As always, it depends where you are. In Canada, it depends on how far away you are from a major centre. If you're near Toronto, Montreal, Ottawa, Vancouver, it's gonna be pretty easy. Even places like Winnipeg are okay. However getting into places like northern Ontario even (not even 4 hours away from Toronto) there can be serious problems with access.
The biggest problem is starting trans healthcare. Most doctors don't have a problem continuing your care if you're already on hormones, and will help fill out paperwork for CAMH for surgery stuff if that's the route you want to go, but are sketchy about changing meds and don't want to start new people on meds because they don't have any experience.
Of course, how does one gain experience, right?
The other problem in Canada in particular is that (if you decide to do it), the wait list for surgery is around 2+ years as of last month. so that's... a pain.