@nerthos "Well I feel you should respect my demigender asexual tumblrkin identity" "...well I think you're being difficult and obnoxious for the point of getting attention, but that's neither here nor there is it?"

What matters when it comes to medical treatment is the plumbing when it comes to physical treatment (biological sex) and the self-image when it comes to psychiatric treatment (gender identity).  I should note that the kind of stuff we see about otherkin and the 98439843 types of gender identity on Tumblr and the like, often represents mild schiznophrenia.  However, there are entirely valid cases of people whom for a variety of reasons, have a mental self image of the other biological sex.  This isn't always just because they're mad or attention-seeking.  For instance I personally dealt with this when I was somewhat younger, because of hormone deficiency.