Asking a surgeon about gender identity is like asking a carpenter how they deal with 16d nails. Gender confirmation surgeries are like icing on a cake, but for many transgender people, are way too expensive and/or excluded by a majority of insurance plans.
Gender identity cannot be observed it has to be reported by humans as their innate sense of being a girl/woman, boy/man or something different. It takes guts and perseverance for people to transition in our two-box (F or M) society, but the drive for authenticity is very compelling.
There are good resources and gender therapist around the world for assisting TG folks, policy orgs and educational groups. Here are just a few:
The L.A. Gender Center
National Center for Transgender Equality
The Center for Gender Sanity
"Nature loves variety. Society hates variety."