Here is an interesting, thoughtful and heart-rendering article at the ever interesting, thoughtful and heart-rendering New York Times, on the transgender issue and vaginoplasty surgery, written from a personal perspective:
  https://www.nytimes.com/2018/11/24/opinion/sunday/vaginoplasty-transgender-medicine.html

“My New Vagina Won’t Make Me Happy And it shouldn’t have to” By Andrea Long Chu

Ms. Chu is an essayist and critic.
•    Nov. 24, 2018

“Next Thursday, I will get a vagina. The procedure will last around six hours, and I will be in recovery for at least three months. Until the day I die, my body will regard the vagina as a wound; as a result, it will require regular, painful attention to maintain. This is what I want, but there is no guarantee it will make me happier. In fact, I don’t expect it to. That shouldn’t disqualify me from getting it. I like to say that being trans is the second-worst thing that ever happened to me. (The worst was being born a boy.) Dysphoria is notoriously difficult to describe to those who haven’t experienced it, like a flavor. Its official definition — the distress some transgender people feel at the incongruence between the gender they express and the gender they’ve been socially assigned — does little justice to the feeling. But in my experience, at least: Dysphoria feels like being unable to get warm, no matter how many layers you put on. It feels like hunger without appetite. It feels like getting on an airplane to fly home, only to realize mid-flight that this is it: You’re going to spend the rest of your life on an airplane. It feels like grieving. It feels like having nothing to grieve.

Many conservatives call this crazy. A popular right-wing narrative holds that gender dysphoria is a clinical delusion; hence, feeding that delusion with hormones and surgeries constitutes a violation of medical ethics. Just ask the Heritage Foundation fellow Ryan T. Anderson, whose book “When Harry Became Sally” draws heavily on the work of Dr. Paul McHugh, the psychiatrist who shut down the gender identity clinic at Johns Hopkins in 1979 on the grounds that trans-affirmative care meant “cooperating with a mental illness.” Mr. Anderson writes, “We must avoid adding to the pain experienced by people with gender dysphoria, while we present them with alternatives to transitioning.”

     Yes, clearly dismissing a person’s suffering, whether physical or psychological, is indeed cruel. No suffering is an illusion. But, looking at the bigger historical position, I wonder how this socio-psychological problem will be dealt with in the longer term, with the coming economic collapse? What happens when the Western medical systems go the way of Venezuela, only a few years down the track and struggle to be even able supply basic medical services? In Venezuela, women often give birth in hospital corridors. X-ray machines and medical equipment, fail and can’t be repaired. Surgery has become a risk. What then? Is surgery the only answer? What if there is none?
  https://www.npr.org/2018/02/01/582469305/venezuelas-health-care-system-ready-to-collapse-amid-economic-crisis
  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00277-4/fulltext 
  http://theconversation.com/venezuelas-health-systems-are-crumbling-and-harming-women-in-particular-98523 
  https://edition.cnn.com/2018/03/28/americas/venezuela-hospitals-report/index.html

“A survey of 104 health facilities in Venezuela, commissioned by the opposition-controlled National Assembly, paints a grim picture of a collapsed system hurting for even the most essential goods and services. According to the report, most laboratory services and hospital nutrition services are intermittent or completely inoperative. Staggering statistics highlight the shortages of items such as basic medicines, catheters, surgical supplies and infant formula. Venezuela has been in a downward spiral for years, caused by a combination of mismanagement of government funds and the plummeting price of oil. Skyrocketing inflation has created extreme shortages of food, medicine and other essentials, while planned (and unplanned) power outages are common throughout the country and don't discriminate between critical services like clinics and hospitals and the average household.
Water, the survey found, was rarely available at the participating facilities -- 79% of them had no running water at all. Fourteen percent of intensive care units have been shut down because they're unable to operate -- and the vast majority of open ICUs have intermittent failures due to a lack of supplies, according to the report. Almost a quarter of pediatric ICU's have closed.”

     No doubt, people will have other things on their minds in such apocalyptic conditions.