I know it’s not something we like to talk about as a community, but I thought this piece about deciding whether or not to have genital surgery was useful. I’d put the “it’s personal” section a lot higher on the list, but the article does point out that what was once a requirement is starting not to be in a (very) few countries, in order to change gender markers on US passports, etc.
Because it is so deeply personal, this decision should be up to the individual, not health insurance companies, not gatekeepers, not governments. There are so many people who are unable to afford surgery that there’s really not much “choice” involved – finances dictate. But even if surgery were readily accessible and affordable, it should never feel like or be a requirement for anyone.