Transgender Teen Survival Guide

Lee says:

Yes, the Top surgery page has two links on that!

There’s a template for a top surgery letter, and a link to my actual letter I got for top surgery so you can see the template and then see a real-life example.

My post has pictures of the letters I got for testosterone, top surgery, and my hysterectomy (slightly redacted for privacy reasons) so you’ll have to ignore the other letters. The caption lists the WPATH criteria for said letters.

Lee says:

Any therapist can write the letter- I believe the WPATH standards doesn’t specify any particular degrees they need to have. 

You can see the general format of what a letter for hormones looks like here:Sample Referral Letters for Hormone Therapy and Gender-Confirming Surgeries

And you can see a real-life example of an actual letter for hormones here: Lee’s testosterone letter

You should be direct about what you want when you contact a therapist- say something like “My primary goal in my sessions with you is getting a letter to start HRT/get surgery. Here is the relevant portion from the WPATH-SOC on writing the letter. How long will it be/how many sessions do you think it’ll take before you’re comfortable writing this letter for me?”

Our Therapists and therapy post has more info on getting a therapist.

Lee says:

Any therapist can write you a WPATH-compliant top surgery letter to give to your surgeon or insurance, they don’t need to have any specific trans-related qualifications beyond being willing.

Here’s the letter I got as an example!

Lee says:

I got my top surgery letter from a regular therapist- you don’t need a “gender therapist” in particular, just any therapist will do as long as they agree write it.

Info on finding a trans-friendly therapist is here.

Lee says:

I’d say don’t look a gift horse in the mouth. It is super quick, but there’s nothing wrong with that!

It’s possible you can get a letter that meets WPATH criteria after only two sessions, and it seems even more likely that she’d reduce the gatekeeping because she consulted with an actual trans person in the field who is more knowledgeable about it.

I got my first lower surgery letter after seeing my psychiatrist for a long time, but I got my second lower surgery letter on only my second visit to Callen-Lorde because they’re more trans-friendly and used to writing WPATH letters, so the amount of time it takes before a therapist is ready to write a letter varies.

Just make sure you review her letter and see that it says everything that it needs to!

Followers say:

galaxiesand6 said: That’s how quickly a got my letter for t with a good therapist. Then, once I asked for the letter for top surgery I got that instantly. There are therapists out there who understand how important it is

itsnotblonde said: i once went to a trans conference and listened to a trans man who worked as a therapist talk about how he didn’t even require people to come in (or pay a consult fee!!) before he’d write them a top surgery letter because of how bad the gatekeeping is

Lee says:

No, I don’t think there’s any data about how long it takes on average before you can get a letter for surgery.

It took me around 6 months to get a top surgery letter because I had other mental health issues and they didn’t want to write me a letter until I was more stable. When I got top surgery, I was about 4 months on T.

On the other hand, one of my friends was able to get a top surgery letter after only three sessions with a therapist.

How long it takes before you’re able to get your letter depends on your mental health, what disorders you’re diagnosed with, sometimes how long you’ve been out is part of the equation, and of course the most important factor is the particular psychologist who you’re seeing. Some are willing to write letters quickly, but others aren’t.

Lee says:

Their website has an FAQ that answers this:

“Q: Can my counselor provide a letter/recommendation for HRT?

A: Whether an individual counselor is willing to provide some kind of letter or recommendation is up to each individual counselor. We want to be transparent with you in that many of the counselors on the platform do not provide recommendations of this nature due to the limitations of doing counseling online (can’t see you face to face for a full evaluation/assessment; the counselors on the platform do not confirm/provide any official diagnoses).”

Followers say:

a-fan-fighting-for-equality said: Hi! As far as I’m aware, the short answer is maybe, but almost none of the councilors will. I don’t really know the ins and outs, so I’ll explain what I’ve learned. The Pride Counselor are licensed professionals in their states. Because of the nature of the therapy being online it is optional for a therapist to write a letter. Many refuse because they cannot complete a full evaluation. It also hurts their case because they CANNOT diagnose patients. I hope this helps!

Lee says:

I’ve always had my surgeon picked out before I got my letters, but I think you can get them addressed to a generic “to whom it may concern” if the person writing the letter is okay with that.

Lee says:

Any therapist can diagnose you and write a letter.

Lee says:

Yeah, it doesn’t matter the state. I got my therapist’s note in CT and got top surgery in CO.

Lee says: 

It depends on your endocrinologist since there’s no Official tm expiration date on letters. Some endos may want a letter that’s recent like within the year and others might not mind if it’s from a while ago. 

Lee says:

No, as far as I’m aware there isn’t a certain required time you have to be in therapy before they write you a letter listed in the WPATH-SOC so it’s up to the therapist’s discretion. So the therapist can choose to write the letter after 1 session if they wanted to, but they usually don’t- the average time seems to be around 3 months.

Jay says:

It varies dramatically depending on where you live and who the therapist is, and what your needs are. Some people do take a year. Some people (like me) are approved at their second appointment. Most people I’ve asked say it took them about 2-6 months to be approved. It really depends on what you need though.

Lee says:

It took me like 4 months of intensive outpatient therapy which is like 10 hours of therapy a week. Like Jay says, it varies, but it can take longer if you have a stigmatized mental illness. 

Kai says:

we have resource pages on coming out but check out our “coming out” tag and “school” tag. Here’s a link to our coming out page.

generally for teachers/adults at school i recommend in person if you want, but email should work just fine. we have example emails in our “school” tag but a general format is just

Hello _teacher name_,

My name is _preferred name_ and I am listed as _legal name_ but I would prefer if you call me _preferred name_ and _pronouns_. If you have any questions, please email me back.

Thank you,

_your name_

for peers/students coming out to friends first is a good first step and then what i did was make a post on Facebook asking people to call me my name and pronouns. If you don’t use Facebook, Instagram would work fine for this and maybe Snapchat or Twitter? other social media that people at school follow/can see works as well.

Alternatively, just tell your friends and then once teachers start calling you the right name and pronouns people will figure it out.

If your school has a GSA/LGBT club, i would recommend you join that because you can meet fellow LGBT+ students and get support - plus that means there is a teacher who would be an ally if you run into trouble at school.

good luck!