Interesting response, Tequila. Unlike you, I have decided not to outsource my thinking.
Not offering psychiatric treatment for gender dysphoria is quite a recent development, in the last couple of years, since it was decided that psychiatric treatment amounted to 'conversion therapy'. This was the result of lobbying by transactivist groups.
Surgery used to be only offered as a last resort, when non invasive treatments had failed. Patients had to confirm that they understood that they couldn't change sex and that the surgery was not a 'sex change'. This also seems to have changed as a result of lobbying, not because people can actually change sex now.