At this point in time the medical community (or individual medical practitioners) get to decide who will get gender-treatment and who will not. Now given this fact it appears very odd that there are thousands of commentaries on the web discussing if it is at all ethical to provide such treatment to us as well as for whom it is 'ethical' to receive such treatment and for whom it is not, while at the same time there is only a small fraction of pages whose authors question the ethicacy of medical practitioners taking the right to deciding on such treatment, to de-facto assigning a gender to an individual by either granting his/her request for treatment or by denying it!


The questions that really need to be answered in this context are not the ones if we have a right to our bodies, if we have a right to experience our self-identification freely or not and if we have the right to medical treatment but why anybody would possibly think that they have the right to deny this to a fellow human-being, how a group of people (medical practitioners, in the case of transsexuals in particular mental-health practitioners) could possibly think that they have either the right or the qualification to decide another person's gender and then to force this decision onto this person and how either society or medical doctors can think that enforcing such views by means of violence could be justified or deemed acceptable, never mind ethical.


This may sound radical to some people, but really, it is not. Today we deem the freedom of religion one of the achievements and a fundamental pillar our society is built on, the freedom of thought and the freedom of expression would be others in the same category. It is odd that a great number of people, including apparently a large majority of medical practitioners, don't seem to notice a discrepancy between their own freedoms they take for granted and these very same freedoms they routinely and completely casually deny to others.
Why would I say this? Well, there are two ways to fundamentally explain and interpret our experience of gender, neither of these two can be proven correct or incorrect as of this day, but either way what happens is wrong and inconsistent because the people who pass judgement on us (medical or other) assume the very freedoms they deny us to pass their judgement: 


Our experience of gender (and the subsequent need or wish to express this) could be mental or social nature, in which case it could be an inborn trait or it could be learned. Either way in this scenario gender would be a personal value or more precisely it would be of a spiritual nature. Now given the fact that we deem the freedom of religion essential it appears odd that the free expression of gender would not fall under this protection, after all, we also deem philosophical values worthy of this protection even if these are not necessarily of a religious nature. But however this is, in this scenario our treatment would be a spiritual procedure, not a medical one (this would in particular apply to our surgery), an orchiectomy for example would have to be treated akin a religiously motivated circumcision.
I do not mind if medical practitioners offer body modifications that a customer seeks for a religious or spiritual practice or belief, however I find it deeply disturbing if medical practitioners mandate their services for this by having religious practitioners banned from performing these same procedures themselves and I find it unconscionable when medical practitioners subsequently abuse their exclusive position as providers of such spiritual procedures to regulate, alter, limit the access to or even prohibit such religious or spiritual procedures.


This is very simple: If medical practitioners put themselves in a position where they are the exclusive providers of spiritually motivated body alterations (by means of having everybody else banned to offer such services) then it becomes their duty to provide these upon request, on every request, no questions asked (at a reasonable fee, within a reasonable time-frame that fits the spiritual purpose of the procedure and with minimal interference to said spiritual practice, if any). IF THEY DO NOT AGREE WITH THIS THEN THEY SHOULD NOT MAKE THEMSELVES THE SOLE PROVIDER OF SUCH PROCEDURES BUT RATHER ENCOURAGE AND SUPPORT OTHERS TO PROVIDE THESE INSTEAD!

Medical doctors cannot be in the business of regulating spirituality. If they do this anyway, they act unethically.


Our experience of gender (and the subsequent need or wish to express this) could be physical in nature, in which case it could be an inborn trait or it could be physiologically acquired. There clearly are indications that this is the case: The many reports we have from people who - for whatever reason - use cross-gender hormonal therapy pretty much unanimously suggests that, with the exception of transsexuals, people do not like the mental / emotional effects this causes [cross-gender hormonal therapy or artificial hormonal changes have most notably been used for doping in elite-sports (testosterone in females), other applications include treatment or prevention of certain forms of cancer as well as other medical conditions]. In this scenario our treatment would be a medically indicated correction of a physical problem, gender-alignment would be nothing else than any other corrective treatment out there.
It is true that today medicine generally does not accept that there exist people who react negatively to male steroids and positively to the female ones while being biologically male (and v.v.), or to put this differently: That there exist "female brains" and "male brains", that these have preferences (at least when it comes to sex-steroids) and that these clearly function differently as the resulting psychological / emotional states demonstrate. Their denial of neurological differences of the sexes in fact goes as far as to put the following line into our dogma [quoted from HBIGDA's Standard Of Care]: "Satisfaction with the hormone's effects consolidates the person's identity as a member of the preferred sex and gender and further adds to the conviction to proceed. Dissatisfaction with hormonal effects may signal ambivalence about proceeding to surgical interventions", while still denying that a neurological reason for this could exist and claiming that this is all 'mental' (presumably transsexuals have read the label on the bottle and thus feel good about the hormones they are taking?).
Now to me this appears as if medical doctors pre-emptively reject evidence of a physical nature of gender preferences in spite of clear evidence that it exists (see the previous quote). This denial of an obvious observation (namely that transsexuals take HRT because this feels very positive to us, not because we don't like its effects - which really would be a rather stupid motivation to imply) lets medicine look like some form of a religious belief-system one has to adhere to rather than the science it claims to be.


Once again, this gets very simple: If medicine were science then we should get our treatment expediently BECAUSE OUR REACTION TO HRT IS PROOF THAT THIS IS RIGHT AND NECESSARY FOR US. The only possible doubt would be, as this is self-identified and it is the only hard evidence to come by, to doubt the truthfulness of the patient, but to systematically doubt hundreds of thousands of individuals who all put forward the same testimony is simply absurd.


Medical doctors cannot create a religion out of their personal beliefs (which then they force on everybody in the form of a mandated belief-system through their power of being the only ones to provide access to healthcare). They are to follow scientific principles, wherever this guides them - even if they may not like what they find. If they suppress science in favour of their personal beliefs then they act unethically.


In any case, no matter if one suspects the roots of transsexuality to be spiritual or physical in nature or a combination thereof, the reason for this is not mental - therefore, once again, transsexuality cannot be construed as a mental illness. That this is done anyway is in itself proof that medicine is no longer science but has succumb to being an irrational belief-system where facts and observations are rejected in favour of dogmatically upheld beliefs.

The fact that by now this has been going on in transgender-care for more than half a century and still is not on it's way out is - to me anyway - of great concern. AS DOCTORS APPEAR TO BE INCAPABLE TO CORRECT SUCH MISTAKES WITHIN HEIR OWN SYSTEM THE QUESTION NEEDS TO BE ASKED JUST WHERE ELSE IN MEDICINE DO WE HAVE RELIGIOUSLY FRAMED BELIEF-SYSTEMS INSTEAD OF SCIENTIFIC TREATMENT?