If you are seeking a surgical procedure as part of your transition, you may have learned that you need a letter of support from a mental health professional in order to move forward with your procedure, or to have insurance approve coverage of your procedure as medically necessary. This is true for procedures such as chest reconstruction, breast removal or reduction, and breast augmentation (often referred to as “top” surgeries); as well as orchiectomy, vaginoplasty, phalloplasty (often referred to as “bottom” surgeries); and other surgeries or procedures, such as facial feminization surgery, electrolysis, rhinoplasty, tracheal shave, and others.

In order to obtain a letter of support, you must meet with a mental health professional who will ask you questions about your journey, identity, and life. This is called an assessment session.

Consistent with the latest Standards of Care, all gender confirming surgeries require only one letter of support from a health professional, and this provider must hold at least a Master’s Degree – they may refer to themselves as a counselor, therapist, psychotherapist, or mental health professional. However, many insurers continue to use an older version of the SOC, which requires two letters for ‘bottom’ surgeries (such as orchiectomy, vaginoplasty, phalloplasty, etc). Some surgeons or insurance companies further require that the second be produced by a doctoral level provider.

As a doctoral level provider, with a PhD in Clinical Psychology, I am empowered to write letters for all procedures. I reserve space in my weekly schedule to conduct assessments, and typically am able to complete assessments in a single, hour long session, with a letter produced 1-2 weeks later. Please be aware while I am happy to write for multiple procedures, this typically will require additional meeting time in order to ensure I can produce a robust letter that adequately speaks to the different factors relevant to each procedure (particular facets of dysphoria, alternatives already tried, understanding of surgical risks, and plan for recovery).