If someone isn’t comfortable speaking from their main account (which apparently isn’t the case here) then that’s more of a sign the community needs to change and be more open to differing points of view. It’s not always a problem with the individual, and implying that to be the case when it clearly isn’t is a toxic thing to do.
I don’t know the context here because I am not American. That being said I can see it being useful that there is a record somewhere that someone has transitioned and what medical steps this involved for no other reason than their safety. Things like HRT, or any kind of surgery can have serious complications. Even gender dysphoria itself can lead to suicide. There should be some mechanism in place for Doctors to get this information quickly, and by nature that would probably involve the government. It should obviously be protected information like any other piece of medical data not available to all government workers unless it directly concerns their responsibilities.