The SOC state:[3] Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person's responsibility.With respect to mastectomy/chest reconstruction and breast augmentation, the seventh version of the SOC do not require an RLE for these procedures; nor is an RLE required for hysterectomy, salpingo-oophorectomy, or orchiectomy, or for other procedures such as facial feminization surgery and voice feminization surgery.
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.
[citation needed] Though the WPATH SOC's one-year RLE requirement prior to GRS has been widely followed by surgeons in the past, it has not gone without criticism.
[8] Supporting such claims, physician and sexologist Anne Lawrence, in a paper presented at the XVII Harry Benjamin International Symposium on Gender Dysphoria in 2001, stated that there is little scientific evidence that a one-year RLE is necessary or sufficient for favorable outcomes following GRS.
In addition, she presented the results of a study she conducted on a group of trans women in which she showed that GRS without a prior one-year RLE could be undergone without the subsequent expression of regret.
[10][11] Further in support of the idea that a one-year RLE requirement prior to GRS is unnecessary, regret, as well as suicide, appear to be very rare in post-operative transgender people in general.
[15] Amnesty International emphasized in 2017 that the RLE has been criticized by the Committee on the Elimination of Discrimination against Women for promoting stereotypical gender roles.