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Though the SOC's one-year RLE requirement prior to GRS is almost universally followed by surgeons, it has not gone without criticism.Like the previous three-month RLE requirement for HRT, some transgender people have expressed unhappiness with it, declaring that it is unnecessary.In addition, WPATH emphasizes that the SOC are merely clinical guidelines, and are intended to be both flexible and modifiable to meet the circumstances of the patient and the preferences and judgement of the clinician.Clinical practice in many places may be more or less stringent.In another study conducted by Lawrence, she showed that in a group of 232 post-operative trans women, none expressed outright regret, and only a few expressed even occasional regret.

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They also state that documentation of a name and/or gender marker change can be presented as a way of providing proof that the RLE has been completed, but do not state that a name and/or gender marker change is a necessary requirement for completion of the RLE.

The SOC are followed by most medical professionals who specialize in the care of transgender individuals, and are the most widely followed clinical guidelines for the treatment of transgender persons in use.

Sometimes surgeons may require proof that the RLE has been completed.

The SOC state that, if applicable, proof may be provided in the form of communication with individuals who have related to the patient in a gender identity-congruent role (such as, presumably, the patient's physician, therapist, boss, or a teacher), or as documentation of a legal name and/or gender marker change.

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