The unfortunate(from a clinical standpoint) thing about humans is that we are all individual. Gender identities, and identities at all would not exist if we were all cookie cutter stamps of each other, so everyone will feel differently about gender role, presentation, and so forth.
I always looked at the physical side of transition as body modification rather than anything else, and wish that the medical community would as well, it would lift the stigma of mental disease from the transgendered community.
Even though I have major issues about the "gatekeepers" to body modification, personally, went the gender therapist route vs. informed consent, because I will be changing my actions, voice, and other things about my life as well as my physical body, and it is what the people prescribing HRT, performing surgery, and the people paying for the Rx want to see.
I am a person that has always seen the wrong body in the mirror. That being said I really feel for the people who want to change physically, but don't have the feeling that it is something that they have "known" from childhood.
I'm not saying it is a great idea for someone to be able to go out and get srs on a whim, but arn't we reinforcing gender stereotypes if we define what it is to "live as a woman" and have a minimum levels of lifestyle before some services can be rendered?
Gender therapy will really help if you are transitioning "mentally" as well, but too many folks just want the physical, and get discouraged by some less progressive GTs, which I think is sad.