WPATH: World Professional Association for Transgender Health​

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1. Persistent, well documented gender dysphoria.

2. Capacity to make a fully informed decision and to consent for treatment.

3. Age of majority in a given country.

4. If significant medical or mental health concerns are present, they must be well controlled.

5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).

6. 12 continuous months of living in a gender role that is congruent with their gender identity.

7. TWO Referral letters: (1) mental health professional such as psychiatrist or psychologist; (2) hormone provider. NOTE: most insurance companies want THREE referral letters: (2) mental health professional AND (1) hormone provider.

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Although not an explicit criterion, it is recommended that patients also have regular visits with a mental health or other medical professional. The criteria noted above for some types of genital surgeries – i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity – is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role before undergoing irreversible surgery.

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*Above requirements are from the WPATH Standards of Care version 7*

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Optional Prerequisites for Gender Affirmation Surgery 

• Adult age (at least 18 years old)

• Support of spouse, family, significant other, friends

• Economic stability