When my relative revealed his condition to me, he gave me two books on the subject, one an autobiographic account by a psychiatrist who specializes in treating transgendered patients and another that was more technical and general. What struck me in both was that virtually all of these patients report all their bad symptoms go away as soon as they receive hormone therapy. For example, you start giving a male with gender issues a daily dose of estrogen and he stops feeling like a woman trapped in a man's body.
And yet, instead of saying (as you would with other patients who have a brain imbalance that causes them mental difficulties) "Great, we'll keep you on that and you'll be able to function and be happy" the medical response is, "Great, soon we'll be able to schedule you for an extremely invasive, extremely expensive and completely elective series of surgical procedures." My wife says it's a good thing we don't take that approach with people who think they're golden retrievers. She also points out that if you say you're a specific woman (say, Marilyn Monroe) they treat you with drugs and therapy, but if you just say you're a woman, it's off to surgery.
I also have a distant inlaw who, if I have heard correctly, plans to go to Cambodia for a transgender operation.
It’s not my business. He’s a grown adult, and I have only seen him a few times since he was what appeared to be a rather ordinary little boy, when his family came to visit us many years ago.
But I’m afraid I can only think of this in terms of a permanent and irreversible mutilation, not an operation. And I don’t much doubt that the doctors or butchers who perform these “operations” do so mostly for profit.
Last I heard, Johns Hopkins—a liberal place if there ever was one—still refuses to do these procedures. I can well understand why.