of Care because they do not consider their gender identity to be a cause of psychological problems. Brown and Rounsley noted that "some transsexual people acquiesce to legal and medical expectations in order to gain rights granted through the medical/psychological hierarchy." Legal needs, such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually difficult to obtain without a doctor or therapists approval. Because of this, some transsexual people feel coerced into affirming outdated concepts of gender to overcome simple legal and medical hurdles. Regrets and detransitions
People who undergo sex reassignment surgery can develop regret for the procedure later in life, largely predicted by a lack of support from family or peers, with data from the 1990s suggesting a rate of 3.8%. In a 2001 study of 232 MTF patients who underwent GRS, none of the patients reported complete regret and only 6% reported partial or occasional regrets.
The terms gender dysphoria and gender identity disorder were not used until the 1970s, when Laub and Fisk published several works on transsexualism using these terms. "Transsexualism" was replaced in the DSM-IV by "gender identity disorder in adolescents and adults". Male-to-female transsexualism has sometimes been called "Harry Benjamins syndrome" after the endocrinologist who pioneered the study of dysphoria. As the present-day medical study of gender variance is much broader than Benjamins early description, there is greater understanding of its aspects, and use of the term Harry Benjamins syndrome has been criticized for delegitimizing gender-variant people with different experiences. Sexual orientation
Since the middle of the 20th century, homosexual transsexual and related terms were used to label individuals sexual orientation based on their birth sex. Many sources criticize this choice of wording as confusing, "heterosexist", "archaic", and demeaning because it labels people by sex assigned at birth instead of their gender identity. Sexologist John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women. He says that he now tries to choose his words more sensitively. Sexologist Charles Allen Moser is likewise critical of the terminology. Sociomedical scientist Rebecca Jordan-Young challenges researchers like Simon LeVay, J. Michael Bailey, and Martin Lalumiere, who she says "have completely failed to appreciate the implications of alternative ways of framing sexual orientation. "The terms androphilia and gynephilia to describe a persons sexual orientation without reference to their gender identity were proposed and popularized by psychologist Ron Langevin in the 1980s.