This story read almost as a long and scantily-clad dig at transgendered people.
The character of Thomas was entirely predictable by the time he appeared. There were all the tired old tropes about how they're not really happy and they always end up in some miserable relationship with their own kind. Everyone around them suffering for it, and so on. Even the bit about unions makes more sense in that context as it's only been via state and city employee unions that a lot of transgendered people have gotten coverage for what is otherwise a very expensive operation.
Much like in the story's world, in recent years, a right-wing nuts have busily set about trying to rewrite the standards of care making it much more difficult for transgendered people to go through transition, making claims that they'll be unhappy and 'no better off' and that people 'become' transgendered by associating with other transgendered people. They toss around the label of 'autogynophile', which is clearly what the character Thomas is meant to represent. Mirrors on the ceiling et al.
Nevermind, of course that these people are generally 'deeply religious'(tm) and you could make the same arguments about their 'faith' that they make about 'transgendered'. They seem fundamentally unhappy and unchanged. Most of them become born-again only after associating with other born-agains, and they certainly like to stare upwards and proclaim how holy and righteous they are.
Sorry. Couldn't really see this as a story so much as a political essay and it made me wince for friends and loved ones that I know have suffered for those sorts of stereotypes.
As a story, it really fell flat. What happened? Fat lot of nothing. All the characters were static. Nobody changed, nothing happened. The reveal wasn't really very big. There wasn't any real exploration of his experience or of any of the other FTs. Nothing that would qualify as sci-fi really.
It was a story about a marital problems. Wowie zowie. You could have replaced 'FT' with 'Cancer Survivor', 'Amputee', 'Impotent', 'Had an affair', 'lost a child', or 'going bald' and you would have had exactly the same story.
Finally, I couldn't even parse the part about Dr. Fire. Seemed like it was some fragment of a rant that was supposed to make some kind of point yet utterly failed to be coherent.
But... I suppose if you want to give us a taste of what it will be like to stand in lines at the unemployment office, waiting for the government dole in the apocalyptic post-Bush nightmare of a failed economy... Flawless execution!