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There's a difference between gender issues and sex issues.
Gender isn't about who you sleep with, which kinks and fetishes you have, or even what clothes you wear. Sexuality isn't about whether you are male or female.
The thing about gender is that it is not something that you can conceal without hurting yourself. Changing your physical appearance through medical procedures isn't about comfort, as you suggest, it's about psychological wellbeing. I sincerely doubt that the procedures one goes through to change their appearance are "comfortable."
People are brought up being told things like "This is what boys wear" or "this is what a female looks like" and when you know you're not in the right category, you want to become what you know you should be.
Ustwo, you're pretty certain you're male, but if you woke up one morning and you were suddenly mostly hairless, soft cheekbones, had breasts and a vulva, and were mighty pretty, I have a feeling you'd still be certain that you were male.
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