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Medical gatekeeping is also very much a problem. I started petitioning for bottom surgery 6 years before I was actually able to get it. Not because of any wait list or qualifications or anything like that. Purely because my doctor and my counselor thought I wasn't ready. Getting a new doctor here (Eastern Canada) takes close to a decade. So I had to wait till they decided I was ready. I was repeatedly told that my poor mental health made it so I couldn't get surgery. My mental health never magically got better. They just eventually changed their minds and gave me referrals. Having bottom surgery saved my life and dramatically improved my mental health. I spent 6 years in abject misery when I could've gotten the surgery to begin with and spent that much more time happy and moving forward with my life.
I'm very happy to have had it and I for once in my life see a future for myself and a life that is worth living. But there is definitely a bitterness about the way that multiple health professionals all seemingly misunderstood that my anatomy was a significant contributor to my poor mental health.
That's the real issue isn't it. In an informed consent system if your GP is a transphobe or clueless or ill trained then they can deny you care based on moon logic. Theres similar issues with sterilization on all fronts. It's rarer for vasectomies but still happens depending on where you are for the most part. You have to beg for sterilization because anything under the age of 40 is like " you're too young - you might regret it. So I, a person who doesn't even know you personally will tell you what is best for your situation and you're going to have to live with it because I hold the power over your bodily autonomy in my hands."
Like dude, I'll sign a waiver. It's not your lookout whether I'll regret it or whatever - just stay in your lane and do your bloody job. Made me angry enough I could have bent rebar between my teeth with how hard my jaw was clenched.
Like those are the practical arguments for informed consent, but I just keep coming back to a different reason: because it’s my body and that makes it my choice and my consequences.