Hm, interesting. I requested letters like these from professors in case I had issues getting hormones, but I didn't even have to show it.
Essentially, this is what the best one said:
- Who they were, how they knew me, how long they knew me.
- That I have been living full-time as a man and flourishing (giving examples, such as my grades and social interaction in class)
- my comfort and confidence in my identity
They didn't talk much about how it affected them since we mainly know each other on a professional level but they were beautifully done letters. I'm sure a friend could construct something similar. Hope this helps somewhat.