NPR today had a show about [surprise, surprise] trans youth, and they were talking about a FTM kid named "Finn" and Finn telling teachers and classmates that she was now going to use male pronouns. The interviewer emphasized how important pronouns were and stated that if people get her pronouns wrong, "it makes him feel physically ill."
I just thought, "Pronouns make you feel physically ill. Huh. How about we interrogate that statement?" It's no huge insight on my part, but it just brought into sharp focus that pronouns are not the real issue here. The issue is that these people are claiming the absolute need to be insulated from other people's objective perceptions of them because if other people don't perceive them the way the want to be perceived, it makes them "physically ill."
That's what I would call a serious mental health problem, and the implicit conclusion that people who think like this NPR reporter have reached is that nothing can be done about it, so we must protect them from what anyone who sees them knows. We all have to pretend. In what other circumstances would such a demand be made?
So when people start arguing about pronouns, keep in mind that it's never really about pronouns. It's about the fact that you're being told to deny the evidence of your senses.