I don't think getting to the point where the only choices left are transition or death is necessary by any means, it's just that a lot of us do wait till it gets that bad, and that is the only reason it is a pretty common narrative.
In order for me to live the best version of my life, and become the best version of myself, I have to be female. That has always been true—toddling, teen, young adult—and at any point in my life if I had transitioned, it would not have been a choice of life and death, until my early thirties, when it actually became that.
It took getting to that dark place for me to finally course correct. By then it was so hard. You have to imagine being the weakest emotionally you have ever been in your life, and being utterly drained of hope, and somehow finding the wherewithal in that state to choose to do the hardest thing you will ever do, and then actually do it. Just because you want to live, meanwhile despising your own existence and not wanting to wake up in the morning? I mean how in the world I did that ... I just don't get it.
Don't wait till it gets that bad, if you can. It is super dangerous.