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Sure. I mean, you are also allowed to question the sexual identity of a celibate closet gay in Kabul, or the faith of a Christian in Tehran who does not try to preach the gospel to the locals.
For most people, a faith, gender or sexual identity is not their whole utility function. There is probably a trans person somewhere who would emigrate to Somalia if that was the only country where they could transition, or be willing to murder people for their wallets if that was the only way they could affort HRT. But almost all people have more complex utility functions, where trade-offs exist.
Physics determines part of how easy or difficult maxxing certain terms in one's utility function is. If visiting the Moon was as easy as taking a tram, you can bet I would visit the Moon, and if changing your sex was as easy as picking another option in a drop-down menu before going to sleep, I would certainly experiment with being a woman. But giving the constraints of physics, both of these things have significant tradeoffs, so I am very unlikely to gaze at Earth or grow tits.
But on top of that, societies can incentivize or disincentivize the maxxing of certain terms of one's utility function ("self-actualization"). I like to eat licorice sometimes, but if my society places it on Schedule I, I will not spend half my paycheck on getting some from the darknet. Likewise, if the penalty for the possession of redhead porn was death, that would definitely affect my porn habits. Or if the government decided that unlimited vanilla ice cream was a Basic Human Right and heavily subsidized its sale, that would likely lead to me changing my ice cream habits.
If your model of mental health services is that they will give people whatever will make them feel better, then I totally agree that no society could afford this. "Doc, I am a bit down, but I think a {new dress|adventure holiday|blowjob|fancy dinner|MMORPG item} would cheer me up" - "Sure, let me just write you a voucher for that".
In the real world, the mental health services do not work like that. Feel free to visit a psychiatric hospital sometimes and check. Engaging with mental health services because you feel bad is like using a life buoy because you are wet. Either system is designed to keep you alive, not ensure your comfort. Unless you are wet to the point which we call "drowning", or feeling bad to the point we call "clinically depressed", your best option very likely does not involve these emergency nets.
Trans issues are a strange exception to all sorts of the usual bureaucracy/hangups/etc. One visit, 45 minutes-hour max, possibly even a virtual consult to get HRT through planned parenthood. Then there's the whole sports debacle, bathrooms, pronouns have kind of faded but they were fireable offense for many years, 'cotton ceiling' discourse... et cetera.
Most mental health services do not work like that. Western societies made an exception for one subset and nobody seems to know why.
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There were people who checked and the results look a lot closer to his model than what you call "the real world".
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