The amount of hormones they have to take, on top of living with the results of full castration and a life long physical deformity that does not make you what you thought it would, is of course a mental illness. Estrogen is powerful. When I went through the change (menapause) I took hormones for awhile due to crazy hot flashes every 20 minutes. After being on the initial dose, I remember driving in my car and being overwhelmed with sadness, I was weeping for no reason and had sad sad thoughts. I called my doc because I knew something was not right, and she immediatly lowered the estrogen, it was like someone turned the light on in a dark basement. Now, I am a woman, just think of the amount of estrogen a man has to take to feminize himself, probably 4x what I took for hot flashes. Gender dysphoria is a thought disorder, and to hell with doctors who comply in this.