They recommend low dosages which can be more harmful and less effective, recommend against treatments when they really shouldn’t, and dangerously favor certain drugs over others. Trans people basically have to advocate for themselves and know more of the science than their doctors to get proper treatment.

They just don’t minimize costs and maximize benefits of treatment, taking the common attitude that sees external hormones as harmful by default. This a broader problem for all hormone treatments, with the medical community being hesitant to provide effective treatment to people postmenopause and others with hormonal issues. The old guard was taught a certain way and are hesitant to adjust with the times. Research moves too fast for them to keep up, so we basically need to wait for many of them to die or retire.