Gender Affirming
Letters of Support
California & New York
Surgical Letters
Insurance and surgical providers require letters of support for surgeries and other procedures treating Gender Dysphoria. Most procedures require a letter from at least one licensed mental health provider in addition to a letter from a medical provider. Gender affirming genital surgeries (i.e., vaginoplasty, metoidioplasty, and phalloplasty) and gender affirming surgeries resulting in sterilization (i.e., orchiectomy and hysterectomy) often require two letters of support from mental health providers. Other gender affirming surgeries (i.e., face, chest, body shape, hair distribution, or voice) may only require one letter from a mental health provider.
Whether you need a letter for a single procedure, or you are seeking letters for multiple procedures, generally all that is required is a single letter of support.
Please keep in mind that it is often a requirement to have been on hormones for one to two years prior to genital/sterilizing surgeries and breast enhancing surgeries respectively.
Surgical Letters FAQs
What’s involved in an appointment for a letter?
A letter in support of surgery requires a psychosocial assessment. During this appointment we will discuss your gender history and goals, social support, housing, aftercare plan (i.e., where you’ll recover and who will assist you), as well as your mental health and substance use history in preparation for writing a letter. This appointment is not an evaluation of your gender identity, nor is it meant to provide therapy or case management.
How will the information I share be used in the letter?
Only the minimum necessary information required will be shared in the letter. Providers requiring letters want to know some specific information, including the procedure, a diagnosis of Gender Dysphoria, when you first experienced a difference between your gender identity and assigned sex, if/when you started gender affirming hormones, if/when you started living openly as your gender identity, your housing status, your aftercare plan, and your mental health or substance use history as it may be relevant to your care.
How will my mental health history be used in the letter?
Having a mental health history needn’t prevent you from having surgery. It’s important you are prepared to talk openly about your mental health history, including any diagnoses, hospitalizations, self-harm, and medications, as this information will need to be briefly summarized in the letter. Again, only the minimum amount of information necessary will be included.
What do you charge for letters?
Evaluation sessions for letters of support are pay-what-you-can with a suggested range of $20 - $300.
