There are so many issues that are difficult to reconcile in this area, the main one being TRAs objecting to healthcare professionals insisting their care is given the same high level of attention as other areas of medicine.
I think, ultimately, the key issues link to what is considered a good health outcome. Medicine is interested in patients functioning well mentally, physically, and socially, and having a positive sense of well-being. TRAs are interested in people having their gender identities validated, regardless of the impact that this has on mental, physical and social outcomes. Perhaps a more balanced way of putting it is that they are wedded to the idea that affirmation and validation will automatically address any issues with functioning.
Hopefully, the new clinics will see a more rigorous approach to measuring outcomes for patients they treat, with patient satisfaction and other subjective variables being considered alongside other, more objective variables.
The key issue is that of formulation. Patients with trans identities often arrive with fixed ideas about their symptoms and the cause- my body is wrong, I need treatment to change my body, regardless of any contraindications arising. They believe that no other outcomes to that of changing their bodies (halting puberty and/or changing hormone levels) are significant.
A healthcare professional's formulation should include exploring a range of potential underlying causes for the presenting symptoms (dysphoria) and should aim to treat the causes rather than the symptoms.
'Power and oppression' and post modern narratives can be like kryptonite to well educated/professional healthcare practitioner's critical thinking skill. We see the negative impacts of inequality and discrimination on health outcomes for marginalised groups and are frustrated by being limited to treating the symptoms of this.
There is validity to claims that patient's healthcare experiences are often that of experiencing further marginalisation. However, related research often flags up issue to do with marginalised groups not being fully informed about the full range of possible treatments, or not being considered for the full rage, and too little research being undertaken relating to outcomes (or symptoms) pertaining to the specific group. There is a widespread movement relating to 'doing with' rather than 'doing to' when it comes to research and development.
TRAs stand out here. They reject the 'doing with' and consider anything other than 'do as we say' oppressive. I think this may come from a similar place as a functioning alcoholic not wanting treatment as they fear having to give up alcohol, and self harmers fearing losing the relief that comes from cutting. I expect many with gender dysphoria fear losing the relief that comes from their gender identity.
However, those working in addiction services (and, interestingly, many effective treatments for anorexia and self harm are based on these being conceptualised as an addiction) have been more successful in navigating (tolerating?) patient anger and resentment. They do adopt approaches that seek to empower patients and 'do-with' but are clear that the outcomes they are working towards are based on improving functioning.
In short, I don't think there is any place for treating 'identity' in medicine. Identity in itself should not require medical intervention, the exception being when it negatively impacts on functioning. When this happens, the goal of treatment should be to return to full functioning.