I sort-of don't understand the question... but I have been in counseling for 10 years now, and when I got the hyst surgery they gave me a letter (we had to request it) so I could get the F changed to an M on my DL and birth cert. But my case - they didn't base it on how many therapy sessions I had, it took me having to have a surgery to get the type of letter I got. I went out of town to a bigger city to have both of my surgeries though. They said they would have to go through "the board" for me to get the surgery down here in my small town. The reason, I assume, is because I have had mental illness.
I know my post here probably didn't help anyone out but well, I tried to fit in

When I went for my psych evaluation before surgery, the doctor / psychiatrist told me that if I had some sort of illness, then he wouldn't let me go on through surgery because we'd have to have cleared up my illness or at least get me some good therapy and medications to make sure it's not just a "delusion" or something like that. On that first psych evaluation, I lied on several questions because I knew that if I had 'those parts' any longer then I'd do away with myself. So I lied, I admit. But my second evaluation the doctors made it look like I was "uncooperative" by telling me to only answer about 20 of the 500 questions. They did that on purpose, I believe because there's a therapist up there in mental ward who treats me bad and calls me a girl and all these other things. He once embarassed me in front of my room mate. I hate the man. His name was Lawerence Underwood. Mum said that if he ever comes near me again that she will make it to where he won't have a job anymore. He's very abusive - he shouldn't be working with mental patients in that case.
Anyway, I'm off topic. So sorry. My fingers got carried away.
Did you all have to get a letter from your therapist in order to have the surgery? I never had to have one. I think it was because I was in counseling for so long.