Gender Affirming Care Letters
We’ve got your back.
If you are working toward gender affirming care and a provider or insurer needs a letter from a mental health clinician, we can write it. We serve adults across North Carolina and California, the appointment is usually a single virtual visit, and these letters are provided at no cost. You do not have to become an ongoing therapy client, and you do not have to prove anything to us. We are here to support your access to care, not to stand in front of it.
What a gender affirming care support letter is
A gender affirming care letter, sometimes called a WPATH letter, is documentation from a qualified mental health provider that supports your access to medical transition care. It is based on the World Professional Association for Transgender Health Standards of Care. Surgeons and insurers often ask for one before scheduling surgery, and some hormone providers or insurers ask for one before starting hormone therapy. The letter describes that you understand the care you are seeking and are in a position to make that decision.
Surgery readiness letters for gender affirming surgeries, including top surgery, bottom surgery, and other procedures
Hormone therapy letters for clients whose prescriber or insurer asks for one
If you are not sure which you need, we can talk it through at your appointment.
The letters we write
Provided at no cost
These letters are free through our Standard Service. Most providers in this space charge a flat fee, and with coverage rules shifting, we did not want cost to be one more barrier between you and your care. If you need your letter faster, you can add Expedited Service for an additional $150.
Do you need a letter to start HRT?
Often, no. Many hormone providers now work on an informed consent model, which means you can start hormone therapy without a separate mental health letter at all. But this varies. Some prescribers and some insurers still ask for one. The most reliable move is to check directly with your hormone provider and your insurance plan. If they want a letter, we will write it.
How many letters do you need for surgery?
Under the current WPATH Standards of Care, adults need only one letter, regardless of the type of surgery. That said, some surgeons and some insurers still follow the older standard and ask for two. Confirm the requirement with your specific surgeon and your insurer before scheduling. We provide one letter. If your surgeon requires two, the second will need to come from another qualified provider, and we can point you in the right direction.
Affirming, not gatekeeping
If it were up to us, these letters wouldn’t be required.
This appointment might feel like a test you could fail- That is not how we work. The visit is a conversation about your goals and your care. We are not there to second guess who you are. Our job is to understand what you are seeking and to write a letter that helps you move forward.
Gender affirming care letters in North Carolina and California
We see clients virtually across both states, so where you live in North Carolina or California does not change your access. The number of appointments can occasionally vary by the type of letter and by your situation, and we will tell you up front if yours needs more than one visit.
How it works
Standard Service. You are scheduled as soon as possible, usually within 2 to 3 weeks, and receive your letter within 48 hours of your appointment. This service is provided at no cost.
Expedited Service. You are scheduled within 7 days and receive your letter the same day. There is a $150 fee for this service.
All letter appointments are virtual.
Frequently Asked Questions
Do you charge for gender affirming care letters? No. They are free through our Standard Service. Expedited delivery is the only add-on cost.
Do I need a letter to start hormone therapy? Often not. Many prescribers use informed consent and do not require one. Check with your hormone provider and insurer, and if they want a letter, we can write it.
How many letters do I need for surgery? The current standard is one letter for adults. Some surgeons and insurers still ask for two, so confirm with yours before scheduling.
Do I have to be an ongoing therapy client? No. This is usually a single appointment, with no requirement to continue.
Will the appointment feel like an interrogation? No. It is a supportive conversation about your goals and your care, not a test.
What procedures can you write letters for? Top surgery, bottom surgery, electrolysis, and other gender affirming procedures. If you are unsure, ask us.