An individual's gender is understood often at a very young age, long before medical intervention and legal permissiveness is even an option or even necessary for the health and happiness of an individual.
Setting a a legal loophole for "surgery" is often an impossible hurdle due to age requirements, financial means, and in many cases is simply not necessary.
Such a requirement imposes a serious and unnecessary breach of privacy between a citizen and the government.
Such a requirement imposes nothing less than mandatory sterilization on such individuals, and imposes on their reproductive rights.
Such a requirement springs from small mindedness, ignorance, fear, and bigotry.
Modern science and modern psychology have mutually shown that gender is quite distinct from biological sexuality, and one only needs to put the most minimal effort into researching sexual anomaly in humans and other animals to see among "gender" and "sexuality" that neither is in any way a binary issue.
And finally, gender non conformity is not a "new" issue. For thousands of years First Nations recognized gender diversity on this very soil, "Two Spirit" peoples have been recognized and allowed rightful place in society for tens of hundreds of generations in Native American peoples, and gender fluidity and gender non conforming people have been documented in practically every civilation at every time and place on this planet.
It it is time to end discrimination and legislated bigotry against our gender non conforming friends, family, neighbors, and citizens once and for all.