There used to be an entire process that would confirm that a) they have dysphoria, b) they haven't grown out of it, and c) less extreme treatments (like therapy) have failed. Even then they would start with cross dressing and name changes, only moving onto troomer pills and chop chop surgeries if that didn't work. They sure as shit didn't do this to children. Of course, that was a massive inconvenience to the pedophiles and fetishists, so once the left was able to deify these groups that process was the first thing to go.