Recently, in the UK, there was testimony to members of the British parliament that Doctors were telling trans women that they were not wearing enough lipstick. Let that sink in.
The heart of all trans healthcare is the essential notion that cis people have to be sufficiently satisfied that trans people will have no regrets over any stage of their transition before being allowed to proceed. This is fundamentally tied to the notion that cis heteronormativity is the most desirable state for everyone and that anyone not wanting to follow must be broken in some way and must therefore show commitment.
As a result, they do this gatekeeping at every stage of the process and often it requires trans people, especially trans women, to perform to whatever notion of cis "normal" that that gatekeeper has in their mind, if they wish to progress in their transition. Canada is not immune to this, even with informed consent around HRT, there is still quite a lot of cis gatekeeping at play. You still need to pass whatever test is there to get a letter for your birth records or to get any gender confirming surgical procedures. It's all about possible regrets.
We need to get past the notion that our body autonomy should be managed differently than that of a cis person. If a cis woman wants breast augmentation, she can go get it. A trans woman? Needs a letter. Why? Even if I didn't already have breasts, making the question on having them moot anyways, who, other than me, is impacted? Even if I have no intentions, at this stage of my journey, in having any of these procedures, the fact that I might require permission to have them, in case I regret, is intensely offensive.
Stop policing my regrets. As the saying goes, I'm a big girl, I don't need it.
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