GENERAL: 3 LETTERS required by insurance; 2 LETTERS required by WPATH

• One from mental healthcare professional (psychiatrist or psychologist with transgender healthcare experience)

• One from another mental healthcare professional

• One from your hormone provider

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WPATH Approved Letters of Recommendation for gender affirming bottom surgery includes:

1. The patient's general identifying characteristics.

2. The initial and evolving gender, sexual and other psychiatric diagnoses.

3. The duration of their professional relationship, including the type of psychotherapy or evaluation that the patient underwent.

4. The eligibility criteria that have been met and the mental health professional's rationale for hormone therapy or surgery.

5. The degree to which the patient has followed the Standards of Care to date and the likelihood of future compliance.

6. Whether the author of the report is part of a gender team.

7. That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described.

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NOTE: Most insurance carriers now require current supporting letters for all gender-affirming surgical procedures, regardless of prior surgical history. This includes, but is not limited to, procedures such as penile or testicular implant placement, urethroplasty, and reconstruction of the phallus or scrotum. Documentation requirements vary by insurer, and compliance with specific plan criteria is necessary for authorization and coverage determination.

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