I would like to add that, no matter what the situation, the psychological component is always a part of it. Exactly the part it plays is highly dependent on a lot of factors.
But you know what, all those years of therapy they do at clinics that do gender reassignment? They do those because they know most people coming in actually can be helped with therapy, can actually resolve their dysphoria issues enough to be highly functional, even happy, with cognitive therapies, and even just understanding the feelings they have.
Some though, it really is a hormonal issue that can’t be resolved with therapy and cognitive exercises, their hormones themselves keep setting up a state in their nervous system that makes it difficult, if not impossible, to actually function.
More deeply, there are those with such huge issues, such a disparity between genes, brain, and genitals, that just having the wrong genitals sets their minds into a deep spin. It’s more extreme, but giving them the genitals to see and to feel that match with what their brains tell them can help, on top of having hormone replacement therapy to match.
All of this because there are actually some minor structural differences in our bodies and nervous systems to respond differently to the same hormones, and that cause problems when given the wrong hormone levels to work with.
But, like I said, those years of therapy? That’s what these asshole insist every transgendered person needs, and they get it if they start asking about gender reassignment, because these surgeons already know most people asking for it are treatable with therapy, and will actually be worse off getting the surgery. The therapy isn’t just treatment, it’s screening to see who can really benefit, and who would be harmed, so those it would harm never suffer through it, and those who would benefit can transition much more comfortably, and actually be happy in their lives.