I do not have the time to go through all the footnotes and track down all of the references this paper refers to, but it's a very interesting summary of the state of transgender "medicine". One interesting thing I learned is that a lot of the "innovators" in this area have some very troubling connections, including the fact that after performing an early sex reassignment surgery, Dr. Erwin Gohrbandt did pioneering, and criminal, hypothermia work.
In Dachau.
All in all, the sense I get from reading this is that first of all, those "doctors" engaged in this enterprise are not paying nearly enough attention to the likelihood that "trans" identity is merely a symptom of deeper underlying mental health problems. Going a bit more broadly, I'm not sure that a lot of mental health practicioners understand this, either.
Other observations; the document has a fair number of reports from transition "doctors" of detransitioning, which indicates that the real numbers for regret are probably a lot higher than advocates of transition surgeries would like to admit. The document also has a fair amount of evidence that these "doctors" are doing some "interesting" things to get things paid for by insurance (i.e. insurance fraud), that many practicioners are rubber stamping requests for surgery on minors, that many practicioners are fudging required wait times, and a lot more.
Looks like my comments about the state of psychology were, if anything, very optimistic and over-gracious to a broader scope of medical professionals, and they need to grasp a very basic principle;body parts in the specimen bag do not grow back, and they do not reattach. So you want to make for darned sure that it's the right path before you amputate.
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