Once I got my letter, I first tried to get my therapist to refer me to an endo, and my therapist gave them the letter, that first endo didnt work out. so then I went to a small medical clinic, gave them my therapists referral and my letter, then THAT medical clinic found me an endo and gave him the letter.
Then I made an appointment with that endo, (had to wait a few months) and when I saw him he asked me a few questions, told me what the hormones would do to me, asked me if i was ready, and then his nurse gave me my first shot. Then he gave me a prescription, and I went to a pharmacy and got a vial of testosterone that I inject myself every 2 weeks, and my next appointment with my endo is in march to check my blood levels.
(most doctors check your blood levels, and then give you T, my dr was just a little different)
word of warning (something I had to go through) getting your T letter, doesn't automatically mean T. I had to wait forever to find an endocrinologist, and then wait longer to get an appointment with him. I had a friend who had to wait 6 months for an appointment.