Letters of Readiness for Gender-Affirming Care

Accessing gender-affirming care — including surgery — can be life-changing. For some procedures, you may need a Letter of Readiness from a qualified mental health professional to move forward.

At Your Choice Mental Health Therapy, we understand how important it is to have the right documentation in place. Many insurance companies and medical providers require this letter before approving or performing gender-affirming procedures. Our role is to guide you through the process with compassion, professionalism, and respect.

How We Work Together

During our sessions, we’ll create a safe and supportive space to:

  • Explore your gender identity and expression

  • Discuss your goals for gender-affirming care or surgery

  • Address any concerns, challenges, or barriers

  • Develop a plan for moving forward

Once we’ve established a therapeutic relationship and determined you meet the criteria outlined in the WPATH Standards of Care (Version 8, 2022), we can prepare your Letter of Readiness.

Our Goal

We want you to feel supported, informed, and confident as you take the next step toward living your most authentic and fulfilling life. The letter is simply one part of that journey — our focus is on making the process clear, affirming, and free of unnecessary delays.

  • Guide to Gender-Affirming Surgery Letters & Requirements

    A combined resource for clients before getting started.

    1. Understanding WPATH Standards of Care (SOC 8, 2022)

    The World Professional Association for Transgender Health (WPATH) publishes the Standards of Care used worldwide to guide gender-affirming treatments. The most recent version, SOC 8, was released in 2022 and focuses on individualized, patient-centered care.

    SOC 8 Key Criteria for Surgical Readiness Letters

    A qualified mental health professional should confirm:

    • Gender Dysphoria or Gender Incongruence: Persistent and well-documented.

    • Informed Consent: You fully understand the risks, benefits, and potential outcomes.

    • Psychosocial Readiness: Emotional stability, mental health support, and adequate coping skills.

    • Mental Health Stability: Any mental health conditions are reasonably well-managed.

    • No Fixed Therapy Requirement: SOC 8 removed the “one year of therapy” rule — readiness is based on individual assessment.

    • Letter Requirement: One letter from a qualified provider is sufficient for most adult surgeries.

    • Letter Content: Must include diagnosis, informed consent, readiness for surgery, mental health stability, and (if relevant) discussion of fertility implications.

    2. Surgeon and Hospital Requirements May Differ

    While SOC 8 is widely respected, individual surgeons or hospitals may set stricter rules than WPATH. Examples:

    • Requiring a longer therapy period before surgery (e.g., 6 months or 1 year).

    • Requiring letters from specific mental health credentials only (e.g., psychologist vs. counselor).

    • Requiring more than one letter for certain surgeries.

    These are internal policies, not laws, but they will override your letter’s acceptance for that specific surgeon.

    3. Insurance Considerations

    If you are using insurance to cover gender-affirming surgery:

    • Some insurance providers require a letter of readiness to approve coverage.

    • They may have rules about who can write the letter (specific license types) and how long you must have seen that provider.

    • Always call your insurance company before your letter is written to confirm their requirements.

    Questions to Ask Your Insurance Provider:

    1. Does my plan require a letter of readiness from a mental health professional? If so, what are the specific criteria?

    2. What is the process for submitting the letter and other documentation for coverage?

    3. Are there pre-authorization or pre-certification requirements for surgery?

    4. What is the expected timeline for a decision?

    5. Are there any support services or resources offered for patients seeking gender-affirming care?

    4. How We Work With You

    At Your Choice Mental Health Therapy, we:

    • Follow current WPATH SOC 8 standards for writing letters.

    • Confirm all readiness criteria in as few or as many sessions as needed.

    • Will provide your letter promptly once you meet the criteria.

    • Will adapt documentation as much as possible to meet your surgeon’s or insurance provider’s rules.

    • Can help you find surgeons who follow SOC 8 if your current provider’s policies are more restrictive.

    5. Key Takeaways

    • Always check both your surgeon’s requirements and insurance requirements before starting the letter process.

    Disclaimer

    This guide is for informational purposes only and should not be considered legal, medical, or insurance advice. Requirements for gender-affirming surgery letters can vary by provider, insurance plan, and jurisdiction. Always confirm the exact criteria with your surgeon and insurance provider before proceeding.

Our Commitment to You

At Your Choice Mental Health Therapy, we believe cost should never be a barrier to accessing gender-affirming care. A Letter of Readiness is often a necessary step in receiving gender-affirming surgery or medical treatment, and we are committed to making this process clear, supportive, and financially accessible.

What We Offer

  • No additional fees for writing your Letter of Readiness — the letter itself is provided at no cost.

  • If you have insurance, the evaluation session will be billed to your plan as a standard clinical visit.

  • For clients without insurance or those choosing not to use their insurance (for example, due to a high deductible or lack of coverage for this service), we offer one free Letter of Readiness per month for individuals in financial need.

Eligibility & Limitations

  • Reserved for Uninsured or Self-Pay Clients – Clients using insurance benefits for the evaluation are not eligible for the free-letter program.

  • Limited Availability – One recipient per month, awarded on a first-come, first-served basis.

  • Reasonable Additional Work Included – Brief follow-up correspondence, necessary provider contact, and small letter revisions are included at no extra cost. Requests requiring significant extra time or multiple revisions may require an additional session.

  • Age Requirement – You must be 18 years or older to participate in our Letter of Readiness program. We do not provide Letters of Readiness for minors.

Why We Do This

Our mission is to help remove documentation as a barrier to necessary care. By integrating our services with insurance when available — and offering one no-cost letter each month to those without coverage — we aim to support your journey toward authentic and affirming medical care without financial strain.

Our Connection to GALAP

We are proud to participate in the Gender Affirming Letter Access Project (GALAP), a network of providers dedicated to reducing financial and clinical gatekeeping. While we follow GALAP’s principles, all services are provided solely by Your Choice Mental Health Therapy in compliance with state law, licensing requirements, and ethical standards. GALAP is not responsible for our clinical services.

Disclaimer

Our free-letter program is a courtesy service designed to reduce financial barriers to gender-affirming care. Participation in this program is subject to the following terms:

  • No Guarantee of Letter Issuance – Participation in an evaluation does not guarantee that a Letter of Readiness will be issued. The decision to issue a letter is made solely at the discretion of Your Choice Mental Health Therapy and its therapists and contractors, based on the WPATH Standards of Care (Version 8, 2022) and the provider’s professional judgment.

  • No Guarantee of Acceptance – We cannot guarantee that any letter issued will be accepted by your insurance company, surgeon, or other medical provider.

  • Not Ongoing Therapy – This program covers the evaluation session and, if appropriate, preparation of a Letter of Readiness. It does not include ongoing therapy services unless scheduled and billed separately.

  • Eligibility Criteria – This free-letter benefit is reserved for uninsured individuals or those choosing not to use their insurance and paying entirely out of pocket. Clients using insurance benefits for the evaluation are not eligible.

  • Limited Availability – Only one uninsured or self-pay recipient is accepted per month, on a first-come, first-served basis and subject to provider availability.

  • Scope of Included Work – Reasonable follow-up correspondence, necessary provider contact, and small letter revisions are included at no additional cost. Requests for extensive revisions, repeated edits, or significant additional work may require scheduling another session at the standard rate.

  • Program Changes – This program and its eligibility criteria may be modified or discontinued at any time without prior notice.

  • Independent Operation – While we follow the principles of the Gender Affirming Letter Access Project (GALAP), this program is operated solely by Your Choice Mental Health Therapy in compliance with state law, licensing requirements, and ethical standards. GALAP is not responsible for services provided.

FAQs

Is the entire letter-writing process (including the time it takes to meet) completely free?

For clients with insurance, the evaluation session is billed to your plan just like any other clinical visit, and there is no additional fee for the letter itself. For uninsured or self-pay clients who qualify for our free-letter program, the evaluation and letter are both provided at no cost. We offer one free-letter slot per month for those without coverage.

Have you written surgery letters for trans and nonbinary clients that were accepted by surgeons and/or insurance companies?

Yes. Our providers have written Letters of Readiness that have been accepted by both surgeons and insurance companies. We follow the WPATH Standards of Care, Version 8 (2022) to ensure letters meet clinical and procedural requirements.

How many sessions will the letter process take?

For most clients, the process is completed within one to two sessions, depending on the complexity of your history, the requirements of your surgeon or insurance provider, and whether additional information is needed.

If you’d like ongoing support, we are happy to work with you as a recurring client before, during, or after your surgeryto help you prepare, navigate the process, and adjust after your procedure.

Are there any reasons you would not write a letter?

Yes. A letter may not be issued if, including but not limited to:

  • You do not meet the WPATH readiness criteria for the requested procedure.

  • There are significant untreated or unstable mental health concerns that could interfere with informed consent or safety of care.

  • The request falls outside our scope of practice.

Have you received training about writing letters and providing knowledgeable care to trans and nonbinary clients?

Yes. Our providers have received training in gender-affirming care, including best practices for writing Letters of Readiness and providing informed, respectful, and affirming services for trans and nonbinary clients.

Will this letter guarantee that I can get surgery or that my insurance will cover it?

No. While we follow recognized standards and work to ensure your letter meets the requirements of your surgeon and/or insurance provider, we cannot guarantee acceptance or approval. Final decisions are made by your surgeon, medical team, or insurance company.