If you are in need of gender-affirming care, you may have heard about WPATH letters. These letters are an crucial part of obtaining certain transgender healthcare services and having your insurance cover those services. Let's explore what WPATH letters are and what clients need to know when seeking one from a therapist.
What is WPATH?
WPATH stands for the World Professional Association for Transgender Health (https://wpath.org/). WPATH is an international organization that sets standards of care for the health of transgender and gender-diverse identifying individuals. Their work is crucial in securing and establishing the safety and protection of the gender-diverse community.
What is a WPATH letter?
WPATH letters are also known as letters of recommendation or support. These are documents written by licensed mental health professionals (or those that are co-signed by a licensed individual for those who have an associate license) who have assessed the client seeking gender-affirming care. These letters confirm that a client meets the criteria for gender-affirming treatments such as hormone therapy or gender affirmation surgery. It also states that you and your therapist have discussed the potential risks of starting hormone therapy or undergoing gender-affirmation surgery and any post-surgical plans care and support.
Why are WPATH letters necessary?
Almost every insurance company that does cover gender-affirming care, require WPATH letters before approving gender-affirming treatments. These letters help ensure that clients are well-informed and psychologically prepared for their transition.
How To Find The Right Therapist
When seeking a therapist who is trained to write these letters, consider these important parts of the process:
Collaboration: Writing a WPATH letter is a collaborative process between the therapist and client, working together towards the client's goals. Once you advise the therapist you are seeking a letter for hormone therapy or gender-affirmation surgery, the therapist can be aware of that and begin their "assessment" process to gather information they will synthesize and write in the letter.
Number of Sessions: The number of sessions required can vary depending on the therapist. Some therapists may write a letter after a single sessions, while others may require a more extended evaluation. You can inquire about the number of sessions ahead of time in a consultation before starting work with them or even by email or text when setting up your initial appointment. Hormone therapy "assessments" should only take 1-5 sessions max. For Gender Affirmation Surgery, insurance companies often state a requirement of a minimum amount of time in therapy being required. For example, some insurance companies state that an individual will need a letter from a therapist they have been seeing for a minimum of 1-year's time before they can apply for gender affirmation surgery and have it approved for coverage by the insurance provider. Contact your insurance provider for information about the requirements they have for coverage of care.
Costs For WPATH letters: Some therapists may charge a fee for any letters they produce in addition to session fees. You can ask them this question at the consultation or before you make an appointment. The fees may also be listed on their websites or in the intake documents sent to you before starting services.
Culturally Trained & Trauma-Informed: Ask your therapist if they use an intersectional and trauma-informed approach which recognizes your diverse cultural experiences and potential triggers that may impact your journey. Most therapist list this training or expertise on their websites or profiles. You can always directly ask this question in a consultation.
Sharing Your Experience: Being open can feel vulnerable in these sessions especially due to the history of “gatekeeping” in the medical system. Be prepared to share parts of your experience with your provider in order for them to have the needed information for the letter and access to care. Since it will likely be only 1-5 sessions, expect to share more personal details in the first session possibly. Always feel free to also ask your own questions about the process and expectations at every step.
Discuss Your Goals: Clearly communicate your goals and expectations at the onset of services to decrease wasted time in your efforts to obtain your letter. You do not need to have all the answers, but should share your current goals and expectations.
Understanding Risks and Benefits: Part of the conversation you will have with your therapist will be to ensure you understand the potential risks and benefits of various gender-affirming treatments, hormone therapy and gender affirmation surgery. Additionally, you should recognize that if you choose a therapist who is not educated on these letters or who does not have much experience working with the gender-diverse community, they may not be aware of the requirements and may look to you to provide the information - we would strongly suggest you find another therapist if that is the case. YOU are the client, the therapist should be the expert on this, not you.
Support System: You can also expect to talk with your therapist about your support network and how you plan to navigate the social aspects of transition, which you may have already started by the time you reached a therapist for hormone therapy, but you may not have and that is also okay. Reaching out to even explore gender is a great way to help you figure out if transitioning physically is even what you want. Talking these things through with a professional can help you figure out what feels more authentically true to you. It is important to develop a support system for many reasons, but one that is important for transitioning, is the post-surgical care you will need after gender affirmation surgery. If top surgery is occurring, you will need help with draining for the few days post surgery. Bottom surgery will require intimate care as well. You will need help and support, so be ready to identify who specifically will be assisting you post-surgery.
Letter Expiration: WPATH letters typically expire after one year of the date on the letter. Be prepared for this and understand that you may need to obtain updated letters for ongoing or future treatments.
Finding a Qualified Therapist
Look for a therapist who uses a trauma and culturally informed, collaborative approach
Is familiar with WPATH Standards of Care/Trained to write WPATH letters
Has a history of writing WPATH letters
Is LGBTQ-friendly / queer-friendly
Is upfront about fees, number of sessions and process details
Although we recognize this process is daunting and tiresome, and that it can feel like there are constant hurdles you must overcome to get to your goals to just feel comfortable in your body, it will be worth it in the end. The hope is that in the future obtaining this care will not be such a tedious process and be so time consuming. We understand you know who you are and how you want to identify, and we love you for being your beautiful, authentic self!
Reach out to Grounded Connections Counseling, Inc to schedule with one of our therapists to begin the process of obtaining a WPATH letter for hormone therapy or gender affirmation surgery. We are here for you through your next steps towards a more authentic you.
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