The old system was barbaric. It was severely and punitively restrictive. It was misogynist, racist, and homophobic, with male doctors judging your validity based on how much they wanted to fuck you.
It was also essentially out of reach of anyone not independently wealthy.
The standards of care were relaxed BECAUSE of the failures and abuses of that heavy-handed gatekeeping system, which was designed to prevent as many people from transitioning as possible.