Letters

Current SOC v7 requirements

All letters must be:

• Dated within one year of surgery
• On letterhead
• Indicate the type of procedure (top surgery, vaginoplasty, phalloplasty, etc.).
  • We cannot accept letters that say gender reassignment/gender confirmation/gender affirmation surgery.
• Signed by the provider with their license number
• Letters cannot be written by an intern or resident.

Top Surgery, Breast Augmentation & Facial Feminization Surgery:

One letter from a licensed mental health specialist (LCSW, MFT, LMFT, CSW, Ph.D., Psy.D., etc.)

Bottom Surgery:

Two Letters from two different licensed mental health specialists.

• 1 letter can be from a provider who has only had an evaluative
• It is highly recommended that at least one of the letters be from a provider with a doctorate-level degree (Ph.D., Psy.D., etc.).

Mental health provider letter(s) must include ALL of the following:

• Patient’s legal and preferred name
• Patient’s date of birth
• Date provider/patient relationship began and the frequency of contact
• A statement that the patient has been diagnosed with persistent, well-documented gender dysphoria/gender identity disorder and exhibits all of the following:
  • The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; and
  • The transgender identity has been present persistently for at least two years; and
  • The disorder is not a symptom of another mental health disorder; and
  • The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Documentation that the patient has completed a minimum of 12 continuous months of living in a gender role that is congruent with their gender identity, across a wide range of life experiences and events that may occur throughout the year.
• The patient has undergone a minimum of 12 continuous months of hormone therapy. (RECOMMENDED FOR BOTTOM SURGERY & BREAST AUGMENTATION ONLY).
• A statement that the patient has the capacity to make fully informed decisions and to consent to treatment.
  • That the patient can comply with long-term follow-up requirements and post-operative expectations have been addressed.
•  If the patient has significant medical or mental health issues present, they must be reasonably well controlled.
• Any substance use (marijuana, alcohol, etc.) is well controlled for at least 6 months prior to the patient’s surgical date.
• The provider must state their experience with treating patients diagnosed with gender dysphoria.

 Hormone provider letter must include:

• Patient’s legal and preferred name
• Patient’s date of birth
• Date provider/patient relationship began and the frequency of contact
• Date hormone therapy began and the frequency of treatment
• That the patient has undergone a minimum of 12 continuous months of hormone replacement therapy
• If the patient has a contraindication to hormone therapy, please note this