No, guidelines do not require this step and instead it is recommended that patients transition socially with hormone therapy at the same time. During Dr Lenihan’s assessment she will be able to discuss this in greater detail.
In the past the guidelines recommended patients undergo “real-life experience” prior to starting medical therapy. This test required patients to live full-time in their self affirmed gender for a predetermined period of time, approximately one year, before starting cross sex hormones. The recommendation was intended to help patients transition socially, however, this step is unreasonable for many patients. Social transition can be very challenging if there is incongruence between the individual’s self affirmed gender and their physical appearance.