What To Expect When You're Seeing A Therapist To Get A Letter of Support For Gender Confirmation Surgery
If you're a trans person receiving gender affirming care, you know it sometimes involves jumping through some annoying hoops. While overall access to trans-affirming healthcare is getting easier in California, there are still some steps we wish weren't there. One of those is getting a letter from a mental health professional to undergo gender confirmation surgery. We hope this step is eliminated soon. But until then, we'll continue to offer our assessment and letter writing services. If you're considering coming to us for this kind of assessment, here's what you can expect.
We Believe You Have The Right To Make Choices About Your Body Without Anyone Else's Permission
Adults should have the right to make changes to their body without anyone else's permission. No one is required to get a therapist's letter to get a tattoo, breast augmentation, or piercing. When it comes to what we know is life-saving medical care for trans people, we wish you had the right to access it without our help. But until that step is eliminated, we're here to help.
We believe that gender-affirming care is essential, life-saving medical treatment. We recognize that you are the expert on your own experience, and no one should stand in the way of your access to this care. We acknowledge that the current medical and mental health systems often place doctors and therapists in gatekeeping roles they should not hold. Our goal is to reduce barriers and support trans people in living fully and authentically.
We Understand Both Models Of Gender Affirming Care: Medical Necessity vs Informed Consent
Laurel Roberts-Meese, LMFT
Laurel is a queer therapist seeing adults online in California, Florida, and Washington. She hopes to help remove barriers to accessing gender affirming care for all her trans clients.
We don't recommend going to any provider who doesn't understand the distinctions between medical necessity and informed consent in trans healthcare. The medical necessity model requires a diagnosis to justify the procedure so insurance will pay for it. This diagnosis is usually Gender Dysphoria. We understand this diagnosis can be hurtful and pathologizing, and wish there was a way around giving it. We also know for some people it feels correct and affirming. We don't believe you need to be dysphoric to receive surgery, but insurance companies feel otherwise.
The other model of affirming care is Informed Consent, meaning your right to access care after being informed of the risks and benefits. All other elective procedures use this model, so it's frustrating that gender affirming procedures don't.
In our letter writing services, we cover content for both medical necessity and informed consent. That means we will document reasons your surgery is medically necessary, likely including a diagnosis we'd rather not give. But we stand firmly in the Informed Consent camp.
We are also careful to document how your procedure aligns with the WPATH Standards of Care (version 8).
We'll Try To Eliminate As Much Hassle As We Can
We streamline our process so most of the paperwork and red tape is taken care of ahead of time. Plan to spend about 30 minutes on paperwork before your first assessment session. After that paperwork, we ask that you commit to three sessions with us. During those three sessions, we will assess you and get all the information we need to write an effective letter of support. These assessment sessions are conversational and warm. We treat you like a whole person, not a case number.
Timing Matters
We know the scheduling of surgeries and other procedures isn't totally up to you. But whenever possible, please plan to start the assessment process for your letter at least six weeks before the surgery date. This gives us enough time to assess you, provide the letter of support, and for insurance to review it before the surgery date.
We'll Have To Ask Questions For Documentation Purposes We Wouldn't Otherwise Ask
Again, we believe trans people have the right to make decisions about their bodies without anyone's approval. But to get insurance to cover procedures, the procedures need to be medically justified. This means that we need to thoroughly document and include information about all gender affirming care you've received in the letter we write.
In day to day conversation, we know better than the ask trans people about their medical and legal decisions. Your transition is highly personal and you get to decide who you share your choices and experiences with. But for the purpose of writing a support letter, we unfortunately have to ask personal questions. These questions include:
How long you've identified as your gender
When you first realized you were trans or gender nonconforming
How long you've been living as your gender and in what settings (professional, social, academic, etc)
Whether you've received hormone therapy or blockers
Steps you've taken to legally transition; documents supporting this legal transition (such as a passport or driver's license)
Mental and behavioral healthcare you've received related to your gender transition
Other medical or surgical care you've received to affirm your gender
The exact name of the procedure you are seeking (e.g. double mastectomy with chest contouring, bilateral orchiectomy, etc)
If you're familiar with the WPATH Standards of Care (version 8); specifics about this procedure included in those standards
If you have not yet legally transitioned, we will unfortunately need to include your deadname in the letter. We know this can be painful and cause dysphoria. This is only for the purpose of getting insurance coverage; outside the letter we will never use or address you by anything other than your chosen name. If you have legally transitioned we will not need to include your deadname and will not ask for it.
We're Happy To Consult and Advocate For You With Other Providers And Insurance
If your doctor or any other care provider wants to consult with us, we're happy to do so. We will ask you to sign a release to speak to the doctors performing your procedure, as well as a release that gives us permission to advocate for you with your insurance company. We'll also make any changes or adjustments to the letter we provided on the recommendation of your doctor.
We Want To Remove As Many Barriers To Good Gender Affirming Care As We Can
Our current medical system has put therapists and doctors in gatekeeping positions they haven't earned. We hope to open the gate for as many people as we can. Trans-affirming healthcare is lifesaving care, and we want to help you access any and all procedures you are seeking. You are always free to ask questions and give us feedback.
Allyship For Our Trans Siblings via Letters of Support For Gender Affirming Care In California, Florida, and Beyond
If you're in one of the states where our licensed clinicians are licensed, we're happy to consult and see if we're a fit for your assessment. Nothing promotes better mental health for the trans community than gender affirming care. We want to help you access it. Book a free consult today!
