5 Things to Know about Gender-Affirming Surgery Letters

For people seeking gender-affirming surgery there is a current requirement that a provider-written letter be presented to the surgeon and insurance company. Many surgeons will not schedule a consultation until they receive this letter. While the meeting to obtain the letter can be a great opportunity to talk through planning for the procedure, many view this requirement as discriminatory and an added barrier to accessing life-saving services.

During my clinical career I have seen the standards of care change around gender-affirming surgery, I am hopeful that in our lifetime we may see this requirement change as well. While it remains, let's clear up common misinformation and confusion around what the letter process looks like. 

Transgender pride flag

5 tips for the letter process

1. The letter can come from any healthcare professional, you do not have to meet with a mental health provider. I encourage you to reflect on any current or past providers you have felt comfortable with and see if they’re able to complete the letter for you. 

2. If you do decide to meet with a mental health provider, be prepared to be asked about your: mental health history, experience of gender dysphoria, relationship to substance use and your after-care plan once the procedure is completed. They will also discuss informed-consent with you to ensure you are making an informed decision and have considered risks/benefits of the procedure. 

3. For some people one appointment will be enough however be prepared to have between 1-3 appointments to review all the above information. 

4. Only one letter is required for bottom surgery. This is a recent change in standards of care. You may hear surgeons or insurance companies say they need 2 - this is incorrect and based on previous standards of care. The provider who completes your letter can help advocate around this by citing the new standard within the letter. 

5. You can search online to find providers who will complete the letter for free like the ones below:

• https://www.thegalap.org/home

• https://trans.health/medically-necessary-letters/

• https://www.prospecttherapy.com/hrt-and-gcs-letters

Wishing you ease on your journey,

Riley