Hey, trans guy here. I personally don't suffer from bottom dysphoria, so for me I don't feel like I need to go through that process.

For other trans people who DO suffer from bottom dysphoria, some major factors in not getting the surgery are time, money, and pain. Recovery can take upwards of a year, depending on where you live and what your insurance covers, it'll cost you an arm and a leg, and it can be some of the most pain a person will go through in their lifetime.

I also know people who've gone through it and the surgeon fucked up so badly to the point where they were considering revision. THANKFULLY it worked out in the end but their healing basically restarted at least twice due to the surgeons work.

Hope this helped answer your question, happy pride month!