Gender-affirming surgery letters, HRT letters, and assessments.
If you need a gender-affirming surgery letter, an HRT letter, or a gender dysphoria assessment, I offer that as a standalone telehealth service for adults in Washington State, as my schedule allows. You don't have to be in ongoing therapy with me, and asking for a letter doesn't sign you up for therapy you didn't want. You come in for the assessment, we do the work it actually requires, and you leave with documentation your surgeon or insurer will accept.
I write letters for top surgery and for other gender-affirming surgeries — where a surgeon or plan requires two letters, mine can be one of them — as well as HRT letters for providers who still ask for one. When something in your life requires it, I also write support letters for gender-marker and name changes.
An assessment is not a test you can fail
The letter exists because a surgeon or an insurance company requires documentation from a licensed mental health provider. My job in the assessment isn't to decide whether you're trans enough to deserve affirming care. It's to document, clearly and in the language the requirement was written in, what you already know about yourself — and to make sure the letter covers everything your specific surgeon or plan asks for, so it doesn't bounce back and cost you months.
I offer real clinical assessment; the letter carries my license, and it only helps you if it's credible. But that the process is collaborative. I'm not hunting for reasons to say no, and if anything does need addressing before I can ethically write, you'll hear it from me directly, early, with a plan.
How it works
We talk first. A free 15-minute call to confirm what you need, what your surgeon or insurer requires, and whether I'm the right person to write it.
The assessment. Usually a single telehealth session; sometimes a second, if your surgeon's or insurer's criteria need more ground covered. Bring any written requirements your surgeon or insurance plan gave you, and we'll work from those.
The letter. I write to the criteria your provider specified; most requirements track the WPATH Standards of Care, and I make sure the letter speaks their language.
Everything happens by telehealth.
What it costs
Assessments bill as regular sessions, nothing extra for the letter itself. Because this is private pay, the assessment itself stays out of insurance databases; the only people who see the letter are the ones you send it to.
If you're looking for more than a letter
Some people need the paperwork and nothing else. But if you're also looking for ongoing support — gender exploration, transition logistics, trauma work — that's the other half of my practice. Start with the gender-affirming therapy page.