If you are seeking a surgical procedure as part of your transition, you may have learned that you need a letter of support from a mental health professional in order to move forward with your procedure, or to have insurance approve coverage of your procedure as medically necessary. This is true for procedures such as chest reconstruction, breast removal or reduction, and breast augmentation (often referred to as “top” surgeries); as well as orchiectomy, vaginoplasty, phalloplasty (often referred to as “bottom” surgeries); and other surgeries or procedures, such as facial feminization surgery, electrolysis, rhinoplasty, tracheal shave, and others.

In order to obtain a letter of support, you must meet with a mental health professional who will ask you questions about your journey, identity, and life. This is called an assessment session.

For top surgeries only one letter of support from a health professional is required, and this provider must hold at least a Master’s Degree – they may refer to themselves as a counselor, therapist, psychotherapist, or mental health professional. For bottom surgeries, two letters of support are required. Some surgeons or insurance companies further require that one letter be obtained from (at least) a Master’s level provider, and the second from a doctoral level provider.

As a doctoral level provider, with a PhD in Clinical Psychology, I am empowered to write letters for all procedures. I reserve space in my weekly schedule to conduct assessments, and typically am able to complete assessments in a single, hour long session, with a letter produced 1-2 weeks later.