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  • Monique Nash

Gender Affirming Letters...What Are They?

At Sage Owl Therapy Services, we believe that the current requirement for gender affirming care letters is a form of gatekeeping life saving health care. While we do not agree with the current standards, we have trained in the process of writing these letters in attempt to help reduce barriers to the care many of our clients need. Our intention of this post is not to imply agreement with these standards, but simply to outline the current process for those who may want and/or need to know.

Gender affirmation is an essential aspect of healthcare for transgender and non-binary individuals. One crucial component of gender affirming care, as outlined by the World Professional Association for Transgender Health (WPATH) Standards of Care (Version 8), is the requirement for mental health professionals to write letters to support various aspects of a person's transition. These letters are important documents that can facilitate access to gender-affirming medical interventions such as hormone therapy, surgeries, and legal gender marker changes. In this guide, we will discuss the letter writing process in accordance with WPATH 8 standards.

Understanding WPATH Standards

WPATH is an international multidisciplinary professional association that provides evidence-based standards of care for the health of transgender and gender diverse individuals. The WPATH Standards of Care (SOC) are guidelines for the provision of healthcare for trans and gender diverse individuals and are regularly updated to reflect current research and best practices. The most recent version, WPATH SOC 8, emphasizes informed consent, patient autonomy, and the importance of mental health support in gender affirmation.

Purpose of Gender Affirmation Letters

Gender affirmation letters serve several purposes within the context of gender-affirming care. They provide documentation of a person's gender identity, confirm that they have been assessed for readiness for medical interventions, and demonstrate that they have received appropriate mental health support. These letters are typically required by healthcare providers offering gender-affirming treatments such as hormone therapy and surgeries, as well as by legal entities for gender marker changes on identification documents.

Key Components of Gender Affirmation Letters

According to WPATH 8, gender affirmation letters should include the following key components:

  1. Patient Information: The letter should include the patient's name, date of birth, and any other relevant identifying information.

  2. Assessment of Gender Dysphoria: The letter should confirm that the patient has been assessed for gender dysphoria, as outlined in the DSM-5 or another relevant diagnostic manual.

  3. Informed Consent: The letter should indicate that the patient has been informed of the risks and benefits of gender-affirming treatments and has provided informed consent for these treatments.

  4. Mental Health Assessment: The letter should include a brief overview of the patient's mental health history, including any relevant diagnoses or treatments.

  5. Support for Gender-Affirming Treatment: The letter should clearly state that the mental health professional supports the patient's request for gender-affirming treatments and believes that these treatments are medically necessary.

  6. Duration of Therapy: The letter should indicate the duration of therapy sessions, as WPATH 8 requires a minimum of three months of continuous therapy sessions before providing a letter for hormone therapy.

  7. Qualifications of the Mental Health Professional: The letter should include the professional qualifications of the mental health professional writing the letter, including their licensure and any relevant experience working with transgender and gender diverse individuals.


Writing gender affirmation letters is an important aspect of mental health support for transgender and non-binary individuals seeking gender-affirming care. Mental health professionals play a crucial role in providing support, assessment, and documentation that is essential for accessing gender-affirming treatments. And while many mental health professionals are of the same mindset that we are here at Sage Owl, that these letters are a form of gatekeeping medical care, they are still a necessary part of the process, for now.



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