Letter Program for those seeking Hormone Replacement Therapy (HRT)
& Gender Affirming Surgery

*If you are a client of Prospect Therapy, you can get your letter through your clinician for no additional charge - please reach out to your therapist directly for fastest service. This program is for people seeking a letter who do not want ongoing therapy services or who cannot afford services at this time. If you would like to begin therapy services and also want a letter, please mention that in your inquiry form.*

DO I NEED A LETTER?

First of all, it sucks that you need letters to make decisions about your own healthcare and your own body.

In California, if you are over 18 and are seeking hormone replacement therapy (HRT) to support your transition - you don't need a letter. Some providers may still require a letter as part of their policy, but it is not required by California law.

You can find a medical provider (physician, ob-gyn, endocrinologist, advanced practice nurse, physician assistant) who is familiar with gender dysphoria and who can evaluate your ability to provide informed consent to HRT. They can prescribe you hormones to support your transition without needing a letter from a therapist. If you need some names of providers (or if you are a provider) who offer this service, please contact us.

If you are seeking gender affirming surgery, your surgeon may require more than one letter. This is true whether you are planning to use insurance or not. Some surgeons’ offices will explain what needs to be in your letter. Our letters are written with WPATH 8 standards and meet most requirements, but we’re happy to add additional information if your surgeon requests it!

Please note we are master’s level therapists, not doctorate level psychologists or psychiatrists. You may need one of each. But it’s cool - we know people we can connect you with.

OK I NEED A LETTER, CAN YOU HELP ME? WHAT DO YOU CHARGE?

Yes, if you are a resident of California. After several years of only offering free letters, we now have three options depending on your timeframe/budget to best accommodate everyone's needs:

Express Service ($200): Letter within 7 business days; includes free revisions for the next year for formatting, factual corrections, or standard updates requested by your surgeon. You'll get your appt date when booking and your letter (uploaded to your secure client portal) by the end of the day of your appt.

Standard Service ($100): Letter within 3-4 weeks; includes free revisions for the next year for formatting, factual corrections, or standard updates requested by your surgeon. You'll get your appt date when booking and your letter (uploaded to your secure client portal) within 48 hours of your appt.

Budget Service ($0, Free!): Letter within 2-4 months; includes free revisions for the next year for formatting, factual corrections, or standard updates requested by your surgeon. You'll get an estimated date range for your appt, but scheduling won't occur until we contact you within that date range. You'll get your letter (uploaded to your secure client portal) within 48 hours of your appt.

Please submit your request below with your timeline. Once you submit a request, our Letter Access Coordinator will email you back with next steps, usually within a few days, and will be able to tell you more specifics about the current waitlist and your expected timeline. Regardless of which route you choose, your letter will be the same high quality! You only need to consider the paid options if you need your letter sooner.

WHAT ARE YOU GOING TO ASK ME?

We are not here to decide if you are "trans enough." Our evaluation is designed to make sure you have what you need to move forward, not to question whether you belong in this process.

What we are here to do is make sure your letter accurately reflects your experience and gives your surgeon and insurance everything they need to move forward with your care. A thorough evaluation protects you. It means your letter is less likely to be questioned or challenged down the line.

We will ask about your gender journey and transition, your understanding of the procedure you're pursuing, your aftercare plan, and your general mental health history. There are no objectively right or wrong answers, just the truth of your experience. We are required to tell insurance about your transition so far, and this can be the very first step.

Most clients complete their evaluation in one appointment. In some cases, we may need a follow-up session to make sure we have everything we need for a thorough and accurate letter. We will always let you know if that's the case.

Our letters are written in accordance with WPATH Standards of Care Version 8, the current prevailing standard for gender affirming care, and meet most surgeon and insurance requirements. We're happy to add additional information if your surgeon requests it.

All letters are completed by one of our licensed clinicians and reviewed for clinical accuracy before being sent to you. You’ll be able to review it to make sure it accurately reflects what you shared with us.

As part of our standard process, we may reach out to your surgical team directly to ensure your letter meets their specific requirements and to invite any follow-up questions they may have.

Please note that our clinicians are master's level therapists, not doctorate-level psychologists or psychiatrists. Some surgeons or insurance plans may require a letter from a doctoral-level provider. We'll let you know if that applies to your situation, and we know people we can connect you with.

What if my evaluation Requires more than one session?

In most cases, one appointment is all you need. Occasionally, based on what comes up in our conversation, our clinician may determine that a follow-up session is needed before your letter can be written. This isn't a judgment about your readiness. It's a clinical decision to make sure your letter is as accurate and complete as possible.

If that happens, we will let you know right away, explain why, and work with you to schedule a follow-up as quickly as possible. The cost of a second session, if needed, will be discussed with you at that time.

What if You’re not able to write my letter?

In rare circumstances, our clinician may determine that we are not able to write your letter at this time. This could be because something came up in the evaluation that needs to be addressed first, such as an active concern that would benefit from support before surgery.

If that happens, we will always tell you why, note our clinical reasoning, and make sure you leave with referrals and next steps so you're not left without a path forward. Our goal is never to be a barrier. It's to make sure you have what you need to get there safely.

WHAT IF I DON’T LIVE IN CALIFORNIA?

Prospect Therapy clinicians are only able to provide services to people in California.

The Gender Affirming Letter Access Project is a nationwide network of clinicians who offer sessions and letters at no charge. Many offer online sessions if you reside within their state but are not local to their office.

SO IF THIS SERVICE IS FREE- ARE THE CLINICIANS WRITING THE LETTERS WORKING FOR FREE?

Our clinicians are paid for all of their work! While this service is completely free to you, our clinicians are compensated for their time writing letters by Prospect Therapy: it’s a win-win!

If you’d like to make a donation towards our letter program (and potentially increase the number of letters we can offer per month), you can do so on Venmo.