And, if you feel the client is not a good candidate for surgery, you should be honest about that giving the client clear, understandable reasons why you feel that way. You should also offer assistance in helping that person find alternative ways to cope with his gender issues. This last may be particularly hard, because the client may argue vociferously that he has a right to surgery. But it needs to be made clear that the reasons for denying surgery has nothing to do with meeting some set of arbitrary rules. You have to let the client know that it is done with the client's best interests in mind.
Surgery is irreversible.
Post- surgical regrets will be harder to deal with than a temporary disappointment at not being able to have a fast surgical procedure. I think this quality of client respect is perhaps the most important of all. Most transsexuals battle with self-esteem. We feel out of place, guilty, ashamed, like freaks. If our therapists also treat us like children or mentally deranged individuals, that just lowers our self-esteem further.