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This, however, can cause significant problems when transgenders they try to obtain physical treatment. Therapists' records reveal that most transsexuals do not believe they need psychological counseling, but acquiesce to legal and medical demands in order to gain rights which are granted through the medical/psychological hierarchy. Legal issues such as a change of sex on legal documents, transgenders and medical issues, such as sex reassignment surgery itself, are usually impossible to obtain without a doctor's and/or therapist's approval. This leads to the inevitability that many transsexuals feel coerced into confirming pre-ordained symptoms of self-loathing, impotence, and sexual-preference, in order to see simple legal and medical hurdles overcome. Transsexuals face the unattractive option of remaining invisible with no legal rights and possibly incongruent identification, or submitting to a medical hierarchy which alone has the ability to grant legal gender status.
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