I don’t think they thought I was ready for surgery… They wouldn’t hear me out… I felt like they didn’t believe me. Until I was like “I’m in therapy, and I’m in this” and… I felt like at that point they can’t deny me because I’m doing everything they asked and telling them everything they want to hear. And at that point I’d been presenting as female for almost 4 years [3 years beyond the WPATH requirement for lower surgery].

Trans patient, quoted in MacKinnon et al., (2020), International Journal of Mental Health