Modern Medicine

Greenwald added that there's no real time constraint on when he needs the documentation—he could get it the day before the surgery and still go ahead with the scheduled operation.

"I'm not in a rush to operate on this patient, and I'm not in a rush to sensationalize this," he said. "I'm uncomfortable with the Web thing, but I'm willing to provide the service the patient requests. I'm not going to put up a barrier if the patient needs this to fund the operation. I understand that all patients who would like this surgery can't afford it, and if this is a way for the patient to get funded, I'm okay with that."

Sex-change surgery can cost tens of thousands of dollars, and it is frequently a challenge for those wanting surgery to come up with the money. Attempts to get funding from government agencies, such as Medicaid, have often met with fevered and hostile resistance from those opposed to the whole idea of gender surgery.

"My goal here is not to publicize the operation," he said. "My goal is to take care of the patient."