Letter Requirements


  • 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.)

Important note: letters have to be updated once surgery is scheduled. Insurance companies are requiring that they are dated within 6-12 months of surgery.

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 are seeking revision surgery and have already had gender confirmation surgery, if performed by the same surgeon. 

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