Many individuals pursue hormone therapy to achieve secondary sex characteristics, such as changes in skin texture, body fat distribution, and hair patterns. These medical tools have historically provided trans people with the means to express their identity more fully.

The experience of transgender individuals varies significantly by culture. In some regions, there is a long history of recognized third-gender roles, while in others, the struggle for legal recognition and safety remains a primary focus of the community.

From the early 20th century through the postwar era, medical advancements allowed for greater access to gender-affirming care. This included the development of hormone replacement therapy and various surgical procedures that allowed individuals to align their physical appearance with their gender identity.

While the terms mentioned previously were once used more broadly, the transgender community has largely moved toward more respectful language. Terms like "transgender woman" or "trans woman" are now the standard, emphasizing the person's gender identity rather than their physical attributes or their role in media.

Often appearing alongside the term "shemale" is "futanari," a Japanese term referring to a hermaphrodite character often found in anime and manga. This fictional concept is frequently blended with real-world transgender adult content.