Posts tagged ‘therapist’

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


Therapy Session 2 & 3

My second therapy session was such a fail it didn’t even deserve its own post. All he did was talk about what gender dysphoria was. I was quite upset by the wasted hour.

The third session went good. He seems to repeat what I am having the sessions for, which is kind of unnecessary. He assured me he wouldn’t ask for any more money. Then it was just the basic questions of when the dysphoria started and when I noticed I was different. He asked what puberty was like and how work and friends gendered me. Then he asked how I dressed again. It’s kind of annoying when they ask the same questions over again.

The best part out of the session was he asked if was wanted the letter sooner or later. Of course I said sooner. Turns out he will be writing it this week and we will review it together next session. I’m so excited to be getting my letter. One step will soon be out of the way for a better life.

First Therapy Session

So my first with session Dr Graham went well. He asked all kinds of questions and some I wasn’t even expecting. He tried to dabble into my past but as I have a bad memory we quickly talked about now. It was a relief that we didn’t get hung up on things that happened forever ago. He also assured me that Medalie would take his letter. I already knew that but that’s fine. Then he asked me when I was having surgery. The way he worded it, it sounded like if I needed the letter ASAP he would make it happen.

We talked about my name and where and who and how I go by it. We also talked about my wardrobe. It was more complicated as I haven’t really shopped for new clothes in like 5 years, besides the few things I pick up here and there. Nothing was girly girl clothes so that satisfied him as an answer. He wanted to know how often I dressed male. We dabbled on my grandmothers support for me and how I made it clear my mom wasn’t going to know any time soon as she doesn’t know how to keep her mouth shut. It didn’t seem like that answer bugged him.

We also talked about T. I was clear I wasn’t sure if I would ever start it. I was amazed at his answer. “Well as I said there is no pre requisite to take hormones with top surgery – If you pass well and feel comfortable with that then quite frankly I see no reason for you to take T”. Finally someone who gets it. I don’t have a fear now that he won’t think that I’m not “trans enough” to get this done.

We also talked about me getting a hysterectomy. Now I was surprised as yes it has crossed my mind,way before I knew I was trans actually, but it wasn’t something I was researching or planning to get any time soon. With that discussion came about the monthly periods. I told him I was on Depo and I was fine taking that for now. Though if I could take something without proestrogen it I would. Then he was like T is for life, or until the inner girly parts are removed.

Then we wrapped up with how I thought the session went. We even joked about how it saves gasoline. “Come to me – I save you gasoline :-)” It must suck for those that have to travel over an hour just for therapy. They should really meet Dr. Graham and save a bundle. I will see him again next week. Turns out it will only be about 4 sessions, not the 8-10 that I had said before.

Planning Surgery Part 4

So the last week has done a complete 180. Shortly after giving my $500 deposit to Dr. Steinwald I had a revelation. I quickly called up my insurance and gave them the surgery codes that are on Dr. Medalie’s website. My surgery is covered by my insurance… well except for the nipple grafts. From there I contacted Dr. Medalie and found out the nipple grafts are only $500. Plus body contouring that’s a $2000 out of my pocket.

But now I am back to my original problem. I need a letter from a therapist. I started looking on Susan’s at the list of online therapists. Then it occurred to me that Medalie had mentioned they would recommend a therapist if I needed one, so I asked. Turns out it was the one I was looking at. Dr. GRAHAM L PEVELLER After a briefly contacting him I was sent all kinds of information. 8-10 therapy sessions plus a letter for $280. So affordable. Not even half a day later and I have my first appointment scheduled for Thursday.

I really hope I can get a letter from this guy. I am completely out of options otherwise. I turned to online therapy as all my face to face therapy in the past has blow up at me. I will let everyone know how it goes. It seems like the right option. Dr. Graham has all kinds of packages on his website to. So if you just want a hormone letter or a full blow SRS letter, it’s all packaged affordable at around $40 a session.

I am for sure considering other liposuction now. I was planning to spend around $10k and to have that shot down to $2k is awesome. Obviously I won’t spend $8k in liposuction. Probably just my lower abdominal area and maybe if Dr. Medalie suggests anywhere else to get rid of my feminine shape.


This will document my journey to discovering Alex. An alias which I have taken on in some forms of life while still living as my birth name in others. I am trying to discover the best label to fit me and the steps that I need to take to be most comfortable in life. I may not be the best writer but by looking back at these past posts I will hopefully discover what it means to be me.

My transition to Alex started not to long ago. At the end of 2011 I had decided that something was definitely up. I wasn’t just some girl with issues. The real beginning of my transition started in February of 2012. I had moved away from my mother; into my grandmothers house. She was on a two month vacation and I buckled down and bought my first binder. That was the first physical step I took and one that I won’t take back. That feeling of the first time binding is wonderful and relieving (well after you almost die from trying to put the damn thing on the wrong way).

Before that I had been seeing various therapists at the demand of my mother not kicking me out of the house. Let’s just say they were a waste of her time and money. The thing about therapy is if you are not ready and willing for it don’t bother. Even if you are ready for it the therapist may not think you are and just fuck with you to take your money. That was the case of the first one I opened up to. I came out as transgender FTM to her. I had been seeing her at a Developmental Disabilities due to me not giving a fuck about therapy at first and so not speaking which caused the first few therapists to think I had some mental problems. Well she wanted me to start seeing her at another office in the hospital. Little did I know that each appointment would be $90+ dollars after insurance and after over six months of that I had nothing from her. No letters No nothing.

She wanted me to get a job first to fund my transition. Okay that made sense. I wanted a letter to start hormones. Little did I know at the time that I didn’t need a letter for that. But the bitch sure was good about not telling me about it. She was more focused on me having a job and hanging out with non-existent friends. (okay I might have what appears to be issues to the normal everyday person) It got to be about October of 2012 and she finally wanted me to take a test to understand me better. Six months later and now you want to understand me??? Keep in mind I don’t open up well in the first place. I’m not an open book and will never be so people can’t expect to just chat with me and get all the answers. I answer things short and as little detail as I can. It is an automatic reaction and not something that is easily changed. I don’t particularly want to seeing as people that are like that disgust me.

So I took this test. I later found out it was a personality test, that I had schizoid personality disorder, and that I was out $600. All of that and no one bothered to tell me it was the determining factor in if I was ready for surgery. Okay it was the beginning of my transition and I wasn’t aware I had to come fully read up on the subject of who what where why how of all the surgery details. Needless to say it was a waste of money. Also due to the diagnosis she wanted me to retake the test in a year to see if it develops into a form of Schizophrenia. Yeah sorry tester bitch your not getting another $600 from me. If I start seeing things that aren’t there maybe I will consider going back – probably not. After that I stopped seeing the therapist.

Fast forward to spring of 2013. I decided that I didn’t want the hormones any more. Go figure it was probably a good thing she didn’t give me the letter. She could of also kept my respect by just saying to take some time off and think hard about what you really want instead of paying her for over six months. I didn’t speak of this to anyone as I don’t share my personal business with people, its personal.

Now it is summer and the boobs are quite painful. They even kept me awake one day in immense pain. It comes and goes and I could feel nothing for weeks. It was shortly after the pain that I decided to get top surgery as soon as possible. I read up on surgeons and others accounts of it and have been getting prepaired for it. By January I will have enough for surgery. The problem is that I am having a hard time getting a letter. I have seen two different therapists since then. The first one thought all my issues steamed from my mother and that any trans issues wouldn’t be addressed until afterwards. After asking advice of my transbuds over on Susans I cancelled my next appointment with her and never went back. The second one demanded a minimum of six months of therapy and from the first appointment thought that because I’m in the middle that it could be body dysmorphic disorder and if that was the case she wouldn’t write me a letter due to “not believing in changing your body for those reasons”. So that meant I could waste months of money and get no letter. I didn’t even bother to schedule a second appointment with her.

Now I currently stand at trying to get a letter or find a surgeon that will take me without one. I did find a Dr. Steinwald in Illinois who does top surgery on informed consent but that will take travel and hotel expenses into account. I would really like to get it done locally with Dr. Medalie in Ohio but the letter is key and I’m coming up dry.