FAQ

Yes. We write letters of recommendation for both hormones and surgery. We recognize that these procedures can drastically help improve one’s mental health. When your body finally begins to match the person you feel you are inside, you might feel happier, more relaxed, and less conflicted about your gender. We can process and discuss this in therapy.

The short answer: probably a few weeks, although each person is different.

The long answer: The World Professional Association for Transgender Health (WPATH) states in their Standards of Care that psychotherapy is “not mandatory” for either hormones or surgery. This means that, under WPATH Standards of Care, you don’t have to go through therapy before you can access these procedures. However, you do have to have a “mental health assessment” to ensure that you are psychologically and practically prepared to start these procedures. Keep in mind that a “assessment” is not really the same as therapy. Many doctors and/or gender clinics feel comfortable enough to do this screening themselves, or have someone on staff to do it. Some, however, will want this assessment done by outside therapist.

In our practice, a typical assessment usually takes about 2-4 sessions. During this time, we will collect your history, talk to you more about your gender, and make sure you understand the risks and benefits of hormones and/or surgery. We can also help you plan for the emotional, psychological, and financial aspects of surgery. After the screening, we will typically write you a letter (the most common scenario) or recommend further therapy (for some circumstances, such as substance addiction, as a client may not be able to follow surgery protocols while actively in addiction).

For children and teens, the assessment may take longer, as we need time to coordinate with parents, schools, doctors, etc.

Please note that second letters are no longer required under the latest version of WPATH, effective September 2022. However, if your insurance company and/or surgeon has this requirement, we are happy to participate in the process.

Most clients choose to continue therapy with us after we have written them a letter. We encourage this! Our clients have told us that being able to have a “transition ally,” and a safe, supportive space to discuss and reflect on their transition, was immensely helpful for them. In addition, many clients come to work on issues not related to, or only slightly related to, transition, such as trauma, anxiety, or family problems.

Clients might also find that hormones can change their emotions, thoughts, or reactions to events. It can be helpful to have a therapist with whom to discuss these things.

A few clients choose not to see us for therapy after we write them a letter, and that is perfectly okay as well. Some of these clients will return to us in the future if they face unexpected challenges during their transition.

In most cases, yes. Mental health conditions, such as depression and anxiety, can be related to the feeling that one’s body does not match one’s gender (gender dysphoria). Having access to medical interventions such as hormones or surgery can greatly help to reduce the symptoms of depression, anxiety, and other mental health conditions. The WPATH clearly states that “medical transition is associated with a reduction in mental health problems.” In addition, having a mental health condition usually does not impair your ability to make your own medical decisions.

The WPATH Standards of Care state that mental health conditions should be “assessed and discussed” before you can be prescribed hormones or undergo surgery. What does “assessed and discussed” mean? This will probably be different for every client. In some cases, it might mean being able to come in and see us on a regular basis to process your feelings and get support. However, this does not mean we will delay writing you a letter; we usually simply write in your letter that you have a mental health diagnosis, and that we plan to address this with regular therapy. Or, “assessed and discussed” might mean that you have an established support system and a safety plan in place. We have never had a physician, or insurance company, reject a letter of recommendation based on a client’s mental health diagnosis.

Our clients tell us that it is a relief to be able to “be themselves” around us, and fully express their pain and struggles without worrying that something they say is going to disqualify them from getting a letter. We are aware that, historically, therapists have been “gatekeepers,” holding the unfair power to decide whether or not a client could access medical interventions. Our goal is to create as little hassle for you as possible to access these interventions, while at the same time providing you with individualized support under the WPATH Standards of Care.

Under WPATH Standards of Care, this is not true. You are not required to have therapy to get a letter of recommendation, only a mental health assessment. Of course, many clients find that therapy can be extremely helpful to them throughout their transition. But the decision to pursue therapy is yours alone.

Yes, and we encourage it! As a parent, you have the greatest influence over your child— transgender youth with supportive families are exponentially less likely to suffer depression and have problems in adulthood. When a child or teen comes out as transgender, this means a change for the whole family in some way, and therapy can be very helpful to help parents, siblings, and other family members navigate that change. Therapy can help increase communication between you and your child, especially around topics like name change, appearance, medical options, transition at school, and coming out to other members of the family.

Of course, sometimes your child will not want you to sit in on session. In this case, we’ll discuss our options and try to find some sort of compromise for all parties (maybe you will sit in for the first ten minutes of sessions, or only every other session).