Dear Laurie,

Read the letter and this is the classic example of how a letter of endorsement should not be written. This type of letter is in fact seen when a therapist feels a certain obligation to say something but in fact has deep seated reservations about making any written commitment. This is akin to a “letter of recommendation”  for an employee.   Miss so and so worked in my office from June 1st 1999 to September 5, 2001. (Start, period, end of letter).

This is a more a letter of detachment.

The standards for how a letter should be written if the Dr. is interested are posted on WPATH.   To wit:

The Mental Health Professional’s Documentation Letter for Hormone Therapy or Surgery

Should Succinctly Specify:

1. The patient’s general identifying characteristics;

2. The initial and evolving gender, sexual, and other psychiatric diagnoses;

3. The duration of their professional relationship including the type of psychotherapy or

evaluation that the patient underwent;

4. The eligibility criteria that have been met and the mental health professional’s rationale

for hormone therapy or surgery;

5. The degree to which the patient has followed the Standards of Care to date and the

likelihood of future compliance;

6. Whether the author of the report is part of a gender team;

7. That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described in this document.  

The organization and completeness of these letters provide the hormone-prescribing physician and the surgeon an important degree of assurance that mental health professional is knowledgeable and competent concerning gender identity disorders.

More or less in the first paragraph the therapist should introduce him/herself by virtue of their background and training and societal memberships. Next the therapist should endorse the client for transgender surgery (”I recommend, I endorse, or Miss so and so would be a good candidate for transgender surgery, etc”).

Next suicidal ideation or attempts (yes or no) should be mentioned, as well as any drug abuse history or ethanol dependency (yes or no).

Lastly the therapist should invite the recipient to call their office for further discussion should questions arise.

Look at Dr. Mora’s letter hopefully and you will see the difference.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

I followed a GLBT advocate and counsellor. My talk on sexuality included as per syllabus from Dr. Clark…

Medical factors related to sexuality and sexual functioning

Objectives:

· Define the DSM sexual disorders, and discuss the following in relation to it: symptoms, factors increasing susceptibility, and prevention.
· Describe how surgical procedures, such as a hysterectomy, may affect a woman sexually, physically, and emotionally.
· Define hormone replacement therapy and explain its advantages and potential risks.
· Describe the incidence of, symptoms of, and treatment alternatives for penile cancer, testicular cancer, prostatitis, benign prostate hyperplasia, and prostate cancer. Describe tests for prostate cancer and treatment alternatives.
· Describe the reasons why women would choose to have or not have breast implants and controversies concerning the implants themselves.
· Learn how major disabilities my affect sexual function and expression. Learn coping and enhancement strategies for people with disabilities.

2 hours later with time for serious questions and answers, we were done. But aside from potty breaks their day was still going strong. Young therapists seeking their doctoral degrees, thirsty for knowledge. Commendable, Carol (who is a board certified sexologist with a doctoral degree, how many therapists can claim that!).   Dr. Carol L. Clark   (closest to our office)  305-757-6070 

Harold M. Reed, M.D.

305-865-2000

Reported by Drs. Tyler Lewis and Irwin Goldstein in Journal of Sexual Medicine (Vol. 6, No. 10, 2009) Testosterone gel 1% has been approved for transdermal testosterone application. Preparation names include, Androgel and Testim. Even sharing a wash cloth or hugging can cause transfer. Women have noted growth of hair and lowering of the voice and children have experienced very early onset of pubic hair. Once recognized early-on, fortunately these changes were reversible.

Proper usage should be: allow to dry and cover with clothing and do not share wash cloths unless laundered.

Harold M. Reed, M.D.

possible phalloplasty.

Dr. Reed,

 I have been on T since Jan 2008. I am looking into having a hestorectomy, but also want to have both top and bottom surgery as well.
Specific_Questions: I am on psychratric medications. Seroquel, Methylphenidate ER, Methylphenidate, and Lexapro. Would these medications be a complication?

 Armando

 Hi Armando, 

Thank you for your interest in what we do.

Hysterectomy is performed by others, but if you have this done, please go for a laparoscopically assisted vaginal hysterectomy and simultaneous oophorectomy (removal of ovaries) as well.  2 letters of therapy clearance should be obtained prior to this irreversible surgery.

We operate on patients taking your medications all the time, and this is not a contraindication.  A letter of clearance from your psychiatrist will be requested, and also we do advise your taking any AM medication on the morning of surgery with a sip of water. 

A word about methylphenidate…

Methylphenidate is the most commonly prescribed psychostimulant and is indicated in the treatment of attention-deficit hyperactivity disorder

Contraindications:

Methylphenidate should not be prescribed concomitantly with tricyclic antidepressants, such as desipramine, or monoamine oxidase inhibitors, such as phenelzine or tranylcypromine, as methylphenidate may dangerously increase plasma concentrations, leading to potential toxic reactions (mainly, cardiovascular effects). Methylphenidate should not be prescribed to patients who suffer from severe arrhythmia, hypertension or liver damage. It shouldn’t be prescribed to patients who demonstrate drug-seeking behaviour, pronounced agitation or nervousness. Care should be taken while prescribing methylphenidate to children with a family history of Paroxysmal Supraventricular Tachycardia (PSVT).

Special precautions:

Special precaution is recommended in individuals with epilepsy with additional caution in individuals with uncontrolled epilepsy due to the potential for methylphenidate to lower the seizure threshold.

All the best,

Harold M. Reed, M.D.
305-865-2000

Good morning Mariah,

We would not recommend any surgery be done until a patient is over 18 years of age, unless there is some very strong compelling reason, and then your parents would need to be a part of the decision making process.

Have a restful Sunday,

Harold M. Reed, M.D.
305-865-2000

Yes, I have been on Testosterone for almost 5 years and had chest surgery done 3.5 years ago.
Specific_Questions: Can I have the metoidoplasty and scrotoplasty (to stand to void)done now and later obtain a hysterectomy?  Monty

Hi Monty,

 Medical technology continues to evolve.

In this day and age, we have come to recognize colpocleisis, removal of the vaginal lining with subsequent closure by healing, helps to minimize the occurrence of urethral fistula.  However, and this a big however, you cannot close up the vagina and leave the uterus inside, as where will secretions and any mentral flow go.  What is needed is a laparoscopically assisted vaginal hysterectomy with bilateral salipingo-oophorectomy (removal of ovaries and tubes) first.  Doesn’t have to be, but is a recommendation.

You could have an attempt stand to void metoidioplasty and scrotalplasty done now but I must advise the likelihood of a urethral fistula is probably over 50%. Even if you have colpocleisis, the likelihood of fistula is probably about 25%

This is always more upsetting for the patient than for the doctor as we will pursue these problems one by one and hopefully ultimately give you an intact extended urethra.

That is the nature of this type of surgery, and this needs to be put out front.

Believe me I am in your corner and will do whatever possible to assure that you have the best possible result.

Sincerely,

Harold M. Reed, M.D.
305-865-2000
 

GENETIC: Male
BECOME: Female – MTF
Hormones/Conversion: no but need some send to me for free or i will pay for it. Can you give me a prescible for it?

 Glendon

July 31, 2009

Good afternoon Glendon,
Thank you for your continued interest in what we do.  Yes, we do hormones.  You will need an appointment as we will be spending good hour together and a letter of therapy clearance from a licensed therapist with a doctoral degree.

You only pay for a consultation once and that is 250.  We charge 600 a year to initiate hormone therapy although we will delay billing for 3 months.  You will also need baseline laboratory testing and interval laboratory tests obtained every 3 to 4 months, until we see a pattern of stablizaion and then these tests can be spread further apart.

 All the best,

Harold M. Reed, M.D.
305-865-2000

To Tara at Tarareources.net 

Dear Tara, 

This is to advise you that we have not been able to offer grants, which had been solely based upon testicular donation,  for over 2 years. That project was concluded by the research lab.

We do offer individual consideration for needy people only. However, without any contingency funds to cover the unexpected, we cannot operate.  A financial statement may be requested. 

Thank you for referring the many nice patients who have made inquires, some of whom we have been able to assist.

As is, our fees run about 6000 below what other charge in North America if that is of any help. Unless you have an impulsive need for genital ablation, please select a doctor whose work is pleasing to you

and who may respond to your request for assistance (circumstances change for us all, for example some doctor may have a cancellation and be willing to fill that time slot for less).

All the best to your group.  Your good deeds will not go unnoticed.

Harold M. Reed, M.D. 

Dear Friends and prospective patients.  This year we gave out 15 grants with a combined savings of about $50,000.   These funds were made possible by a testicular research program who paid for the specimens.   All gone.

However, however, we may still offer compassionate professional courtesy discounts to those who need feminizing vaginoplasty (MTF procedures) such as augmentation mammoplasty or FTM procedures such as male chest reconstruction and metoidioplasty and testicular implants.

Anne, our office coordinator, is the maker of deals and the brains behind Pa.

Please call her at 305-865-2000.

Merry Christmas and Happy Holidays to All,

Harold M. Reed, M.D.                                                                                                                 305-865-2000

For construction of a penis, there are 2 approaches: metoidioplasty and (full-scale) phalloplasty.   Metoidioplasty is the simpler and least expensive of the two.  Metoidioplasty taken from the Greek words, meta meaning toward oidion meaning male organs, and plasty to form.

Metoidioplasty with stands to voidurethra has the advantage of being more economical $12,500 (in our practice) vs. $75,000 to $100,000 in the United States for complete phalloplasty.

In Europe a phalloplasty can be obtained for $15,000 to $30,000.  A completed phalloplasty requires several stages and the likelihood that all stages will proceed without any complication or produce a perfect result without revisions is quite remote. Anticipate revisions and discuss with your intended surgeon what you may reasonably expect as related to his/her technique.  Please confer if you wish with Dr. Stanley Monstrey in Gent, Belgium or Dr. Sava Perovic or Dr. Miroslav Djordjevic in Belgrade, Serbia, all excellent surgeons.

Dr. Monstrey does an excellent forearm flap.

I have personally seen each do this surgery several times.

An ideal phalloplasty will produce a phallus that looks upon close inspection to be a penis with good glans (head) formation and a corona (rim).  The phallus must be completely sensate and beyond that orgasmically sensate.  Within the phallus shall be a urinary channel of decent caliber so the patient can void urinating from the glans as with normal males.

Additionally there needs to be a mechanism for producing a penetrable erection.  Alternatives include: an inflatable penile prosthesis carrying a 50% complication rate and in genetic males having an average survival of 6 to 8 years (less in transgendered patients); or a semi-rigid prosthesis (possibility of extrusion from continued pressure); or a bacculum (silicone rod) which is inserted into a special channel just for sex.

Many dance steps to go through.  Also there will be a noticeable deforming harvesting scar which represents the donor site, could be in the forearm, back, lower abdomen, or thigh.

We do not perform primary phalloplasty but will do revisions.

If you are considering metoidioplasty, you should be on testosterone for 2 years to maximize growth before surgery.

Our metoidioplasty fees are the best around (we believe) at $12,500 to include anesthesia, surgery, use of the facility, and my aftercare.

During this procedure if you desire one stage urethral extension, a buccal graft, small mucosal strip from the inside of your cheek, will also be performed to assist in tubularization of the additional urethral length. Most patients are able to eat the next day and are fairly comfortable with an ice pack for 24 hours.

Soft testicular implants can be inserted at the same time and our fee inclusive of the implants and anesthesia time is $4000. “Add-ons” are less expensive. Augmentation with testicular implants and scrotalplasty as an independent procedure is $5,500.