well you can go to an informed consent clinic (there's some in cali and possibly other places in usa, and one in montreal where i am, from what i can remember, not sure about elsewhere), you basically sign a paper, they refer you to an endo, you get a script. no therapy needed. it just depends where you live though.
I think some people would still need therapy to be sure, but if you really know what you're doing i think everyone should be free to do what they want to their bodies, just under medical supervision.