I worked 40+ years in health care, practicing internal and occupational medicine. My practice was affiliated with a highly ranked medical school and teaching hospital. Managing gender dysphoria is way outside of my field of expertise. But our med school has a transgender clinic, staffed by physicians and counselors experienced in adolescent, and adult transgender medical care. You are seriously mistaken if you think that proper diagnosis and treatment wasn't practiced. Before anything else was done, all patients had to undergo extensive psychiatric evaluations lasting 4-5 months. As I recall, about 1/2 of the patients were accepted for gender reassignment. For the next 6 months, the adolescent and adult patients began hormone injections for feminization or masculinization. They also began dressing, behaving, and living as a woman or man. I know they had to keep a diary and check in regularly at the clinic for followup and counseling. This all took close to a year. Only after that would gender affirming surgery be scheduled. Most of the patients were fortunate to have insurance coverage. But some were treated gratis.
And for the record, this is pasted from a 2022 study on patient satisfaction after 40 years of gender affirming surgery. Only 15 of 97 patients agreed to participate. True, this is a very small sample. But the overall outcome score was positive:
Both transmasculine and transfeminine groups were more satisfied with their body postoperatively with significantly less dysphoria. Body congruency score for chest, body hair, and voice improved significantly in 40 years' postoperative settings, with average scores ranging from 84.2 to 96.2. Body congruency scores for genitals ranged from 67.5 to 79 with free flap phalloplasty showing highest scores. Long-term overall body congruency score was 89.6. Improved mental health outcomes persisted following surgery with significantly reduced suicidal ideation and reported resolution of any mental health comorbidity secondary to gender dysphoria.
October 2022 - Volume 89 - Issue 4 : Annals of Plastic Surgery