Letter Requirements

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

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.

NOTE: Letters are generally not required for patients who have already had gender affirmation surgery and who are interested in surgeries like penile or testis implants, urethroplasty, reconstruction of their current neophallus and neoscrotum, or other related surgeries. However, some insurance companies require letters despite already having had multiple gender confirmation surgeries. 


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