Matthew’s Place
Published in

Matthew’s Place

How to compile the documents needed before gender-affirming surgery

by Andrew Adams


This is the fourth installment of a series of articles detailing my journey to get phalloplasty surgery. After determining what surgery you’d like, researching and consulting with surgeons, and choosing a surgical team, the next step is to acquire the letters required for your specific surgery. This process is unique to every surgical procedure, insurance company, and surgeon. My top surgery, for example, required a letter from a therapist and my psychiatrist. You can find the information for the letters that your surgeon requires for your procedure on their website or by calling the clinic.

For me, The Crane Center requires 3 letters for phalloplasty, and they will not schedule the surgery until the letters are in. They require a letter from a Ph.D level psychologist or therapist, my hormone provider confirming that I have been on testosterone for over 12 months, and from my psychiatrist.

The first letter I was able to get was my hormone provider. I simply made an appointment with the doctor who prescribes me my testosterone, and I brought a list of things that the letter needed to include with me to the appointment. This list was found on the Crane Center website, but if your doctor doesn’t have that list posted somewhere, you can call and they’ll give it to you. My letter needed to have my legal name, the duration of the doctor treating me, when I started testosterone, the dosage and type, and affirmation that I’ve been on hormones for over 12 consecutive months. For this reason, keeping records of previous hormone providers and sharing records between doctors is important, as I had changed doctors several times and had issues making sure that my current doctor got my records and could affirm that I had been on testosterone for over 12 consecutive months. Luckily, even though it took a little longer than I thought it would, I was able to get my letter within 3 months. The doctor was able to email it directly to the Crane Center, although I’m unsure if every surgeon works like that.

The second letter I got was from my psychiatrist. Similarly to the first letter, I made a regular appointment with my psychiatrist, with the provided list of letter requirements. My letter needed to have my legal name and info, the length of time I’ve been seeing that doctor, my prescription information, and a mental status exam. It also needed to include the duration that I’ve been out as transgender, the affirmation that I am capable of making decisions regarding my medical care and that I can consent to surgery. It also needed to list that I understood that I understood the risks of the surgery. Satisfied by my answers, my psychiatrist wrote the letter and emailed it to the Crane Center within one month.

The third letter I needed was from a therapist or psychologist. I figured that this one would be the easiest to get since I have a very good relationship with my therapist, who is very trans friendly and whom I’ve been seeing for three years. When I shared the letter requirements with her, however, she told me that she doesn’t have a Ph.D or equivalent degree, which the Crane Center requires the psychologist writing the letter to have. While she wasn’t able to write the letter, my therapist was able to find and refer me to a psychologist with a Ph.D who was able to write my letter. I made an appointment, which was more expensive due to her not taking my insurance, which is something to consider if seeing an extra person for letters. This letter needed much the same information, with some psychology specific stuff added. This included my legal information, my transition history, my transition goals, and an affirmation that I am of sound mind to make medical decisions for myself. She was able to get this letter to the Crane Center shortly after the psychiatrist.

Each letter came with the initial appointment cost and a fee for writing the letter. This fee ranged from $25 to $100, and you need multiple of them, so that is something else to consider.

After all 3 letters were sent to the Crane Center, I received my surgery date: May 5th, 2023!

About the Author

Andrew (he/him) is a transgender student at the University of Central Florida where he is studying psychology in the hopes of becoming a therapist. He is a peer mentor for at risk teenagers at Aspire Health Partners, and he enjoys gardening, taking care of several pet reptiles, playing the piano, and replaying Skyrim on X-Box. While he has focused on his own growth and wellbeing recently, he has previously worked or volunteered with The Trevor Project, Point of Pride, GLSEN, March For Our Lives, and for local political campaigns as an advocate for LGBTQ rights. Specifically, he also is the plaintiff in an ongoing legal battle against his high school who barred him from using the men’s bathroom due to him being transgender, and that legal battle is still ongoing (See Adams v. St John’s County School Board). Additionally, as an Autistic ADHDer with a connective tissue disorder, Andrew is an advocate for both neurodiversity and disability rig.



Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store
Matthew's Place

Matthew's Place is a program of the Matthew Shepard Foundation| Words by & for LGBTQ+ youth | #EraseHate | Want to submit? Email