The following describes the troubles I had with the gender therapy requirement.

Transitioning can be a very lengthy and frusterating process. At least, it was for me. As I was learning more and more about gender identity/transgender issues, I found that was the only thing I would talk about during my weekly sessions at the University's free counceling center. The more I talked about it, the more I felt it. And the more I felt it, the more I talked about it. And the more I realized that what I had been feeling and thinking for all those years was OK.

I wanted to make sure I did it right regarding legal issues and such so I read the Harry Benjamin Standards of Care and outlined what I needed to do to start testosterone. The Standards of Care define eligibility criteria and readiness criteria:
Eligibility Criteria:
1. Age 18 years;
2. Demonstrable knowledge of what hormones medically can and cannot do and their social benefits and risks;
3. Either a. a documented real-life experience of at least three months prior to the administration of hormones, or b. a period of psychotherapy of a duration specified by the mental health professional after the initial evaluation (usually a minimum of three months).

Readiness Criteria:
1. The patient has had furter consolidation of gender identity during the real-life experience or psychotherapy;
2. the patient has made some progress in mastering other identified problems leading to improving or continuing stable mental health (this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, and suicidality);
3. The patient is likely to take homrmones in a responsible manner.
Since I was 20, had demonstrated my knowledge of what hormones can and cannot do to me, and had been living exclusively as a man for over 6 months, I felt more sure than ever, and I wasn't suicidal, I thought I was set. All I needed to do was get my councelor at the counceling center to vouch for me that I had been living as a man and talking about gender identity issues. However, I found out that the councelor I had been seeing wasn't licensed enough for her word to "officially count." And, the only person licensed enough at the counceling center was leaving that summer. I asked the counceling center if they were going to be getting anyone (or forsaw themselves getting anyone) that could give me my letter, and they blatently said, "No," and referred me to a private office, the Behavor Therapy and Psychotherapy Center (BTPC).

In July 2002, I began my therapy at the BTPC. I went in making it clear that I was seeking a service. The only reason I was there was to get my letter. In all honesty, I did not get anything more out of the BTPC than I did at the counceling center. The only difference was that I was paying $15 per session (one per week) at the BTPC. If it weren't for their sliding scale, I wouldn't have been able to do it.

Since I had so much real-life experience and knowledge under my belt, I expected any decent therapist to recognize such and make it 12 sessions, equaling about 3 months. Even if you negated the 8 months of real-life experience I had before starting therapy, the 3 months in therapy should at least count for the required 3 months in the Standards of Care. On the 10th and 11th sessions, my therapist kept promising that we would "talk about the letter soon," and, "how much longer it's going to be." But the 11th session came and went so finally, on the 12th session I brought it up again. She claimed there was one more "issue" she wanted us to talk about. She said, "Some therapists would claim that the reason why you want to change your gender is because you have internal homophobia. You've been dating members of the same sex, but because of this internal homophobia, you feel like you need to change your gender." Anyone who knows me knows this issue isn't even worth bringing up, let alone discussing. I had spent 12 intense hours with this person, telling her how I came out at 14, how I'm involved in the community so much sometimes my social life and school work suffers, etc. Of anyone, she should know that I'm not internally homophobic, and yet she wanted to spend one hour, $15, and a week delayed of my letter on this subject. I don't think so.

I posted on the FTM Forum on LiveJournal about it (and on my journal, the entry is here). I got so fired up from the responses and thinking about it more that I went into my next session (#13) ready to say, "I could understand how you might think that internalized homophobia might be an issue, but upon thinking about my situation even more, I realized that it is not an issue for me...and I think there are more important things that session time should be used to discuss." But, to my surprise, before I could even get one word out, she appologised for "badgering" me the week previous. She went on to tell me that she had talked with her supervisor and realized that she had only one hangup that was preventing her from giving me my letter.

She blatently admitted that her hang up was her own personal question of "whether or not this is a good idea." She continued with the realization that her personal opinion on that question had no bearing on giving me my testosterone recommendation letter. She said she has no reason to believe that I had other psychological issues, and she has every reason to believe that I am "of sound judgement." So, she said to give her two weeks to write the letter and to come back for our last session for me to read the letter/make changes/pick it up.

All seemed fine and dandy. I was finally getting my letter, despite the personal bullshit. I had a meeting set with her for Monday November 18 to get my letter. But, on the previous Wednesday, she left the following message on my cell phone:
Hey Ethan it's (name) here at the Behavorial Therapy Center and I am writing, um, the documentaion letter for you and I just realized something. I realized that one of the things we did not do as part of your, um, time here were a couple of sort of...clinical evalations that I feel will lend themselves positively to this documentation letter you will give whoever your, um, endoclinologist ends up being...some sort of data that says, you know, you did these tests, these are the results, and here is why I believe that there is, you know, nothing wrong in terms of your judgement regarding this decision. And I'm kicking myself 'cause I didn't think of this before, um, but I wanted to let you know that I think it might be a good idea to do a couple of these sort of, um, questionaries and to get the results from them and indclude them in your letter. Um, I really do think it'll lend themselves in a postive, um, and strenthing way. So I was propsoing that we do that on monday when you come in which means that the letter will take a little longer to get done. Um let me know if you are amenable to this, um, (phone number). I'm planning on seeing you on monday, um, along with, um, Caitlin for the project. Alright, but give me a call and let me know what you think of this. Alright, I hope you're well. Bye.
For 2 and a half hours I was freaking out because, just a couple days before I've been promised to get my letter, my therapist is having second thoughts. Luckily, I didn't have a chance to call her back until later that afternoon. When I picked up my phone to call her back and tell her I didn't think additional tests were necessary, I found this message on my cell phone:
Hey Ethan it's (name) from the Behavorial Therapy Center, I called you earlier today. Go ahead and ignore my message from earlier this morning. It made absolutely no sense, um, after a little more thought. Um, I will have the letter ready for you on Monday when you come in...and...I will just see you then. Ok so, take care. Bye.
By this time, it was obvious that my therapist had some serious personal issues with transsexualism. But, I did as she said and ignored her messages. On the following Monday (Nov. 18th), she had my letter ready for me to proofread. In it, she had put some of the most ridiculous things that she obviously either imagined me saying or put in there just so it would "look good." The letter claimed that in elementary school, I insisted on playing with only boys my own age and refused to wear dresses or skirts. All of my friends were girls, and I enjoyed playing with them (boys were too dirty anyway), and as you can see from my kid pictures, I did not refuse to wear dresses or skirts. And I can assure anyone that I did not say anything that could be contrued as anything that she claimed. If anything, I told her outright that all my friends were girls and there were actually some dresses I enjoyed wearing. It may sound like I was being nit-picky, this was just one more reason to believe she had never really listened to me. I edited the incorrect things out of the letter, she corrected them, and sent me the final copy. You can read the final copy of my tesosterone recommendation letter.