I can’t say exactly when the gate-keeping model for sex reassignment surgery was abandoned. That happened after 1995, when I switched my focus from gender-dysphoric patients to the assessment of sex offenders. After I became absorbed in my new position, I quit paying minute attention to the gender world.
There had always been some patients, especially gender-dysphoric autogynephiles, who hated the gatekeeping model. These patients saw gate-keeping clinics as exercising unfair and oppressive control over their lives. They ignored the fact that it is the physicians’ prerogative to prescribe treatment, not the patient’s prerogative, in most areas of medicine, probably because these patients did not accept that extreme gender dysphoria is a mental disorder.
At any rate, I began to sense a sea-change in patients’ attitude by about 2008 or 2009. After trans activists had re-framed transsexualism as a social justice problem rather than a clinical problem, the rationale for gate-keeping was pretty well undermined.