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Therefore, the parental caregiver teaches the child to mask his or her issues." In many jurisdictions, abuse that is suspected, not necessarily proven, requires reporting to child protection agencies, such as the Child Protection Services in the United States.

Recommendations for healthcare workers, such as primary care providers and nurses, who are often suited to encounter suspected abuse are advised to firstly determine the child’s immediate need for safety.

Many transgendered women are offended by this categorization and call themselves T-girls or trans." In addition to its use in pornography, the term has been used as a punch line or for rhetorical effect.

As part of the 42nd Street Art Project in 1994, designer Adelle Lutz turned a former shop in Times Square called American Male into "American She-Male", with brightly colored mannequins and clothes made of condoms.

It is a variation on the familiar term "hafu" (half or ハーフ) that is commonly used for people of mixed Japanese descent, signifying that transgender people are a new type of "half".