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so can it be as clinical psychologist who gives the initial gender dysphoria certificate or does it have to be a psychiatrist it can be a clinical psychologist or a psychiatrist but many a times a clinical psychologists are not very sure then they say that we need a psychiatrist referral so then we do a psychiatrist referral also but in some of the places what we do like one psychiatrist gives the opinion and then a clinical psychologist also talks to the patient that helps the decision making capacity better because itamp;#39;s not that it is mandatory but it makes the patientamp;#39;s decision better patients should not regret later that is also important because many a times there are possibilities that we may not be able to make a correct diagnosis so the patient may also not be able to make a correct diagnosis so it is not wrong that the psychiatrist sees a clinical psychologist also helps which is one actually for starting hormone therapy either clinical psychologist or