Denied GD letter — told it’s a “rare case” and “not in our chapter”

Hi everyone,

I’m a non-binary/genderfluid person in India with very clear gender-affirming goals. I want phallus-preserving vaginoplasty (PPV) with realistic aesthetics. My aim is an individualized outcome rather than a conventional binary transition, and I’ve researched this extensively.

Recently I consulted a psychiatrist for a Gender Dysphoria assessment to support my ongoing Transgender Certificate process and future surgical plans. After hearing my case, the doctor described it as a “rare case.” They mentioned discussing it with a senior, who reportedly said this situation was “not in our chapter,” and therefore they could not issue a GD letter. They refunded the fee instead of proceeding with the assessment.

They framed my identity under the “queer category.” While I understand a clinician may not want to assess something outside their expertise, the experience left me feeling that many mental health professionals may only be comfortable supporting binary transitions. (Even the Indian guidelines say so) Non-binary people with non-standard surgical goals like full phallus preservation seem to fall outside what they consider their scope.

I’m not posting this to criticize anyone. I’m genuinely looking for advice and community support. As international surgeons also may require a psychiatric evaluation from the patient's country of origin

Has anyone here — especially non-binary or gender-diverse people pursuing individualized or non-standard gender-affirming surgeries — faced something similar? How did you find psychiatrists or psychologists who are knowledgeable about non-binary identities and willing to do a proper GD assessment? Any suggestions, referrals, or experiences would be really helpful right now.

Thank you for reading.