Lets keep gatekeeping,
to a minimum.
I provide letters of support for gender-affirming care as a licensed mental health professional and AASECT Certified Sex Therapist. My approach is affirming and informed-consent based. My job is to support your care, not stand in the way of it.
Surgery letters,
done with minimal gatekeeping.
Letters are available as a standalone service — you don't need to be an ongoing therapy client. Each letter is written on letterhead and tailored to the specific requirements of your provider, surgeon, or institution. I follow WPATH Standards of Care and an informed consent model throughout.
Surgical Letters for Gender-Affirming Procedures
You need this if: your surgeon requires one or two letters (note: WPATH SOC 8 now only requires 1 letter) from qualified mental health professionals as part of their pre-surgical assessment, as outlined by WPATH or their own practice requirements.
Most gender-affirming surgeons require at least one letter from a licensed mental health provider, and some require two (note: this is outdated per WPATH SOC 8). I write letters meeting WPATH Standards of Care (SOC 8) for a range of gender-affirming procedures. These letters are thorough, clinically grounded, and written in the language surgeons expect — without the paternalism that too many trans people have had to navigate to get here.
For surgical letters I typically require one evaluation session and I ensure the letter is comprehensive and meets the documentation standards most surgeons require. I'll be clear about this from the start so there are no surprises. If you already have one letter and need a second, I can provide that too.
What to expect
start to finish.
The evaluation is a clinical conversation, not an interrogation. I'm not here to test whether your gender identity is real — I'm here to gather what's needed to write you a thorough, accurate letter that allows trans and gender diverse folx to access the care they deserve.
- 🎥 Video must remain on for the entire session — no exceptions. This is a documentation requirement.
- 🪪 Valid government-issued ID must be uploaded securely before the session begins.
- 👤 You must be 18 years of age or older to receive a surgery letter evaluation.
- 🔒 Sessions are via secure HIPAA-compliant teletherapy — available anywhere in CA, WA, NY, and OR.
Reach Out & Schedule
Get in touch via the form below. Let me know what procedure you're seeking the letter for and who your surgeon is. I'll confirm what the evaluation involves and what your surgeon specifically requires. Before your session, you'll upload a valid government-issued ID securely through the portal.
Evaluation Session (~1 hour)
We meet via secure telehealth for one session, typically 30–60 minutes. I assess history, gender identity, gender dysphoria symptoms, and treatment readiness using DSM-5-TR criteria, along with a risk-benefit discussion of your affirming care options. Video must remain on throughout — this is a documentation requirement, not a preference.
Letter Drafting & Your Review
I write the letter on professional letterhead, tailored to your surgeon's specific requirements. You'll have a chance to review it before it's sent or released. If anything needs adjusting to better reflect your situation, we address that before it goes out.
Delivery & Provider Consultation
The letter is delivered to you or directly to your surgeon. It is valid for one year from the date of issue. Up to 30 minutes of consultation time with your medical team is included at no extra charge. If you need a revised letter or a letter for a subsequent procedure down the line, that's included too — no additional fee.
The practical
details.
The evaluation and letter is a one-time fee of $225 — no recurring charges. That covers the evaluation session, the letter itself, up to 30 minutes of provider consultation time with your medical team, and any future revisions or letters for additional procedures. You pay once.
I'm in-network with Cigna. For all other plans, I provide a superbill for out-of-network reimbursement — many plans reimburse a significant portion of the fee. You do not need to be an ongoing therapy client. The evaluation is available as a standalone service, and you can be located anywhere in the four states I'm licensed in.
Need a letter?
Let's get started.
Standalone evaluations available · Telehealth in CA, WA, NY & OR
Common
questions.
Do I have to be your ongoing therapy client to get a letter?
No. Letter evaluations are available as a standalone service. You don't need to have seen me before and you're not committing to ongoing therapy by requesting a letter. Some people do choose to continue working together after the evaluation — that's entirely up to you.
Do you use a gatekeeping model?
No. I use an informed consent, gender-affirming model. My role in the evaluation is to document your understanding of the care you're seeking and provide the clinical information your provider needs — not to decide whether your gender identity is real, or whether you've met some arbitrary threshold of how trans you are. I take that seriously.
How long does the process take?
The evaluation is typically one session — usually 30 minutes to an hour. The letter is completed shortly after and provided to you and your medical providers. I aim to turn letters around as quickly as possible so your care isn't delayed. Rush turnaround may be available if your timeline is especially tight.
What if I need letters for multiple procedures?
The $225 evaluation fee covers your letter and any future revisions or letters for additional procedures at no extra charge. Whether you need an updated letter, a letter for a subsequent surgery, or any revisions, you won't be billed again.
What information do I need to bring to the evaluation?
It helps to know your surgeon's specific requirements — if they have a preferred letter format or particular criteria they want addressed, share that beforehand. Beyond that, just bring yourself and be ready to talk through your gender history and what you're seeking. There's no right way to tell your story.
What does WPATH SOC 8 mean, and does it matter?
WPATH (World Professional Association for Transgender Health) publishes Standards of Care for gender-affirming treatment. SOC 8 is the current version, and it significantly reduced gatekeeping requirements compared to earlier versions. Most surgeons and providers in the US now accept letters written in alignment with SOC 8. My evaluations and letters follow these standards.
Do you accept insurance for letter evaluations?
I'm in-network with Cigna, so Cigna members have the evaluation billed directly. For all other plans, the fee is $225 and I provide a superbill for out-of-network reimbursement — many plans reimburse a significant portion of the cost. It's worth checking your out-of-network benefits beforehand.
Which states do you provide letters in?
I provide letters as a licensed mental health professional in California (LPCC #4340), Washington (LMHC #LH60684311), New York (LMHC #015648), and Oregon (LPC #C8199). You need to be physically located in one of those states at the time of your evaluation session.
Let's connect.
This form is delivered via Paubox HIPAA-compliant secure messaging — your information is encrypted end-to-end. Fill it out and my intake coordinator will be in touch within one to two business days.