Two perspectives

Most transsexuals in the past would tell you they suffered from a medical condition which we now term dysphoria (gender identity disorder before that). This was something they had felt from earliest memory and needed tending to. 

We would call this viewpoint transmedicalism which is the concept that some intervention needs to happen to make the individual feel whole. 

Others might speak about a way of being which isn't constrained by societal ideas of a gender binary but involves less internal struggle of identity and thus they may reject transmedicalism as a concept. 

However, I think that both things can be true at once. 

Those whose dysphoria was affecting their quality of life to the point where they would rather not continue living would have seen their suffering more from a medical stance. Conversely those who found a formula which worked within the existing framework of their lives would be less prone to see their situation as a condition. 

Some of Harry Benjamin's patients did see their tranvestism as a curse but I suspect this was mostly due to shame and social stigma rather than a need to have medical interventions. However, some blurred the lines between transvestism and transsexualism and ended up in the middle of his 6 typology scale.

For a very long time I have been convinced that gender dysphoria has a solid aspect rooted in biological predisposition but can also be affected by social factors. It is how those factors combine and their tenacity that will yield a very different and unique result in each person.