Okay so I'm having my first appointment to discuss getting on estrogen on November 21! They told me that depending on "several factors" they might do some labwork. Other than that, they were very vague about what's going to happen. What should I expect?
Also, for what reasons might they deny me? For example, I dress more or less unisex, partly because I don't own any women's clothing yet, but also because I'm a metalhead and I really like the band t-shirt, jeans, and some skateboarding shoes look. Don't get me wrong: I do plan on acquiring more feminine clothing; I just don't have the money for it at the moment. Would this be grounds for them to deny me? What about the fact that my voice isn't where I want it yet? What other factors would they deny for?

I cannot speak for all doctors, but mine didn't seem to care what I was wearing etc.  The only thing they did care about was that I had an HRT referral from my psychologist. 

I went in dressing like a redneck dude.  Cut off jeans, cut off t shirt ( hey it's NC, it was hot hahaha), 5 day stubble.  The only fem me thing was my long hair in a ponytail.  My Dr asked what I was being seen for and I said my therapist suggested her for mtf hrt.  She didn't ask for a psychologist referral or letter, she does informed consent.  She did bloodwork and I went back the next day for my prescriptions.  Unless you have something show up on bloodwork I don't see why they would deny you.

With knowledgeable doctors, you only need to express a need. Year ago I was full male without a trace of female showing and I was able to start HRT. I continue about 2.5 years after that before switching over to feminine dress. If that is how you normally wear your hair, in your avatar picture, you will appear far more feminine that I did as I had my hair short, almost shaved on the side and about 2 inches on the top.

As long as everything is in order and your in good health, you shouldn't have anything to worry about. My doctor wasn't concerned about what I was wearing all. I was also worried about being denied to even though I knew it was a done deal didn't stop me from worrying about it. No worries many start HRT before dressing at all. Hugs
Mariah

I went in girly because that's what I wanted.  I felt better.  hugs Shannon