over the phone or does it have to be done in person? What if they are located out of state?

As I understand it, they write a letter. I think it comes down to what the therapist wants to do, as I believe it is them who will be held liable if something goes wrong. I don't think being over the phone would specifically invalidate their letter (I don't think it would even be mentioned), but out of state may cause issues with state laws and/or insurance (Maybe?).

Good question... I've wondered this myself

After 3-sessions, my gender therapist contacted, via phone, a D.O. who prescribed low-dose HRT.  These discussions about letters are so foreign to me.

The HRT letter only gives the diagnosis of Gender Dysphoria. An Endocrinologist then makes the determination of what meds, doses, etc as to actual HRT and future monitoring of the patient.

Quote from: Jessica Merriman on December 30, 2013, 05:43:25 PMThe HRT letter only gives the diagnosis of Gender Dysphoria. An Endocrinologist then makes the determination of what meds, doses, etc as to actual HRT and future monitoring of the patient.

Every system works differently; officially I was diagnosed with GID (the DSM-IV version of GD) but was written no letter and was told I had to see another psychologist for a letter for hormones.

In the US system, HRT is a prescription drug, which means a therapist generally cannot prescribe it themselves - they have to work with someone who can, an MD or DO or someone else duly trained and licensed.

Lest that sound too discouraging, it's exactly the same legal situation with anti-depressants, and those certainly get prescribed no problem.  Any halfway decent gender therapist should be able to refer you to a doctor for HRT (or several), so you shouldn't have to worry about finding one when the time comes.

If you start with an endo or general physician, they'll almost certainly refer you to a therapist - professional and liability reasons.  (Technically they don't have to, but it's their medical license and liability on the line.)

If you have a favorite doctor already (who's sympathetic) there shouldn't be an obligation to switch.

Any other rules are the invention of your healthcare professionals, not what the law requires.

Quote from: musicofthenight on December 30, 2013, 07:28:27 PM
Any other rules are the invention of your healthcare professionals, not what the law requires.

There's the crux of it right there.  Most of the medical road blocks you encounter aren't law.  They're just the due diligence practices that doctors, HMO's and hospitals have put in place to keep from being sued. 

There are some clinics in the U.S. that work on an "Informed Consent" model.  If you can show that you understand the risks and consequences of HRT, they are happy to arrange it.  Others are going to insist on a letter from a psychiatrist and RLE.

I suspect that HMOs and insurance providers play a significant role in determining standards of care.  Health care professionals tend to have a lot of pressure to keep their costs down and their malpractice liability to a minimum.

You might want to start by looking at what your Insurance Plan or HMO covers or requires for HRT.  Talk to your regular doctor if you have one and do what you can to get insurance to pay for it.  If what they offer isn't acceptable to you... try googling "Informed Consent Hormones" to find a clinic in your area. They may still be able to help you find a endo who's in your insurance network or you might end up paying out-of-pocket.

(HRT aside... you'll still want to hook up with a good gender therapist, especially if you are looking down the road towards SRS.)

Quote from: Shana-chan on December 30, 2013, 12:36:03 PM
over the phone or does it have to be done in person? What if they are located out of state?

They pretty much only need to be state licensed for mental health services. Otherwise surgery letters would be a lot more difficult if a requirement was being local to the surgeon (vs local to the client).

I'm not sure if this is relevant but consults with the psychiatrist by skype is very common here. They then send a letter to a local endo/Dr for your HRT clearance. Same with the surgeon letter they send it direct to the surgeon.