November 30, 2005
RE: Elliot [lastname]
Dear Doctor Brownstein:
I am writing at the request of my patient, Elliot [lastname], to provide a letter of referral for surgical services. Elliot has been my patient since 2005 when he began care for assessment of hormone therapy for gender transition services. I have also been in contact with Dr. [psychologist], who has provided Elliot with psychological services relating to gender identity and adjustment issues. Prior to initiating care with Dr. [psychologist] and me, Elliot had initiated transition by assuming a masculine gender identity including life style and dress. By my personal experience and by Dr. [psychologist]’s communications, I believe Elliot has demonstrated stability, self-awareness, and remarkable responsibility in pursuing and following through with all therapies relating to this care.
Since our first meeting in March of this year, Elliot communicated a desire to pursue reconstructive chest surgery once hormone replacement therapy had been stabilized. After a thorough medical assessment and careful review of the medical and psychological implications of hormone therapy for transition, I initiated therapy for Elliot with weekly injections of testosterone cypionate 100mg IM. Over the summer, Elliot received instruction in self-injection and has continued to follow through with regular administration of medications and regular laboratory analysis to monitor medication effects. At this time, Elliot appears to have achieved a stable replacement hormone level.
It is my impression that Elliot has demonstrated significant appreciation and understanding of his transition needs and goals. I am quite confident that his ability to follow through on postoperative care will be excellent. I am also quite certain that this procedure is appropriate and will be beneficial in furthering his transition and recommend him to you for this procedure.
I will be continuing to manage Elliot in his primary care and hormone replacement needs over the next several years and would be happy to be a primary care contact for any follow-up to your treatment.
If you have any questions or concerns, please contact me at (xxx) xxx-xxxx or fax at (xxx) xxx-xxxx.
Thank you for your kind consideration in this matter.
Dr. [Primary Care]