No. One. Wants. To. Deny. Healthcare.
We want ethical health care.
It is not ethical to transition a child without robust safeguarding and making sure they are not gay, autistic, or otherwise vulnerable. Even then it's still arguably not ethical to transition when so young because of our understanding of how identity forms and when. Never mind the consent related issues.
It's also not ethical to carry out treatment with exceptionally high complication rates, in the absence of evidence that it is effective and the risk of detransition is too high.
Ensuring good and equal health care for trans people INCLUDES an acknowledgement of sex because of the numbers of scenarios where failing to recognise sex could cause actual harm.
Then there's the cosmetic aspects. For fair access to cosmetic procedures we need to understand what is the base line. The base line is that the NHS does not provide cosmetic care universally. It is done by need in clinical terms.
If you can't PROVE a clinical benefit then you can't ethically approve a cosmetic procedure. Particularly on the NHS. Cos that's how the NHS works.