The Silence of the Lambs1991

Hannibal Lecter:
Billy is not a real trans-sexual, but he thinks he is. He tries to be. He's tried to be a lot of things, I expect.

Clarice Starling:
And you said that I was very close to the way we would catch him. What did you mean, doctor?

Hannibal Lecter:
There are three major centers for trans-sexual surgery: Johns Hopkins, the University of Minnesota, and Columbus Medical Center. I wouldn't be surprised if Billy had applied for sex reassignment at one or all of them, and been rejected.

Clarice Starling:
On what basis would they reject him?

Hannibal Lecter:
Look for severe childhood disturbances associated with violence. Our Billy wasn't born a criminal, Clarice. He was made one through years of systematic abuse. Billy hates his own identity, you see, and he thinks that makes him a trans-sexual. But his pathology is a thousand times more savage and more terrifying.