whats it mean to have a WPATH form letter from a therapist...does it have to be a transgender specialist therapist for it to be written or could a physician/family dr, counselor, or psychiatrist write it.

Psychiatrist can do it. Depends on the purpose for the letter. Some surgeons want 2 letters, one from a doctor and the other can be a therapist under him.

I believe that the current SOC requires one letter for top surgery.  It could be from a therapist, psychologist, or psychiatrist.  The expectation is that the person have some experience working with trans people, but I don't think that is a huge sticking point with most surgeons at this point.

For bottom surgery, you must have two letters.

A primary care doctor, or any physician that feels competent to do so, can approve "informed consent" for testosterone therapy.  Prior to this current SOC (Sept 2012), it had to be a therapist/pscyhologist/psychiatrist who wrote a letter.

If you are like me and no one is going to change your mind no matter what. Seek out Dr. Graham. $320 for top surgery letter and he did it in three sessions. http://gendertherapist.com/ You might be able to get it for $280 if he hasn't changed his email format yet.

Scroll down and read about my experience with him. You will need enough history of dysphoria to make it happen. A fresh pup with eyes closed does not make an expert fetcher. http://discoveringalex.wordpress.com/

I think I read that you are from Ohio too? Then Medalie is your surgeon and he accepts Dr. Grahams letters.