I understand that the few doctors who will perform elective bilateral orchiectomy without two letters of referral from certified psychiatrists. Will they accept letters from any psychiatrists, or do they prefer ones known to them who have referred patients in the past?

How expensive is it to obtain such a referral?

How many sessions would it take to get such a letter?

How does one convince a psychiatrist that the desire to be castrated is a rational one?

Any advice would be welcomed.

These are excellent questions. The first step, however, is for you to do some of your homework so that you can effectively talk to a gender counselor (who may or may not be a psychiatrist).

There are four articles on voluntary eunuchs that have recently been published in well-respected medical journals. I can send you copies of them in PDF format if you send me a <Private Message> asking for them and giving me an email address to send them to that will accept attachments. (The EA server does not.) You ought to read the articles for your own background information and take copies of them to any counselor whom you choose. He or she may have already read them, but demonstrating that you are aware of them should be useful.

You also need to read the Harry Benjamin International Gender Dysphoria Association's

Standards Of Care (http://wpath.org/Documents2/socv6.pdf) For Gender Identity Disorders. While the document discusses only Male-to-Female and Female-to-Male varieties of transgenderism, it will give you some appreciation of what any counselor would need to know about you and the vocabulary that will be most effective. Work is currently underway (involving several members here) on a proper standard for Male-to-Eunuch. It will follow the same format as the existing standards of care.

Once you have done your homework, you can search for counselors in your area in the Yellow Pages, on the Internet, and through any gender issues related group. Since your profile only says that you live somewhere in the U.S.A., I can’t be any more specific than that, but this should get you started.

Once you are into the process, you will discover that surgeons have different criteria. A few require only one letter from a psychiatrist (one who has both an M.D. and a PhD), others will take letters from two counseling psychologists (minimum of M.A. degree), others would refuse to perform the surgery no matter what hoops you jump through. Your counselor will be your guide.