Often in older writings (pre ~1990s), but rarely today, the term transgender is used to refer to "non-op transsexuals" or "non-op trans people" who live as the gender opposite to their assigned gender at birth and though sexual reassignment surgery is possible, have chosen not to undergo it.

Another label or term used is ‘Pre-op transexual’, meaning that they have not engaged in surgery to change their genitals. Many people who are trans are comfortable with their genitalia, and do not believe that their sexual anatomy defines the gender of the person. This view is also very true for people who identify as non-binary.

There are also trans people who chose to live with the genitalia that is consistent with the gender that they identify as, (e.g. male = penis, female= vagina), and will choose to have gender reassignment therapy to change their genitalia.

Sometimes, the term transgender is used as an umbrella term to encompass all gender diversities.

Dave Wells has experienced a large divide between the way western health views ‘gender’ to how he views gender. From a ‘health perspective’ gender is associated to the male and female genitals. For example:

If a heterosexual identifying male (has penis), is in a relationship with a pre-op Trans woman (has penis), many health professionals would identify them as being in a homosexual relationship, due to both having penises.

Dave Wells allows for the individuals to identify their own relationship, however at the same time, Dave Wells would assume that they are in a heterosexual relationship because the gender identity that is being presented is that of a male and female.

‍Transgender as "in between"

‍Transgender is sometimes also used specifically in an "in-between" sense, rather than as an umbrella term. A newer related term is "gender queer", which refers to the mixing of qualities traditionally associated with "male" and "female," and can also refer to the "in-between" sense sometimes associated with transgender or transgenderism.

‍Transgender in non-Western cultures

‍This page describes primarily Western modes of transgenderism. Many other cultures have or have had similar phenomena:

• The so-called berdache in many Native American groups is recognized as a separate gender, a woman-living-man, not as a man who wants to be a woman. The term "berdache" is a misnomer, however, as no Native American group actually used the term; different ethnic groups had different names for the role, such as the winkte. The husband of such a person is not viewed as being gender-different themselves, but as a normal male. In some societies there is a corresponding gender for man-living-women (amazons).
• In Thai culture, there is the kathoey, who is very similar to the English definition of transgender, but is sometimes broader, including effeminate gay males more so than "transgender" does.
• South Asian cultures have hijra, usually genetic males who have been castrated and live as women.
• Chinese cultures have a wide variety of transgender modes of existence.