Dreams about certain things don't necessarily mean they're about certain things, if you get what I'm trying to say. The mind uses what it knows, or what you know, in order to convey emotions. It works with what it has. That you've been thinking about. And if that's a focus on gender issues, then that's the easiest thing to provide the imagery around. The feelings evoked from not passing and feeling like an outcast may be related to something entirely different.
Not to make light of it, but to illustrate the point: after a particularly severe bout of dysphoria, I had a very vivid dream that I was on the operating table, having SRS, but something had gone wrong and I was bleeding internally. Everyone was panicking and I was starting to feel more and more pressure, like I wanted to burst. I felt that if I did, there would be a vast, gushing river of blood everywhere.
At that point I woke up, and realised I desperately needed to pee.
It seems reasonable to assume that a subject which occupies a large amount of our time is likely to illicit dreams which are symbolic of something else, using imagery you're familiar with.
Also, I would say that knowing what you have to do, knowing what you want to do... and actually doing it... well, it's not always a natural progression. Things have a nasty habit of getting in the way, distracting us, throwing up obstacles. Defense mechanisms thrown up for us to find "the right time", you know? "Oh I'll do it when I <insert pre-requisite>." Not to mention fear is both very powerful and can be very subtle. The thought of someone else seeing into our soul and telling us we're wrong. That there's nothing we can do, or they won't help. All that can play at the back of your mind.
I don't think you have to actively do, or prove anything to know you are a certain way. Rather that's the other way round, perhaps. It's that you are who you are which drives you to feel the way you do and act accordingly.
What matters, I think, is not when you took action, but that you did. Based on how you feel about yourself. How you feel about who you are can often be the one constant indicator when everything around you is in flux.