In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.

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The removal of a single dominant individual has been shown to trigger a sex change in some coral-reeffish. In the saddleback wrasse (Thalassoma duperrey), however, female-to-male sex change requires visual stimulation from smaller conspecifics. This change is not dependent on the sex or color of the stimulus fish and can be inhibited by larger conspecifics. On the reef, a female probably changes sex when the relative numbers of larger and smaller conspecifics change within her home range.