Sperm, reproductive organs, natural production of hormones. Come on.
There was a great article a few weeks ago about these “doctors” collaborating in gender disorders instead of attempting to cure them.
There are many women post menapausal (and post surgery) without the latter two, and they are still classified as "women". But certainly it is a incredibly pampered society that would make these expensive surgeries available without first requiring some serious psychological counseling first.