Before the mid-20th century, various terms were used within and beyond Western medical and psychological sciences to identify persons and identities labeled transsexual, and later transgender from mid-century onward.[5][30] Imported from the German and ultimately modeled after German Transsexualismus (coined in 1923),[31] the English term transsexual has enjoyed international acceptability, though transgender has been increasingly preferred over transsexual.[32] The word transgender acquired its modern umbrella term meaning in the 1990s.[33][34]