Some of the effects of hormone replacement therapy are not reversible. To illustrate, many trans men are happy with their voice deepening, and some will report a scratchiness in their throat soon after starting testosterone. The length of vocal cords changes and the timbre of the person's voice hence also changes. Voice changes, once t are permanent. Similarly, there are also risks associated with estrogen therapy. There are risks of blood clots (thromboembolism) and a slightly increased chance of breast cancer. There is also the potential for permanent cessation of sperm production.
With regards to gender reassignment surgery, the changes that take place are considered irreversible and hence the individual has to consider carefully before undergoing such a procedure.
The main barrier to persons with transgender issues is their access to care. It is important for the healthcare professionals to be more aware of gender diversity and to provide better care for them. In some cases, they are so severely distressed by their gender dysphoria, hormone replacement therapy and gender reassignment surgery will provide the best treatment outcomes for them despite all the risks and potential side effects.