To All the Clients Who Desire a Letter
One of the most common things I’ve done for clients (and something I feel very comfortable with) is writing letters in support of their access to HRT (Hormone Replacement Therapy and/or desired surgeries. It’s a process that unfortunately some people need to obtain in order to start their transition. The thought of navigating the gatekeeping process can be intimidating. Will I be denied a letter? How many sessions will it take? Can I keep seeing a therapist even if I obtain a letter? I’m hoping this post calms some fears and answers some questions!
First off, clinics will not necessarily require a letter for HRT. In fact the World Professional Association for Transgender Health (WPATH) states that “clients do not have to be in therapy to acquire a letter.” However, if you plan on having insurance pay for HRT or surgery there is a higher chance a letter or two may be needed. The good news is the process can be quick and painless! It does require some opening up about your experience, and it’s in your best interest to find a therapist who is accepting, affirming and knowledgeable. California is also an informed consent state which means that the provider needs to disclose all information about the procedure to the client so they fully understand when they consent to the procedure.
I had a discussion with one of my friends who went through the process and he mentioned that the process was fairly easy, but that his insurance required letters. Some fears he felt were the possibility of ‘not being trans enough’ to obtain a letter. While this is a valid fear, especially in our society today, know that as long as you feel you would like HRT, you shouldn’t let getting a letter stop you! To answer another question from above, if you want to continue with a therapist and get HRT that’s not a problem. No one can or should deny you HRT if you continue to see a therapist for any other mental illness and/or personal issues. Sessions just for HRT can genuinely be short so expect at least 1-3 sessions. 3 months or 12 sessions are no longer required. If a therapist requires more or can’t tell you when you’ll receive your letter it may be a sign that they have less familiarity with the process and are following outdated standards of care.
Still, if you are struggling with insurance or letters you can always contact an affirming therapist or your local LGBT Center’s trans coordinator to help you with the process. Hopefully, the future will get better and improve the process so that the trans community doesn’t have to deal with gatekeeping around transition services.
If any readers out there need a start to find a local LGBT center check out Center Link, search for local therapists that support transgender folks on Psychology Today or reach out to me directly! I’d be happy to help!