Discovered how easy it is to get approved for sex-change surgery when one of the host’s producers got a thumbs up for an orchiectomy — a procedure to remove testicles — after just a 22-minute virtual appointment with Plume, the largest transgender health care provider in the U.S.

Made it clear that he had not been experiencing gender dysphoria for six months or more, he mispronounced the name of the surgery he wanted, and he said he didn’t know what effect the surgery would have on him. Yet, Plume’s nurse practitioner told Re “she wanted to write the most ‘solid’ letter possible to justify surgery,”

Three days later, Plume sent a letter to Re, who said his name was “Chelsea Bussey,” saying Re was experiencing “significant, ongoing gender dysphoria” — despite “Bussey” stating unequivocally that this was not the case — and recommending “Chelsea” for testicle removal. Walsh said that in a text message to Re, Plume explained that the letters of recommendation are sent using a template based on standards provided by the radical World Professional Association for Transgender Health, also known as WPATH. Plume sells letters of recommendation for $150 to those seeking transgender surgeries.