Surgery Letters for Gender Affirming Care
Affirming Letters of Support for Trans and Non-Binary Individuals
If you're over 18 and seeking gender-affirming surgery—including top surgery, hysterectomy, phalloplasty, vaginoplasty, or other procedures such as facial feminization surgery, facial masculinization surgery, and/or gender affirming body contouring —you need a professional letter of support from a licensed mental health provider. Harry Dixon, MA, LMHC, LPCC, LPC, CST provides comprehensive gender dysphoria evaluations and WPATH-compliant letters for gender affirming surgeries in:
California (CA) — including Bay Area, Los Angeles, San Diego, and statewide
Oregon (OR) — statewide coverage
Washington (WA) — statewide coverage
New York (NY) — statewide coverage
Get the professional mental health letter you need for gender-affirming surgery. Rainbow Connection Counseling Collective provides WPATH SOC 8 compliant gender affirmation evaluations and letters for transgender and gender-diverse individuals in California, Oregon, Washington, and New York.
Our Evaluation Process
We use an informed care model that respects your autonomy while meeting insurance and surgical requirements. Here's what happens:
Comprehensive Evaluation: We assess your gender identity, gender dysphoria symptoms, and readiness for gender-affirming care
DSM-5-TR Assessment: Clinician evaluation for gender dysphoria diagnosis criteria
Risk-Benefit Discussion: We discuss the benefits and risks of different gender-affirming treatments
Professional Letter: Upon completion, receive a letter for your healthcare providers and insurance company. This letter is effective for 1 year following the date of the letter
Provider Consultation: Up to 30 minutes of professional consultation time with your medical team (included)
Ongoing therapy is not required, but many clients find it valuable during their gender-affirming journey.
Transparent pricing and keeping gatekeeping to a minimum
Our transparent pricing model removes barriers:
Evaluation & Letter: $225 (one-time fee)
Provider Consultation: Up to 30 minutes included
Future Edits: No additional charges for revisions or re-evaluations
Insurance Billing: We accept Cigna insurance (in-network). For other insurance or out-of-pocket payment, we can provide a superbill
You pay once for your evaluation and letter. Future letters for additional procedures or updated information are included at no additional cost.
Informed Consent Model & Letter Requirements
It's important to know that best practices for hormone therapy (HRT) now include the informed consent model, where some providers won't require a letter. However:
Hormone Therapy: Many informed consent clinics provide HRT without a letter
Gender-Affirming Surgery: Most surgeons and nearly all insurance companies still require a professional letter
While we respect informed consent principles, insurance coverage for surgery typically requires documentation from a licensed mental health professional confirming your evaluation and readiness for the procedure.
What Your WPATH Letter for Gender Affirming Care Includes
Professional assessment of gender identity and gender dysphoria
Evaluation for gender-affirming treatment eligibility
Formal letter suitable for surgeons, insurance companies, and medical providers
Documentation of mental health evaluation and clinical recommendation
Professional clinician consultation time with your medical team
Virtual Evaluation
Our evaluations are conducted virtually via secure teletherapy. For security and documentation purposes:
Video must remain on during the evaluation
Valid government-issued ID is required (uploaded securely)
No exceptions due to privacy or comfort concerns (safety requirement)
Schedule Your Gender Affirmation Letter Evaluation
Ready to get started with your letter for gender affirming care? Contact Rainbow Connection Counseling Collective today to schedule your evaluation. We'll work with you to make the process simple and affirming.
-
The evaluation typically takes one session (typically 30 minutes to an hour). Your letter will be completed shortly after and provided to your medical providers and insurance compa
-
Yes. Ongoing therapy is not required for a gender affirmation letter evaluation. You only need to complete our comprehensive assessment.
-
e are in-network with Cigna. For other insurance plans, we provide a superbill that you can submit for reimbursement. Many out-of-network benefits may cover a portion of the $225 fee.
-
Most gender-affirming surgeons and insurance companies require a letter. Some surgeons using an informed consent model may not, but insurance coverage typically requires documentation from a mental health professional.
-
We serve California (CA), Oregon (OR), Washington (WA), and New York (NY). Telehealth services are available throughout these States.
-
Your initial evaluation fee of $225 covers your letter and any future revisions or letters at no additional cost.