When you get right down to it, "gender" is really just a categorization of behavioral traits. This is what we mean when we say that gender is a social construct. I mean, what are people so worried about with trans people? That they use the "wrong" bathroom, wear the "wrong" clothes, use the "wrong" pronoun? These are all arbitrary bullshit.
If we had genderless bathrooms and accepted that people could wear whatever they want and got rid of gendered pronouns, maybe we really wouldn't need special gender-affirming care.
I have it on good authority that having the "wrong" genitalia for your gender is legitimately distressing, but perhaps that is just part of the expression of the social construct of gender and if the person had grown up without the concept of gender they wouldn't care what their genitalia were. Regardless, it wouldn't be an different than any other form of plastic surgery as far as I'm concerned.