Devlyn : Not too personal at all, but it's been a few years so I'm not sure about the precision of my memory anymore.
As I recall, she asked a bunch of questions about how I felt, and we talked about a lot of possibilities for what I could do or might want to do in the future. As time went on I became more and more certain that I wanted to start HRT, but to be clear, she was willing to write the letter/sign off on it on day 1 if I told her so. She said in the first session that she'd wait for me to tell her when I was ready, and in fact she did give me a letter well short of the 3 months' worth of sessions recommended by the SOC 6. The decision was definitely left up to me, though. She reiterated every time I saw her that she wasn't going to do more than rubber-stamp my choices, because I was "stable and well-informed and prepared for any potential consequences" (that I've quoted directly from the letter, which she emailed me so I still have it). Now, admittedly, I found a fairly mellow and cooperative therapist, and she was walking the edge of what the SOC 6 recommended at that point. She did clarify later on that she judged me emotionally and psychologically healthy and prepared, with the implication that if she thought someone else was less so she would insist on more therapy before approving their letter. If that doesn't answer the questions you had in mind, I'll be happy to keep trying?
I was pretty clear that I considered myself on a path to transition, though, because I had significant social dysphoria even if not physical. So that part differs from your story as I understand it. (What we may have in common is that I wasn't sure I was "really trans" until AFTER I started HRT and realized I could never go back.) But she explicitly stated that she did not require a "real-life test" *or any immediate plans to socially transition* as a requirement for HRT. She had other patients who were doing low-dose HRT as effectively an antidepressant regimen or who wanted to do the "middle path" (apparently defined by them as living legally as male but cross-dressing and cross-living at least part-time outside of work). Between that and the fact that her own partner was non-binary and living publicly as an AMAB person on HRT but not female, it seemed clear that at least in this area it was possible to find medical providers willing to be flexible. Add to that the Fenway informed consent clinic that basically does a "sign this paperwork, we'll do blood tests, OK here's your HRT" method and I know quite a few people who didn't have to fit classic definitions of "transsexual with GD" to get treatment. Which, honestly, is why I'm startled to hear that the SOC 7 might be more rigid than I've seen people living through...
(Snow is finally melting here, too!)
