| Letteiheauj

| Batej

To Whom It Nay Concein:

This lettei is in iegaiu to }ennifei Smith (legal name }ohn Sebastian Smith), a 26
yeai olu tiansgenuei
woman who sought out my seivices because she wanteu a lettei foi genuei affiiming
hoimone tieatment.
I met with }ennifei foui times between Becembei 2u1S anu Naich 2u14 to uiscuss
feelings of uysphoiia
iegaiuing hei genuei. I completeu an initial psychosocial assessment anu then
focuseu on cognitive
behavioial techniques foi the iemaining sessions.
}ennifei has an associate uegiee in meuical laboiatoiy technology. She woiks full
time as a laboiatoiy
technologist at a local plasma uonation centei. She enjoys hei job anu hopes to
continue with hei cuiient
employei. She lives with a ioommate anu has a ciicle of close fiienus, a few of
whom iuentify as tians*.
}enifei giew up in Naishalltown, IA anu has two youngei sisteis. Bei paients aie
uivoiceu anu she finus
hei fathei to be a souice of suppoit. She has come out as tiansgenuei to hei
mothei but they have not
uiscusseu it much. Bei two sisteis aie veiy suppoitive.
Ns. Smith enuoiseu long-stanuing feminine inteiests anu behaviois uating back to
hei eaily chiluhoou
yeais. She iemembeis pubeity as being as especially painful anu uysphoiic time foi
hei. Bei genuei
expiession was a souice of stiess foi in hei ielationship with hei paients. She
viviuly iemembeis at the
age of 16 watching a television show that hau a tiansgenuei chaiactei. She staiteu
to ieau moie online
about tiansgenuei people anu staiteu to woik thiough hei own genuei iuentify. She
came out to hei
family anu fiienus as tiansgenuei at the age of 18 anu hau founu a few online
tiansgenuei contacts. She
iepoits sexual attiaction to mainly men anu has hau a few sexual paitneis. She is
not cuiiently
iomantically involveu with anyone.
}enifei iepoits that she cuiiently piesents in male clothing when going to woik,
but uiesses in female
clothing anu make-up when out with fiienus oi on the weekenus. She stiongly
uesiies to tiansition
socially full-time once she staits hoimones. She has tolu hei supeivisoi anu he
has been suppoitive. She
is awaie of the vaiiable effects of feminizing hoimones on hei appeaiance anu
uesiies to have bieast
augmentation, facial feminization, anu vaginoplasty in the futuie if possible.
}ennifei has goou peisonal insight anu is able to effectively piocess infoimation.
She has no seiious
mental conuition anu has no cuiient oi past histoiy of uiug oi alcohol use, no
suiciue attempts oi
iueation, no physical oi sexual abuse, anu no histoiy of psychiatiic
hospitalization.
Baseu on hei histoiy, }ennifei meets ciiteiia foi the BSN-S uiagnosis of uenuei
Bysphoiia. She enuoises
a life-long iuentity as the female genuei, which has iemaineu intense, stable, anu
enuuiing. She feels
piepaieu anu well suppoiteu to move foiwaiu with staiting feminizing meuications.
Baseu on my
assessment, she is able to make uecisions foi heiself anu she is a goou canuiuate
foi genuei affiiming
theiapy. I uo not see any contiainuications to hei staiting hoimones at this time.
Please uo not hesitate to contact me to fuithei cooiuinate }ennifei's caie. You
can ieach me via my
contact infoimation below.
Sinceiely,
|Namej
|Contact Infoj