Some do, some suffer from other issues because of the dysphoria, and certainly some people with other mental issues claim dysphoria for various reasons. Having these conversations in the aggregate is always made more complicated by weaving in individual cases. People are complicated.But, no facts to back it up, I would assume that they also suffer from a lot of other mental issues and this is only a bandaid fix to do medical procedures like this. Through my course of owning a business I have know 2 people who didn't know "what they were". But that wasn't the only issues they suffered from.
Also if we allow it not to be a mental issue where do we stop it. Eventually being a pedophile will be acceptable because, afterall, they can't help themselves. That was just what they identify as.
I think you and I can probably agree at least that nobody should be undergoing these procedures without considered psychological evaluation, especially minors.
Re: the pedophile thing... that is a slippery slope that goes back a long time. The thing is we don't jail people in this country for being pedophiles. We jail them for pedophilic conduct. Choosing a course of gender-affirming care for oneself is not comparable to that.