There are many issues when it comes to human rights for transsexuals. One of the more obvious is that as of today [March-2010] no country on earth has enacted legislation on a national level to protect our self-expression. It is therefore legal to discriminate against transsexuals, at least in some form, in every country on the planet.


Much progress has been made, however advancements have typically been incidental, uncoordinated and limited to a single nation (this is particularly problematic when it comes to accepting gender-corrected documents needed outside of the jurisdiction of issue or for international travel, such as passports and driver's licenses). But while even slow progress is commendable there is by and large no vision or plan for a meaningful complete framework that would make our lives more liveable and our treatment more equal. Even worse, because so often this happens uncoordinated and focused on single issues at a time more often than not any progress for the rights of one segment of transsexuals turns out to be a huge liability for another group within this very same population! This, in addition to creating many new problems, is particularly problematic as there also is very little willingness to correct past mistakes (or the ones arising from such new creations), even insofar as this is possible. [see legal for examples]


I find it very commendable to work for a better future, I like to do this too. However nobody can truly enjoy the benefits of a better future if the past this future is supposed to be built on is distorted in ways that make precisely living this future impossible. Therefore from my perspective this should all start by building a working foundation. Or more directly put: What are the freedom of self-expression and equal rights good for if I live under a constant threat of being denied the right to life? To be cynical I could put it like this: If a slave is told that he/she is now entitled to sit at his/her master's table then that slave is still a slave. 
But why would I say this? Unfortunately it is simply a fact that when it comes to human rights for transsexuals what we talk about becomes very, very basic. Because for us this doesn't start with the right not to be discriminated against at the workplace, to be given a useable piece of ID or the right to have a family and raise children (or adopt these if it comes to that). This, for us, starts in the medical office and the systematic abuse we are handed-out there when we ask for our existence. It starts with that declaration of mental illness which is handed-out without considering any evidence whatsoever (with all its stigmatization and potential, social, educational and legal ramifications), but it is much more fundamentally true in that today our self-expression, who we are, and our existence is granted to us as a medical treatment (to which we don't even have a right!), instead of it being a human right! Because of this it is a medical practitioner who decides, on every prescription visit and on every surgical referral, if any of us merit our self-experience, our self-expression, even our existence for another little while. And unlike an orderly social process (like the legal system) this is done in sole responsibility in a secret trial, the doctor is lawmaker, prosecutor, judge, jury, warden and spectator all in one, the positions left to us are accuser and inmate - and potentially executioner, of ourselves. There is no defence, no legal protection, we do not get an advocate and there is no recourse!


Now this would not be a problem if the goal of medicine were to uphold human rights by employing ethics, but of course this is not the case. In fact in transgender-care doctors enforce absurd "standards of treatment" on patients with no regard to the well-being, personal safety, emotional or physical integrity of the patient, they limit our access to surgery and hormonal treatment while mandating years of their own services (as in psychiatric therapy and treatment) so we may eventually qualify to get any real medical treatment. Practically this means for me (as I have had all the gender related surgery I'll ever want) that I am now allowed to be and express myself as long as I find a medical doctor who is willing to sign me off on it by writing these prescriptions for hormonal treatment, in intervals of 3 to 12 months, depending on this doctor's choosing. At the latest after one year my right to exist expires, I have to go back and ask for yet another extension.
It is true, one could argue that this is the same ritual for every person who is on long-term prescriptions, diabetics for example aren't given the right to obtain their insulin for life even though many of them run their own medical lab, self-dose and do this very successfully. And yes, the question if it is ethical to pressure a patient into a doctor's office every few months by means of an implied death-penalty (from medication withdrawal if the doctor's service is not retained to obtain a prescription for continuation of treatment) ought to be addressed, however in the case of transsexuality or more generally in the case of hormonal treatment to achieve normal levels of sex-hormones (as in post-hysterectomy or -orchiectomy hormonal replacement) the question rather is if this really is medical treatment at all or if the substitution of missing sex-hormones (and the suppression of any surplus thereof), and with it a normal physical, emotional and sexual self-experience and expression, isn't much rather A HUMAN RIGHT! Because there is a very significant difference between that diabetic who needs insulin and the post-hysterectomy female or the transsexual who needs hormonal treatment:


A diabetic gets his insulin as illness management while hormone-replacement treatment (for our purposes) is prescribed to allow a person to experience him/herself in a way she experiences as meaningful and to facilitate this person's self-expression. Now the problem is that the doctor is there to keep the patient alive, preferably as long as possible, but not to facilitate either a meaningful self-experience nor to allow a specific self-expression, which means that the diabetic is assured treatment in whatever form is best for his/her health (which is all he/she in this position wants) whereas the transsexual is not extended this guarantee BECAUSE THE DOCTOR'S DUTY TO KEEP THE TRANSSEXUAL PATIENT HEALTHY (IN A MEDICAL SENSE) MAY CONFLICT WITH THE PATIENT'S REQUEST FOR A NORMAL SELF-EXPERIENCE AND -EXPRESSION!
As in the current scenario it is the doctor who gets to decide if the transsexual will be given hormonal treatment (and with it his/her normal self-experience and a meaningful life) and each medical practitioner is bound by the framework of acceptable medical practice for the benefit of the health of the patient (not his/her freedom of expression) IT IS IN THIS SCENARIO BY NO MEANS CERTAIN THAT WE WILL ALWAYS BE GIVEN WHAT WE NEED, EVEN BY THE MOST WELL-MEANING PHYSICIANS.


BECAUSE OF THIS CONFLICT OF INTEREST IT CANNOT BE THE DOCTOR WHO HAS TO MAKE THIS DECISION AND WRITE SUCH PRESCRIPTIONS! Consequentially there needs to be another way for us to obtain the right to get the substances our lives depend on, either permanently or on a last-resort basis if the doctor denies these to us for professional or medical reasons.
Practically this could either be done through the legal system (by means of a permit which would exempt a transsexual person from the regulations on pharmaceuticals so he/she could obtain the specific drugs needed in transgender-care at the pharmacy without a prescription. It should be easy to put this in place, after all none of our medications are controlled substances). The big disadvantage in a permit-system however is that our purchases of medication would not be covered by insurance unless this were covered by subsequent legislation. Such problems could be avoided if instead of a legal permit an actual prescription would be issued, for example by persons who would be licensed to write these for this very purpose. Obviously such persons could not be doctors or other medical practitioners as otherwise they too would be bound by legal and professional restrictions that come with this profession. In this scenario any such person would not be in a position to provide medical services, his/her duty would simply be to allow people with an established need access to otherwise restricted substances by giving the patient a human-rights or social prescription (instead of a medical one).


While on first glance something like this would only be applicable in extreme cases this in fact would solve many other problems in transgender-care as well: For one it would facilitate the doctor/patient relationship as in today's system a patient may be inclined to be dishonest to his/her physician or to withhold important information for fear of discontinuation of hormonal treatment whereas the doctor can no longer tell how forthcoming a patient truly is because in this set-up it is to be expected that the patient will second-guess the doctor's reaction pre-emptively and react accordingly. It also has the potential to get people off grey-market hormones, this in particular applies to people who do not accept to submit to the current system of medical lifestyle control, it indeed would allow us to disclose our hormonal treatment more easily to any doctors who does not know about our situation (such as specialists or in emergency-treatment). But most importantly it would liberate us from being forced into mental treatment because the fact of the matter is that transsexuals can only be pressured and stigmatized as being mentally ill because medical practitioners have the power to regulate our lives in such a way (and are obviously willing to abuse their power for this purpose).
If we get the right to obtain the substances we depend on for life freely, outside of the control of the medical system, then we may choose to go to mental-health or we may not (or some of us may self-organize for support). In any case our relationship to our medical practitioners would finally be free of fear as the continuation of hormonal treatment would be OUR OWN FREE CHOICE, NOT THEIR DICTATE!
This way even a transsexual patient could finally focus on getting the maximum benefit for his/her healthcare out of this relationship while the physician could focus on providing the best possible service WHILE SIMPLY ACCEPTING THAT TRANSSEXUALS HAVE THE FUNDAMENTAL RIGHT TO MAINTAIN NORMAL HORMONAL LEVELS (as every other human-being they treat does!) IF THEY SO CHOOSE


There is a saying: Nothing in medicine is absolute! I think it is high time for physicians to recognize that this is true even when it comes to their absolute right to treat a patient. Because sometimes the only ethical decision is to allow the patient to treat him/herself at his/her own discretion!


Once we are free from being slaves of the medical system any and all human-rights issues, political, social and other changes should be addressed. But as usual for slaves nothing really matters as long as we aren't free, as long as our lives, the means to experience and express ourselves, the means to live our self-identifications aren't given to us freely, unconditionally and for a lifetime!