I didn't read the entire ruling, but remember when the ruling came out. The synopsis I read, at the time, indicated that this particular case concerned genital surgery and the ruling was made on that point only. I think that there was some discussion that if other types of transition expenses were litigated then they might be allowed also. Beard removal, FFS etc. You just have to reach the same standards with professional opinions. Of course I might be wrong. And if the deduction is taken it may end in litigation.