MAN I just can't believe how things have changed! Everything seems to have turned into a huge bureaucracy of rules and procedures with common sense having gone out the window!
To the best of my knowledge there are no "laws" anywhere governing RLE - it is all procedures and guidelines. Any doctor has the option of following the guidelines or not and it is up to individual surgeons what requirements they set for SRS. Any country is free to set their own bureaucratic "rules" that they may require to FUND treatment but, again, those are bureaucratic guidelines and NOT law!
Back in "the bad old days", before all these "standards of care" were wide spread (I am thinking pre-1974 which is the period I am familiar with), common sense prevailed and all of the decision making fell to the doctors. HRT could be started at the doctor's discretion, with or without any RLE, and even SRS was at the doctor's discretion! Of course no medical professional wanted to put a patient in a worse position than before treatment so the number and nature of any "roadblocks" was largely based on how confident the doctor was in the patient's ability and determination to succeed in their new gender. If the doctor felt a patient would be "passable" and had shown a persistent determination to change gender, the road was straight and and unimpeded. I had heard of cases, however, where a patient's ability to integrate smoothly into their target gender was very questionable and in such cases the requirements for HRT and SRS were much more demanding.
At 14 I was living part time as a girl, whenever I could get away from home (- it was not permitted at home and would have got me thrown out!), at 16 I was diagnosed (by Dr. Benjamin), and at 17 I was started on prescribed HRT (without parental consent) and at 20 I had a one-day 'psychological assessment'. It was not until I was 24 that SRS became available and my pre-surgery meeting with Dr. Biber was more like an audition than anything else. I had more doctors "bending the rules" to help me along rather than throwing up roadblocks!
It wasn't easy in those days finding help but I would rather have gone through it all when I did than to encounter the bureaucracy of today - I simply would not have survived the delays today!