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Some surgeons also recognize that the RLT may be difficult for some MTF transsexuals without facial feminization surgery. Therefore, many surgeons are willing to perform some or even all elements of SRS without an RLT period. This is especially prevalent amongst surgeons who practice in Asia. However, almost all US surgeons who perform sociology vaginoplasty on MTF transsexuals require a minimum one-year RLT as sociology well as recommendation letters from two psychotherapists. Generally, both physicians who prescribe hormones and surgeons who perform SRS may request letters of diagnosis and recommendation for treatment from the patient's therapist. However, experienced physicians and surgeons, especially outside the United States, sometimes waive this requirement with patients who, by their evaluation, are obvious candidates for treatment. [edit] Hormone replacement therapy Main article: Hormone replacement therapy (trans) For both transsexual men and women hormone replacement therapy (HRT) causes the development of many of the secondary sexual characteristics of their desired gender.
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