Since the procedure became a right, more than 1,000 people have had the surgery, hormone treatment and pyschotherapy required for a sex change operation. Something in the order of 80% of the operations have been male to female. The cost to the NHS over the last decade is something in the order of £10 million for the 1,000 or so transitions performed. In an appeal court verdict in 1999 , health authorities were required to assess the need for treatment for transexuals as though they were suffering from a disease rather than in need of cosmetic surgery. The health authority in the appeal claimed that it was entitled to take into account its own “scarce resources” and to refuse funding for the operations if it meant funding for serious illnesses, such as heart disease, cancer, kidney cases and Aids would suffer.
I don't suffer from gender identity dysphoria and I would want an extraordinary good reason before I had my testicles removed and my penis cut off even under a full anaesthetic. So while I, from an admittedly medically biased position, think that there are far greater priorities for a financially pressed NHS; I am very prepared to believe that there is much more than a cosmetic fetish at stake here for those who agonise over their particular problem.
As for flight crew, what possible difference could a little biological tweak make so long as the individual was competent and happy?