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A heart attack is involuntary. What makes it a threat is that you are going to act if they don't do as you demand. The fact you are pinning actions you are going to take to hurt yourself on them makes it more abusive.
Again though remember the original example was about other people hurting themselves. So maybe we're losing it in analogies.
If I say stopping medication to bipolar people increases the risk of bipolar people killing themselves. That can be either true or false. Whether I am bipolar doesn't change anything about what those other people do. If I say I will kill myself if you stop that medication, then that is a different type of statement.
If my son is a truck driver and wants to call out to play Call of Duty and I say, if you don't deliver that shipment of widgets, the widget factory will shut down and people will lose their jobs, some might starve and some might even commit suicide, I am not going to hurt anyone or myself, I am pointing out the potential consequences of his actions. I might be making those consequences up to guilt him, or they may be true or I may be exaggerating them for effect. But we can't tell which without knowing about the widget factory and the financial situation in the town etc.
I think what offends, at least to me, about this line of argumentation is that it implicitly incentivizes committing suicide. It's a kind of brinksmanship of slave morality. It has the same kind of energy of forums that hear about a mass shooting and are, often not even secretly, hoping for it to be their kin slaughtered by the hated outsider. It's this ugly race to the bottom of grievance where instead of groups showing how excellent they are everyone is slavishly hoping for their ingroup to come out as pathetic and worthy of sympathy as possible. It's an impulse I recognize in the worst parts of myself. And if this is the impulse that gets my ingroup what it wants why not indulge it?
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Yeah that got a bit too abstracted.
The problem is, you are 100% correct imo, the idea that better treatment of trans people will reduce the risk of their suicide is not inherently abusive, and it's a fairly standard part of risk management re the mentally ill. Which is why it became such a popular talking point. But then you had trans people lobbying for their community with it. And when trans people started lobbying with that talking point the potential for abuse increased by orders of magnitude, because when you lobby for the community you belong to, anything which affects your community necessarily affects you.
And a percentage of trans people, like a percentage of the rest of the world, are manipulative abusers who saw a superweapon - by ramping up the emotion and playing on their fear, they could make their community (many of whom are on hormones, never mind their default mental state) feel like they were being viciously persecuted and driven to suicide. Then even if someone points out that they are a sociopath manipulating everyone, they can discredit them as a transphobe trying to kill trans people.
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