Just to chime in, I'm non-binary and just got approved for bottom surgery with E and spiro, but no RLE (after a year of trying). It can be done. Depending on where you are, you'll find it necessary to locate a sympathetic psychiatrist. I saw a few people and was told "Nobody will touch you" before a guardian angel on Susan's pointed me in the right direction. A lot of it depends on getting the right person for your letter, and demonstrating that you've really thought this stuff through.