Immature anarchists with the mindset of adolescent males... That's what the "surgery on demand" crowd sounds like. Oh, now we have a new, kinder and gentler term..."informed consent," well, actually, we have a term that is being badly misused. Another term that is likely to be bandied about is "the Argentinian Approach." The idea is the same...no gatekeepers, no Standards of Care, no screening of applicants for SRS, and no recourse if a mistake is made. You don't want people telling you what to do, so do it "your way." And if you make a mistake, well as Suzan Cooke says, "cowgirl up/cowboy up." Hmmm, that sounds like what I heard before my transition. "Don't transition. Just live with it." Or the advice that some offer gays and lesbians, "Okay, so you have these feelings... Suppress them, and be chaste."
The problem here is, not everyone who presents seeking treatment for "gender issues" is transsexual, and not everyone should be encouraged to transition. But some misguided people, who seem to have problems with concepts like authority and morality, insist that anyone who wants sex reassignment surgery, or hormones for that matter, should be given them without having a doctor's approval. Now, in the case of male to female patients, hormones are relatively benign. With the exception of eventual sterility, there are few truly permanent effects. This is not true for female to males. On the other hand, particularly for male to females, surgery is a one way path, and if someone makes a mistake, it can be very tragic.
But for some, the appeal of being in complete control, of not having to seek the advice and consent of a medical professional who's job it is to prevent a tragic mistake, is such that they seek to circumvent the Standards of Care just for the sake of doing so. But they don't understand that those standards are there for their protection, not as a hinderance. They are not there to prevent transsexuals from getting the care that they need. They are in place to prevent people who are not transsexuals from making a mistake (a fact that seems lost on Suzan Cooke who seems to think that the people who have regrets were transsexuals before surgery) and by doing so, the help insure that those who would put an end to surgery don't have an excuse to do so.
The simple fact is, human nature is such that there will always be a significant number of people who will, for any number of reasons, decide that the solution to their problems lies in gender transition. I'm not talking about transsexuals, who are born with a brain that is sexually differentiated at odds with their body, but about people who suffer from mental illness, or who are crossdressers going through a mid-life crisis. I am talking about, though increasingly rare in this country, gay men who think that becoming a woman will make them okay. These are the things that doctors are supposed to screen for.
Are there abusive "gatekeepers?" Yes, some exist. Ray Blanchard would be one of the best examples. But there are plenty of competent therapists. The problems generally arise when someone goes to a therapist with no experience in dealing with transsexualism. Unfortunately, more than a few professionals refuse to acknowledge their own limitations.
My advice to anyone considering transition is, if you can live without it, then don't do it. If you are just looking to go full time with your desire to crossdress, then please, spare us. If you are ambiguous about surgery, don't even think about it. You should only go down this path if the only other option is suicide or some other form of self-destruction.
The bottom line is, simplistic ideas, like "cowgirl up/cowboy up" or "surgery on demand" will just result in people getting harmed. One can expect such from extremists like Cooke. I prefer a more sane approach.