To ensure that gender-affirming surgeries are medically necessary and safe, the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) provide a comprehensive framework outlining the prerequisites for surgery. One key requirement is the Surgical Readiness Letter, a formal document written by a qualified mental health professional. This article explores the significance of the Surgical Readiness Letter, detailing its role in the process of gender-affirming surgery, the qualifications needed for those who write it, the required components of the letter itself, and the timing considerations involved. Understanding these requirements will help ensure a smooth and informed path toward surgery.
One of the key requirements for individuals seeking gender-affirming surgery is the submission of a letter from a qualified mental health provider. This letter, often referred to as a Surgical Readiness Letter (SRL), Letter of Medical Necessity, Letter of Support, or simply a Surgery Letter, recommends that the patient proceed with surgery and affirms that the individual is psychologically prepared for the procedure.
Why a Surgical Readiness Letter is Essential
A Surgical Readiness Letter is required by surgeons, insurance providers, and sometimes medical facilities that follow the WPATH Standards of Care (SOC). Without this letter, surgery dates can’t be scheduled. The purpose of the letter is twofold: to confirm the medical necessity of the procedure and to ensure that you fully understand what the surgery entails, as well as that you are in a stable place in your life for the procedure to be performed safely.
The most recent version of the WPATH Standards of Care (SOC 8) requires only one Surgical Readiness Letter for adults, regardless of the type of surgery being sought. In contrast, the previous version (SOC 7) required two letters specifically for individuals seeking genital surgeries. However, many surgeons and insurance companies continue to follow the SOC 7 guidelines and still require two letters for genital procedures.
Who Can Write Your Surgical Readiness Letter?
Your Surgical Readiness Letter must be written by a qualified mental health professional, not your primary care provider. Acceptable professionals include licensed counselors (LPC), social workers (LCSW or LICSW), psychologists (Ph.D. or Psy.D.), marriage and family therapists (MFT), and others who meet the WPATH SOC guidelines. The provider must have relevant experience and training in working with transgender individuals and be familiar with the SOC. While it’s ideal for the provider to know you well, this is not a requirement.
Key Components of a Surgical Readiness Letter
While the specific content of a surgery letter may vary depending on the requirements of the surgeon or insurance company, WPATH recommends the letter contains the following:
- Confirmation of a diagnosis of gender dysphoria or gender incongruence.
- Documentation of the psychosocial evaluation to assess the patient’s readiness for surgery (including the patient’s emotional and mental health status).
- Evidence that the patient has been living in their desired gender role for an adequate period (typically 12 months, although this can vary).
- Confirmation that the patient has provided informed consent for the procedure.
- Reassurance that the patient is mentally and emotionally prepared for the surgery and its aftercare.
Some surgeons and insurance companies may require specific language and details in the Surgical Readiness Letter. To ensure your letter meets all necessary criteria, it’s a good idea to consult with your therapist, surgeon, and insurance provider beforehand to confirm that you’re all on the same page in terms of the letter requirements.
A surgery letter template can be found on the American Psychiatric Association website.
The OHSU Transgender Health Program also has a letter template that can be found here.
Timing Your Surgical Readiness Letter
The timing of obtaining a Surgical Readiness Letter can be tricky. It’s helpful to have the letter ready before your consultation, as it can assist with planning and scheduling. However, some surgeons may not schedule a consultation until the letter is submitted. Additionally, depending on the insurance policy, the letter must be dated within six months or one year of your surgery date. Given the long wait times for surgery, you may need to update your letter a few months before the surgery to avoid any delays.
How to Find a Provider for Your Surgical Readiness Letter
A private, licensed therapist can provide valuable support throughout your gender transition and is also qualified to write Surgical Readiness Letters. If you live in a progressive area, you’ll likely find therapists with experience in gender-affirming care. Many therapists also offer virtual sessions, allowing you to access care from anywhere with a reliable internet connection.
Psychology Today has maintained an online directory of therapists since 2003, now serving 20 countries. The directory can be filtered by location, insurance, and other criteria. To find therapists with experience in gender-affirming care, use the advanced search and select “Transgender” as the specialty.
Be sure to choose a therapist who is experienced in both gender-affirming care and writing Surgical Readiness Letters.
If you’re not already working with a therapist who can write your Surgical Readiness Letter, ask your surgeon for a recommendation. Many surgical practices have established networks of mental health providers who are experienced in writing these letters. These providers are familiar with the specific requirements of both the surgeon and the insurance companies they work with.
The Gender Affirming Letter Access Project (GALAP) is a collective of mental health professionals dedicated to increasing access to free or low-cost letters for gender-affirming medical care. Their website offers a national directory of providers who can write Surgical Readiness Letters. The GALAP was founded by trans and nonbinary mental health providers in the San Francisco Bay Area.
The Surgical Readiness Letter confirms the medical necessity of a procedure and verifies that the individual is psychologically prepared for surgery. By knowing who can write the letter, what it must include, and when it should be obtained, you can better plan for surgery, meet the requirements of both your surgeon and insurance provider, and confidently move forward on your path to gender-affirming surgery.