I suspect they get given a 15 page form to sign. But the compulsion is so strong that the implications, although considered, are dismissed.
There are lots of forums about how to get around the gate keeping.
But I agree. Personally I do see how surgery can alleviate symptoms. I think there are many people who are quite happy afterwards. I just think it shouldn't be the answer. Because of the lifelong reliance on medication and because if you do detransition it must be horrendous.
People say it's like getting anorexics liposuction. And although I don't think it's exactly the same, there has to be a better way.
A few months ago I read about the part of the brain that when stimulated alleviated the symptoms of anorexia. There seemed to be some kind of correlation between that and gender dysphoria.
And this is where the money should be going.