Trans & Gender Diverse Care
Letters for
Gender Affirming Surgery
WPATH SOC 8 compliant evaluations and letters of support for transgender and gender-diverse individuals — quickly & minimal gatekeeping.
Schedule Your EvaluationA letter written with care, & minimal gatekeeping
If you're 18 or older and seeking gender-affirming surgery, most surgeons and insurance companies require 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 across California, Oregon, Washington, and New York.
Our process is built on the informed consent model — we respect your autonomy and keep barriers to a minimum while meeting all clinical and insurance requirements.
Procedures we write letters for:
- Top Surgery
- Vaginoplasty
- Phalloplasty
- Hysterectomy
- Facial Feminization Surgery
- Facial Masculinization Surgery
- Gender Affirming Body Contouring
- Other gender-affirming procedures
Our Process
What Happens During Your Evaluation
A straightforward, affirming process designed around your needs — not a checklist.
Schedule
Book your evaluation online with a $25 holding fee. Telehealth only — available anywhere in CA, OR, WA, and NY.
ID Verification
Upload a valid government-issued ID securely before your session. Required for documentation purposes.
Comprehensive Evaluation
We assess gender identity, gender dysphoria symptoms, and treatment readiness using DSM-5-TR criteria, with a risk-benefit discussion of your affirming care options.
Your Letter
Receive a professional WPATH SOC 8 compliant letter for your surgeon and insurance company, valid for one year from the date of issue.
Provider Consultation
Up to 30 minutes of consultation time with your medical team is included — at no additional charge.
Ongoing therapy is not required, but many clients find it valuable during their gender-affirming journey.
Transparent pricing, no surprises
We believe financial barriers should never stand between you and the care you need. You pay once — everything is included, including any future letters or revisions for additional procedures.
We accept Cigna insurance in-network. For all other plans, we provide a detailed superbill for out-of-network reimbursement. Many plans reimburse a significant portion of the $225 fee.
Schedule Your EvaluationEvaluation & Letter
Transparent pricing; a $25 fee is required to hold your appointment and credited at the time of service
What to Expect
Your Letter & Your Session
Everything your surgeon and insurer need, delivered through a secure, affirming virtual experience.
What Your Letter 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
- Valid for 1 year from the date of the letter
- Clinician consultation time with your medical team included
Virtual Evaluation Requirements
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Video must remain on throughout the session — no exceptions. This is a safety and documentation requirement.
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Valid government-issued ID must be uploaded securely before the session begins.
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Sessions are conducted via secure HIPAA-compliant teletherapy — available across CA, OR, WA, and NY.
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You must be 18 years of age or older to receive a surgery letter evaluation.
Hormone therapy (HRT) often follows an informed consent model and may not require a letter. Most gender-affirming surgeries and their insurance coverage still require professional documentation.
Frequently Asked Questions
Your Questions, Answered
Everything you need to know before scheduling your evaluation.
The evaluation typically takes one session — usually 30 minutes to an hour. Your letter will be completed shortly after and provided to your medical providers and insurance company. We aim to turn letters around as quickly as possible so your care isn't delayed.
Yes. Ongoing therapy is not required for a gender affirmation letter evaluation. You only need to complete our comprehensive assessment. Many clients choose to continue with therapy during or after their gender-affirming journey, but it is entirely your choice.
We are in-network with Cigna, so Cigna members will have their evaluation billed directly. For all other insurance plans, we provide a detailed superbill you can submit for out-of-network reimbursement. Many plans cover a significant portion of the $225 fee through their out-of-network benefits.
Most gender-affirming surgeons and virtually all insurance companies require a professional letter of support. Some surgeons operating under an informed consent model may not require one, but insurance coverage for surgery typically requires documentation from a licensed mental health professional confirming your evaluation and readiness.
Hormone therapy (HRT) is a different situation — many informed consent clinics provide HRT without any letter requirement.
Your initial $225 evaluation fee covers your letter and any future revisions or additional letters at no extra charge. Whether you need updated letters, letters for subsequent procedures, or any revisions, you will not be billed again.
We serve California (CA), Oregon (OR), Washington (WA), and New York (NY) via secure teletherapy. This includes major metro areas — Bay Area, Los Angeles, San Diego, Portland, Seattle, and New York City — as well as anywhere else within those states.
Get Started
Your journey deserves
affirming support
Schedule your evaluation today. We'll make the process simple, quick, respectful, and centered on you.
Questions? Email us at hello@rainbowconnectioncounseling.com or call 619.363.4674