The patient has to be diagnosed with the "mental illness" GID (Gender Identity Disorder) in order to qualify for surgery, but anyone with a severe "mental illness" cannot possibly give informed consent. There is a basic contradiction here, one that everyone has ignored because "the system works". Well, it's only a matter of time before someone notices, and legislation is passed to prevent surgery.
I wonder about this a lot. Really. Added to that are the people I listen to that also suffer from other conditions that may be co-present, if not codependent. It's an interesting Catch-22 to be sure. If you have, say BPD, or OCD AND GID, how do you really know which is which, and say, if we could treat the OCD, and make the GID symptoms go away, is that a better course of treatment.
The real problem here is that its all based on a medical model, and when you use that as a basic premise, you're pretty much confined to a medical intervention based solution.