I read that some girls see a therapist and then are able to get hormones. How does this happen? Do you have to be referred to an endocrinologist? Can some types of therapists write a prescription for you? There seem to be a wide variety of paths. It would be simpler if your therapist could just write a prescription when they feel you are ready for it. If you could clarify this for me, it would be helpful and appreciated.

Where I come from you have to see a therapist and have a really good reason for wanting HRT. Basically, you future is in their hands. If they give you a letter for HRT the next step is to see an endocrinologist. Baseline blood work is done then to see if it safe for you to do HRT. Then if everything is OK you get your meds. Here a therapist cannot write scripts for HRT because they are not doctors and only doctors can write scripts. It is a long process if you want it to happen quickly. The therapist has no time deadline and can delay you for quite a while. I don't agree with that except in cases where people are not sure or whatever the case may be. I got mine quickly because she saw I was prepared, had long term Gender Dysphoria and had plans in place for post transition (support system, etc). Being prepared for therapy is a good idea. Know what you want before going in and be prepared to defend your position.

Well, I state how it happened for me, though with the confession that my approach is probably atypical.  The first thing I did was to have a complete orchiectomy.  So then my body basically had no hormones & it became a medical necessity to prevent osteoporosis / cognitive deficit / etc.  Then, I legally changed my name, documents, gender marker, etc. which was easy enough b/c of where I live and b/c I had had the orchi.  Then I brought up the need for hormone replacement with my primary care physician due to my body not producing its own hormones and since I was legally female, she prescribed me oral Estradiol & treated the situation the same way she would have had she been treating a postmenopausal woman and/or someone who had had a hysterectomy. 

In reflection, there were pros and cons to approaching it in this manner-
Pros- No one batted an eye when prescribing hormones, insurance covered & still covers my HRT, and it *may* be safer to have avoided using anti-androgens & also always utilizing a lower amount of estrogen, the amount a doctor would give to any other woman who needed HRT.
Cons- Making the orchi be the first main step in transition meant that there would be two surgeries which just overall sucks (not to mention the fact that my surgeon did the orchi the way he usually does them for men which in the long run complicated my SRS results), and my physical transition has been prolonged with only subtle changes happening over the years (due to using a much lower amount of estradiol than what some use while transitioning).

As far as therapy - I was in therapy throughout this entire ordeal, I had to be in therapy long before transition, thru transition and probably forever (due to mental health issues non related to GID).  My therapist supported me throughout the entire process & at times, even "brainstormed" with me so as to help me know how to navigate my way to & thru surgery.  The main role she played was in advocacy - she told the surgeon he could do the orchi, she told the DMV to change my license, etc. etc.  So, in my personal experience, my therapist did not directly make anything happen but DID support me. 

Therapists cannot write prescriptions, unless they are a psychiatrist.  Usually, the therapist will evaluate you for some time and will provide you with an hrt letter, should they deem you are right for hormone therapy.  If you get the letter, you take it to an endocrinologist who will then prescribe you the hormones as long as you are medically fit.    This is the general path.  Of course, some gp's prescribe hormones, but it isn't common.  Also, the time frame that the therapist evaluates you is usually 3 months, but it differs from practice to practice.

Are you in the US or are you international?  Things are a bit different for our non-US members.

Oh. That's what I thought. Thank you! USA. I'm still searching for a therapist and sent out some emails. I'm leaning away from the orchiectomy idea.