I am who I am.
Let's wade into the deep water for a few minutes here and talk about sexual feelings. This is a big why issue for some. Whether you want it to be or not, it can become an issue, because when one needs to make use of the public health system here in Canada, one needs to satisfy government regulations and meet up with the gatekeepers at CAMH. In my case, that meant having interviews with psychiatrists, since transsexualism was classified as a mental illness up until very recently. They ask about your sexual desires in those interviews (among other things) because they think it is relevant to your motives for wanting to align your life to your proper sex.
Just for fun, I searched autogynephilia and was rewarded (first hit from a site called Trans Road Map) with "Autogynephilia is a sex-fueled mental illness made up by Ray Blanchard. Blanchard defines it as 'a man's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman.'"
Now, let's call this narcissism. Yes, being narcissistic is potentially annoying for others, but unless it is accompanied by a long-term pattern of exaggerated self-importance with a lack of empathy for others that results in taking advantage of those around you, it is hardly a disease.
My first assumption, with apologies to those whose religion rejects this, is that sexual feelings and arousal are natural and good. The propagation of the species depends on those feelings and urges. What is wrong with sexual feelings is something layered on by society. Those feelings begin a long time before socially acceptable uses for those feelings are possible. Some suggest that even in the womb (using ultrasound technology, I assume) children have been detected stimulating their genital area repeatedly.
When one's body fails to be aligned with one's internal perception of oneself, then sexual thoughts get, not surprisingly, confused. When a person is first discovering their own body, and its potential to give them sexual pleasure or possibly feelings of guilt, that confusion is particularly great. Feelings and thoughts flow back and forth during that experience. The arousal can become mixed up with the need to be the sex you know yourself to be at the deepest level.
To my mind, society's "need to know" ends at assurances that the individual in question is not forcing anyone else to say yes when they really mean NO!
We have the right to be comfortable in our own skin. When that isn't the case, we should be able to use the resources of our society - our financial resources or the health care system we support with our labour - and the skills of medical professionals to become comfortable with our own body.
Our sexual feelings, whether they are toward a man, or a woman, or toward ourselves, should not be a part of that discussion, unless we choose to involve them.