The surgeons performing these surgeries are ironically often disgusted by their clients. In the same way pain specialists are the biggest sceptics of chronic pain patients. These gender reassignment guys charge huge fees and usually under-perform in actual surgical specialities. It's something of a grift considering the success rate and post op complications.
This, a friend who does esports commentary was invited to demo some games (I think it Harry Potter and a spider-man game) as part of an event promotion. He received hundreds of pages of documents relating to exactly what he could and couldn't say, scripts, prompts, confidentiality, legal repercussions, even the facial expressions he was allowed to make, clothes he could wear and the proximity of other conversations on particular topics to discussion of the games.