After a brief historical review of the clinical management of gender dysphoria, the authors argue for a comprehensive treatment model that recognizes a wide spectrum of gender identity disorders. This treatment model explores the meaning of a gender dysphoric individual’s desire for sex reassignment in the context of the individual’s biography and psychosociosexual adjustment. Unlike previous treatment approaches, this model makes no attempt to identify the ‘true’ transsexual. The model’s treatment tasks are: assessment, management of comorbid psychiatric disorders, facilitation of identity formation, sexual identity management, and aftercare. The implications of this treatment model for classification and ethical standards of care are discussed.