Psychiatric Evaluation: The HRT Approval Letter

Swan River Sunset - South Perth

First things first, I’m excited to announce that I’ve gotten my letter of approval from my psychiatrist to start hormone replacement therapy (HRT) today. Yay!

My transition seems to be moving on a fast track – which has affirmed my thoughts on this being the right path for me. I was expecting to hit several road blocks but the one I’ve encountered so far has got nothing to do with my transition (I was in a motor vehicle accident in April).

I don’t know the process in other countries, but in Australia it’s better to have referrals from your doctor to specialists so that you can claim Medicare benefits – this is of course if you’re a PR or citizen. I’ve listed the contact details for my GP and psychiatrist at the end of this post for anyone in Perth who are looking for medical practitioners who have experience with transgenders.

Here’s the list of the steps I’ve taken to get my HRT approval letter:

1. Get a referral from my GP to a psychiatrist

My GP wrote me a letter of referral to a psychiatrist. While he was happy to put me on hormones immediately if he could, I would need 2 medical practitioners to sign off on me being sound of mind and that I am aware of the consequences of the big life changing decision that I am about to make.

The hardest part of this was actually finding parking in the city to get to my GP in the first place.

2. Make an appointment with the psychiatrist

Pretty straight forward, pick up the phone and call to make an appointment.

The hardest part? Waiting for the appointment as psychiatrists are usually booked out for weeks and they can only have so many patients in a period of time. I was actually referred to a different psychiatrist but he was no longer taking new patients so I had to go back to step 1.

3. First appointment: The “get-to-know-you” session

Before my session, I had to answer a questionnaire that was about 3 pages long about my medical history and personal details. At the start of the session, my psychiatrist did a short introduction of herself and explained the process and aim of the session. I was told up front that I would need at least a second appointment before I could get the official letter – fair enough, I am well aware that no psychiatrist/psychologist can diagnose a patient in just one sitting.

This step would be the hardest of all. Having to put into words why you feel the way you do is frustrating. Your mindset is your truth – having someone ask you why you feel that way about something that you have never felt otherwise is just… hard. Just the simple question of “Why do you feel that you’re a boy?” smacked me right in the face.

It’s not something that I’ve chosen, it’s just how I’ve always felt despite being told I was a girl repeatedly for more than 2 decades. While I know that I’m biologically female, my mind has always been male. While it’s easy for a cisgender person to point at parts and go “It’s cause I have a penis/vagina”, I had to explain how I came to that conclusion that I am male by sharing my experience, memories and a whole lot of “That’s just how it IS!”.

Part of me felt like deflecting the questions but I knew I had to face them the best I could because it would just delay my progress in getting the letter.

4. Second appointment: Sealing the deal

My psychiatrist asked if she could speak to any of my close friends and I brought my housemates to meet her. I live with 2 younger people – one girl, one boy – and I call them my “kids” as I feel like their dad sometimes (okay, maybe most of the time since I am the one who does all the planning and financial things in the house).

At the end of the previous session I asked what were the chances of me getting the letter during the 2nd session, and she said that it was fairly high. So for my 2nd session I was focused on getting that letter.

Surprisingly I didn’t do much talking this time. Questions about me were mainly directed to my housemates.

Hardest part? Not bursting into laughter when listening to the kids talk in their “official-serious-matters” voice. Oh, and waiting for the psychiatrist to actually type out that letter.

Now like I said before, my transition seems to be on a fast track – some could take a lot more than 2 sessions to get the approval letter. It does depend on a lot of factors that would contribute to your psychiatrist’s decision.

It’s also worthwhile to note that the letter doesn’t HAVE to come from a psychiatrist – it can also be written by a clinical psychologist.

Contact Details:

General Practitioner
Dr. Bede Rogers
(08) 9481 4342
Perth Medical Centre, 713 Hay St Mall PERTH

Dr Geetha Menon
(08) 9498 6277
GP Cockburn Central, Unit 14, 11 Wentworth Parade SUCCESS

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