Honestly, at this point create waivers, stating very clearly that any surgery they request COULD kill them or alter / hinder their life or ability to function and if they sign, let em get mutilated. They die, oh well, they were informed and signed a waver, with a notary public and another witness to ensure they are properly informed. Even add a video recording of the consent and risk conversation for court. Either they stop requesting stupid ass surgery or the pool of TRA shrinks.

also, I think there needs to be regulations, such as living as your gender for 2 years, while receiving weekly psychological appointments and treatment. Then applying for a license which would allow transition by transferring you to the other gender legally. Then you can apply for surgeries which take a year of psychological treatment to ensure you want said surgery, each time you get surgery for gender reassignment stuff.