Hi Lisadear

(It's a cute name too!

)
I'm pretty sure for bottom surgery you need 2 letters - 1 from a someone like a LCSW (masters degree) and another from someone with a PHD (like a psychologist) who can independently evaluate you and write the second letter.
I hope the LCSW is a good route to go since thats the route I'm on right now- they are a lot more plentiful in my neck of the USA than people with higher degrees, and I think when it comes time to get a second therapist involved, I think she or he should be able to refer you to a colleague. Granted I'm not in a position yet to be concerned with surgery, only looking for HRT and emotional issues.
I think it wouldn't hurt to read the latest standards of care to get an idea of what you may need.