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Gender Therapist – Behavioral Health Letter Criteria

Dr. Sidhbh Gallagher

These requirements are based on WPATH Standards of Care v.7 and are not generated by our office. As WPATH members we do follow these guidelines to move forward with consultations and surgery.

These are minimum standards and additional items could be requested or required on a case-by-case basis.

These letters can be written by most licensed behavioral science providers with experience in gender identity expression. *SOME* letters will be require to be written by a Ph.D or Psy.D. You will be advised when that pertains to your case.

All procedures will require at least ONE letter from a qualified Behavioral Science Health Provider. Some procedures and/or insurance policies will require TWO letters be submitted.

Potential patients will be advised on a case-by-case basis on how many letters you will be required to obtain.

One (1) or Two (2) Gender Therapist Letter(s) are ALWAYS required for:

* FTM Top Surgery – Double Incision, Keyhole & Nipple-free
* Vaginoplasty – Penile Inversion & Zero Depth
* Orchiectomy – w/ & w/o Scrotoplasty
* MTF Breast Augmentation – Implant based & Fat Grafting
* Hysterectomy & Salpingo-oophorectomy – Performed as “combo” with Top Surgery

One (1) or Two (2) Gender Therapist Letter(s) are SOMETIMES required for:

* Facial Feminization
* Other Gender Affirming Plastic Surgery Procedures

 

The Gender Therapist(s) letter(s) must include ALL of the following when applicable and factual:

  1. Patients legal and preferred name, if different
  2. Patients date of birth
  3. State that that the patient is the “age of majority” (18 years of age or older)
  4. Date provider/patient relationship began
  5. Frequency of contact/visits/follow up care
  6. State that the patient has the “capacity to make fully informed decisions and is able to consent to treatment”
  7. State that patient has a confirmed diagnosis of Gender Dysphoria
    1. State that the patient has the desire to live and be accepted as a member of the gender they align with usually accompanied by the wish to make their body as congruent as possible with their preferred gender via hormones and surgical intervention.
    2. State that the Gender Dysphoria diagnosis is not a symptom of another known mental health disorder
  8. State that the Gender Dysphoria diagnosis causes clinically significant distress or impairment in social, occupational or other important areas of life.If the patient has significant medical or mental health issues present, they must be reasonably well controlled and stated in detail as such.
  9. State that hormone therapy is specifically for the treatment of Gender Dysphoria
  10. Letter must be physically signed by the treating provider
  11. Letter must be printed on official practice or providers letterhead

Completed letters should be sent to Dr. Gallagher’s office via any the following methods: 

Fax:  Attention- Dr. Gallagher (317) 968-1371
Email:  AskUs@UniversityGenderAffirmationSurgery.com
Mail:  Attention- Dr. Gallagher, 545 Barnhill Dr. EH 232, Indianapolis, IN 46202

**The gender therapists providing these letters have a duty to write them at their discretion and to the best of their knowledge based on the relationship they have with their client. It is up to them to determine if they would like to see their client for additional visits or care before agreeing to write them. It is also up to them to determine if their client meets the following criteria. These are the minimum items that need to be represented in the letters; further detail should be added when appropriate and warranted.

Please visit our website for further information at www.UniversityGenderAffirmationSurgery.com