I believe in an Informed Consent model. However, most insurances and surgeons require letters of readiness that follow the World Professional Association for Transgender health (WPATH) standards of care. I have extensive experience writing gender affirmation letters, including working with insurances, understanding WPATH standards of care and training other therapists.
When letters are required, they should be as an affirming experience as possible within the inherant power disparities of a gatekeeping model.
1. My assessments for adults usually take one session, occasionally two to three. My assessments for adolescents involve family and 1:1 time with the adolescent, and can take 2-3+ sessions depending on complexity. You will never have to “prove you are trans or nonbinary”. We will talk together about risks and benefits from your perspective and your goals. It will be necessary to engage in safety planning or relapse planning if needed for adequate support and stability. We will touch on your thoughts about fertility, if relevant, and how expected changes will effect your school, social, work and family life.
2. You will review a draft letter usually within a week of our meeting.
3. Once you let me know of any suggested changes, then I will send you a signed copy of the letter. Usually you forward the letter to your doctor or surgeon, and their office sends it to your insurance for preapproval. I am happy to fax a letter if you provide a name and fax number.
I write one free letter a month as a pledge-member of the GALAP. Please let me know if you are interested. If I cannot see you in as timely a way as you wish, I can refer you to another clinician who can write a free letter for you.
The GALAP is a group of transgender, nonbinary, and allied mental health clinicians in the U.S. who believe in improving access to letters for clients who are seeking gender-affirming medical care. We resist the harmful practices of gatekeeping and believe in an informed consent model where clients can affirm their gender identity without the steep cost of sessions with mental health professionals and reductionist clinical practices. As such, we want to create a movement towards providing free and low-cost letters for gender affirming access to medical care.