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Sexual orientation

Gender, gender identity, and being transgender are distinct concepts from sexual orientation. Sexual orientation is an individual's enduring pattern of attraction, or lack thereof, to others (being straight, lesbian, gay, bisexual, asexual, etc.), whereas gender identity is a person's innate knowledge of their own gender (being a man, woman, non-binary, etc.). Transgender people can have any orientation, and generally use labels corresponding to their gender, rather than assigned sex at birth. For example, trans women who are exclusively attracted to other women commonly identify as lesbians, and trans men exclusively attracted to women would identify as straight. Many trans people describe their sexual orientation as queer, in addition to or instead of, other terms.

For much of the 20th century, transgender identity was conflated with homosexuality and transvestism. In earlier academic literature, sexologists used the labels homosexual and heterosexual transsexual to categorize transgender individuals' sexual orientation based on their birth sex. Critics consider these terms " heterosexist ", "archaic", and demeaning. Newer literature often uses terms such as attracted to men (androphilic), attracted to women (gynephilic), attracted to both (bisexual), or attracted to neither (asexual) to describe a person's sexual orientation without reference to their gender identity. Therapists are coming to understand the necessity of using terms with respect to their clients' gender identities and preferences.

The 2015 U.S. Transgender Survey reported that of the 27,715 transgender and non-binary respondents, 21% said queer best described their sexual orientation, 18% said pansexual, 16% said gay, lesbian, or same-gender-loving, 15% said straight, 14% said bisexual, and 10% said asexual. A 2019 Canadian survey of 2,873 trans and non-binary people found that 51% described their sexual orientation as queer, 13% as asexual, 28% as bisexual, 13% as gay, 15% as lesbian, 31% as pansexual, 8% as straight or heterosexual, 4% as two-spirit, and 9% as unsure or questioning. A 2009 study in Spain found that 90% of trans women patients reported being androphilic and 94% of trans men patients reported being gynephilic.