Gender-affirming surgery letters

An essential service, offered without a fee

I write secondary letters for people seeking gender-affirming surgeries. Because I consider this an essential service to the trans and gender-diverse community, I do this at no cost to the client. I will bill insurance if you are insured, but if you are uninsured it will be free to you.

What a secondary letter is

Many surgeons and insurance plans ask for letters of support from mental health professionals before surgery. Some procedures call for two letters. A secondary letter is the second of these, written by a different licensed clinician than the first.

How it works

1. Email me to request a secondary letter, and we’ll set up an appointment.
2. We meet by video, usually for a single appointment. You need to be in Washington State at the time of the appointment.
3. I write the letter and send it to you, usually within one business day.

What to bring to your appointment

• Your legal name, as it appears on your birth certificate, passport, or other legal documents. This should match the name your insurance company has on your plan.
• The names of any hormones you take, and when you started them
• The date you began living in your affirmed gender
• The name of the surgery or procedure
• Your surgeon’s name, address, and phone number
• Any specific requirements your surgeon has given you for the letter

My approach

This is not a test you have to pass. You are the expert on your own gender. My role is to document what your surgeon and insurer need, clearly and respectfully. Ongoing therapy is available if you want it, but it isn’t required to get a letter.

Practical details

Sessions are 55 minutes, by video. I’m in-network with several insurance plans. See fees and insurance and how to get started.