Originally Posted by Mord
Not so much, the treatment side is specified by the WPATH Standards of Care, http://www.wpath.org/publications_standards.cfm
the DSM just serves as what it is, a diagnostic handbook, were it not to be included it wouldn't make much difference, though it would be a little odd as a psychiatrist is usually required to make the initial diagnosis. That's the crux of the issue really, on the one hand being in the DSM implies it's a mental health issue, which has social stigma. On the other a shrink is required to figure out if it's a delusion or fetish. I think ideally it wouldn't be within the DSM however all similar things would be and thus to proceed with treatment one would have to have those things ruled out by a psychiatrist.
The current debate has absolutely nothing to do with the validity of the treatment, just the protocol for the diagnosis and the naming of the condition. There is no current mainstream serious debate over whether this surgery is necessary or not, even the IRS accepts that it is tax deductible and thus neither cosmetic nor elective.
I am not doubting the validity of treatment, or even if the surgery is or is not necessary. I have absolutely no authority to make that kind of a call. I am, however, saying that if it is to become something in the US that is done with tax money that a specific type of research needs to be done, and that this research is done in a specific manner for very important reasons. Furthermore, anyone who is a government employee is likely going to be thrown into a different debate. Not sure about the UK, but in the US, private issues of public officials often become everyone's business. I'm not saying that I agree with it, but that is a common theme with American government. The most obvious proof of this is almost surely Bill Clinton.
I am not sure how private insurance companies use the WPATH or individual agencies. To my understanding, there are some private insurance companies that do cover the procedure and related treatment. My note on the DSM was more that a formal backing may have some benefit. However, as you noted, it also could mean stigma. I would assume though that in most cases, prior to a surgery, a psychiatrist is involved who specializes in the area given the permanent nature of the operation, which is not all that different from many other operations given how important state of mind affects recovery and future health...and so whether it is or isnt in the DSM may just be a minor detail.