Letters of Readiness for Gender Affirmation Surgery

Source: From WPATH SOC version 7, 2011


  • Surgical treatments for gender dysphoria can be initiated with a referral (one or two, depending on the type of surgery) from a qualified mental health professional. The mental health professional provides documentation – in the chart and/or referral letter – of the patient's personal and treatment history, progress, and eligibility. Mental health professionals who recommend surgery share the ethical and legal responsibility for that decision with the surgeon. 
  • One referral from a qualified mental health professional is needed for breast/chest surgery (e.g., mastectomy, chest reconstruction, or augmentation mammoplasty). 
  • Two referrals from qualified mental health professionals who have independently assessed the patient are needed for genital surgery (i.e., hysterectomy/salpingo-oophorectomy, orchiectomy, genital reconstructive surgeries). If the first referral is from the patient’s psychotherapist, the second referral should be from a person who has only had an evaluative role with the patient. Two separate letters, or one letter signed by both (e.g., if practicing within the same clinic) may be sent. Each referral letter, however, is expected to cover the same topics in the areas outlined below. 
  • The recommended content of the referral letters for surgery is as follows:

    • 1. The client's general identifying characteristics
    • 2. Results of the client's psychosocial assessment, including any diagnoses;
    • 3. The duration of the mental health professional's relationship with the client, including the type of evaluation and therapy or counseling to date;
    • 4. An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting the patient's request for surgery;
    • 5. A statement about the fact that informed consent has been obtained from the patient;
    • 6. A statement that the mental health professional is available for coordination of care and welcomes a phone call to establish this