Requirement for Transgender Surgery

As of June 25, 2024, the Standards of Care (SOC) 8 from the World Professional Association for Transgender Health (WPATH) require only one assessment letter from a qualified healthcare professional for gender-affirming surgery. This provider must be equipped to care for transgender and gender-diverse individuals and can be either a medical or mental health professional with at least a master’s degree. If the provider is out-of-network for the patient’s insurance, they might need to provide a referral letter.

The letter should include:

• The patient’s legal and preferred names; and date of birth

• Be dated within one year of surgery

• The start date of the patient-provider relationship and frequency of contact

• A statement confirming the patient’s well-documented diagnosis of gender dysphoria or gender identity disorder

• Evidence that the patient has lived in a gender role aligned with their identity for at least 12 consecutive months

• The patient has undergone a minimum of 12 continuous months of hormone therapy (for bottom surgery and breast augmentation only).

• Indicate the type of procedure the letter is for (e.g. vaginoplasty, top surgery, facial feminization)

• Confirmation that the patient has managed any substance use, including alcohol, nicotine(including vaping) or marijuana, for at least six months before surgery.

• Statement that state the patient has the capacity to make fully informed decision and consent to treatment.

• Provider should state their experience with treating patients diagnosed with gender dysphoria.

• Signed and date, with the provider and their license number