Part of the problem is I’m very close to this issue and I’ve explained some things, like this process, in great detail on this message board multiple times. There’s only so many times I can keep reposting the same information because some folks want to weigh in on a subject without using “Search.”
If I implied that a simple note from a doctor was all that was needed, that implication was incorrect. What I’ve done was the mistake of assuming that some prior people I debated were referring to the same thing I was thinking of. Meaning that they had done even a Wikipedia-level of research before weighing in on the SDMB. So to avoid further confusion, let me repost some details.
The actual WPATH-accepted (or recommended) process involves a significant period of counseling, which may include both individual and group sessions, sessions with parents and even friends involved. For our clinics, these sessions explore the roots of the gender identity development in the patient, mitigating factors of social environment, whether the patient has other possibly confusing or compounding psychological issues or problems, and most importantly, a search to discover if their gender identity is persistent, consistent, and insistent. Substance and alcohol abuse are considered, as is the possibility that other legal (prescribed) or illegal drugs might be altering the gender identity of the patient on a temporary basis. Parents, spouses, friends, and other may be interviewed to gain further information. They may also be tested for intersex conditions (like I was) if there is evidence of such.
Of the people who come into the office I work with, I was told that about 1 in 4 have some other compounding factor which renders a diagnosis of transgender impossible. Another 1 in 4 are diagnosed as transgender, but not to the degree where it’s recommended that they actually start a transition process (meaning, they don’t get a letter). Some unknown but small number of transgender persons receive their letter but choose not to transition at that time, due mostly to second thoughts about becoming unemployed and possibly homeless (like my friend I spoke with last night, who had her letter for 6 years before coming out).
Of those patients remaining, there is also the decision that a psychologist must make, which is “will the patient prosper at the current time with transition, or will it be a net negative? Are they strong enough to survive this, emotionally? Do they have any support network at all?”
I’m not a licensed psychologist. I’ve been through the process and I’m an unpaid adjunct for several licensed psychologists. I participate in these sessions (more patients than I can remember), with the prior approval of the patient, to assist in the assessments and to provide a sounding board for them. Outside of the office visits I mentor them, meet with and help their families and friends and peers, and work with them in social settings, and report back to the psychologists how the patient is handling certain social challenges and barriers, and how their attitude towards their gender identity and expression is being upheld. Again, this is done with the patient’s permission and knowledge.
This process can take as little as a couple of months, to years.
At the end of it all there is a letter, from the psychologist, stating the gender identity of the patient and requesting that all possible accommodation be made for them. It’s often brief, maybe 2 paragraphs plus an intro and closing. This is what I refer to as the “doctor’s note.” There will also be a letter to a physician talking about the patient and recommending hormone therapy, but that is (normally) sent directly to the physician to avoid the possibility of forgery.
If I gave the impression that one could just go to a doctor, they’d check them over, and write out a note, that impression I gave is incorrect. It was based on my summarizing a process which I’ve already posted about many times before.