Good evening Cassie,
There are many good surgeons near you. Look in Philly, NYC, or Boston.
For GCS, I know several ladies who went to Dr Blue-Bond Langer in NYC. For FFS, there is Dr Spiegel in Boston and of course, Dr McGinn in Philly.
As for the letters, if you are now on hormone therapy, you should still have the letter that allowed HRT to start. Did you ever get the surgery letter? If not, then you will have to start with a therapist as soon as possible. If Washington DC is near by, I am sure you can find someone there.