Maybe it's because I'm risk averse or maybe I'm just not as well read on it, but I do personally think it's generally riskier than other transition surgeries.

For vaginoplasty, even if the job is botched, you'll still be able to walk normally. FFS, you'll still be able to talk and eat and smell normally. Breast augmentation, you can still lift your arms normally. Plus since these three are the "main" options available, there's more people doing it and more people experienced in handling the complications.

For vocal surgery, if the job is botched, you can permanently damage your voice and not be able to shout. And even then it still takes a degree of voice training to get a good result (althought it does lower the bar). The relative rarity of the procedure also does not inspire me to take that kind of risk.

I'm open to being convinced that it's not as risky as I think it is, but I do think that it's a pretty risky option. Especially when you compare it to voice training on its own, which is way harder to fuck up. And voice training will get most people across the line.