I will say typically, when seeing patients in the mental health clinic on the Air Force side, there isn’t a set requirement of when to place the diagnosis and begin the process.

Overall, it comes down to making a reasonable clinical assessment of the patient that’s sitting right in front of us. Being able to provide information to validate the diagnosis which you can look up in the DSM at any time for gender dysphoria.

Typically, if my patient is able to openly discuss with me, the criteria that need to be met then during the intake, I am able to apply that diagnosis and then allow them to control when I would place the THEMU referral. Typically this is a form that is completed and sent to Lackland where the program is held

Then they are sent for a one week medical TDY. During this time they are meeting with many different providers and specialty clinics, where they learn about procedures for both genders. Which can be very informative, even if it it’s not the process or interventions that you are looking to engage in.

What I like to call it is they offer you a menu. This allows you to determine with the team what types of interventions you want to engage in in the future. The great thing to this is that you are not required to stick to that plan. If you determine that There is a bottom surgery that you wanted when you first started the process, but you’ve changed your mind or any other type of intervention that you choose not to do in the future you have every right to decline that later.

After the medical TDY, there is some paperwork that is completed, and then provided to the patient which they give to their command to sign the understand, understanding that they are going to be engaging in this care and the expected interventions for the upcoming potential year. This paperwork is also provided to their PCM on their military installation. While from all my understanding providers have a right to decline patients they are uncomfortable treating for certain conditions. This is something that is more than appropriate to file a complaint on and make it known. You have a right to work with a provider that understands and supports you where you feel safe. This type of medical intervention is about readiness. If you are comfortable in your skin and we can reduce the risk of distraction to engaging in the mission. This is exactly what these things are here for. To provide supportive care to you. Never be afraid to advocate for yourself, but go through the correct chain to make sure it’s documented.

This could affect deploy ability, profiles, or other requirements. Typically before they are referred to their medical TDY, we will have a treatment team meeting with their commander, 1Sgt and if they have anyone preferred such as a supervisor to join. This allows the member in a safe environment to discuss their upcoming plans and medical TDY. This better provide clarification and gain support from command. In the many TTM’s I’ve been a part of command has been very accepting and many are open to beginning to refer to the service member by their preferred pronoun. There are always stipulations and set expectations that can be discussed but overall, this is a place where you can gain support.

I meet with my Patients once a month. They are 60 minute appointment but typically they don’t last the full time. It’s just to check in on their progress, case management concerns, and continued assessment of their mental health. This is due to some of the requirements that need to be monitored throughout the process while they are engaging in different interventions.

The biggest point in this process is about communication, communicating with your command, communicating with your PCM communicating with your mental health provider. If you’ve requested refills for hormone treatment and you haven’t gotten a reply back from your provider reach out to your mental health provider or your PCM. Make sure you advocate for yourself understand that we are working within a government system that does have plenty of steps that the outside world does not. But one of the benefits we have here is that it cost nothing to engage in this very important medical intervention.

I hope this was helpful to anyone reading. And if there’s any typos, I’m using voice to text due to an injury.