A term that is commonly trotted out by the religious right in arguing against transsexuals is "gender confusion." It is used in the context of arguing that transsexuals should not receive sex reassignment surgery as treatment, but should receive psychiatric treatment to help them overcome their "gender confusion."
Now, for those who are true, or classic transsexuals, i.e. those who have what is better referred to as Harry Benjamin Syndrome, there is clearly no confusion about their gender. They know, quite fully, that they are mentally female, and no amount of psychiatric browbeating is going to change this. For example, I identify as a woman, period. I do not identify as a "trans woman," or any other variation on the numerous man who had a sex change and became a woman concepts that so many cling to. From the beginning of my transition, I knew I wanted to be accepted as a woman, not seen as a transsexual, or worse, as transgender.
But, unfortunately, there are also those who are transgender. In their case, the answer is not as simple. First off, I should point out, again, that "transgender" is actually an artificial political construct. A more proper term for those who are not transsexual or HBS would be "crossdressers". I mean, they are clearly not transsexuals if they are not seeking SRS, or even if they are seeking SRS but do not have a brain that is sexually differentiated differently from their body. Most of those who would fit this description seem to have a very strong need to maintain an identification with their birth sex. For them, it is not about being, but about appearances.
Robert Stoller, a researcher at UCLA, wrote about crossdressers (he used the term transvestites) having an identification as being a "woman with a penis." Now, I don't agree with much of Stoller's ideas, mainly because they were rooted in the silliness known as psychoanalysis, but I have come to see that he did have a point about crossdressers. There does seem to be a strong identification of the sort he described.
Now, in the process of writing this article, an interesting thing has happened. You see, I don't always write a post in one setting. I work on it some, take a break, do some more research, etc. Well, this morning the suggested DSM revisions came out, and one of the suggestions is to classify autogynephiles as "transvestites."
That would mean that a lot of the "transgender" crowd, the vast majority, would now be classified as having "transvestic fetishism" instead of "gender identity disorder."
But to return to the original subject, the term "gender confusion" does seem more appropriate for someone who wishes to be seen as a "woman" while clinging to his status as a "male," though I am not sure that is is rooted in "confusion" so much as it is just a conscious rejection of reality.
Is there anyone who is truly "confused" about their gender? I don't know, but I cannot honestly say I have seen any real cases. I have encountered people who are clearly suffering from mental illness that seems to manifest itself in cross gender behavior. In some cases, the person goes back and forth, but I am not sure that it is actually confusion.
In any case, the bottom line is that "gender confusion" is a myth created by the religious right in an attempt to appear compassionate while actually doing real harm to people simply because they do not fit a world view that has no foundation in reality, and that includes the Bible.