Gender-Affirming Surgery and Care Letters

I provide letters of support and assessment for gender-affirming care that you can provide to your physician. While I don’t work with those under the age of 18, I can help connect you with someone who is safe and can write that letter for you. Your consultation typically takes one 50-90 minute session and costs $150, a flat rate that includes both the assessment meeting and all paperwork. I have dedicated spots for gender consultations, so I can usually see you within one week of our initial contact.

How it works

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EMAIL ME

Email hello@robyncullen.com to book a time for your virtual Zoom meeting, which will take 50-90 minutes.

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PREPARE

You will be emailed Informed Consent and Agreement for Gender Evaluation to read and sign prior to our meeting.

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FOLLOW UP

If you meet the necessary criteria, I will write the letter and email it to you within 72 hours (3 days) of our meeting.

Accessing Gender-Affirming Surgery and Care

Please note: The scheduling of a gender evaluation does not guarantee that I will write a referral letter for you; your readiness for transitioning is something that we will discuss together during your evaluation.

I believe you have the right to engage in informed care decisions privately and confidentially with your chosen health providers. I believe that requiring gender-affirming care letters constitutes an unnecessary barrier to gender-diverse folks receiving the care they need. I provide these letters through an efficient, quick, and low-effort process to remove as many of the barriers as possible. I do not support or encourage the gate-keeping rationale behind them. I believe requiring a letter from a therapist for a life-saving medical procedure is unfair.

I am opposed to the “gatekeeper” mentality that has plagued therapy for so many years; just because you want to begin hormones or have surgery does not necessarily mean that you need ongoing therapy.

However, if there are other issues that you would like assistance with – such as anxiety or depression – then we can certainly discuss further therapeutic sessions or alternative resources.

Therapy sessions are $150 per 50-minute session or $200 for 90-minute sessions.

To set up a consult, please email me directly at hello@RobynCullen.com

Frequently Asked Questions

  • In the assessment, I will ask you a variety of questions about: your personal experience that has led you to this decision, your understanding of the benefits and risks involved in receiving different forms of gender affirming care including but not limited to hormone therapy and surgery. I will also be assessing if you meet the DSM 5 criteria for gender dysphoria (which is required) and what forms of gender affirming care will aid in the alleviation of distress. This assessment could last anywhere from 50 minutes to 90 minutes. This letter is primarily for insurance companies to authorize the use of benefits for gender-affirming care. There are only 4 people who would need to see this letter: Me, you, your physician who requested it & someone at an insurance billing department.

  • I do not provide letters of referral for minors under the age of 18 years old. Inclusive Therapists Directory and LGBTQ+ Healthcare Directory are two places to find providers who will write letters for minors.

  • Finding a gender affirming therapist near you is always ideal. Especially in case you want to continue working with them in a therapeutic setting. But it is not required. I conduct most of my evaluations online, in an effort to provide accessible, convenient & private support.

  • The short answer: No.

    The more nuanced answer: It’s definitely encouraged.

    Often, requiring adults to present assessment letters or support letters from mental health professionals so they can access gender-affirming surgery or care of any kind can be considered a form of gatekeeping. While I recognize the supportive role a therapist can have in the process, I also believe requiring a letter from a therapist for a life-saving medical procedure is unfair.

    Preparing for and recovering from surgery/any procedure can take an emotional toll on you. I encourage anyone accessing any sort of gender affirming care to have an active support network of loved ones and a mental health professional to strengthen your ability to cope with challenges that may arise. 

    When looking for support, please consider seeking out gender-competent mental health professionals who can support you through:

    • Helping you figure out which care/procedures are right for you

    • Identifying realistic expectations for the results and recovery of surgery

    • Figuring out how and to which people in your life you would like to share your decision with

    • Organizing a support network or plan for your physical and emotional recovery from surgery

    • Helping you navigate temporary feelings of post-operative depression and regret that might come up as you deal with the physical limitations and inflammation (having to wait to see the final results of your surgery)

    • Celebrating your gender affirmation with you!

    If you’d like to discuss working together for therapy or any other supportive services, CLICK HERE to schedule a consultation.

  • Informed consent is a particularly important process for any gender-non conforming, non-binary and transgender people because it gives them autonomy over their own healthcare. Historically, accessing quality health care for the trans and gender non-conforming community has been difficult, in part because of gatekeeping and discrimination on behalf of mental health providers and medical professionals. Therapist-mediated support and the therapeutic process can be highly valuable in the gender transition journey. The informed consent model honors patients’ self-knowledge and ability to make informed decisions regarding medical interventions they want to access. Regardless of insurance coverage requirements, adults who have the proper education are able to determine for themselves if they are ready and willing to access surgery and other gender affirming medical care. This extends to trans people who do not fall within the binary; patients of all genders are able to determine their own surgical/medical goals in collaboration with their surgeon and other providers.

  • According to SOC 8, the purpose of a support letter for an adult seeking medically necessary gender-affirming medical treatments should be assessed by a licensed mental health professional with at least a master’s-level education in their clinical field (psychiatry, social work/LCSW, marriage and family therapy/LMFT, etc.). Providers should be able to assess a patient’s capacity to consent to surgical treatment, discuss mental and physical health conditions that could negatively impact the outcome of gender-affirming care, discuss the impact of the surgery on reproductive health, and more.

    In the case of bottom surgery, WPATH recommends that two licensed mental health professionals provide a support letter. This can be in the form of one letter signed by two professionals or two letters provided by the professionals, separately.

    According to SOC 7, the set of WPATH standards that many providers and insurance companies still follow, letters should include the following components:

    • The client’s general identifying characteristics;

    • Results of the client’s psychosocial assessment, including any diagnoses;

    • The duration of the mental health professional’s relationship with the client, including the type of evaluation and therapy or counseling to date;

    • An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting the patient’s request for surgery;

    • A statement about the fact that informed consent has been obtained from the patient;

    • A statement that the mental health professional is available for coordination of care and welcomes a phone call to establish this.