Referral

Letters

This page refers to referral letters (also known as WPATH letters or letters of support) sometimes desired or required to access gender-affirming medical interventions.

I REFUSE TO PASS ON THE FINANCIAL BURDEN OF A GATEKEEPING SYSTEM.

I write letters and complete letter-writing assessments 100% free of cost. Yes, really really!


If you've reached a point in your transition that you're in need of a letter, let's connect about how I can help break down this barrier. I try to keep the process pretty straightforward because gatekeeping is not in line with my personal values or professional ethics.

I operate as much as possible on the Informed Consent model - under the presumption that you are a self-determined person with insight and awareness about how to use your bodily autonomy. In order to do this within a system that continues to use gatekeeping, I frame letter writing and the assessment as a way of improving outcomes and hope to end each assessment by sharing a new consideration or idea with the individual.


  • Provider Requirements:

      • If you're seeking a letter for hormone therapy, you do not need an identified provider.

          • For hormone therapy, Planned Parenthood of Florida operates on the informed consent model and does not require a letter.

      • If you're seeking a letter for chest surgery (removal or augmentation) or gonadectomy (hysterectomy or orchiectomy), you must have an identified surgeon and ideally had an appointment or consultation with your surgeon.

      • If you are seeking a letter for facial surgery or genital reconstruction, you must have identified a surgeon and had a surgical consultation prior to the letter-writing assessment session.


  • For the letter, I must write that you are mentally, emotionally, practically, and financially prepared for the intervention, as well as being aware of the risks, benefits, and implications. This means that it's important for you to have done research in advance regarding what to expect. This is also why I require having a surgeon and consultation in certain circumstances.

      • I recommend this site to review the guidelines, potential complications, and expected outcomes for the planned intervention (hormones or surgery).

      • These videos demonstrates the injection process for intramuscular or IM vs. subcutaneous or Sub-Q injections.

      • For questions to ask during a surgical consult visit here.

      • For information about variations of chest reconstruction (removal), visit here.

      • Find information about GoodRx coupons for testosterone, spironolactone, and estradiol.


Here's a bit about my letter-writing process so you can make an informed choice.

  • There is NO therapy required for letters. If you desire ongoing therapy, you can schedule a consultation here.

  • As a Registered Mental Health Counseling Intern, I have my licensure supervisor co-sign my letters to ensure they meet insurance and surgeon signature requirements. My supervisor in an LMHC and has a PhD.


  • If you read this page and wish to move, the first step will be to select a date and time for your letter-writing assessment appointment.

  • You will schedule a 1-hour appointment (this will need to be scheduled at least 4 days out from the day you request it).

  • I'll send you an invitation to my FREE client portal with consent forms and intake forms. I'll also send an intervention-specific questionnaire through email.

      • All forms must be completed at least 48 hours prior to the scheduled session.

      • I will use this information to guide the letter-writing session and will pre-write some of the letter in advance.

      • If you are seeing a therapist or psychiatric provider I will also send a release of information to be completed before the appointment. It's entirely your choice whether or not to sign the release, but I require it in order for me to write the letter.

  • We will meet for the appointment session through a HIPAA-secure version of Google Meet.

      • During the session we'll review any necessary pieces of information from the forms, and review the letter together.

  • After the letter is completed, I securely send the letter to my supervisor for her signature. After she signs it, she will send it securely back to me.

  • When I receive the signed letter I will print and sign it.

      • I will send the letter to you by password-protected email.

      • If you designated a provider, I will fax them a copy directly.


If you've read all of this page and are ready to schedule your appointment, select a date and time here.