It seems to be different depending on location. I do know that in the last few years they set parameters and a central learning facility in Loma Linda. EVERYTHING that is changed/adjusted is by "Loma Linda" standards.
While I am within 3 hours of Philadelphia, NYC and DC, the VA I go to is in the back end of nowhere. I was the first through their system and they had no clue how to deal with me. We muddled through and there are many more now. We have a support group that I honestly never go to, voice therapy that is a few years too late for me and a shuttle to the more specialized VA endo in Philly. Okay so support group; It is supposed to be for transSEXUALS but appears to be open for all trans. I wouldn't mind but I have nothing to offer in support for them and I end up feeling like I can only really talk to or relate with the only other full time girl. AND a couple of them make me feel VERY uncomfortable. I am there to talk about trans issues and not have someone say how attractive they think that I am or what they would do to me if I was their girlfriend. At first I thought some of it was dysphoria for them, you know how before you are passable seeing a passable trans person makes you feel like... I don't know, UGH! I guess. Maybe for one of them, she still makes my skin crawl the way she looks at me though, but the other just got worse. I told the therapist and she said she would do something but that person was still there the next time I went, I never even checked in, just turned around and left. The bus ride to the specialist; One of the ones that makes me feel uncomfortable rides it. And the voice therapy is at the specialists. 😊
Really though it's better than I make it sound. The meds are soooooo much cheaper and with everything else they are doing the best that they can. One thing that I hate is that they still have me down as male and the mail that they send is addressed to Mr Michelle. They refuse to do anything about it and the one girl even called me he like 10 times in 5 minutes when she was asking for help to fix it. I hadn't been called he in more than a year, i wanted to scream at her, 'I am a girl you evil witch!' When my surgery is done, if they don't change it, I will stop using them for anything. I don't know how to lie about or avoid talking about my past but if I could and feel comfortable with it, I would go complete stealth in a heartbeat. There are so few people that when they know will completely accept you and treat you as female. To the rest we are a boy or trans and sometimes it gets old. Even some the men that hit on you! Really! I fall for the person period, but they don't know that. I am not saying that I am out of their league but they would need the Hubble Telescope to see my league from theirs. They would NEVER hit on a cis girl like that. Um... that sounds shallow and petty. I just hate how there are different rules for us and I don't know how to change it.
End of rant and back on topic.
The VA has so much to offer us, you should definitely check it out. I transitioned in a vacuum in an area and VA that barely accepted that there were transsexual people. This area and VA are no longer like that and I hope that you have an easier time of it than I did.