Now, I was lucky...I had planned to complete a training program, and then start working and save half my income to cover my surgery. I figured a year or two would be enough. Of course, that was after I completed a training program that would take about two years. Instead, I found out about a possible job that would include surgical coverage. I jumped at the opportunity. Now, as it was, I had to work a bit over a year before I got my surgery. I was the first one who worked for this particular employer who took advantage of the benefit.
You are misreading what I said. The point is that a fair portion of people living as transgender are economically transgender and would get SRS were it available either publicly or privately.
This is much more so in the US than in places where a National Health System covers SRS.
What I am saying is that there is a grain of truth in the claims of many transgenders when they say they are really transsexual.
At the time, I worked for a research project that included a number of "transgender people." Three of my co-workers were post-op transsexuals (though all three identified as transgender). Six others had not had surgery. Out of seven who were MTF (including myself), only myself and one other ha have surgery. One is still actively pursuing, and I have heard that another might. Another was fired and is trying to get her current employer to cover it. I had my surgery as soon as it was available, as did the other who completed surgery, The rest took very casual approach to the issue. They expressed interest, but were in no rush.
Elsewhere in the same organization, there have been others who have not taken advantage of what is virtually free surgery (there is a co-pay, $250 with the plan that provides the fastest path), Various excuses are offered. The same is true for the City of San Francisco, which has offered coverage for SRS for years. Most "transgender" employees simply don't bother.
So, Cooke is, again, wrong. Even when it is almost free, excuses abound.