As mentioned the medical community (on whose well-meaning we depend on for life at this time) currently defines transsexuality as a mental illness. There currently is one and only one avenue to ever obtain treatment: We need to submit to the treatment-regime these mental-health practitioners have dreamt-up. In particular these so-called "standards of care" [henceforth referred to as 'dogma'] clearly state that we do not have a right to medical care ("genital surgery is not a right that must be granted upon request." [quoted from HBIGDA's Standard Of Care, Please note that as transsexuality it is an exclusively self-identified condition our request for hormonal treatment as well as for genital surgery is THE ONLY possible indication for this treatment]). So if we do not have a right to treatment and this is apparently given to us as some form of mercy-consideration, then just what are they looking for in addition to our self-identification to diagnose an exclusively self-identified condition? Well, if anybody would like to find out, the current version of dogma may be found at for download. In short this dogma is a strictly regulated one-fits-all approach the authors call "triadic treatment".
Practically dogma works by limiting our access to medical care, or in particular to certain surgeries (such as genital surgery or breast augmentation/reduction) as well as to hormonal treatment, it mandates a strict "minimum timeline" as well as a whole host of other criteria (see later). It basically works on the premise that we are incapable to make any informed decisions in regard to our own lives, that we remain uninformed and are incapable to ever acquire any kind of competence and that we therefore need our lives laid out to us, that indeed this mandated life needs to be forced onto us should we not like it! Dogma furthermore works by declaring that looks are everything and emotions count for nothing (please note how much coverage physical aspects get in dogma and how little the emotional ones do), which to me seems odd, given the fact that this is a mental health doctrine.
True, this all doesn't sound very ethical and it doesn't sound as if it had anything whatsoever to do with the issues a great number of transsexuals actually have, in fact this more than not gets into our way (some particularly enlightened therapists have noted themselves that we perceive them as gatekeepers to treatment, not as providers of useful treatment, but for some reason they fail to draw any of the obvious conclusions from this observation).
After almost 100 years of officially treating transsexuals the medical professionals still seems at a loss as to what this actually is and what they should (or should not) contribute to it.


Theoretically dogma sets a minimum timeline (or in-treatment waiting-time) for genital surgery of 15 months of psychiatric or psychiatrically supervised psychological therapy (this does not include the waiting-time to obtain psychiatric services for this, neither does it include the waiting-time for the surgery itself, each typically amounts to many months), however there are very few people who actually have received the entire treatment in less than 2-3 years, a great number of patients are left in limbo for 5 years or more, some for a lifetime.
Dogma also sets social, behavioural, even economic conditions on patients in order to make them qualify to have a medical problem solved. Nowhere else in medicine is it known that a patient would be required to prove social status (as in full-time employment according to WTO-standards, self-employment for example is not listed as an acceptable form of breadwinning) or that he/she would have to dress in a certain way to qualify for medical treatment. However dogma is full of such requirements that have little or nothing to do with any medical issues, apparently such conditions are seen as "test of sincerity" (such as filing for a legal change of name - which subsequently has the potential to create a lifetime of legal and social nightmares - as well as mandating social behaviours which, in some countries, could land a transsexual in court and even in prison, see legal issues. Some of the requirements have the potential to be highly dangerous for the personal safety of at least some individuals).
At the same time dogma exclusively focuses on physical changes, apparently any emotional changes that come with hormonal treatment (to me anyway these were the single most important reason why I needed this treatment) aren't even mentioned, never mind explained. Furthermore there are practical problems with the conditions this dogma imposes, in particular it is at best unclear what their condition that one has to "live a specific gender-role" actually means - particularly in light of their declaring that being a mother, homemaker, in-home caregiver, co-worker in a family business (such as a farmer's wife) are not acceptable expressions of femininity!


More generally it appears as if the authors of this dogma have little or no understanding of transsexuality or at least of the segment of transsexuals I belong to and therefore substitute understanding with completely arbitrary and at times highly destructive conditions on treatment (I have yet to find a statistically significant number of patients who say outside the therapist's office that they are happy about how they get treated).
One, and most definitely not the least important one, is that as long as the authors of dogma continue to advertise genital surgery as a treatment for mental illness it is likely that there will be people with mental or emotional problems who mistake this treatment for a solution of such issues. This results in two rather obvious problems: (1) In this scenario people with 'co-existing' mental conditions have the best chances of ever obtaining treatment for transsexuality because these are the ones who can be diagnosed with something whereas others may well be rejected for the mere fact that they do not have such issues! (This then reenforces the treating practitioner's belief that transsexuals do in fact, or in an extreme interpretation must, exhibit such co-existing conditions). (2) The likelihood that people who would not otherwise ask for this treatment (and would be better served with other treatments) request it and subsequently need to be discouraged from it or turned-down during evaluation will increase significantly! (This then reenforces the medical practitioner's belief that many more patients ask for the treatment than actually should be given it and that therefore an overly lengthy evaluation is justified. This way turning down patients becomes routine - which may end in the discharge of people who actually need the treatment!).
Because of this I urge the medical community
to stop marketing genital surgery as a treatment for mental illness. It is wrong to do this, it is detrimental to transsexuals and destructive to people who seek this treatment erroneously because of this P/R, it  distorts the medical practitioner's view of both the issue as well as their patients and it gets into the way of research and real progress!

To conclude this part I would like to post a list of other problems with this Dogma. The list is by no means complete, however even as is it appears quite long enough.