He married four women, including a Vestal Virgin, in addition to lavishing favours on male courtiers thought to have been his lovers. He was also reported to have prostituted himself.

Nice.

Dio says Elagabalus delighted in being called Hierocles's mistress, wife, and queen. The emperor reportedly wore makeup and wigs, preferred to be called a lady and not a lord, and supposedly offered vast sums to any physician who could provide him with a vagina by means of incision. Some writers suggest that Elagabalus may have identified as female or been transgender, and may have sought sex reassignment surgery. Some historians treat these accounts with caution, as sources for Elagabalus' life were often antagonistic towards him.

In November 2023, the North Hertfordshire Museum in Hitchin, United Kingdom, announced that Elagabalus would be considered as transgender and hence referred to with female pronouns in its exhibits due to claims that the emperor had said "call me not Lord, for I am a Lady". The museum has one Elagabalus coin.