I speak from a definite bias here.
Are transgendered people mentally ill, or, for lack of a better term, off their rockers? Maybe. Does having gender reassignment surgery and hormones cause their quality of life to improve? For most of them, yes, as long as they can find inner peace and community tolerance, I say go for it. The same as we tell a depressed person to take a pill, or a restless person to find peace, I see nothing wrong with supporting a transgendered person to seek whatever it is that will make them comfortable in their own skin.
As to the Miss Universe pageant, it's not like there's much natural beauty there to begin with. Now, if it were an all natural pageant, no implants, tucks, collagen, liposuction, reconstructions, dental work, lifts, dyes, sprays, or Latisse allowed, then it would be a little different. But, when you consider that Miss Universe is already full of manufactured women, manufactured smiles, manufactured stories, and manufactured dreams, why are people so up in arms over a couple more manufactured breasts, attached to a mostly plastic human being with no real goals and no real impact on the world? (Sorry, I think my personal views of pageant contestants may have snuck in there at the end.)