The are a few reasons, it could be age, religious background, job security, worried about surgery risks or of course they just don't want to do it.
But another big reason is the waiting times, waiting three years seems to be the minimum and some services it could even be years longer than that. Leaving many with difficult situations of whether to pay privately to complete it sooner. But the costs are a significant outlay, so would stop most pursuing this option.
Unfortunately these waits can contribute to suicide rates, as studies have indicated 82% have considered suicide and 40% have attempted suicide.
With the volume of individuals wanting to transition rising at a rate higher then the NHS can handle. Is why I mentioned earlier it will take at least 10-15 years for the numbers to change from below half to over half having surgery.
As waiting times for gender services soar, transgender people speak of their experiences as time ticks by.
www.bbc.co.uk