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In 1923, Hirschfeld introduced the (German) term "Transsexualismus", Benjamin went on to popularize the term in his 1966 book, The Transsexual Phenomenon, in which he described transsexual people on a scale (later called the "Benjamin scale") of three levels of intensity: "Transsexual (nonsurgical)", "Transsexual (moderate intensity)", and "Transsexual (high intensity)".
Benjamin gave certifying letters to his MTF transsexual patients that stated "Their anatomical sex, that is to say, the body, is male.
Their psychological sex, that is to say, the mind, is female." After 1967 Benjamin abandoned his early terminology and adopted that of "gender identity." and some people who pursue medical assistance (for example, sex reassignment surgery) to change their sexual characteristics to match their gender identity prefer the designation transsexual and reject transgender.
Transsexuality was included for the first time in the DSM-III in 1980 and again in the DSM-III-R in 1987, where it was located under Disorders Usually First Evident in Infancy, Childhood or Adolescence.
Beyond Benjamin's work, which focused on male-to-female transsexual people, there are cases of the female to male transsexual, for whom genital surgery may not be practical.
Transsexual people experience a gender identity that is inconsistent with, or not culturally associated with, their assigned sex, and desire to permanently transition to the gender with which they identify, usually seeking medical assistance (including hormone replacement therapy and other sex reassignment therapies) to help them align their body with their identified sex or gender.