i'm walking on this road of life where i can do stupid things like implanting silicon in my butt, try botox treatment, get a third boob, probably even a fourth and fifth too if i want them, cut off a finger just to see what it feels like, get a tattoo in a visible area like my face, pay a professional to cut off skin in my body so that when it heals my skin will be full of scars in the most beautiful patterns, split my tongue in two, get piercings pretty much anywhere on my body, etc.
most people who get botox treatment don't even know that the tox in botox is the same as in toxic (and very lethal). get it in your bloodstream, and your hearth will take a break for eternity.
do we consider it a sign of severe mental illness to want those kinds of things? maybe the extra boobs, but not the rest.
so why is it so difficult to get surgeries to change secondary or primary sex characteristics?
i don't have the slightest idea, but it might have to do with people who don't conform to gender roles being thought to be possessed by demons, in a distant past that we like to think we have gotten over and above. the extra boob would have gotten that woman burnt at a stake back then, while the scars would have been from the battlefield. tattoos just made you an ex-convict, where they were used to mark criminals.
of course, there is the problem that a whole lot of mental disorder can cause some gender confusion, or be caused by having a gender identity or body map that don't align with the body one was born with. but we don't really need hormones or real life experience or gatekeepers to prove that someone is telling the truth and isn't just... ehh.. well. anyway. all that is needed to know that a person is sane, is assessment by a therapist. to check for any kind of actual mental disorder that might have caused some confusion of fantasy and reality.
if a person is generally sane, apart from wanting opposite sex hormones, different genitals, more or less boobs, and this persists over time, that in itself should be proof of commitment. a whole year of consistently knowing that something is wrong and that the righting of this wrong would make the person happier, should be enough. tattoo artists, the serious ones, will always make sure a person has good reason for wanting a tattoo, and also knows of possible consequences. less invasive treatment, like short time hrt just to see if this fits with the person's brain wiring, could be tried even without any trial time.
and it amazes me to see how a "person who is not planning to present as female" turned into "trans woman" during the course of this discussion.
let's say the person is a real manly man whose body map insists on his penis being the most useless organ this person could ever have been born with, and that a neovagina would be a most desirable replacement.
should this man have to live a full year presenting as a woman, just to get the right genitals?
remember, his genital dysphoria is just as strong as that of many trans women.
oh, and him being a man, he'd of course take testosterone after the surgery.
i really don't see why a person shouldn't be allowed to choose for themselves which genitals are right for them, if any.
of course he needs to be screened for mental illness, just to be sure, and sign a contract that mentions both later corrective surgery if result isn't satisfying, and waiving of rights to sue for doing this procedure, as long as they do everything in the way that poses least risk for the person. this after the person has been properly informed of possible complications and later troubles, of the physical type.
and just to let you know. if they could make nice well functioning penes, and gatekeepers would just quit keeping gates (i'm not trying to break into someone else's house. just renovating my own), i would definitely consider just getting one of those and let that be it for my transition.