We could use the lawyer who triggered a lot of this discussion to really help us out here, because so many of those protocols and procedures - like RLE - have as much to do with the doctors trying to avoid malpractice lawsuits as it does with best practice medical research. It's a whole lot of both, and unless you are looking at both sides, you're not seeing a complete picture. For better or worse, the patient is not the only person who has a vested interest in the guidelines, protocols, and procedures - not by a long shot.
Second. What exactly does best practice medical research say in cases of GID? Who knows? It's not like there is a huge (much less overwhelming), or even really a sufficient, amount of good solid scientific (as opposed to scientifically-based) research to frame anything like what the 'best practice' would be.
Where exactly are the numbers (and I'm not even sure if we have an agreed upon 'satisfactory outcome' defined even) of satisfactory outcomes for people who have undergone various means and measures of medical and psychological intervention (as measured against a control group who had neither)? Nowhere. No such study has been done. Like I said, I don't even think there is an agreed upon definition of what such an outcome would consist of. Can we even say that Treatment A: a year's therapy, one year RLE, then hormones, then surgery (all while continuing the therapy), which is the 'classic' approach is better than Treatment B: Hormones on demand, surgery if one wants it/can afford it based on a Informed Consent model, or Treatment C: therapy only, or, or, or... (and all of those compared to a rigorously monitored control group that has done none of this -- so you don't have it going all Hawthorne/Heisenberg on you)? Are those numbers at someone's fingertips? Nope. They just don't exist. Not even vaguely. The vast majority of 'evidence' about GID cures is all anecdotal, and such evidence is not reliable because it's self-selecting.
Third. If there is one bunch of girls in the world who know one thing ... I mean a substantial, if not overwhelming statistical set of girls who know with absolutely certainly - 100% dead certain - that One Size Does Not Fit All it's girls like me. And, if that is true for something as simple as a pair of panties or stockings, then how much more complex is a combination of psychological and medical interventions?
We accept that in life there are people who can't come close to estimating the amount of money they are spending walking through the grocery store (my ex for one) and there are other people (usually nice, but no fun at parties) who can do quadratic equations in their heads. In other words we accept that mathematical skills exist in human beings not at a set level, but on a continuum. We know that is true for people's abilities and levels of being able to read, write and comprehend information. We know that people are social on a scale from total attention whores who can't stand not being around people, to totally withdrawn and alone persons who hate the entire conversation/party/social deal and actively avoid it. We know that there are ranges of psychological and physical ailments from very mild to unable to function at all.
It would stand to reason at the very least that both the levels of GID and what they effect differ from person to person, what treatment(s) and at what levels would be effective would also then have to differ from person to person as a consequence of that. For an example, there are people with GID of some sort in here who seemingly have very highly developed social skills. There are other people in here who have high levels of social anxiety and really have no idea at all how to deal with, or behave around, other people. It's not much of a stretch to see how those two people would have very different paths through therapy right from the outset.
So I've never been to sold on the 'one way' approach. Not when what I have seen how GID fluctuates as much as it does, has as many manifestations as it does. Is as tied up into other things (sexuality, social skills, family) as GID gets. And I'm not adverse to finding best practices, methods and techniques that have higher success rates, but I'll need to see some scientific evidence for that first, and I'm not seeing any at all.
