I'm Christine Eagleson. I use she/her pronouns, and I work in the adult endocrinology department here at UVA. I see patients with gender dysphoria. This means that a person may be assigned one gender at birth, but identify differently. They may identify as the opposite gender, or not identify with either gender. So a patient who identifies as masculine has the option of going on testosterone treatment. in a patch, or an injection. If a patient identifies as feminine, they can go on estrogen treatment. Estrogen can be given orally, or with a patch, or an injection. Patients who identify as feminine can also go on spironolactone. This is a pill which will block testosterone. For all the patients, we try to individualize their treatment plans based on what their needs are. Patients that come to see me the first time, usually the first question is, "How soon can I begin hormones?" Again, we want to make sure that they're not going to have any adverse side effects. So I really do like to get baseline labs. Usually, we have those back within a couple days. And from there, we can start their hormone treatment. And patients who are returning for follow up visits, we use lab draws to help us guide their treatment. They can also inform me how they feel that things are going, in terms of their body changes. And from there, we can determine whether they do or do not need a change in their dose. A patient does not need a referral to come see us in clinic. We do, however, recommend 
the patient have a strong support system in place, which really could include, and probably should include a mental health provider, be that a therapist, a psychologist or a psychiatrist.