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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.

Benjamin gave certifying letters to his MTF transsexual patients that stated "Their anatomical sex, that is to say, the body, is male.

Biologist Bruce Bagemihl writes ".point of reference for "heterosexual" or "homosexual" orientation in this nomenclature is solely the individual's genetic sex prior to reassignment (see for example, Blanchard et al.

1987[24], Coleman and Bockting, 1988[25], Blanchard, 1989[26]).

For them, their sex organs, the primary (testes) as well as the secondary (penis and others) are disgusting deformities that must be changed by the surgeon's knife.

but this view is controversial, and others argue that merely having some medical procedures does not have such far-reaching consequences as to put those who have them and those who have not (e.g.Transsexual people are sometimes referred to with directional terms, such as "female-to-male" for a transsexual man, abbreviated to "F2M", "FTM", and "F to M", or "male-to-female" for a transsexual woman, abbreviated "M2F", "MTF" and "M to F".Individuals who have undergone and completed sex reassignment surgery are sometimes referred to as transsexed individuals; however, the term transsexed is not to be confused with the term transsexual, which can also refer to individuals who have not yet undergone SRS, and whose anatomical sex (still) does not match their psychological sense of personal gender identity.These labels thereby ignore the individual’s personal sense of gender identity taking precedence over biological sex, rather than the other way around." Psychologist Stephen T.Wegener writes, "Langevin makes several concrete suggestions regarding the language used to describe sexual anomalies.

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