I’m in the U.S.

After some therapy I called up my primary care physician (PCP), told my nurse I have gender dysphoria and would like a referral to an endrocrinologist, and then gave the information about the endo so they could send over the referral.

Then the endo called me and I made an appointment, the first available was 3 months away. The endo thought it was obvious I should be on estrogen and sent the prescription in immediately, and I was able to pick up the estrogen that day.

Sometimes the psychologist can send the referral rather than the PCP, but my PCP was happy to send it (I got lucky, my PCP was randomly trans-affirming and turns out, unknown to me, they had other trans patients). So one way this can get bogged down is if your psychologist or PCP isn’t willing to send a referral to an endo, or if you’re relying on the PCP for the HRT, they just won’t write you the Rx.

Another way this can get bogged down is if the wait time to see the endo is longer, or if the endo decides they aren’t sure they should prescribe you the HRT.

This is why it’s good to talk to the local trans community to know which therapists, PCPs, and endos to see. If the community doesn’t know, sometimes there are resources and directories collected online - I found my endo through the Trans in the South guide.