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location:  Transition  >  Testosterone  >  T Letter

November 19, 2002

To Whom It May Concern:

This letter is to serve as documentation that my client, Justin (Ethan) L* has completed 14 sessions of psychotherapy at the Behavior Therapy and Psychotherapy Center (BTPC) in Burlington, Vermont in fulfillment of the requirements for hormone therapy. Having engaged in psychotherapy from July to November 2002, Ms. L* is eager to initiate testosterone therapy in order to begin gender reassignment.

Client Profile

Justin L* is a 20-year old Euro-American student who is biologically female. She is currently a junior at the University of Vermont, majoring in Animal Science/Pre-Veterinary Studies. Ms. L* referred herself to treatment in July of this year to begin psychotherapy as part of the requirements for gender reassignment.

Relevant History

The client was born in *, Florida and is an only child. She described her childhood as good but slightly fragmented , with the family moving several times in order to facilitate her mother's medical school requirements. At the age of 17, Ms. L* was diagnosed with Lyme disease and spent the remainder of school year at home recuperating. Despite this disruption, she was able to maintain excellent grades and graduated in the top 5% of her class. She began classes at the University of Vermont in the fall of 2000.

With regard to gender history, Ms. L* reported that from a young age she has had difficulties reconciling her biological sex with her experience of herself as "male." Even as a child, she consistently identified as male and preferred to wear clothes that were more unisexual such as jeans and overalls.

As she entered adolescence, Ms. L*'s questions of gender identity remained unresolved although her sexual attraction to women began to establish itself. At the age of 14, the client came out as a lesbian. When questioned about her family's response to this, Ms. L* stated that with the exception of her grandfather, immediate and exteded family members were exceptionally supportive of her realization about her sexual orientation.

Despite the approval and support of her family, the client continued to experience distress around issues of gender identity. While she acknowledged her attraction exclusively to women, Ms. L* felt that her identity as a lesbian continued to be in conflict with her experienced male gender. She remembered feeling isolated and unable to seek support from those around her given the unconventionality of her situation.

Upon starting college in the fall of 2000, Ms. L* began participating in online support groups for transgendered individuals. She began researching the topic of Gender Identity Disorder and familiarized herself with the Standards of Care for the treatment of transgendered persons. A year later, in October 2001, Ms. L* came out as a transsexual.

Eligibility Criteria

Over the course of the treatment, Ms. L* has demonstrated more than adequate knowledge of the benefits and potential risks of the testosterone therapy, including the heightened risk of cardiovascular disease. She is also aware that heredity may limit her tissue response to testosterone and that the maximum physical effects of the hormone may take up to two years to become evident. Ms. L* reports that her female partner of 7 months is similarly aware of the benefits and risks related to testosterone therapy, and continues to be supportive of the client's decision.

Ms. L* has been living as a man since October 2001. She began introducing herself as Ethan, has informed professors at the university of her intended gender transition and reassignment, and uses the men's restroom exclusively at both work and school. With the exception of legal documentation, the client refers to herself as Ethan. The client has also informed her family of this decision and experienced significant parental objections resulting in the withdrawal of all financial support. As a result, the client has had to move off-campus to a cheaper living situation and is also working part-time in order to meet her tuition and living expenses. She continues to maintain an A-average in all her classes.

Readiness Criteria

Over the course of treatment, Ms. L* acknowledged that her decision to live as a man has resulted in a significant reduction of personal distress surrounding gender identity. With the exception of her voice which occasionally results in awkward social situations, the client is able to successfully "pass" as a man. She hopes that testosterone therapy will sufficiently deepen her voice and allow for the presence of facial hair.

Diagnostically, Ms. L* meets criteria for Gender Identity Disorder. There is an absence of problems related to mood, anxiety or substance abuse. The client does not evidence any symptoms of psychosis or disturbances in personality. It is recommended that the client continue with the psychotherapy as she begin her gender transition in order to address any issues that may surface. Given that the client's insight and judgement are within normal range, it seems likely that any prescribed medication will be taken in a responsible manner.


Justin (Ethan) L* is a 20-year old biologic female with a diagnosis of Gender Identity Disorder. Ms. L* engaged in psychotherapy from July to November 2002 (14 sessions) to fulfill the requirements for testosterone therapy. She hopes to eventually undergo gender reassignment and fully transition from female to male.

The client has met all the eligibility and readiness criteria outlined in the offical Standards of Care for the treatment of transgendered individuals. There is no evidence of psychopathology or impaired judgement. Given the preceding report, I certify Ms. L* to be a fit candidate for testosterone therapy. Please feel free to contact me at the Behavior Therapy and Psychotherapy Center (802-***-****) if there are any further questions regarding this client.


NOTE: * = edited for privacy