As the "transgender" community continues to broaden and we recognize the rich spectrum of identity it envelopes, I can't help but have mixed feelings about the inclusion of "gender identity disorder" in the DSM-IV, and the proposed definition of "gender incongruence" in the DSM-V.
In a general philosophical sense, I think people should be free to express themselves (including their gender) in whatever form makes them happy, and along those lines I can certainly recognize the validity of someone who simply feels that they have both masculine and feminine identities meshed together, and prefer to express that idea in their clothing as a male-looking person who wears very feminine clothes sometimes. That person may not have any desire whatsoever to modify the body, or perhaps desires partial modification to retain sex characteristics of both genders. In a social sense, do we treat this person as crazy or having a psychiatric disorder? Or do we see that in most other ways, this person behaves just like anyone else, and if not for some "interesting" fashion choices, should be considered mentally sound?
What about the "classic" transsexual? That is, someone who is firmly convinced that her male body is a deformity and an improper housing for her female mind and self-image (or vice versa for the classic male TS). Should society treat this as though it were any other birth defect? Given the propensity for depression and suicide in untreated transsexuals, isn't treating a TS with surgical correction akin to a life-saving procedure or at least one that significantly improves the quality of life of the patient? On the other hand, if we consider it a body-image issue, then should it be treated like breast augmentation or other cosmetic surgeries and categorized as elective?
In the fight to have people with non-standard gender presentation treated as "normal", does that it mean it should no longer be recognized as a medical condition? The ramifications in the US may not be that great - not that many health insurance plans actually cover gender reassignment surgery anyway, so most of that expense if borne by the transsexual patients themselves. However, in Canada, the UK, and other countries with universal health care currently recognizing gender identity disorders as legitimate and surgically correctable medical conditions, most transsexuals who undergo surgery pay minimally for that treatment. "Normal"-izing transsexuality could take that away if it is completely removed from some future edition of the DSM (like homosexuality was decades ago).
I don't have a well-defined opinion on this yet, but I think that this is an argument that the transgender community should be discussing.