I'd consider gender reassignment surgery to be less elective, less expensive and less risky. There is a condition called gender dysphoria, and for a lot of patients hormones and living their gender identity doesn't alleviate it. I'm "cis", so I can't fully understand the situation transgender people are in, but I would hope that we can get to a point where genitalia matter less for gender identity. Easier said than done, probably.

It also depends on how much of your sense of self worth or identity is entangled with your sexual "functioning". I believe I wouldn't opt for such a surgery. Of course, I'm not in this terrible situation. And I can imagine other people having enough of a problem with these parts missing.

Speaking just about the costs, intensive psychiatric and therapeutic care should be more cost effective, and it's necessary in most cases, anyway.