How To Write A Letter of Support

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How To Write A Letter of Support

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Ash Nazario

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WRITING A LETTER OF

SUPPORT FOR GENDER

AFFIRMING SURGERIES
Created by Top Surgeon Dr. Scott Mosser of
The Gender Confirmation Center of San Francisco INTRODUCTION
Insurance companies require a letter from a mental
WHAT A LETTER OF SUPPORT health care professional prior to all gender affirming
surgeries. The letter is a statement that the client is
NEEDS TO CONTAIN ready and able to give informed consent.
Most insurance companies require mental health
The most current edition of the Standards of Care (SOC) by providers to state in the letter that they have an ongoing
the World Professional Association for Transgender Health ‘provider and patient relationship with the patient’.
(WPATH) released in 2011 recommends the following
Although hormones are not a requirement for top
content for gender affirming surgical support letters:
surgery most insurances would like this to be
addressed. Such as, whether the patient is taking
1. The client’s general identifying characteristics
hormones or not. If they are taking hormones indicate
how long they've been on HRT, if they're not taking
2. Results of the client’s psychosocial assessment,
hormones make an indication as to why that is.
including any diagnoses
For patients who are seeking approval through Medi-Cal
3. The duration of the mental health professional’s Dr. Mosser's Insurance Advocacy team has observed it's
relationship with the client, including the type of evaluation helpful for there to be a statement addressing any
and therapy or counseling to date substance abuse issues (or lack there of).

4. 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 IS IT NECESSARY?
5. A statement that informed consent has been obtained
from the patient
At The Gender Confirmation Center Of San Francisco,
6. A statement that the mental health professional is a referral letter isn’t considered to be an absolute
available for coordination of care and welcomes a phone requirement for gender affirming surgeries as
call to establish this Dr. Scott Mosser uses the informed consent model.

However, individuals younger than 18 years of age

need 2 letters of support. Though we do not require
support letters in all cases, insurance companies do
deem these support letters as necessary.

On the next page, you will find a template of what the

support letter should contain. The template on the next
WHAT THE SUPPORT page and has footnotes that indicate how the referral
letter meets the WPATH SOC criteria.
LETTER SHOULD LOOK LIKE
Note: The letter has to include a diagnosis of the patient
having F64.9 Gender Dysphoria.

Get in Touch
WWW.GENDERCONFIRMATION.COM
450 Sutter St. Suite 1010 San Francisco, CA 94108
[email protected]
415.780.1515
Dear [Surgeon’s name],

I am writing you today to assert my full support for [legal name], who identifies as [name or
pronoun] to receive a gender confirming top surgery. [Name or pronoun] is [years old] living in
[location]. [Name or pronoun] is an [occupation] and is living [accommodations]. [Name or
pronoun] has a support system of [example] who will be taking care of [name or pronoun] during
the surgical recovery.1

My clinical assessment is that [name or pronoun] is diagnosed as having F64.9 Gender Dyspho-
ria. [Patient’s name] meets the criteria set forth by the WPATH Standards of Care for gender con-
firming surgeries. [Name or pronoun] experiences extreme distress and dysphoria as they do not
identify with the sex assigned at birth and has felt this way since [insert amount of time] which
is why they are seeking approval for this procedure.2

I have had an ongoing therapeutic relationship with [name or pronoun] since [insert date]. [Name
or pronoun] has had a persistent stable [gender identity] for [insert amount of time]. [Patient’s
name or pronoun] spoke with me about [name or pronoun] desire for surgery due to [insert
reasoning, use patient’s own words].3

Informed consent was provided by [legal name] and has the capacity to consent for treatment
with surgery.4 [Name or pronoun] is aware of the risks, benefits and after care needs of this
procedure. Furthermore, I do not see any confounding diagnoses that would complicate this
process of approving [name or pronoun] for surgery.5

[Name or pronoun] will have continued access to my services for care and support. I am avail-
able for coordination and welcome any appropriate communication with your office. I can be
contacted at [insert phone number and email] if you have further questions.6

Sincerely,
[Name of mental healthcare provider]
[Additional contact information]

1 The client’s general characteristics

2 Results of the client’s psychosocial assessment, including diagnosis
3 The duration of mental health professional’s relationship with the client, including the
type of evaluation & therapy date
4 A statement that informed consent has been obtained from the patient
5 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
6A statement that the mental health professional is available for coordination of care and
welcomes a phone call to establish this