Anyone with any interest in ethical mental health responses to gender dyphoria or any issue related to gender/sex "equality" should care about this issue of the actual nature of transgenderism and its variants.
The widespread notion among many transgenders, some medical professionals, and the whole sex-change therapy/operation industry is a notion that some transgenders are objectively the opposite gender of their outward appearance and sex organs. This is the assumption underlying medical diagnoses that the proper "treatment" for the disorder is not dispelling such a notion but rather physically changing their body so it matches their psychology. Psychology is 100% the brain, so that means this notion assumes there is such a thing as biologically distinct "male" and "female" brains. That is the only way the notions of being "born an X in a Y body" or being "assigned the wrong gender" makes any sense.
However, that very assumption is something that many gender equality activists reject, by claiming that there are no meaningful neurological differences between the sexes. That position underlies that political (but not scientifically valid) notion that "gender" is purely a social construct. Any meaningful brain differences means psychological differences, which means at least some part of "gender" norms are likely biological. This in turn means that completely fair and non discriminatory systems will still produce significant differences in outcomes in all areas of life, including the workplace and economics generally. Since gender equality politics typical entails pointing to different outcomes as clear "evidence" of a discriminatory system, such activism typically must deny that the possibility of alternative explanations, which means denying any biologically-based psychological differences correlated with a person's sex.
The widespread view that gender is 100% manufactured inherently implies that there is no real biological basis for transgenderism and that it is nothing more than biological males and females freely choosing to prefer adopting the social role that norms have created and designated for the other biological sex, but a trans-male is no more an actual male than a person who thinks they are a dog is an actual dog. It means that treating the "disorder" with surgery is reckless and not medically sound and the proper treatment for those who suffer ill effects from this state would be psychological therapy to dissuade them of the delusion that they are innately the opposite gender when in fact that is impossible since all gender is just a made up fiction. Would a person who thought they were an actual bird and made miserable by not having wings be encouraged to get surgery to attach wings? Of course not. The ethics of the issue hinge upon the objective nature of and source of the atypical gender identity, and surgery becomes far less reasonable and ethical a solution if the gender identification is not in fact a product of innate neurological states that dispose people towards aspects of normative gender roles. Even then, sex-change surgery is arguably questionable, except as a last resort (therapy to help people accept that they don't have to "match" and they can have a body that is atypical given their psychological gender seems the first sensible route).
Note that I personally reject this notion that all transgenderism is basically a "choice", because like all scientifically knowledgeable people, I also reject the notion that gender itself is purely a social construct. I recognize the mountain of science showing that the same biology that creates bodily sex differences creates neurological differences with meaningful impact on most aspects of psychology, from emotions and interests to basic aspects of information processing, language comprehension, and reasoning. But since biologically-based sex differentiation has variability in it and "abnormalities" (in the statistical sense, not judgmental sense), that means there can sometimes be bodily sex differentiation that do not match the typical neurological (and thus behavioral) differentiation.
Thus, I recognize than there are likely a segment of the transgender population with very objectively real "mismatch" (relative to what is typical) between how their chromosomes shaped their bodily versus their neural sex-differentiation. At the same time, there are people without this objective physical state that merely are (for various learned/motivational reasons) choosing to adopt outward appearances of what is more typical of their opposite sex. I don't think society should be upset by that choice, but we should understand the difference between these types of "transgender" phenomena because it matters for the ethics and scientific validity of how we should help these people when they experience mental health issues.
