If a transsexual can’t have proper healthcare, it can in fact result in death, that is very real.
Another thing that’s real is that they are treated so poorly in general that they have the highest suicide rate by far of any minority.
Finally many choose not to live as the gender they wish they could, because it’s too problematic even dangerous. Even if this isn’t a physical death, it is killing the existence of people that can live their life as transgender.
Much the same way as the Iranian president when he visited New York some years ago, claimed that Iran did not have homosexuals, so there was no oppression of them.
A completely ridiculous claim we know is biologically impossible, and we know is false because they seek refuge in the west.
And we know Iran executes people for being homosexual, which of course is the ultimate genocide of homosexuals.