I'll assume you're sane, because you're here and you're not chimping out.
What is your opinion on SRS? Because surgery is generally only done to cure, or at least treat, some actual medical condition.
Surgery that is done just because somebody wants it is considered "elective" or is outright illegal, like surgeries for people who want to amputate a limb because of some severe psychological disturbance.
Surgery that is done for some legitimate medical reason, though, can be paid for by insurance or by entitlements like Medicaid.
I tend to think that if someone has a condition, whether it's a "mental illness" or whatever, that puts them at serious risk of depression, suicide, and otherwise torments them and that if there is a medical procedure (like SRS) that has been shown in studies to lead to positive outcomes and increased wellness, that this probably should be covered by insurance.
At the same time, categorizing it as a "mental illness" has some pretty unfortunate implications, like the inclusion of homosexuality as a mental illness. I have long viewed that as a medical and legal fiction essentially used to justify procedures that are useful for their recipients even though the theoretical underpinnings of why that is the case are pretty murky, to say the least.
So how do we both serve people who legitimately need a complex and expensive surgical procedure to avoid severe psychological distress with a ridiculously high suicide rate involved, while not performing unnecessary (and harmful) procedures on people who don't need it and are just acting out? I mean the idiots influenced by "tucute" bullshit who are usually ridiculously immature, stupid, ignorant people who reject the whole idea of medicine.
The WPATH standards of transgender care include being grilled pretty hard to discern whether you're actually trans, but parts of me just think "Play stupid games, win stupid prizes" for people pursuing life changing, irreversible surgery because tumblr told them it was neat. Then again, most of these people are misguided children, and don't really deserve to have their life ruined. I think a lot of them will drop the bullshit once they start the transition process and actually dip their toes in being harassed by strangers and having their body change into something they never really wanted to be in the first place. I wonder if trans health doctors will eventually have "weeding out tumblrinas" as a part of their training regimen.