I get that you're talking about how things are and not how they should be but hopefully Florida is improving the situation. Proscribing hormone pills for troomer purposes or performing mutilation surgery should result in permanent medical license revocation and prison time. You don't tell a schizophrenic who thinks the CIA is putting mind control devices in his cereal that his delusions are true because his lived experience is valid. Similarly you don't tell the autogynephile that he's really a woman because his lived experience is valid. That goes double in the latter case because the autogynephile only wants you to tell him that because it makes his pee pee tingle. You treat the source of the delusion or at the very least keep the lunatic from harming the public.