<link rel="stylesheet" href="//fonts.googleapis.com/css?family=Sanchez%3A100%2C100italic%2C200%2C200italic%2C300%2C300italic%2C400%2C400italic%2C500%2C500italic%2C600%2C600italic%2C700%2C700italic%2C800%2C800italic%2C900%2C900italic%7CRoboto%3A100%2C100italic%2C200%2C200italic%2C300%2C300italic%2C400%2C400italic%2C500%2C500italic%2C600%2C600italic%2C700%2C700italic%2C800%2C800italic%2C900%2C900italic%7CRoboto+Slab%3A100%2C100italic%2C200%2C200italic%2C300%2C300italic%2C400%2C400italic%2C500%2C500italic%2C600%2C600italic%2C700%2C700italic%2C800%2C800italic%2C900%2C900italic%7COpen+Sans%3A100%2C100italic%2C200%2C200italic%2C300%2C300italic%2C400%2C400italic%2C500%2C500italic%2C600%2C600italic%2C700%2C700italic%2C800%2C800italic%2C900%2C900italic">Letters - Crane Center for Transgender Surgery


WPATH Standards of Care recommend letters of support from licensed mental health providers and/or hormone providers as part of the surgical transition process. Your insurance provider also will require the same letters to approve coverage.

Below are the letter requirements pertaining to each procedure type and the WPATH Soc V.7 criteria that must be met for each letter, as well as additional criteria imposed by certain insurance plans.

*Please note: All letters must be on letterhead and signed by the provider with their license number. Letters cannot be written by an intern or resident.

  • Letters for Texas patients can be faxed to 512.597.0402 or emailed to TXLetters@CraneCTS.com
  • Letters for California patients can be faxed to 415.461.3233 or emailed to CALetters@CraneCTS.com

Top Surgery, Breast Augmentation & Facial Feminization Surgery:

  • One letter from a licensed mental health specialist (LCSW, MFT, LMFT, CSW, Ph.D., Psy.D., etc.)
  • California patients: As of December 2018, Anthem Blue Cross is requiring two letters from two separate mental health specialists

Bottom Surgery:

Two Letters from 2 different licensed mental health specialists

  • 1 letter can be from a provider who has only had an evaluative role
  •  At least one of the letters must be from a provider with a doctorate level degree (Ph.D., Psy.D., etc.)

The 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 experience 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 and breast augmentation only).
    • A statement that the patient has the capacity to make fully informed decisions and to consent for treatment.
    • That the patient is able to 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.

The letter from your Hormone Provider 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

*Please note that WPATH Standards of Care states that patients should be the age of majority (18 years of age in the US) for bottom surgery coverage, and it is very uncommon for a minor to have this procedure approved.

Warning !

This website contains graphic images. By continuing to our website, you agree that you are 18 years old or above.

Skip to content