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surgery has been far, far from the first resort
I know, hyperbole and all that. AFAIK, in the context of a society which is still pretty well locked in binary-gender mode, trans people seem to get better long term mental health outcomes when gender reassignment/confirmation surgery is included in their therapy plan. That leaves hanging the wider question of whether surgery would be necessary at all in many cases if we just changed society.
Still, my boyfriend was as happy as a dog with two dicks after his phalloplasty, so I wouldn't want to take surgery off the table.
I have a colleague who is going through this process and surgery has been far, far from the first resort, in this country at least.