Letter Requirements

Letters are required prior to surgery and must be dated within a 12-month period; this is not required but recommended prior to your consultation.




  • One letter from your prescribing physician for your hormone therapy

  • One letter from a psychiatrist or psychologist (PhD or MD)

  • One letter from your current mental health provider (LMFT, LCSW, etc.)

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.

REVISION CONSULTATIONS: Most insurance companies do require copies of the above recommendation letters in order to process the surgery authorization. We will discuss this with you upon scheduling. 

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Office phone: 415-395-9895

Fax: 415-395-9897

After hours: 855-638-7424


45 Castro St, Suite 324

San Francisco, CA  94114


Mon - Fri: 830am - 4:30pm

Closed for lunch: 12pm - 1pm

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