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Just to add, although the US allows informed consent for adults, some of us are still required to do a certain number of months in therapy and/or provide letters from mental health professionals before we can access hrt or surgery, because that's what some health insurance companies require. Even then, ofc, the option does exist to do informed consent and pay out of pocket.
Yeah, 12 months lived in experience, 2 therapist letters (one had to have a PhD), and one primary letter to get me bottom surgery. Also they wouldn't even do the consultation before I get all that done so it was almost another year after that.
Oof, that's harsh. I'm glad you managed to trudge through it. It's not unlike how difficult, if not impossible (and expensive) it is in some states (mine included :/) to get a legal name and/or gender marker changed.
They just gotta make it as hard as they can, don't they.. 🙃