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 at no cost to the client. 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 session by sharing a new consideration or idea with the individual.


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.


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


There is NO therapy required for any gender affirming referral letter. If you desire ongoing therapy, you can request a consultation through the Services Interest Form.

Hormone Therapy

Provider Requirements:

      • You do not need an identified provider.

      • Informed Consent hormone therapy (no referral letter required) is available through:

      • Minors (and the parent/guardian giving consent to care) must also read the Minors/Youth section below.

Assessment Requirements:

      • It is your responsibility to have done your research about the intervention (risks, benefits, implications) and intended provider before the assessment session.

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

Resources

Surgery

Provider Requirements:

      • 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.

      • For facial surgery or genital reconstruction, you must have identified a surgeon and had a surgical consultation prior to the letter-writing assessment session, because there are too many unique variables that must be discussed with a surgeon in order to be able to provide informed consent.

      • Minors (and the parent/guardian giving consent to care) must also read the Minors/Youth section below.

Assessment Requirements:

      • It is your responsibility to have done your research about the intervention (risks, benefits, implications) and intended provider before the assessment session.

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

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

      • For information about variations of genital reconstruction for people who were born with primarily internal genitals, check out these links on vaginectomy, metoidoplasty, phalloplasty, and scrotoplasty.

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

      • For information about variations of genital reconstruction for people who were born with primarily external genitals, check out these links on vulvoplasty, penile inversion vaginoplasty, peritoneal vaginoplasty, and rectosigmoid vaginoplasty.

Financial Resources:

Minors/Youth (14-17 yrs old)

Parent/Guardian Requirements:

      • All adults who have the legal right to medical consent for the minor must participate in and consent to the assessment session.

      • Only youth who have full support by all parents/guardians who can consent to their medical care may participate in letter sessions.

Assessment Requirements:

      • Referral letters for hormone therapy will be written for youth no younger than 14 years old.

      • Referral letters for surgery will be written for youth no younger than 16 years old.

      • For all letters, youth and their parents must have had a consultation with the desired intervention provider AND must have a clear set of expectations and requirements of the provider.

Parent/Guardian Resources

Scheduling

If you've read the above and wish to move forward, the first step will be to complete the required forms for your assessment session.

      • All forms must be completed prior to the scheduling the 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.

  • After the forms are submitted, you'll receive a link to schedule the assessment session.

      • Assessment appointments are currently held on Mondays from 12-3pm. Appointments are typically booked out 2-3 weeks and availability is limited.

  • Assessment appointments are held on a HIPAA-secure version of Google Meet and both audio and video are required for the appointment.

  • 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 you by email.

      • I will send the letter to you by password-protected email. The letter is then yours to send to whomever you decide.


If you've read all of this page and are ready to schedule your appointment, please complete the Services Interest form on the Contact page.