In all fairness, the WPATH standards require someone to be on HRT for at least 12 months before any kind of gender affirming surgeries are done. Many surgeons require letters of compliance from the HRT prescriber and 2 mental health professionals before proceeding. At UCSF they did for my vaginoplasty.

Others are more flexible, and some merely require self identification. But I think you will find that most of the practitioners in the transgender healthcare field require strict compliance with the WPATH standards for liability and insurance reasons. Obviously, UCLA is more liberal based upon your experience. But to describe Rebecca as lacking knowledge is neither fair nor correct. She apparently sticks with the professional association standards. A lot of practitioners do.