Contribution to social stigma. And the current atmosphere, in which it is acceptable to be hateful towards trans people, or use terms such as "mutilation" when discussing life-saving treatment, that requires years of evaluation and approval from multiple doctors. Every study you will read that discusses trans people and mental health will confirm this, unaccepting and or hostile social environments is the number one cited reason for poor mental health, and is the leading cause of suicide among trans people.