Sorry Stephanie, I think your question is a bit flawed. Technically nothing is stopping anyone from choosing to live as a woman if they want to. Change your wardrobe and your name, remove your beard (if you want) and away you go!

It's the "optional" medical extras - like HRT, FFS, BA, GRS that are the gate-kept components. Now, of course, for many of us, they aren't optional, for any number of us they're pretty much essential. We need them to assist us in what is our particular personal process of living as a woman, to help us feel complete and comfortable with ourselves - and it is there that the hoop jumping and roadblocks come into the picture.
I guess the cis centric medical service industry sees those "optional extras" as extreme, that anyone who would want them must be a bit bonkers if not totally unhinged. They are thinking of it specifically from their perspective - "I wouldn't do that, why would anyone want that/want to do that to themselves?". They're cis, they can't understand why we want/need those things. They say, "OK, if you really want those extras you have to at least "prove" to us how much, you have to tick some arbitrary boxes, blah blah blah".
I'm freely choosing to live as a woman, fortunately I live in a city where I could do that with little strife. Yes, I have utilised HRT as part of that process but it's only now that I realise I could have just gone ahead regardless... I wouldn't have been anywhere near as happy that's for sure, but I still could have lived as a woman.