It's transphobia. The Harry Benjamin standards of care gatekept trans folk from medical transition unless they were able to cis pass, and were willing to leave their lives behind and start again. Basically, the only trans people they wanted were trans people that they could pretend don't exist.
And the whole presentation thing was part of their assessment. People who didn't jump through their hoops were denied care.
That's from the 70s and 80s.
This is the lingering after effects of those standards of care, hurting gender diverse folk decades later...