According to statistics for 2020, about 46% of the lesbian, gay, and bisexual community do not disclose their sexual orientation to medical professionals, and 18% of transgender patients avoid seeking medical help for fear of social rejection of gender transition [1]. However, at least 1/100 of the UK population identify themselves as transgenders [2]. It should be noted that the acceptance of gender identity by society enhances the subjective sense of well-being and increases self-esteem [3].

With the development of a child at different stages of maturation, changes in gender identity and its variability are possible [4]. The formation of gender identity occurs at the intersection of biological sex, upbringing, and cultural environment [5]. Masculinity and femininity are gradually formed into an internal structure (personal) with due consideration of the external (social) structure [6]. The formed gender role includes ways of behaving in interpersonal relationships depending on the status in society, which corresponds to certain norms, prescriptions, and expectations. This is a system of social standards and stereotypes that a person must meet in order to be recognized as a male or female [7]. Assigning a person to a group of a certain biological sex affects many aspects of a person's daily life. Health-related beliefs and behaviors, for example, have gender differences. The study by Courtena notes that the concept of masculinity in the field of health does not imply preventive seeking for medical help, which increases the risks for men's health [8]. Therefore, gender concepts formed through the motivational and self-regulatory mechanisms can model gender behavior [9]. As a result, constructs of masculinity and femininity can be perceived as stereotyped limitations. These constructs demonstrate different beliefs inherent in a particular culture, often exaggerating existing differences [4]. Biological sex can be considered by transgender people as a label, a reason for condemning certain behavior that does not correspond to social norms [10]. The "blurring" of gender roles in the modern world, where the traditional division of labor and financial status between the genders has become less clear, should be noted. The possibilities of reproductive medicine have made the choice of gender expression much wider [3]. Gradually, the ideas about male and female become more indefinite, although earlier they were clearly distinguished. It was believed, for example, by default, that action and strength were mainly characteristic of masculinity, and passivity and weakness – of femininity. When perceiving information and communication, people still use the filters "male" and "female". A more "masculine" face is perceived by study participants as colder and more competent than a face with "feminine" features. Participants in the study by Walker and Wänke in most cases changed the description of the impression made by an atypical person with an androgynous face when they recognized the person’s gender [11].

Many studies have noted that the problem of binary choice underlies transsexualism. Distress between the experienced and desired gender is caused not only by the discrepancy between anatomical features but also by the privileges and opportunities of the acquired, consciously chosen gender, which are felt as inaccessible in the actual biological sex [1]. In persons with transsexualism, feminine and masculine images are polar in the value system. They often value the qualities corresponding to the desired gender higher than the qualities corresponding to the biological sex [12]. The desire to look like a representative of a certain gender indicates that social structures are perceived as stronger constructs than personal ones [13].

This research is aimed at comparative studying of the formed images of sexual self-consciousness in persons who applied to specialists for permission to have gender reassignment.

This research involved 80 people; the average age of the participants was 22.25±3.8 years. Groups of transsexuals were examined on the basis of the Moscow Research Institute of Psychiatry of the Ministry of Health of the Russian Federation, Department of Sexopathology, as well as privately. In accordance with the research purpose, the sample was divided into four groups of 20 people: a group of transsexuals – biological women (first group, FTS); a group of biological women whose gender identity matched the biological sex (second group, F); a group of transsexuals – biological men (third group, MTS); a group of biological men whose gender identity matched the biological sex (fourth group, M). When forming the research groups, the primacy of the formation of gender dysphoria was considered, and not the consequence of the deterioration of the mental state. The results were processed using the programs Statistica 8.0 and Microsoft Office Excel. The Mann-Whitney U test was used to analyze the results.

The following methods were used: the Bem Sex-Role Inventory (BSRI) by Sandra Bem (1974, adapted by Kletsina in 2003) [7], the self-attitude questionnaire by Stolin (developed by Stolin and Panteleev in 1985) [14, 15], and the questionnaire by Kustova based on the method of personal semantic differential (1998) [7].

Gender roles were studied using the BSRI.

These results were obtained by calculating the IS coefficient, which was computed by a formula that specified only the selected male and female traits. Table 1 shows that groups II and IV of apparently healthy women and men demonstrated a greater number of androgynous (mixed) roles than groups of persons with transsexualism. Each group, in addition to androgynous roles, included roles corresponding to their psychological gender. Only group II of conditionally healthy women included a representative of a role that did not correspond to their psychological affiliation, which should coincide with the biological sex.

Table 2 shows that the collective image of the "ideal woman" of group I (FTS) turned out to be more beautiful, smarter, and freer than the "ideal woman" image in the representation of group II (F). Love for children was considered a significant characteristic of the image of the "ideal woman" in group II, in contrast to group I.

The data obtained (Table 3) demonstrated that a significant difference was found between such characteristics as "analytical/ figurative thinking" and "love for children". Therefore, the "ideal man" of the first group (FTS) should have a greater degree of imaginative thinking and a lesser degree of love for children compared to the image of the "ideal man" of the second group (F).

Statistically significant differences between the self-image of group II (F) and their representation of the "ideal woman" (Table 4) were found by the following parameters: "beauty", "earnings", and "cooking skills". Women of group II (F) believed that these were the parameters by which they did not reach the level of the "ideal woman".

During the research, the largest number of significant differences was revealed between the formed "ideal" gender-role image and the image that described self-perception (Table 5). It should be mentioned that group I (FTS) endowed the image of the "ideal woman" with pronounced characteristics perceived by society as feminine (likeable, beautiful, charming, benevolent, and trusting).

The data obtained (Table 6) demonstrate that the discrepancy between self-perception and the "ideal" image of the gender-role model, which the participants strived to correspond to, was less. The self-image of the group of transsexual biological females corresponded more to the image of the "ideal man" than to the "ideal woman"; however, they perceived it as more difficult to achieve than the "ideal" image of the female comparison group.

Participants in group III (MTS) considered that the "ideal woman" should be more passive, have imaginative thinking, show more sympathy, and be more emotional and unpredictable (Table 7).

The group of male biological transsexuals (Table 8) considered that the "ideal man" was more timid, closed, trusting, emotional, and unreliable than that of the comparison group.

In the male comparison group, the discrepancies between the self-image and the image of the "ideal man" differed according to 12 criteria (Table 9). Males considered that the "ideal man" should be more enthusiastic, more trustworthy, smarter, more confident, more active, emotionally more discreet, more organized, more reliable, more athletic, be a stronger personality, have a higher social status, and earn more.

The self-image and the image of the "ideal man" in the group of transsexuals with male biological sex (Table 10) had statistically significant differences only by 6 criteria. That is, the "ideal man" is more active, independent, more competitive, more distrustful, earns more, and is happier than the self-image of this group.

The self-image and the image of the "ideal woman" of group III differed in 12 criteria (Table 11). In order to achieve the ideal of their chosen gender identity, they must be more likeable, more beautiful, more charming, enthusiastic, trustworthy, rely on someone's help, have a higher social status, a wide range of interests, dress better, earn more, be happier, and be unpredictable.

When comparing the image of the "ideal man" (Table 12) of group I (MTS) and group IV (M), it should be mentioned that the group of transsexual biological females highlighted physical attractiveness, the use of profane vocabulary, indifference, unreliability, betrayal of a permanent partner, and dislike for children when compared with the comparison group. This allows defining a hypothetical psychotherapeutic target for interpersonal relationships and attachment.

The image of the "ideal woman" of the group of male transsexuals (Table 13) turned out to be more feminine: spontaneous, emotional, with imaginative thinking.

Features of self-attitude were analyzed using a questionnaire developed by Stolin.

Statistically significant results of the self-attitude questionnaire by Stolin (Table 14) demonstrate that such aspects as self-respect, autosympathy, expected attitude from others, self-acceptance, self-guidance, self-interest, and self-understanding were higher in the female comparison group (group II). Female transsexuals from group I had a higher rate of self-blame. The high dependence of self-attitude on social feedback, which reflects the expectations of the reference group, also should be noted.

It was revealed (Table 15) that the average value of the "self-confidence", "self-acceptance", "self-guidance", and "self-interest" factors was higher in group IV (M) compared to group III (MTS). Analysis of the same characteristics among groups of biological males shows a similar trend, with the difference that transsexuals with male biological sex did not have a statistically significant difference with the male comparison group in terms of autosympathy, self-blame, and self-understanding. In general, the global self-attitude was higher for a group of males whose gender identity matched their biological sex.

The conducted research confirmed that the representation of transgender people about males and females was more "polar" than the representation of the control group satisfied with their gender identity. The same results were obtained in the study by Matevosyan and Vvedensky, 2012 [16] where it was demonstrated that transsexuals with a female biological sex were characterized by a greater rigidity of gender stereotypes than homosexual females, as well as compared to males with transsexualism and homosexual males. Transsexuals of male biological sex demonstrated the highest femininity of female images in the "human figure drawing" method compared to images created by mentally ill people and college students who did not have gender identity disorders [16].

This research revealed that in the group of transsexuals with a female biological sex, the images of a man and a woman were clearly distinguished, and the self-image was closer to the desired image of a man, while the image of a woman was less achievable. The group of transsexuals with a male biological sex was closer to the image of the "ideal man" than to the image of the "ideal woman" of this group. Significant personality traits were mentioned that distinguished their idea of ​​a female gender role model, such as passivity, dependence on others, compromise, trustfulness, and the level of wages. The male comparison group considered the image of the "ideal man" less achievable (difference in 12 parameters) than the conditionally female comparison group (the image of the "ideal woman" (difference in 3 parameters)). According to all 4 groups, the "ideal woman" is happier than the "ideal man". In general, indicators of self-attitude in groups whose biological sex coincided with gender identity were higher than in transgender groups.

The images of the "ideal man" and "ideal woman" differed slightly in group I (FTS) and group II (F). A significant criterion of difference was the parameter "love for children". Group I (FTS) did not consider this criterion as one of the mandatory and important qualities. The self-image of group I was closer to the created image of the "ideal man" than to the image of the "ideal woman". When analyzing the features of the "ideal" images of this group and the collective self-image, it should be mentioned that, regardless of gender identity, the subjects of group I would like to be more beautiful, charming, captivating, more self-confident, organized, freer, more trusting, have a higher social status, dress better, earn more, be happier and more liberated in sex. Group III (MTS) showed an opposite trend: no significant differences with the indicators of the comparison groups of both sexes in the "love for children" parameter were revealed. The self-image of this group was closer to the "ideal" image of the gender-role model, which coincided with their biological sex. When analyzing the image of the "ideal man" of group III, "masculine" qualities that they did not correspond to were determined: independence, competitiveness, activity, and alertness. Instead, they strived for the "feminine" qualities highlighted in the image of the "ideal woman" of this group: attractiveness, likeability, trustfulness, and ability to ask for help. The indicators of self-attitude in the comparison groups were higher than in the groups of persons striving for gender reassignment. The reasons for gender reassignment were different for transgender males and transgender females. Based on the results of this research, transsexuals with a biological female sex tend to increase their social status, freedom, and reject the role of mother. Transsexuals with a male biological sex are looking for a radically new way to satisfy their needs without condemnation from society.