I went to the two psychs via chettawut like the day before surgery. I talked to both of them for about 30 minutes each, and was done. They asked a few questions about whether my family was supportive, and one looked me up and down and said "huh. Thai girls usually get everything else done first". Ouch.
Based on my experience, it's nothing more than an expensive formality.

I made appointments with psychs at Bumrumgrad Hospital independently of Chet's office. They were 2000 baht each from a nice hospital. One of the doctors was extremely easy to get a letter out of, no need to prove RLE. But you have to have these appointments booked in advance, usually on a weekend.

I also got a letter from a different doctor but she was far more challenging but genuinely concerned that I was aware of the irreversibly of the srs situation and that I was making the correct choice for myself.

I had both my referral letter done online and I had the psychiatrists send the letters directly to Dr Chettawut, I also had to print off both referral letters and bring them along to my consultation.

Dr Chettawut is moving to his new hospital in September and will require 1 referral letter to come from a Thai psychiatrist. The second letter can either be done in Thailand or you can see a psychiatrist of your choice.

Reading a couple of comments it doesn’t seem too complicated to get the letters for Chett. About the content I can tell you what I was required to provide to Suporn (I’m having my SRS in a couple of months and for the second letter they will arrange an appointment with a local psychologist), I think it should be pretty much the same ( u/hiddenstill maybe it could be useful for the wiki too).

Here we go!

SRS Referral Letter The only criterion that we insist on is that ALL client undergoing SRS MUST provide one original, signed document from a qualified psychiatrist or psychosexual specialist recommending SRS as the appropriate treatment. It is up to the therapist to decide what criteria he or she applies in reaching the conclusion that you are ready for surgery.

It is absolutely essential that you provide one referral yourself. It is the patient's responsibility to obtain such a letter, following consultations with her chosen specialist. There are no exceptions to this requirement. Any patient who arrives without this evidence will not be permitted to undergo surgery.

We will accept a referral letter from a therapist rather than a psychiatrist or psychologist, providing the therapist’s credentials are valid and verifiable, and that he/she is competent and legally authorized to make such a recommendation.

We are not able to provide such a letter ourselves, because of conflict of interest. Nor are we able to recommend a specific specialist who can help. However, if you have difficulty with providing such evidence, please contact The Suporn Clinic by email, so we can discuss other possible ways of meeting this requirement (such as via internet based consultants).

Language Requirements The letter you provide must be in original form, with the referrer’s signature in ink. We only accept referral letters in English, so if yours is in a language other than English, please additionally provide an accurate translation into English, ideally signed in original form by the referring specialist, or officially notarized.

Content of Referral Letter The letter must show the name, address and telephone number of the signee, for possible verification, and must state as a minimum that:

1. You have been diagnosed with Gender Dysphoria

2. SRS is indicated in your case, and is the recommended treatment. Ideally - but not essentially - the referral should also confirm that:

3. You have been living full time as a woman for at least 12 months prior to surgery or - if not - gives an explanation as to why that has not been possible in your case. It is accepted that in some countries the “Real Life Test” (RLT) is not a practical possibility

4. They have been undertaking a course of female hormone replacement therapy (HRT) unless there are medical reasons (to be indicated) that such a course is not advised in your case.

I’ve been worried about this myself. I do think it’s a good idea to bring some type of letter even if it’s one that they won’t accept. I got my letter from a therapist on the https://thegalap.org/ directory a year ago, and while I’ve been told it’s ok I’m still a bit nervous the psychs won’t accept it b/c it’s not from a psychologist.

Historically it looks like things haven’t been gatekeepy as long as you seem to be making an attempt to present female and even then there’s people who had surgery in Thailand without any RLE but I think those people had letters. I’ll link a post where a woman describes her experience with some Thai psychologists here and as you can see they don’t really require much proof for their questions. I also have not heard of someone being unable to get surgery due to the psychologists thinking they’re unfit. I’ve only heard of things like blood tests and x-rays doing that.

That being said I’m still nervous because I’ve been hearing that things are changing. I haven’t been able to verify it of course (I’ve been trying to find people who had SRS in 2020 who went without a letter) but it wouldn’t be surprising if Thailand has begun to become more strict. 20-something years ago you didn’t even need a letter to get SRS in Thailand, just money and good health.