DEFINITION, HISTORY & TERMINOLOGY
A suggestion for those consulting medical professionals is not to believe everything you hear: doctors may not have most up-to-date information. We recommend listening to the doctors, (since they know how the human body works) but don’t assume they can’t make mistakes - after all they are only human. It is advisable to visit an endocrinologist and give him or her up-to-date information about HBS. In this way you will be opening the door and giving him/her the means to allow for more objective treatment. A psychological follow up is very useful for a proper diagnosis of this condition, but should NOT be a mandated requirement for long-term treatment after the initial diagnosis is determined.
In most cases, it is impossible to give a definitive diagnosis before late infancy or pre-adolescence, although countries like the Netherlands are very advanced in diagnosing and treating this syndrome. Thanks to the hard work of Prof. Peggy T. Cohen-Kettenis, people living in the Netherlands are able to start treatment before they reach puberty.  In Spain, although there are HBS specialists in many communities, there is a facility in one of Andalucia's Hospitals that caters to transsexual patients and treats them as medical patients (at this printing we do not have its exact address).
It’s an important reminder that HBS is a physiological condition and not simply a “psychiatric” condition - even though the help of a psychologist can be very useful, especially to younger patients and their families. The treatment of HBS includes HRT and SAS. You should always start by first visiting a therapist for evaluation, then an endocrinologist for hormonal treatment (during what is referred to as the Real Life Test (RLT) period) before consulting with a surgeon.

 
                     From Transsexualism to HBS
The term “transsexualism” was first introduced by Magnus Hirschfeld in 1923, who described the condition as "psychic transsexuality." Hirschfeld considered transsexualism to be a form of intersex. Hirschfeld also delivered the first scientific lecture on transsexualism in his address to the Association for Advancement of Psychotherapy in 1930. His original contention linked it to a “form ofhomosexuality.” In the 1940‘s, David Cauldwell described HBS as "psychopathia transexualis". It wasn't until the early 1950's when transsexualism was openly introduced to the medical community by Dr. Harry Benjamin, author of, “The Transsexual Phenomenon”, a pioneer whose research led to HBS and who supported a biological explanation, as did Hirschfeld’s. In those early years, there was a great need to differentiate this condition from transvestism and homosexuality, which the term “transsexualism” seemed to adequately fill. There were still many scientific “unknowns” surrounding this condition, but it did begin to get some serious medical attention, and for the first time transsexuals started to get the medical care they needed.
Hirschfeld’s opinion that transsexualism was an element of homosexuality never was reconsidered and only with the advent of others research and treatment was the condition recognized more clearly as one with a biological cause or more simply put - a birth anomaly. 
However, while Hirschfeld considered transsexualism to be a kind of "third sex" and while he was an active defender of homosexual rights (for which he is still honored to this day), it was Harry Benjamin who concluded that HBS was a physical condition. Dr. Benjamin determined that HBS patients needed endocrinological rehabilitation to bring the phenotype into accord with the dominant brain sexual identity. Dr. Benjamin also paved the way with the international medical community for a better understanding and recognition of the physiological basis of transsexualism.
Without his deep caring for thousands of patients, his involvement in academic and professional organizations, and his numerous talks and writings, these treatments might not have become as accessible as they are today. As Dr. Benjamin identified transsexualism as a discrete physiological condition, and as his professional biography is strongly attached to this condition in contemporary medical history, HBS now bears his name in his honor.
Prior to Dr. Benjamin’s work, transsexualism had been seen as a psychiatric state of mind in which a person felt he or she was the opposite physical sex. This state was seen as merely psychological, or even as completely unexplainable. (See as example Cauldwell's somewhat dated work: Psychopathia Transexualis, 1949.) However, given the in-depth research of the last two decades and the knowledge that HBS is a biological phenomenon, even the term transsexualism has become inadequate to describe our current understanding of this condition. 
Simply stated, HBS deals with neurological patterns. Transsexual people - people with HBS - already possess the brain sex of the gender they belong to. Studies conclude that the sex of the brain is what determines sexual identity – the “real” sex of a person.  Therefore, somebody born with HBS is already a “real” member of opposite sex despite physical appearances. The fact is that the neurological patterns of their brain contradict their genital sex. The term transsexual becomes obsolete once surgery has corrected the physical mis-match.
Some long-established "mental" disorders (such as Parkinson's and Alzheimer's disease, schizophrenia and bipolar disorder) are no longer seen as "mental" disorders, but as disorders with a physiological etiology. Likewise, HBS (formerly Transsexualism) is now regarded by the world's leading experts as another of the many biological variations that occur in human sexual development.  The term transsexualism now refers to an intersex condition in which the brain sex doesn't match the genital sex. Consequently we can't speak about transsexualism (modern HBS) as a sexual orientation or as a feature of personality, but only as a physiological condition that requires early diagnosis and subsequent treatment.
The old meaning of the term transsexualism urgently needs to be discarded, and with it the old superstitions and prejudices of the past. There has been too much negativity and social stigma associated with its use, as well as decades of media abuse. Apart from its inadequacy to describe the full implications of HBS, the endless sensationalism and misinformation about the subject propagated by the mass media must be stopped. Harry Benjamin's Syndrome will then finally be able to come into the daylight and be dealt with as the medical condition it is - as it should have been from the earliest moments of medical awareness and care.

 
                      Problems of Terminology 
Terminology is another challenge people with HBS face. As for any group, terminology defines who we are and how we are seen by society. It’s about identity: what we call ourselves and how we introduce ourselves to others.

 To achieve full social integration,we need to affirm our identity as a unique group and in doing so, terminology becomes a key factor.
Nowadays too many obsolete and inadequate terms are used to refer to HBS and the people suffering from it. Although acceptable in the past, today these old terms have been superseded by more accurate medical terminology. HBS is seen as distinct condition unrelated to sexual orientation, fetishism and other sexualized behaviors to which it has no causal relationship. And although certain individuals may feel it is within their rights to “identify” with specific groups, or with any number of terms that appeal to them in the moment, such usage may be incorrect and even damaging in the long run. It definitely creates confusion for the general population - as we constantly see in media articles and publications related to Harry Benjamin's Syndrome.
This serious issue doesn't usually occur with any other medical condition. Improper and overly casual use of similar-sounding terms removes the necessary focus of the HBS individual and condition from scientifically grounded fact to facetious and prurient behaviors. Such careless use of outmoded and inadequate terms is therefore irresponsible and directly harmful to others.

 
So, let us look at the terms:
a. Harry Benjamin Syndrome (HBS)
HBS is named after Dr Harry Benjamin, a physician and a pioneer researcher into the condition now named after him. More than any other, his contributions shaped our current understanding and the recognition of HBS as a biological phenomenon by the contemporary medical community. His name is also honored by the Harry Benjamin International Gender Dysphoria Association (HBIGDA), that publishes the widely followed Standards of Care for people with HBS. We firmly disagree with many of the standards now being proposed by those who have 'taken over' HBIGDA and converted it into a transgender 'mix and match' inclusionary grouping catering to the transgender elements...WAPTH, all the while ignoring those born with HBS.
Although known in the past by a variety of names, the term “HBS” is finding increasingly popular acceptance and usage among both medical professionals and affected individuals. The term “HBS” is preferred because it lacks the misleading connotations, the outright inaccuracies and the stigma that some of the older terms possess.

 
b. Transsexualism/Transsexual
The most well known term for HBS is transsexualism which was coined by sexologist Magnus Hirschfeld in the 1920's. Unfortunately, there are several problems with its popular usage. The inclusion of "sex" within the word has attracted undesirable attention, and the word now carries a strong connotation to sexual orientation that simply does not exist. Also, it's similarity to "transvestism" - another completely unrelated phenomenon - is superficial and causes much confusion. Neither of the preceding terms have much in common with HBS men or women, who were born with a biological anomaly, and who are extremely distressed about it.
Labeling people born with HBS carries a negative stigma. Calling people “transsexuals” implies that they are “other”, and is thus dehumanizing. Individuals with HBS are human beings who happen to have a specific medical problem; it is not their identity, and they are not specimens of the condition. Used as adjectives, such terms are not much better: "transman" and "transwoman" too easily shift into "transsexual," which is then interpreted as "pretend" or "in flux".  For some reason, these terms perpetuate confusion about whether the appropriate gender of any particular individual is "male" or "female".
After being raised in an inappropriate gender role and having been through so much emotional confusion in the past, what is needed for a person HBS born is to achieve a supportive psychological and physiological balance. He or she needs to affirm the mental identity, correct the physical anomaly, and leave all the "ambiguities" in the past. It is cruel to force a person to carry the label of "transsexual" for the rest of his or her life, making it part of his or her identity. A person born with HBS is not continually changing sexes, is not involved in a never-ending transition, nor are they “living between” both sexes. And this is what such labels overtly and covertly imply.
When we call someone "a transsexual", we are claiming that his or her "current sex" is not his or her "true original sex". It doesn't matter what their “surgical status” is, how he or she looks, or whether they are happy with their life. The label brings back all the pain and shame of the past - the memories and “scars” of his or her perceived sex at birth and the difficult "transition period". The personal and social stigma attached to the word is also a source of uncomfortable feelings because it is attached to the individual’s past identity. The label becomes the identity of the person who then believes him or herself to be "a transsexual" instead of just a man or a woman. Moreover, this particular label is inaccurate because the nature of HBS is not transsexuality, but the biologically based intersex condition, which is possible to correct completely.

 
Dr. Harry Benjamin wrote:
 “… The term transsexualism may prove to be inappropriate
if it should ever be shown that an anatomically normal male
transsexual might actually be a genetic female, or at least not
a genetically normal male. In such event, we would be dealing
with a transgenital desire instead of a transsexual."

Obviously by "transgenital" Benjamin is referring to a form of intersexuality, which HBS contends with as well. Recent research (Vilain, 2003) points out how this genetic differentiation was suggested by Benjamin many years before. Neurological-sexual differentiation is indicated as a biological marker in persons with HBS and as inclusion in the intersex classification (Kruijver et al., 2000).
If we look in dictionaries for the word "transsexual" we find the following definitions:
"…a person who has undergone a sex change operation,"
"…a person whose sexual identification is entirely with the opposite sex,"
"…overwhelmingly desirous of being, or completely identifying with, the opposite sex".
Many people living with HBS find the term transsexual to be exceedingly awkward and uncomfortable for contemporary use, as do many others who refer to them. And so - as time goes on, we'll watch as this old and stigmatized term slides into disuse among the knowledgeable and the enlightened.

 
c. Transsexuality
There is a great stigma associated with transsexuality - it is often considered a "lifestyle choice" or, for some, even a kind of "expansion" of one's personality. The term transsexuality itself as currently used reinforces this so deeply held stigma about HBS. That's why the findings of biological markers in conjunction with the update in terminology are so liberating.
Transsexuality is a natural phenomenon in the animal kingdom and it is there that the label may still be pertinent. But it is not relevant to use this same terminology in reference to persons. Human beings are not able to 'trans' sex in a "natural" way, and of course it is not a choice that animals make either. People with HBS do not change sex - they don't “become” the opposite sex - they already are the gender determined by their brain sex structure. Brain structure is already how it should be, and it cannot be changed or "trans-gendered". The only appropriate correction is physical correction to bring into conformity the body sex to the brain sex.

 
d. Gender Identity Disorder
The other common terms Gender Identity Disorder (GID) and Gender Dysphoria, although sounding suitably clinical, assume that some individuals with HBS have a psychiatric condition. This is not the case at all; Harry Benjamin's Syndrome is purely a physical problem (leaving aside of course the social and psychological effects resulting from the condition itself). While psychological evaluation is useful in diagnosis, attempts to alter the patient’s mental gender to match their bodies have been spectacularly unsuccessful. Falsely implying that people with HBS are mentally ill or deluded borders on malpractice. Such treatments often result in demonstrable harm to the patient. As a biological condition, HBS is wrongly included in the diagnosis of Gender Identity Disorder.

 
e. Transgender
"Transgender" is a term that has become popular recently as an all-inclusive umbrella term for a wide variety of groups, especially among the gay, lesbian and fetish communities. This is not a positive development. It is far too broad a category (a social non-biological construct) to describe a number of gender variant elements, and it implies a relationship that does not exist. It is using one perceived attribute of people in a specific group to define and describe an individual – in other words, it is a term loaded with prejudice and stereotype that frequently does not apply to a specific individual. It was not coined as a medical description but simply as a masking term; it was also intended to separate more clearly transvestites and other gender variants from the condition more widely known then medically as transsexualism. The term trans-gender was actually promoted by a full time transvestite to mask many behaviors of others much like himself with an identity term most fitting for those moving in and out of gender variances.

f. SAS vs. SRS/GRS
Similarly, the term Sex Affirmation Surgery (SAS) is preferable to some than the older and/or inapplicable alternatives of Sex Reassignment Surgery (SRS), Gender Reassignment Surgery or Genital Reconstructive Surgery (GRS) to describe the surgical procedure used to help correct the anatomies of people with HBS. There is certainly no “reassignment” involved, as it only corrects the external aspect of physical sex. We therefore assert that our sex is affirmed via SAS. The sex of the brain is already as it was designed to be, and Hormone Replacement Therapy (HRT) corrects many other characteristics. For HBS patients, HRT alone can even allow for some adjustment of the secondary sex characteristics and for the body to come into harmony with the brain (although not to the extent achieved through competent surgical intervention).
Other terms for HBS are also used, but are mostly pejoratives or sleazy references that aren't worth dealing with here.