We strictly adhere to internationally recognised guidelines for progressing to such surgery. We know it is self-evident but these are, for the most part, irreversible surgeries. Individuals will be expecting to be living in their new gender role for 1 year, have written confirmation of diagnosis from a doctor specialising in the field, and confirmatory diagnosis and suitability for surgery from a mental health professional.
Once we have all those things in place we can progress to surgery. We do not insist on stopping hormone therapy but we do prefer that patients stop smoking.