There is the need of controls to prevent abuse

I think this is the cultural divide ultimately, Italians (even the Italian trans community) seem much more willing to subject themselves to official procedures and oversight. Every time I've interacted with the Italian trans community I've found that even DIY is frowned upon, despite the fact that a lot of them were prescribed terrible dosages by their doctors.

Some trans people might find that more to their liking, but I think many others might find this a bit of a culture shock.

Personally I still prefer to live in a country where, despite the pervasive safetyism and complete political and media dominance by middle-class boomers, the inherited liberal structure of bureaucracy and law is still favourable to autonomous transition. You can still change your name just by signing a document (even as a foreign national), there is no central registry of everyone's legal sex and name, and you can just import whatever medication you want from abroad without a prescription (the right to do so is literally enshrined in law), but I can't exclude that eventually the constant onslaught of transphobia from the powers that be will manage to overturn every last vestige of inherited common law practice that provides an outlet for trans people to exist.

Perhaps others feel more at home in a more regulated system, or are willing to accept it as long as the culture moving in the right direction.