It’s a 10 year old flawed study. There’s much I could say, about how times are different and the fact that the data collected is from 1973 Sweden to 2003, a vastly different time from today. But let’s put all that aside as if maybe it’s totally a legit study.

Even then... It mistakenly compares ‘people with transsexualism who get reassignment surgery’ to the general population. then it mistakenly concludes based on there being a difference between these two groups, that the surgery is not to be suggested.

The true comparison should have been between ‘people with transsexualism who do NOT get reassignment surgery,’ and people who do.

That is all that can be up for analysis.

If you’re trying to make a case for ‘transsexualism itself’ being a disorder, then we would have to shift to the ‘times are different’ issue. Homosexuality was in the DSM list of psychiatric conditions, until it was removed. People lost their entire careers and social circle if they were found out to be gay. My college roommate was gay and his boyfriend was beaten ruthlessly for the ‘crime’ of walking down the street looking feminine. Of course you’re going to be mentally in a different place when such things happen to you a lot.

‘Transsexualism’ is a similar cluster of factors that can’t be explained away as a disorder, when they’re most DEFINITELY scapegoated and harassed to an extreme degree.

This idea that we should classify someone’s sexuality as a disorder is a truly slippery slope, with the one exception of people who have sexual preferences for age groups below the ability to consent or meaningfully combat grooming.