Criteria and Requirements for Scheduling a Gender Affirming Consultation
Male to Female Vaginoplasty
- 1 year of hormones
- 1 year of living in chosen gender
- 1 letter of support from provider who prescribes hormones
- 1 letter of support from mental health provider (see attached)
- 1 letter of support from different mental health provider
- 1 medical referral from primary care provider
Male to Female Breast Augmentation
- 1 year of hormones
- 1 year of living in chosen gender
- 1 letter of support from provider who prescribes hormones
- 1 letter of support from mental health provider (see attached)
- 1 medical referral from primary care provider
Female to Male Top Surgery
- 1 year of living in chosen gender
- 1 letter of support from provider who prescribes hormones
- 1 letter of support from mental health provider (see attached)
- 1 medical referral
Criteria for Mental Health Provider Letter of Support
- Statement confirming the diagnosis of gender dysphoria using current DSM 5 criteria.
- Assure the client is a good candidate for surgery, which the surgery should be stated
specifically in the letter. - Assure the surgery is the next reasonable step.
- Assure the client has no coexisting behavioral health conditions (i.e. substance abuse
problems, or other mental health illnesses), which could hinder participation in gender
dysphoria treatment. - Assure any coexisting behavioral health condition(s) are adequately managed.
- A statement that the client exhibits a strong and persistent cross-gender identification.
- A statement that the client exhibits persistent discomfort with his/her sex or sense of
inappropriateness in the gender role of that sex. - A statement that the dysphoria causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning. - The date the client started living full-time in the opposite gender.
Criteria for Hormone Therapy Provider Letter of Support
- The date the client started hormone therapy
- A statement that the client has been adherent to their hormone therapy.
- A statement that the provider believes surgery to be the next reasonable step in the client’s treatment.
- A statement that the client has no medical comorbidities that would interfere with
surgery.
