Do you have to get doctor's approval for any type of gender related surgery?

Yes, you must go to therapy. It will probably be a bit more difficult to transition because you are not trans.

I heard there is one surgeon who does top surgery without referrals somewhere in Texas, but I know nothing else about him/her.

 

It may be a little harder to explain but the WPATH does incompass gender non-conforming identities. This is a link to a gender therapist that elaborates on it. Her name is Dara Hoffman-Fox

https://www.youtube.com/watch?v=h5MFwdNfDgg

 

I agree with finding a therapist. While you may not want to go through that process, I do think that it is important when you are making these sort of changes to your body. Therapy helped me cope with the changes as I have began to pass more as male. I also think that it is important to understand why you feel the way that you do. In my case, therapy helped me to understand my masculine feelings, and to become more comfortable with them.

Anytime you make major changes to your body, you must learn to cope, and this is why I think that therapy (or access to therapy) is important.

When it comes to hormones, there is the informed consent process now (where you are informed of the risks/benefits of hormones, and they make sure that you are mentally capable of understanding those risks/benefits) , but there has not been a process for informed consent for any surgery.

 

most surgeons require a letter of some sort. here, you just need one from any sort of doctor, not necessarily a therapist (unless you are considered youth). but i'm sure you could find someone who doesn't require one.

 

For stuff like breast augmentation or mastectomy, I haven't heard of this. I didn't need any sort of therapy letter for my facial feminization surgery, just had to get my general doctor to do an aggressive physical to dem me fit for surgery. I didn't go to a fly by night doctor, I went to Mark Zukowski in Chicago.

For SRS even, the letter requirement seems to depend on who you go to. I've looked mostly at Suporn in Thailand and it sounds like you can get letters for money.

I've been full time for quite a while, hrt for almost six years, and only did three months of therapy. I felt my therapist was a giant waste of time and only stayed around long enough to get an endocrinologist referral. When it comes time for SRS, I'll probably be able to get what I need by jumping through a few hoops. I just didn't get much out of therapy, I'm trans, I knew that, and transitioning didn't make me perfect but it resolved some and mitigated done of my gender issues.

Btw, I'm not anti therapy. Give it a go and see if it helps you! If it helps, it's definitely worth doing. I'd you are any bit on the fence about transitioning, therapy is most definitely a good thing to help you sort through your emotions and feelings.

 

You can get your breasts removed to prevent breast cancer. A similar argument could be made for a radical vulvectomy, however due to the relative rarity of vulvar cancer it will be more difficult to find a willing surgeon.