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As part of the process of preparing to undergo gender affirming top surgery – whether it is for FTM or FTN (also MTF) – you will generally need a supportive letter from a mental health therapist. Among the important items that must be documented are the persistence of your gender dysphoria, living full-time and successfully in your chosen gender for a specified period of time and being mentally competent to be able to make this decision and understand the consequences and implications.

For more specific information on this, read “What Letters Do You Need For Scheduling Your FTM/FTN Top Surgery?”  and the update, “Update on “What Letters Do You Need For Scheduling Your FTM/FTN Top Surgery?” .

Informed Consent

Some plastic surgeons that do perform top surgery use the health care model of “informed consent” and, consequently, do not require a letter from a therapist in order for you to undergo the surgery. However, if you are seeking insurance coverage for your surgery, obtaining this letter is mandatory. Furthermore, most outpatient centers and hospitals also require this letter in order to have surgery at their facilities.

What is informed consent?

Essentially, this is the plastic surgeon informing you of all aspects of the procedure including what is involved, expectations, risks and complications. This also emphasizes the permanency of the procedure. A surgical consent is signed and you are deemed to have the intellectual ability to understand all the relevant issues and information.

It is important to understand that informed consent is the standard of care that should be part of the informational process for any patient seeking to have surgery of any type. I adhere to this rigorously for all my patients seeking any surgical procedure that I perform. It is absolutely an essential, inherent part of the consultation process and pre-operative experiences for my patients.

Importance of a Letter from Your Therapist

Yes, seeing a therapist and ultimately having a letter written supporting your desire for top surgery is an expense that you may rather not have. However, ultimately you actually may be saving money AND you will also be able to have your top surgery. That surely is better than continuing your life having to forever contend with gender dysphoria because you couldn’t get the procedure.

The following are generally the most important reasons for obtaining this letter. Some or all may apply to your situation.

Insurance Companies Mandate that You Have a Therapist Letter

If you are seeking insurance coverage for your top surgery, all insurance companies presently require that you have a letter written by a therapist with specified qualifications. Along with other documentation, this letter must state that you have persistent gender dysphoria and that you are mentally competent and understand the implications and consequences of the procedure.

The Surgical Facility Mandates a Letter

Whether the surgery is to be done in an outpatient facility or hospital, a letter is usually required in order to use the facility.

Your Plastic Surgeon Requires a Therapist Letter

Unless your plastic surgeon uses informed consent, which probably represents a minority performing this procedure at present, a letter will be required in order for them to perform your surgery.

Protection and Confirmation of the Appropriateness of Top Surgery

This letter also can serve as an added protection and benefit to you in your goal to have the procedure. If you have proceeded this far in your transgender journey to the point where you are wanting to have surgery in order to transform your chest, it is highly likely that you are both serious about it and this is an appropriate course of action for you.

What you do not want to have happen is to ultimately experience buyer’s remove – regretting your decision and later having to detransition.

Being fully evaluated by a therapist and having a supportive letter written will not prevent this from ever happening, but surely it serves as another layer of protection for you.

This is a very small price to pay if, for whatever reason, the surgery may not be the appropriate solution for you.

Finding a Therapist to Write Your Top Surgery Letter

In order to get a therapist to write your letter, you will first need a therapist!

Sounds relatively simple and it actually is, for the most part. This is true whether you live in a large metropolitan area like Phoenix and Scottsdale or Tucson or in a small town like Snowflake, Bisbee or Safford. However, in smaller communities, there will be far fewer in person, convenient options.

The following are ways to get yourself that therapist:

  1. You already are seeing one. Use them!
  2. Get a recommendation from your primary care doctor.
  3. If you are getting your testosterone at a clinic, you may be able to get a recommendation from there.
  4. Ask the plastic surgeon who you want to perform your surgery for recommendations. For our patients who do not have a therapist, we offer them a list of therapists recommended by our other transgender patients.
  5. Do an online search. You may want to target those specializing in or at least listing LGBTQ+ services.

Many therapists nowadays offer virtual consultations and virtual treatments. This means that you can select someone in your city or town, elsewhere in Arizona or even elsewhere in the US (depending on relevant laws and licenses to practice) without having to travel anywhere. The same is true if you live in another state.

When it comes to finding a therapist and obtaining your letter, there are more options and opportunities for you than ever before.

And often, with greater convenience.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

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