Look at the word "transsexual" literally. "Trans" means to cross, and "sexual" refers to a person's body, their male or female sex. A transsexual is a person who crosses over from being one sex, to the opposite sex than birth. It is done with hormones, facial feminization surgery and breast augmentation surgery if the hormones are not sufficient to produce the changes, and sexual reassignment surgery although attitudes are changing as to whether SRS is needed since the public doesn't see a person's genitals. Anyway, a TS changes the physical self in order to align it with their gender identity which, for a MtF TS, is female. Does it matter what clothes they wear? No, not really. Clothes are just an aid to help others determine the target gender and I dare say that a successfully transitioned MtF TS can wear what she wants, even a Tshirt and jeans with no makeup and people will still see that she is a woman.

The other end of the spectrum is a crossdresser who wants to hang on to a male identity and who dresses as a woman only occasionally and outside his milieu. He is seldom seen as a woman when out dressed, even with the best of makeup, wigs, breast forms and fashion.

And in the middle, there are people who are physical males who do not alter their bodies and who present as females to either all the people in their lives or a selection of people. Are they transsexual? No, since they are not changing their physical sex. Are they CD? Some are, but others aren't since in many cases they do not feel they are crossdressing when they wear women's clothes. Do the people who do not alter their bodies identify as a woman, a man, gender nonconforming, or gender fluid? You'd have to ask them. But, if they do not alter their bodies, most MtFs will have a difficult time having others see them as women. People will tend to see them as males who are presenting as women. I think this is unbearable for a transsexual and this is why transsexuals go to the lengths that they do. But it doesn't mean that a MtF who does not alter their body does not identify as a woman.