Since sex reassignment surgeries (SRS) medical interventions for transsexual individuals were made available in 1951 (Meyerowitz, 2004), the need had emerged to identify candidates who could benefit the most from such interventions. This opened the way to the elaboration of very strict clinical guidelines for the identification of the typologies of transsexual individuals and for the emphasis on “differential diagnosis” between “true transsexuals” and the rest of the transgender population coming to clinical attention. These guidelines set the stage for a “pathologization” of the sexual life of transgender individuals in the eyes of mental health professionals. This review is intended to offer an overview of the historical roots from which such prejudices and biases have stemmed and draw the process of change that lead to gender confirming (GC) approaches.