I have assisted several people in changing gender. Most of them have been middle-aged. To me, it is simply a sort of birth defect.  Sometimes the chromosomal sex does not match the brain for a variety of very specific reasons, some of which we know something about, some of which we do not.

I am now far less involved with these folks.  Not that I do not venerate them and respect their struggle.  Rather, the condition of being a person requiring transgendering is so mainstream, that plenty of types of medical insurance pay for this.

Then again, several do not.  In fact, I had two patients in one year who worked for a major international conglomorate, and the sexual reassignment surgery was covered by their company benefits.  Let’s see if Obamacare is going to take that into consideration.