Please return with me to 1988 (you'll probably wish you hadn't, but bear with me). I was in a new city and didn't know anyone other than those with whom I worked. One morning I was watching a local television show that had a physician (an M.D.) and his post-op patient. I called his office and made an appointment. When I got to his office, in boy-drag, we chatted for a moment or two, then he offered me a hormone prescription. Wha... Huh? All I was looking for was contact info for the support group, not life-changing pharmaceuticals. I told him I'd call back in a week, I needed to think about it. I did. He prescribed pills. I was off to the races.
I didn't begin therapy until I was about ready for RLE, almost six years (including a week in the hospital for blood clots caused by the pills). The doc prescribing the hormones was a G.P., not an endocrinologist. He neglected to inform me about the risks involved in taking first generation birth control pills. I didn't have much information, so my consent wasn't really informed, was it?
The psychologist I saw over the course of my transition was knowledgeable; she challenged me to think about things that would never have occurred to me until I was confronted by them, which I was. I survived because I was informed. My personal feeling is RLE is critical. If you haven't proven you can live day-in, day-out, in the gender you haven't previously lived a single day as for at least a solid year you're a candidate to become a statistic (and not in a good way). This comes with some caveats. If you don't need to earn a living, and there is no one depending on you for emotional or financial support, you can probably get by with a couple months.
In the end, it all worked out well for me. If I was designing a path to SRS I'd demand more time with a doctor who can explain the physiological risks and benefits of HRT, and the options (pills, injections, patches, implants, whatever). That's informed consent. I think an appropriately trained person, doesn't have to be a shrink, with whom someone contemplating SRS can get counseling from before RLE until past surgery would be the optimum. In the US, surgeons demand proof a candidate has been cleared by a therapist in order to prevent malpractice lawsuits; this isn't a bad idea.
The downside of everything I've written is that we're not all alike. MtF, or FtM, we all have similar stories, but each of us have different circumstances. Because we're dealing with medical procedures, we need medical people to provide us with the best medical information available, so we can make an informed consent. RLE is information gathering critical to that consent.
Now, go read something more fun.
