I used to be a strong advocate for mandatory psychiatric gatekeeping for HRT and surgery. I know when I finally caved and started transitioning, I felt like I was going crazy, but I now think that was because I had the same prejudices about transitioners as the rest of society at large.
Meanwhile, I've observed a lot of needless gatekeeping over the years, where others have been held back for years before finally finding a therapist willing to help instead of hinder them. And I've also seen people turn back during the process. Not one of them had any kind of surgery, irreversible or otherwise. I know there have been some very rare cases where people had GRS and regretted it, and some of those even had long term HRT and even other surgery first, like implants and FFS. But that happened in spite of the SOC, not because the SOC were bypassed. Do we really know that the incidences of regretted GRS would be greatly more frequent without the psychiatric gatekeeping?
I think it would be interesting to have control groups, where one group does traditional SOC under psychiatric supervision, and the other is not psychiatrically supervised and just has to have HRT and some kind of reversible surgery before having GRS. I think that there would not be much benefit to the psychiatric supervision requirement, and any such benefit would certainly be outweighed by the harm done to those who were held back and had an antagonistic relationship with their psychiatric supervisor.
So I think it would be better to let people have HRT with just endo supervision, and the GRS surgeon can treat them if thay have obvious HRT development and some other kind of elective, transition-related surgery they didn't regret. The requirment for psychiatric supervision seems like a result of stigma that transitioners are suspect as crazy, and that's the only reason we still have that requirement. I mean, sure there are a few people who are schizophrenic and will seek to transition because that condition is not treated, but those people are really easy to spot. We don't need the type of gatekeeping that is currently in place, and I think it does more harm than good.