Transgender pornography is a genre of pornography featuring transsexual or transgender actors. Both transsexual and transgender women may transition. The status of transvestite, transsexual or other transgender persons in Indonesia is complex. Many transgender people reject the term "transsexual". Medical treatment for transsexual and transgender people is available in most Western countries. Some Middle Eastern nations have some tolerance and legal protections for transsexual and transgender people. The participation of transgender or transsexual individuals in competitive sports is a controversial issue. Lady Bunny identifies as a non-operative transsexual woman. The term has since become a derogatory term applied to male-to-female transsexual people. This usage is particularly advantageous when discussing the partners of transsexual or intersexed individuals. Max goes back to Ludlow's home wearing the stilettos of a transsexual woman. Miss Tiffany's Universe is a beauty contest that is opened to all transsexual women. Frequency and intensity of orgasms are substantially different among transsexual men and transsexual women. She has twice been nominated for an AVN Award for her work in transsexual pornography. "It's Always Sunny in Philadelphia" as a transsexual named Carmen.