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Also see Trans Equals Gay for common misconceptions. Ambiguous Gender Identity is a trope for characters who may or may not be transgender. Despite the trope name, it is very important to note that the currently preferred term is transgender, not transsexual.The language around trans discourse changes very rapidly, due to being de-pathologised and re-written by trans people themselves instead of by outside onlookers.Now for some definitions of the terminology involved: Portrayals of trans people range between Acceptable Targets and Once Acceptable Targets.
There's a general craving by most of the trans community for more representation of them as just regular people — just like not every female character's story has to be about battling sexism or traditional gender roles, some trans people too would like to see themselves depicted in all traditional narratives.
As a matter of fact, there is still a lot that isn't understood, and because research on the subject is always yielding new discoveries in relatively quick succession, in addition to shifting societal norms and growing understanding that even biology isn't as cut-and-dry as it once was thought to be.
It's best to keep an open mind as previously rigidly held, commonplace ideas are challenged.
The demarcation between gender, sex, gender expression and orientation is also subject to constant historical and cultural shifts in perspective — the realisation that these are different things with only some overlapping points is slowly seeping into our modern narratives.
This should be kept in mind with context to older media and stories from foreign cultures.
Others don't pursue medical treatment for various reasons — for example, because they don't experience discomfort, because transitioning socially is enough for them, or because no available medical options fit their gender.