No mention of a doctor or monitoring. I don't live in the USA - bureaucratic hoops sounds like what I go through to get my id renewed.

I believe it's implied. Typically the bureaucratic hoops involve 1-2 mental health professionals writing letters in support, potentially 0-2 years "living as the gender" before they will write those letters, meetings with your doctor, bloodwork for baseline hormone levels (sometimes multiple times), and then finally you might get a scrip.

But if you encounter someone along the way who doesn't want to co-operate, you might need to redo those steps. It's really rather difficult, depending on where you are.

I was living maybe ten minutes' walk from the local testing clinic at the time so it was actually pretty easy to monitor my blood work.