Beginning in August 2007, we committed ourselves to a clinical review the co-morbid diagnostic patterns of the last 10 patients interviewed by our Gender Identity Clinic. We found 90% of these diverse patients had at least one other significant form of psychopathology. This finding seems to be in marked contrast to the public, forensic, and professional rhetoric of many who care for transgendered adults. Much of this rhetoric sounds remarkably certain about the long-term value of gender transition, hormones, and sex reassignment surgery in improving the lives of those with Gender Identity Disorder (GID). Such clinical certainty would have to be based on carefully established sophisticated follow-up findings. These are lacking. The psychopathologies in this series included problems of mood and anxiety regulation and adapting in the world. Two of the 10 have had persistent significant regrets about their previous transitions. In discussing management decisions, civil rights, and ethics, we planned to separately briefly present the 10 patients. However, our decision to seek patients' permission proved so upsetting to three of the first six patients that we altered the structure of this report. Our attempt to follow the ethical principle of informed consent caused us to violate the principle of nonmalfiescence. This distressing experience only illustrates, however, the disadvantage of discussing professional concepts with lay audiences. Emphasis on civil rights is not a substitute for the recognition and treatment of associated psychopathology. Gender identity specialists, unlike the media, need to be concerned about the majority of patients, not just the ones who are apparently functioning well in transition.