This is really interesting ocelot41.
So does the feeling of bodily wrongness mean that sufferers believe they must be women; or is it that "woman" is the only other category available?
So is the belief "I am wrong therefore I must be something else and the only available something else is female"; or is the wrongness, "I have male genitalia, but I am really a woman"?
The other question is: if men or women with body dysphoria find comfort in living as the other sex, whatever that means, but are self-aware enough to realise that their biological reality has not changed, what are the benefits of a GRC? Is it a psychological comfort or merely a practical one, (it stops confusion if the person in a dress with a female name has matching paperwork)?
How is mental distress at a perceived physical wrongness, eased by identification documentation? Because if dysphoria is the cause of transsexualism, how far should society go in enabling the belief?
We try not to allow anorectics to starve to death; we don't cut off the legs of people who hate their limbs; we don't detonate Armageddon for those who believe themselves deities. We recognise material reality while providing support and compassion for the delusional. People should be able to live with the identity which makes them most content, and do that without harm or prejudice. But should we reshape society around them, denying reality for a small percentage of the population? And should we do this if it impinges on the rights of other people?
I believe that gate-keeping before undergoing serious, life-changing surgery is entirely appropriate. Nor do I believe that having the surgery should be the only pathway to appropriate documentation, provided that serious mental health supervision is a condition of that documentation.
Those who choose not to have the surgery are free to present any way they wish. They don't need female paperwork to go about their lives in a dress or a space suit, as long as they respect those spaces which are reserved for women.
They are free to call themselves anything they wish, but retain their biological identity where it is important.
Insisting on retaining male genitalia AND demanding female paperwork without any sustained mental health intervention is surely indicative of fetishism rather than true mental distress?