I am writing this post in response to the surprising number of people who seem to believe that first-wave gender identity clinics explicitly instructed patients to use washrooms intended for the opposite biological sex.
The gender identity clinic where I worked from 1980 to 1995 required patients to work or attend school in the cross-gender role before being considered eligible for sex reassignment surgery. It further required patients to provide documentation showing that they were working or studying in the cross-gender role.
The clinic did not require patients to use public washrooms intended for the opposite biological sex. The problems of urination and defecation were left to the patient to solve, as were various other practical problems. Patients were free to use single-occupant washrooms, or to hold their urine all day if they preferred.
The clinic was philosophically opposed to excessive hand-holding, on the grounds that the patient’s ingenuity in solving the practical problems of cross-living was part of successfully completing the two-year real-life test. Of course, the first-wave clinics operated under the now-abandoned gatekeeper model. I have no idea whether current “gender-specialists” give their patients any explicit advice or instructions regarding washroom use.