There are many who don’t believe that medical professionals should be making the diagnosis. This is actually quite common in some quarters of the community. They consider it gatekeeping because in the past truly transgender people did not receive proper care. The standards are much more evenly applied these days. The people who wish to eliminate them are mistaken. I have known enough people who have mental health problems and thought they were trans who actually were not, to know that caution is required before proceeding. The current protocols and standards work well. Those who complain most vocally about being required to get a diagnosis are often those who have mental health problems unrelated to gender dysphoria. There has even been a trend over the last 10 years of a certain small vocal group stating that you do not need gender dysphoria to be trans. This is a ridiculous assertion, but is gaining traction in some areas. If you don’t have gender dysphoria, why would you want to change anything about your body or your social presentation? Again the proposition is nonsensical. The firm standards of the professionals involved in transgender care are a way of keeping people from making mistakes which might hurt them.

Beyond this, no reputable surgeon would undertake an irreversible procedure without having all the required letters and proper diagnosis in hand. The potential liability risks are too great. In addition, because gender affirming surgeries are so breathtakingly expensive, this is also an insurance company requirement. You cannot side step them easily.