Medical transition is not the only option available to trans* people. No choice is an invalid choice, and each step is its own decision.  The only rule is that you do what you personally need to do in order to be at peace with yourself.

Not everyone feels comfortable within a strict binary of "male" / "female." Some willfully reject such a binary in defining their own identity, or object to gender stereotypes.

Gender neutral pronouns are increasingly common. They can include sie / xe / ze (usually pronounced "ze") and hir / zir (usually pronounced "heer"), and an honorific that is increasing in usage is "Mx." Other people prefer to simply use a singular "they" to describe themselves.

Likewise, terminology can vary, and terms often have very specific meanings or nuances associated with them. Some terms are discussed in the media page, but that is not meant to be a fully comprehensive list.

Intersex

Intersex is sometimes included as a trans* categorization, but actually refers to a number of birth conditions in which gender variance can occur. This might include physical variance in gender characteristics, chromosomal differences or other situations, in such conditions as Androgen Insensitivity Syndrome, Congenital Adrenal Hyperplasia, Klinefelter's Syndrome and many more. As we learn more about possible biological origins of transsexuality, it may be possible that trans* is a smaller part of intersex phenomena (and not the other way around), but it should be understood that not everyone who is intersex is transgender. It may depend on if a surgical assignation of gender occurred at birth, and / or whether the gender one lives or was assigned to is consistent with their identity.

The AlbertaTrans.org website asserts the following positions:

• that the practice of assigning gender to intersex infants at birth urgently needs to cease, because of the life-long damage that it causes for those intersex children who become assigned to a gender that they later do not identify with,
• that intersex children should have a right to choose their gender and expression, and that choice may sometimes be somewhere in between expectations of "male" and "female" if that is where they understand that they belong.
• that intersex people, like transgender people, deserve respect and understanding, and all the rights ascribed to anyone else.
• that intersex people who are assigned to a gender to which they do not identify should have the right to correct this through gender reassignment, hormones or other corrective treatments if desired (again remembering that their aim may sometimes be somewhere in between expectations of "male" and "female" if that is where they understand that they belong), and that these need to be recognized as medically-necessary procedures.

Two Spirit

The term "Two-Spirit is also sometimes wrongly included as a trans* variation. This is an incorrect misappropriation of an important cultural concept. "Two-Spirit" refers to a collection of Aboriginal traditions (some of which have been since lost by the subversion of Native culture through westernization, Christianization and even genocide) that allow for gender-diverse expression and sexuality, covering the full range of gay, lesbian, bisexual and transgender persons, as well as intersex and other gender-variant people. Traditions varied greatly among different tribes ("two-spirit" is a blanket term created in 1990 to encompass a wide range of beliefs among Native peoples, to replace the derogatory "berdache" that has been used in historical texts), and that a few tribes may not have had two-spirit understanding.

Two-spirit tradition existed freely in North America as late as 1930 (with the Klamath in the Pacific Northwest), before being driven into hiding or shame by the changes that crept across North and Central America over the past two centuries of colonization.

The sensational nature of reports of Two-Spirit peoples and the hatred they contained were used to try to justify genocide, theft of land and the dismantling of Native culture and religion. In Panama, explorer Vasco Nunez de Balboa threw a King and forty others of a Native tribe to be eaten by his dogs, because they crossdressed or had same-sex partners. Spaniards committed similar genocides in the Antilles and Louisiana. It is partly for this reason that some Native peoples and organizations are afraid to re-embrace two-spirit understanding.

The term "two-spirit" comes from the Ojibwa words niizh manidoowag (two-spirits). It is chosen as a means to distance Native/First Nations people from non-Natives, as well as from the words "berdache" and "gay." (The older term of "berdache" had been French in origin, and is derived from Arabic and Eastern words meaning "kept boy" or "male prostitute.") Two-spirit traditions were most notable among the Lakota, Ojibwa, Blackfoot, Cheyenne, Mojave, Navajo and Cree tribes, but certainly not limited to them. Two-spirited childrens' gender could be determined at puberty, based on their inclination toward masculine or feminine activities, and often accompanied by visions.

In the last century, modern Christianity had "evangelized," indoctrinated and destroyed many Native traditions, and two-spirit people are only now just re-emerging from homophobic and racialized stigmas.