1. They don't want to be women, I sincerely doubt they would want to get their period every month, have to carry a child for 9 months, have back issues if their tits are too big, not being sreal womang enough to defend one's self against an aggressive man, etc.
They just like the idea of it; they get off to the idea of looking like women, hence AGP. That's the vast majority of transvestites.
2. Nobody who thinks they're a woman or thinks they can magically become one when they're not is mentally sane.
3. If they chop off their dick or get the axe wound surgery they won't be able to masturbate and their libido will drop altogether because it's a form of fucking castration, thus making them depressed and more likely to off themselves.
Also, the stench. From what I've read online, axe wounds smell like literal shit, a fowl repugnant stench. Imagine trying to live with that 24/7 and pretend like you don't regret it. It also doesn't matter how many times you shower, it NEVER goes away. Then there's the possibility of infection, necrosis, having to shove a glorified dick up your ass four times a month to keep the wound open and always ready for infections.
4. It's expensive. "Facial feminization" surgeries, axe wound surgeries, boob implants, among other shit; you're looking at anywhere between 35k-118k+ (48k-160k USD) for COSMETIC surgery. And if you regret it? There goes your life savings & 401k, money for insurance(s), mortgage, your wife's boyfriend's basdummy kid's college tuition and everything else in your life that actually matters.