I agree that a therapist should be familiar providers in the area. For me it was important to have a therapist who took a more informed consent approach, rather than a strict standard of care approach. You will want to make sure, early on, that if your goal is letter for hormones or surgery, that the therapist will provide those letters and that the therapist will not play games with your letters. If it's been six months and your therapist is setting unnecessary criteria for hormones, then you may need to switch, just and example of what can happen. A therapist who is experienced with trans issues helps immensely. You also want a therapist who is a good fit for you. If the rapport is not there, then you might want to find another therapist. I felt this way with my second letter therapist, I did not like her after the first meeting, but she was upfront that she only required two appointments for a second letter. I knew right away that if I had originally chosen her for my primary letter it would not have worked very well. My primary therapist is a trans guy, totally goes by informed consent, and has just been awesome. I could not be happier.