it's amazing how insular American social values are. outside of America transgenderism and gender dysphoria is seen as a mental illness. From Thailand to India, from Africa to South and Central America, there are a wide variety of hermaphroditic peoples who are culturally and socially accepted without surgical interventions. it's only in the West, driven by the US, that self determination and surgical and hormonal interventions are thought to be a good solution, whereas elsewhere the focus is on mental health support rather than gender "realignment".