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As a matter of fact, there is still a lot that isn't understood, and because research on the subject is always yielding new discoveries in relatively quick succession, in addition to shifting societal norms and growing understanding that even biology isn't as cut-and-dry as it once was thought to be.
It's best to keep an open mind as previously rigidly held, commonplace ideas are challenged.
Despite the trope name, it is very important to note that the currently preferred term is transgender, not transsexual.
The language around trans discourse changes very rapidly, due to being de-pathologised and re-written by trans people themselves instead of by outside onlookers.
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See the Useful Notes on Transgender people for a more Real Life-oriented and complete description.
There's a general craving by most of the trans community for more representation of them as just regular people — just like not every female character's story has to be about battling sexism or traditional gender roles, some trans people too would like to see themselves depicted in all traditional narratives.
Since medical science has only been able to alleviate dysphoria for about a century, the vast majority of transgender people in history did not have the option to change their bodies, and many today still don't have access to medical transitioning options.
Trans women are more common in media than trans men, whose existence is largely ignored by the mainstream despite statistically being equally common in Real Life.
When a Baleful Polymorph causes characters to get transformed into another sex though, it's almost always male characters getting stuck with female bodies — in other words, trans men.
Some transgender people have dysphoria on physical or social levels, and pursue medical means (e.g.
hormone replacement, surgery, etc.) to help mitigate this discomfort.