There’s no need for an FAA license or a Class 1 medical requirement for a commercial pilot’s license for people in loony bins who think they are not the sex they were born as.
Surely some of the meds they have to take must be on the list to preclude a class 1 medical? Or even third class for that matter. Hell, they probably can’t even legally self certify for basic med if they are popping all those hormones?