At it's worst the system kills us, institutionalizes us, and abandons us to poverty. Good therapy is a tool that can help this process. That I am a gatekeeper in undeniable - I have the power to write referral letters to endocrinologists, or not. As a gatekeeper, I am expected to ensure that nobody slips through the system and has surgical or hormonal procedures that do not meet the procedural guidelines. I am aware that too often these guidelines have not really been developed to protect the clients, but to protect the medical profession from being sued.
Clients seek out therapy for gender issues for different reasons.
Adults seeking services for themselves are often of two categories. The other group who seek out therapy for gender issues are people who know themselves to be genderly different - either transsexuals or transvestites who fit the prescribed diagnostic criteria in the DSM, or people who do not fit into any medical classification system, yet know themselves to be trans. This group of people are often less closeted and more articulate about their identity. They are often in less emotional pain, and clearer about their options. Sometimes they also want help - help managing a resistant wife, or confusion regarding coming out to parents, or help coping with fears about how this will impact their careers or financial stability.