I really think the idea that biological imperfections mean that transition is inappropriate is a bit odd. What actually matters in human society is social role and function. Most traditional human societies acknowledge the reality of a certain portion of their population having a mismatch (generally of soul not mind persay) and body, and have rules and customs for dealing with this.
Clinicalisation of this makes me leery. That’s all a modern thing about treating such a characteristic of the mind as a disease, about imposing medical order on the human spirit. Since some religions like Bahai faith, Shia Islam and with the rules of the Hijra community, Hinduism, explicitly accept it, there is jo question that a religiously plural society must accept it.
To me bodily perfection is irrelevant compared to sincerity and sacrifice. The ritual act of bleeding in surgery can be said to be an initiation into womanhood and that equity of blood is more important than any presumption of modern medical science to me. Something involving the human soul should always be timeless, not dependent on technology.
I am more inclined therefore to treat the matter as a spiritual one, and only reluctantly accept a medical definition because of the need to provide a clear-cut social order and sense of security for those with different spiritual views.
Ultimately, whether or not an individual is transsexual will be apparent in their mannerism. If they’re female in spirit they will act it, and they will desire to maximise their femininity. They will try to fit in. They will care about hair removal and plastic surgery on the face. They will take vocal lessons. And they will get reconstructive surgery as soon as possible. In summary, I simply don’t believe it’s appropriate to stand in the way of a human soul on her journey, but by that journey may you judge them.