Gender Affirming Letter Writing
Has your provider or insurance company asked you for a letter from a mental health professional before proceeding with the next step in your transition?
Many medical providers and insurance companies request one or more letters from mental health professionals prior to your procedure. These letters can be invasive and deeply personal, and rarely does someone have more than one mental health therapist at a time.
I am happy to offer free letters of referral / support for gender affirming procedures. As part of my professional ethics and advocacy for accessibility of necessary medical care to trans and gender expansive people, I don’t charge a fee for writing the letter or for the up to three sessions required to do so.
How does this work?
What do you mean we have to check if they’ll accept your licensure? Aren’t you a real therapist?
I know it sounds scary, but don’t worry - most of the time there are no issues! I’ve written many of these letters and they’ve been accepted by many different providers and insurance panels. I am a Licensed Clinical Mental Health Counselor (LCMHC) in the state of North Carolina - I have a master’s degree, but I do not have a PhD. There are a handful of licensures that someone in North Carolina could have, and as far as clients are concerned we’re all mental health therapists. It is very annoying and technical, and I could go on about it forever, but the important thing is if your provider/insurance requirements list my licensure (LCMHC) when it describes the mental health professionals who they will take letters from, we’re good to go!
First, we’ll make sure we know what your provider or insurance company wants to see in this letter.
Usually, your provider or insurance company has a list of requirements for these letters, and they can provide this list to you. Most of the time these are standard requirements that follow WPATH guidelines, but sometimes they’re very specific. Mainly, we need to check whether they specify that they will only accept letters from mental health professionals with certain types of licensures — I don’t want you to go through this whole process only to find out they won’t accept my letter!
Then, we’ll meet and talk about your history with gender at your pace.
Typically this process takes 1-3 sessions (each 45 – 60 minutes long) of talking through a little bit about your history and journey with gender and writing the letter together. Most often one session is sufficient, but I recognize that the information required by these letters is often deeply personal, and I don’t want you to feel rushed.
Are these appointments in person or virtual?
Either! We can meet in person at my office in Durham, or we can meet via telehealth. However, it is important to note that even if we meet virtually, you must be located in North Carolina at the time of your appointment. This is because mental health licensure laws are state specific, and I am only licensed to practice within North Carolina.
Lastly, we’ll review and edit your letter. When you’re happy with it, I’ll send you a signed copy.
After we’ve met, I’ll write your letter according to the list of requirements we got in step one. I’ll send you a draft version of the letter so that you can review it and ensure that everything looks right and you feel confident about the information we’re sharing there with your provider/insurance company. My essential driving consideration is that this is your letter and you get to have final say and control of what ends up in it. After your review and approval, I’ll send you a signed copy of the letter to share with your provider/insurance as needed.
Why do I need to review it? Aren’t we just going to include whatever the requirements say?
We are going to make sure we meet the requirements, but how much detail you feel comfortable including is entirely up to you. It’s not uncommon to find that when we’re just talking about it, sharing details feels okay, but looking at it all written down in the letter feels too personal to share with your surgeon’s office or with your insurance company. We can always err on the side of giving less detail to protect your privacy, and make them ask for more if it’s really necessary.