Hi I am on 4 Months of HRT and have had a lot of similar feelings. I feel like for me the first and second point of yours, at least for me, are inherently linked.

When I still had Testosterone in my system and my sex drive activated my physical body got actual satisfaction of topping people which was why I didn’t really mind it. I didn’t especially like it but when my partner wanted it or I was very horny it was still a way to recieve some pleasure I guess.

When I started HRT suddenly this biological satisfaction was mostly gone and I found myself not enjoying topping anymore. I spoke to a friend about it and they mentioned dissociation, which when I started talking about how I used to experience sex when topping with T in my system, it more and more started sounding like dissociation. At one point I realized that when I was topping I was giving away conscious control of my body cause I felt uncomfortable with it, my actual feelings were disconnected from what my body felt. My body got “some” amount of pleasure and I could give my partner pleasure so I used to cope with it thinking it wasn’t all bad but reflecting it was never good for me.

As for surgery even if the first two points are true it does not mean that you have to get bottom surgery. Your life is not all about sex and sex isn’t all about penetrating or getting penetrated, try out some stuff , experiment learn how you can feel your body and how you feel in your body.

Whichever path you choose I hope you will feel better with your body