A couple of points from my doctor visit yesterday. First off, it was very simple. I just handed my doctor the documentation I had printed out. No questions asked. She just said she'd refer me. Also, she said the referral was to an endocrinologist, so no therapist etc.. Things have really changed since the protocol was changed in 2016. Many years ago, when I was first looking into this sort of thing, it was necessary to go to a shrink, with a low prospect of success. Now, it's essentially informed consent, assuming no medical issues. Surgery, however, still requires evaluations, though no longer by a psychiatrist.