Letter for Gender Affirming Surgery

Accessing gender affirming care can be a challenging and emotionally taxing process. For many trans people, the requirement to obtain a letter of support for gender affirming surgery adds another layer of complexity to the difficult process.

This necessity, often understood as a gatekeeping measure, can feel daunting. However, our LGBT therapists believe it should not be the barrier to accessing care that supports you!

Gender affirming health care is crucial for the mental well-being of queer and trans people. Empirical evidence supports this assertion.  One research study (Almazan & Keuroghlian, 2021) published in JAMA (regarded as one of the world’s most scientifically rigorous journals) highlighted the positive impact of gender affirming surgeries on mental health outcomes.

The research found that access to these surgeries significantly reduced the rates of psychological distress and suicidal ideation among transgender individuals. This and many studies like it underscore the importance of facilitating access to gender affirming care as a critical aspect of LGBT therapy and supporting the mental health of the queer community.

Chicago Specific Care

In Chicago, there are many reputable institutions that provide gender affirming care. The University of Chicago and Northwestern Medicine’s Gender Pathways Program offer comprehensive services in downtown Chicago. Rush University Medical Center and the University of Illinois Chicago (UIC) in Chicago’s medical district also provide specialized care.

Additionally, Howard Brown Health, located in Lakeview and throughout other parts of the city, and the Gender Development Program at Lurie Children’s Hospital of Chicago are key resources for gender affirming care.

What is a Therapist Support Letter for Gender Affirming Surgery?

A letter of readiness for gender affirming surgery, often referred to as a gender affirming surgery letter or a letter of readiness for gender affirming surgery, is a document written by a licensed mental health professional (usually a queer affirming therapist). This letter advocates for the patient’s medical need for gender affirming surgery, affirms that the patient meets the necessary criteria, and has provided informed consent.

Insurance companies frequently require these letters to provide benefit coverage for gender affirming surgeries. The specific requirements can vary based on the insurance provider, and surgeons may have their own criteria for these letters. However, most requirements align with the guidelines established by the World Professional Association for Transgender Health (WPATH).

Controversy Around the Need for a Gender Affirming Surgery Letter

While the value and barriers of these letters are a topic of debate within the queer community and among healthcare providers, this discussion will focus on the practical aspects of obtaining a letter of support. The goal is to provide clear guidance on how to navigate this process effectively.

Obtaining a Letter of Support for Gender Affirming Surgery

First, to obtain a letter for gender affirming surgery, it is essential to seek out a qualified, gender affirming therapist. Here are the key requirements:

• Licensed Clinical Mental Health Professional – The LGBT therapist must be a licensed professional in their clinical field. This licensure ensures they have met the stringent educational and practical training standards set by their governing body, providing assurance of their capability to offer appropriate mental health support.

• LGBT Therapist Educational Background – The therapist should possess at least a Master’s degree in their clinical field, such as psychology, social work, counseling, or a related area. This level of education indicates that they have undergone extensive training and are equipped with a comprehensive understanding of psychological theories, therapeutic techniques, and ethical practices.

• Experience with Trans Clients – It is critical to choose a therapist with experience working with trans and queer people. Such experience ensures that the therapist understands the unique challenges and experiences faced by the trans community as well as the process for accessing gender affirming medical care.  For many gender affirming surgeries, including bottom surgery, letters from two licensed mental health professionals are typically required.

Second, inquire about the LGBT therapist’s willingness to write a letter of support. It is important to discuss their willingness to write a letter of support for gender affirming surgery at times that they deem the letter meets specified standards. Consider the following points:

• Ask About Their Willingness – Directly ask the therapist if they are open to writing a letter of readiness for gender affirming surgery for clients when medically appropriate. This initial inquiry is crucial to ensure they are willing to assist you if criteria are met.

• Familiarity with WPATH Standards of Care – Confirm that the therapist is familiar with the World Professional Association for Transgender Health (WPATH) Standards of Care. These guidelines are commonly followed when writing letters of support for gender affirming surgeries. A therapist who is knowledgeable about these standards will be better equipped to provide a comprehensive and appropriate letter.

• Minimum Duration of Therapy – Inquire if there is a minimum duration for which they need to see you as a client before they can write the letter. Some therapists may require a certain period of engagement to understand your needs fully and to provide an informed and supportive letter. Knowing this requirement upfront will help you plan accordingly and ensure that you meet any necessary criteria.

By ensuring that your therapist meets these qualifications and by having an open discussion about their willingness to write a letter of support, you can navigate the process of obtaining documentation for gender affirming surgery with greater confidence and clarity.

Content of Gender Affirming Surgery Letter

A well-structured letter of support for gender affirming surgery should include the following elements:

1. Diagnosis – The therapist should provide a clear diagnosis, often related to gender dysphoria, as recognized by the DSM-5 or ICD-10.  This is crucial to support the “medical necessity” requirements of insurance companies.
2. Results of the Client’s Intake Assessment – This includes an overview of the initial assessment conducted by the LGBT therapist.
3. Duration of the Therapeutic Relationship – The letter should specify how long the therapist has been working with the client.
4. Description of Criteria Met for Surgery – The therapist must outline how the client meets the necessary criteria for the specific surgery.
5. Informed Consent – The letter should state that the client has provided informed consent for the surgery.
6. Client’s Understanding of the Surgery’s Effects – A description of the client’s understanding of the potential effects and outcomes of the surgery.
7. Coordination of Care – An offer from the queer affirming therapist to support the coordination of care with other healthcare providers involved in the surgery.
8. Evaluation of Hormonal Treatment Response – If applicable, an evaluation of the client’s response to hormonal treatments should be included.

Special Considerations for Adolescent Clients

Access to top surgery for adolescent clients is generally subject to stricter guidelines. It is essential therapist and the client’s adult custodians consult the specific requirements of the surgeon and ensure that all criteria are met. Adolescents may need additional assessments and letters from multiple mental health professionals.

We’re here to help!

For those seeking a letter of support for gender affirming surgery, it is crucial to work with a therapist who is knowledgeable and affirming of trans and queer identities.

Tandem Psychology has a team of queer affirming therapists who are familiar with the process and willing to write letters for gender affirming care when clinically appropriate. By working with our qualified, affirming therapists, you can achieve your healthcare goals and improve your overall mental well-being.

This blog is made for informational and educational purposes only. It is not medical advice. The information in this blog is not intended to (1) replace a one-on-one relationship with a qualified licensed health care provider, (2) create or establish a provider-patient relationship, or (3) create a duty for us to follow up with you.