Kathryn, I know you feel strongly about this, but I don't buy it. First, into the 70's there was no quick assessment and out. People spent months and sometimes years just getting accepted by a gatekeeper, and then went through an extended, and by all reports, excruciating process that few made it through.

Then the lights went out in most of the gender clinics, thanks to Johns Hopkins and Paul McHugh.

The first (now) WPATH SOC was published in 1979. It was most definitely not a quick assessment process, either. WPATH was the principal SOC in use, pretty much worldwide for years outside of the few remaining gender clinics. The APA only broke with WPATH with the publication of their own task force document in 2012. WPATH essentially responded to that via the SOC V7, dropping some of its strictures and presenting its recommendations as flexible guidelines (their term) and not a care standard in the usual medical sense.

The 20th century history of gender practice is one of long, exclusionary, controlled psychotherapy and gatekeeping. Things did loosen, but recently. A lot of the change is hugely positive. Even forgetting the primitive practices and attitudes that prevailed into the 60s and 70s, how many would support RLE before hormones these days? (Not me) Or live with diagnoses of the pre-DSM5 (pre-V4 especially)?

Fast forward to the present. Things have become quite loose indeed. SRS and FFS surgeons actually compete. Non-specialists (pretend to) treat gender clients everywhere. The WPATH SOC is a shadow. Self help groups have proliferated everywhere. And I agree that the results are not always positive. But where is this gender machine you are talking about, despite it all? Rather than extending therapy and cost - the practice of the past - the abuse today has shifted from inappropriate gatekeeping to insufficient (or lack of, or lack of qualified) assessment. Yet quick assessment-only is what you seem to advocate.

I think that an assessment should rarely be short and performed only by a trained specialist. I would not only like a reasonable SOC, but one that is properly implemented with oversight. We've swung too far and too loose, to the point where people are being hurt. But I see no indication among therapists of anything but good intent. Some of the surgeons ... not so sure there.