Archive for October, 2013

My Letter

It is done. I now have my top surgery letter. Now to contact Medalie and get scheduled. I have chosen to publish it in its exact words as when I was looking for examples of letters I couldn’t find any. Hopefully this helps someone who needs to help their therapist write one.

Attn:  Dr. D Medalie – Cleveland Clinic Ohio. US.


The above client is a 21 year old female to male transsexual, who currently resides in ____ Ohio USA he has been a client of mine since early August 2013.  During that time we have spoken online and used various forms of communication.  He chose this form of counseling due to convenience and not being able to locate a suitable resource in his local community.  Currently he works throughout the night and is employed as a retail stocker.


Alex feels his gender issues have been with him since he was quite young. At this time and since the age of 18 he has had to bind his chest every day and feels uncomfortable doing such physical thing as it makes him restrictive and difficult to breath.  Having to do such a thing regularly makes him feel that he cannot be his true self and do normal things.  Over many years he has continuous felt stifled by the dysphoria he has suffered and how he is perceived by others daily.

His life was overall good at home until he started to experience difficulties and conflict both at school and with his mother around puberty and entering High School; he was continually picked on marginalized and bullied.  At the time he was totally unaware of the nature of his gender dysphoria and its related issues.  Entering and going through puberty made him feel extremely uncomfortable about his body and female persona.  It was sometime after that when he realized that it was due to his body’s gender development.  Although during his period of education he continued to be a good student with grade A’s and was actively involved with clubs and activities. He though eventually fell out of classes during the 11th grade and finished being home schooled.


Alex has a difficult relationship with his mother as they do not speak about personal things often.  He does not see his father who left the family home some years ago. He has a few a few friends and goes out with them occasionally. However, at this time he is more focused on working hard to pay for this surgery.  He obviously due to his anti social work hours does not always have the opportunity to see friends.


Throughout his life Alex has suffered an acute lack of confidence due to his dysphoria which has increased over the years.  He states that he has developed into a private and closed person who finds it difficult to speak about things related to his feelings and life in general.  He believes that personal things are not necessarily other people’s business and is fearful about what they may do with the information they gain.  He politely asked me to consider this throughout our sessions which I have endeavored to respect.  My concentration has, therefore, been focused on the gender related dysphoria he has encountered and suffered over many years and I have no doubt about a diagnosis of transsexual male


Alex is medically well.  In the past he has had Wisdom Teeth removal, Gender Dysphoria, and personality problems


Alex in my opinion meets the diagnostic criteria for Gender Dysphoria he has started to transition as male and has developed a support network amongst friends and to some extent his grandmother. His records indicate that he is physically and emotionally healthy, with no evidence of psychopathology or impaired judgment. He is aware of the benefits and potential risks of surgery, and feels prepared to undertake this important step.


The author of this letter is an independent gender specialist and psychologist registered through the American Counseling Association and The Psychological Association of the Philippines, and registered in the UK who is fully qualified and has consulted Alex weekly over the past weeks.  I believe that he will have a better quality of life living as a transmale and undergoing chest reconstruction surgery will only enhance that further.


Alex has chosen to follow the standards of care as he has done so in the past. After reviewing the evidence and facts chest reconstruction surgery is the next logical step in his treatment and should relieve much of any remaining dysphoria which has accompanied his Gender related concerns over the years.


Alex is now psychologically ready for this next step of his transition.  I therefore have no hesitation in recommending Alex ____ for chest reconstruction surgery.  He has met all of the eligibility criteria outlined in the Standards of Care for the treatment of transgender individuals. If you have any questions do not hesitate in contacting me.
Yours sincerely


Dr. Graham L Peveller

Counseling Psychologist

Gender Specialist