People didn't talk about wanting a sex change, but loads of us hated our bodies and wanted to wake up in different ones. Given the option and institutional support and reassurance that transitioning would help us, many of us probably would have been convinced to do so

This is actually one of my primary concerns regarding transgenderism in the modern day. I think it's a tool in the toolbelt for when it's necessary. I also think it's a tool we reach for much more often than is necessary.

The comparable example I like to give is adhd. It isn't binary. You don't just have it or don't have it. Some people have symptoms that need no intervention. Some people have symptoms but are misdiagnosed as adhd. Other people get by with therapy alone. Yet others find medication necessary to be functional.

Giving gender affirming care to all people with gender or body dysphoria is like giving high dose Adderall to all people who have trouble paying attention in history class. It's the nuclear option, and you're using it on someone who may not even have adhd, or may not require such a strong intervention.

I know everyone hates this word, but starting with more conservative treatments first is the norm throughout healthcare for exactly this reason. We've made an exception for transgender people for political reasons, not scientific ones.