My insurance required my primary care physician to refer me to the therapist, who could then refer me to the endocrinologist. I asked the primary doctor if he could do the initial referral with just a phone call or email, but he made me come in for a physical because he'd never met me and I'd never had a physical on my medical records with them. The physical included blood work, height and weight, blood pressure, look in ears and eyes, listen to my breathing with a stethoscope, and gentle prodding in my abdomen. He did not require one of those lower exams or the breast squashing thing, although he did remind me that I was overdue and offered to schedule it for me. I was really nervous about the physical, but it was worth it!