I see people talking about the various steps all over the place and I am very confused as to the middling parts, how they REACHED those steps. I'm putting this here because I am most confused about how you get from shrink and HRT to surgery. Do they have to be in that order? Do they go in the opposite order? Can anything happen whenever? How do you get to the surgery point? Who do you contact? What are the requirements? Basically, I am just confused.

I think the usual steps I see are therapy, then seeing an endocronolgist who does bloodwork, then hormones, and then back to the therapist to get letters for surgery. However I've seen some guys start T before hormones. Surgery usually seems to come last.

For me it went: Therapy, then seeing a doctor who gave me hormones without bloodwork, then bloodwork in 3 months, and eventually I'll go back for surgery letter, then top surgery. Not sure about lower surgery yet.

Try to find a therapist, preferably one already with experience/training in gender identity issues or at least willing to willing to work with you.  I could not at find one with experience at first so I just picked a psychologist and went.  I was their first gender identity patient and they could not directly help me along this path.  However, I continued to see her to work with for my depression and we discussed my gender issues.  Over a few months she searched for me and came up with a referral for both a gender therapist and an MD with experience prescribing HRT.

In most cases you will need a letter from a therapist after some period with a gender identity diagnoses recommending HRT which you can take to the MD to prescribe hormones.

Progress from there depends on how you are handling your life; you need to reach the point where you are living full time in your true gender before being ready for SRS surgery, though some surgery may be able to be done earlier.

You should read the WPATH Standards of Care and become familiar with it as it outlines how medical professionals approach this and therefore how you can plan your own transition steps.  There is flexibilty in the outline depending on your personal situation and how rigid your therapists/MDs are.  I took a copy to my meetings with therapists to discuss my progress and plan for my next steps.

some good general info and steps to take: http://www.tsroadmap.com/index.html

for me i kinda messed it up

i started hrt before seeing a therapist  started seeing one after a year and just at the end of last year she signed my papers and the srs letter

for me it's been GP, referrer, voice therapist, women's group, therapist, bloods taken, continued speech therapy & group (until group was wound up due to lack of funds - boo hoo) then therapist and hopefully I'll be hormonal by the end of the month.