Hormone Replacement Therapy (HRT) & Gender Affirming Surgery

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.

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. *Some providers may still require a letter as part of their policy. But it is not required by California law.

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 at least 2 letters. This is true whether you are planning to use insurance or not. Some surgeons’ offices will explain what needs to be in your letter.

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?

Yep! Please contact us to schedule a free consultation and/or to request an appointment. We prefer to speak to people ahead of time to help figure out what you might need, and to answer any questions you have. If you don’t feel comfortable on the phone, you can start by emailing us.

We will send you some documents ahead of time for you to review and fill out, including a brief questionnaire to help gather relevant information. That way we can start your letter as soon as possible.

What are you going to ask me?

We’re not here to decide if you are “trans enough.” Just that you are an adequate candidate for the procedure or medical support you are seeking and have prepared a reasonable amount. (Have you planned out aftercare, are you able to take care of basic needs while recovering, are you familiar with the expected risks and benefits of the procedure, etc.)

Between your consultation and our appointment, we can usually cover everything we need. In order to ethically gather the information that needs to be in your letter, we may need to meet with you for more than one session.

What do you charge?

Prospect Therapy offers this service to the transgender and nonbinary community at a pay-what-you-can rate. We’ve done letters for $20 or $200. No one is turned away due to ability to pay.