I also think it's a tool we reach for much more often than is necessary.

Do you have any evidence for this? Because the vast majority of people who transition stick with it, and the vast majority of people who don't go back because of social pressures. here is an article about how many people are happy with the care they receive, I really think you should read it.

The comparable example I like to give is adhd. It isn't binary. You don't just have it or don't have it.

Yes, you either have it or you don't. You either have diagnosable, actual adhd or you don't. Sure, it can be worse for some people. But to be diagnosed, it has to be causing you problems in your life. Mental illnesses aren't something that everyone has to some extent.

Other people get by with therapy alone. Yet others find medication necessary to be functional.

Yes, people cope with their issues in different ways. Same for trans people. Most don't get top or bottom surgery, for example.

I know everyone hates this word, but starting with more conservative treatments first is the norm throughout healthcare for exactly this reason. We've made an exception for transgender people for political reasons, not scientific ones.

I hate the word conservative for reasons completely unrelated to how you use it here, I'm not sure why you'd mention it. And there's not an exception for trans heathcare, why would you think that?