No, there arent actually any literal boxes to tick. The problem stems from the fact that a trans person can be denied various forms of healthcare on basis of them simply being trans. For doctors, trans people are alien, so many clinics are very prone to blaming a lot of issues that they don't understand on hormones, to the point its actually an inside joke and exaggerated for comedy.

"You have AIDS? Musta been the hormones then!"

A trans person is often seen as unable to make decisions for themselves, and are routinely denied hormone treatment on basis of this. I met a trans guy in my hostel who was disowned by his parents a few years ago because he was trans. Doctors refused to give him hormone treatment because his recent homeless status had apparently "coloured his perception". So he developed a profuse drug habit as a result. Nowadays, they refuse him treatment on basis of his drug habit, which he has because they refuse him treatment. Instances like these are the more common ones. He likely won't ever get the treatment he needs to live his life for a very long time, if ever. Meaning, he is only going to get worse and worse. He overdoses all the time and was recently rescued from a noose. His situation reflects those of many.

I don't really know what its like in other places outside of Ireland. But I do know for a fact its a hell of a lot worse. We have it ez.