The GDPCO strives to tailor its services to the needs of individual clients, so there is no fixed sequence of procedures that applies to all participants. Some treatment options, however, have "prerequisites." Listed below are typical options a person might pursue. Each option builds on the previous ones; participants will be asked to explore options 1 and 2 before moving to option 3, for example.

option 1	option 2	option 3	option 4
individual meetings	group meetings	hormone therapy	surgery

Option 1: individual Counseling       [see services]

Anyone interested in participating in the GDPCO should begin by scheduling an individual meeting. (See contact information). At this meeting we will discuss how far you intend to go with your transitioning and will consider your options. Depending on your needs, we may discuss future steps, including testing, and a preliminary timetable.

You may find that it takes more than one meeting to resolve basic issues. Some people find individual counseling sufficient and choose not to pursue other options. It is difficult to say in advance what will best suit your needs and circumstances — the first step in all cases, though, is to schedule an appointment to talk about your options and your plans.

Option 2: Group Meetings       [see services]

In addition to individual consultation and therapy sessions, the GDPCO offers regular support group meetings once a month.

Although some participants feel initial hesitation in coming to group, most find it helpful in the end. The group provides a "lifeline" for participants, especially in times of discouragement. Group members not infrequently form lifelong friendships. Group meetings can help individuals decide whether they are truly interested in reassignment surgery and whether they are good candidates. The group provides support for those who opt against gender reassignment in their lives as unique, gender-blending individuals. Every effort is made to ensure that these and other possibilities are all supported equally and that group members do not feel pressured to move in any particular direction.

Like individual counseling sessions, group meetings facilitate problem solving and assist those dealing with the difficulties associated with transgendering. Issues typically addressed include:

• dressing and living in the nonbirth gender
• "passing" or "being read"
• strategies for coping with challenges
• participation in the workplace
• career or job concerns
• education
• coming out to family, friends & coworkers
• empathy for caring family members
• problems involving name change
• public bathrooms
• interactions with family members
• interactions if dating or married
• sexual expression & orientation
• body image
• dealing with children
• dealing with rejection or acceptance
• social and emotional adjustment
• legal issues
• spiritual issues

Regular participation in individual and/or group sessions is expected of persons seeking referral for any medical or surgical intervention. One individual meeting every other month and one group meeting each month tends to be adequate for most people most of the time, but more individual sessions may be appropriate for people in unusual circumstances or during periods of special difficulty.

People not aiming for SRS but using the GDPCO for consultation and support, may attend group meetings as needed and schedule individual consultations less regularly.

Already transitioned GDPCO "graduates" are encouraged to attend group meetings (free of charge) from time to time. The GDPCO also offers a separate group to help program graduates deal with post-transition issues.

Option 3: Hormone Replacement Therapy

If, after exploring your feelings in individual and group meetings, you still intend to transition, and if your progress is congruent with your goal, you will be referred to a physician for a physical exam and endocrinological work-up. If all is normal, hormones may be prescribed at that time. Regular follow-up meetings with a physician are essential to guard against possible complications of hormone therapy.

Occasionally, candidates start the program having already been on hormones. We recommended strongly that you not obtain hormones "off the street." It is important for your long-term health to have your body chemistry evaluated for a baseline before you begin HRT.

Finally, it is highly recommended that you quit smoking before you start on your hormone regimen. Smoking while taking exogenous hormones dramatically increases your risk of blood clots, which can lead to circulatory problems (which can make you permanently ineligible for HRT), or even to strokes and heart attacks.

Option 4: Recommendation for Sexual Reassignment Surgery

Following a period of successful living in their new gender, GDPCO participants may schedule an individual consultation to plan further steps, including SRS. The GDPCO may then write a letter of recommendation to the surgeon of your choice.

If you have been seeing a therapist, please procure a letter reporting his or her work with you. Depending on the intensity of your therapy and the qualifications of the therapist, this letter may serve as the second letter of recommendation required by most surgeons. If you have not been seeing an outside therapist, the GDPCO's consulting psychiatrist will evaluate you and provide the required second opinion.