If you're considering starting testosterone, here's a general overview of 'male' puberty. As for what changes may happen to you, consult your family-of-origin history if you're able.

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In accordance with the DSM-IV, I underwent therapy to start testosterone in August, 2006. At the time, the only way to be approved to take hormones was by meeting the criteria in the WPATH (formerly Harry Benjamin) Standards of Care, which meant one had to fit into very stereotypical gender roles or lie their ass off about it. Now there is this glorious thing called "informed consent!" Yay progress! Although it should be noted that trans people are still "disordered" in the DSM-V.

While I don't think everyone who is able to medically transition should have to go to therapy, it might not be a bad idea to look into it if no other kind of support is readily available and it's something you can easily access. Talking it out with someone else could be helpful.

Here are my medical transition letters, in case you're curious. Please note that any grammatical errors are not mine, and some of the wording used doesn't accurately describe my sense of self.

Date: 12-12-06

To whom it may concern,

This letter is written at the request, and the permission, of Alex ___ date of birth 12-4-86, supporting the readiness for hormone therapy. I have been working with Alex ___ in individual therapy since 8-09-06. Alex has been a motivated and active participant in the therapy process. He has explored issues around his gender and adjustment disorder which is being managed by therapy, as well as the impact transition would have on him and his family, friends as well as how it would feel to not transition. Over the past several months, Alex ___ has been coming out with positive reactions. He is in the process of pursuing legal name change and has asked others to call him by his male name and to use male pronouns.

Alex ___ feels ready to make the physical changes that hormones would bring. He has been fully compliant with the Harry Benjamin Standards of Care, and will no doubt continue to be compliant with the standards of care and his therapy in the future. Alex ___ meets the criteria for the DSM-IV diagnosis of Gender Identity Disorder(302.85). I fully support Alex ___ beginning hormone therapy without reservation. I believe he is fully aware of, and ready for, the changes that will likely occur. I expect Alex ___ to continue therapy to help support a successful transition.

Sincerely,
[My therapist at the time]
LMHC

When seeking out a therapist to write my top surgery letter, I had only one criterion: They must be willing to write me a letter after only one session. By 2010, I'd been living authentically, passing as cis consistently, and not at all loving the idea of being put on a waiting list for several months just to justify my need for top surgery for several more months. I realize this may have come across as immature on my part, but there hasn't been a moment where I'd thought that this step wasn't necessary for me.

Fortunately, I found a therapist through a friend, and since he's also trans and had letter-writing experience, the session was pretty relaxed and straight-forward. No gatekeeping!

September 10, 2010

Dr. Garramone:

I am writing to you on behalf of my client Alexander ___. Alexander is a 23-year-old genetic female who, aside from surgery, has transitioned to male. I have evaluated Alexander through use of a Gender Assessment as well as a detailed Biopyschosocial Assessment, and have found that he is psychologically healthy, stable and ready to move forward with his transition. Alexander has a strong circle of friends and identified community support to help him through any challenges he may face.

Alexander's identification with the male gender began in early childhood (he reports around age 3) and has been strong and persistent through the present day. The feeling of discomfort with his biological sex has been present for many years. He has been dressing full-time as male for approximately five years. He has been using the name Alexander since age 17 and legally changed his name on December 14th of 2009. Alexander began testosterone to aide in his transition on December 18th of 2006. Currently he is taking Testosterone Cypionate (50mg every two weeks). Alexander has experienced a long period of distress related to his gender as the result of Gender Identity Disorder. The experience of this distress will resolve as Alexander continues his transition. He has already taken a number of steps towards gender modification over the past several years and is now eligible and ready to continue onto the next step towards becoming physically male. Alexander feels very strongly that his body is intended to be male and it is clear for him that living as male allows for the fullest expression of who he truly is. The ability to feel physically and mentally at ease in his own body will provide an improvement in mental health and overall well-being. Surgery would clearly enhance the quality of his life.

Alexander does not present with any significant psychiatric illnesses. He has struggled with anxiety and has been diagnosed with General Anxiety Disorder. Alexander reports he has had a history of Major Depression. Both depression and anxiety are common in clients experiencing GID and are likely to improve with transition [Zander's note: My depression and anxiety diagnoses are not related to my gender or any dysphoria caused by the sex assigned to me at birth]. There are no indications of other psychological disorders. Alexander's judgment is clear and rational. There are no signs of psychosis, thought disturbance or substance use.

Through assessing Alexander and completion of an in-depth biopsychosocial assessment it is clear that Alexander is ready to move to the next step of his transition through chest surgery. I will be available to Alexander through this process for support and will be happy to continue working with him after surgery as needed.

Please feel free to contact me with any questions or concerns.

Regards,
[My one-time therapist], MSW
Psychotherapist

Lower surgery is something I really want as of September 14, 2013, but this hasn't always been a goal for me for many reasons - some of it having to do with the limitations of medical science, and others being the need for more soul-searching. Unlike top surgery, which was a sure thing for me from the word "go", I feel I would benefit from really talking it out when that time comes.