How to Get a Letter for Gender-Affirming Care: Where to Start
For many transgender and nonbinary people, accessing gender-affirming care — whether that’s hormone therapy, surgery, or updating legal documents — is a deeply personal and important step. Sometimes, part of the process includes getting a letter of support from a licensed mental health provider.
At Salinda Health, we believe this step should be straightforward, respectful, and rooted in dignity — never a barrier. Here’s a clear breakdown of what these letters are, when they’re needed, and how to get one.
What Is a Gender-Affirming Care Letter?
A gender-affirming care letter (sometimes called a “readiness” or “support” letter) is written by a licensed mental health provider and usually includes:
Confirmation that your gender identity is valid and enduring.
A note that you’ve discussed the risks and benefits of the treatment or procedure.
A statement that you can make informed decisions about your care.
These letters may be requested by:
Surgeons – for gender-affirming surgeries like top surgery or bottom surgery.
Endocrinologists or primary care providers – for starting hormone replacement therapy (HRT).
Legal entities – for changing your name or gender marker on official documents.
Step 1: Know What Kind of Letter You Need
The type of letter you need depends on the care or process you’re pursuing:
Hormone Replacement Therapy (HRT)
Some providers require a letter before starting hormones, while others use an informed consent model.
Gender-Affirming Surgery
Many surgeons follow WPATH (World Professional Association for Transgender Health) guidelines.
Requirements can include:
One letter (sometimes two) for chest/top surgery.
Two letters for genital/bottom surgery.
Letters must come from licensed mental health professionals.
Legal Documentation
Some states require a support letter for legal gender marker changes on IDs or other documents.
Tip: Always confirm requirements with your medical provider, surgeon, or local government office before scheduling.
Step 2: Schedule a Gender-Affirming Mental Health Evaluation
To get a letter, you’ll usually meet with a licensed mental health provider — such as a psychiatrist, psychiatric nurse practitioner, psychologist, or therapist — for a short evaluation.
This is not about proving your identity.
It’s about documenting your informed readiness for care and making sure you have the information you need to feel confident in your decision.
At Salinda Health, we approach this process with:
Respect and affirmation for who you are.
Minimal gatekeeping.
An understanding that these letters are often a formality, not a test.
Step 3: Attend the Evaluation (Telehealth Available)
Because Salinda Health is fully virtual, you can complete your evaluation privately and conveniently from anywhere in New York.
During the conversation, we may talk about:
Your gender identity and journey.
Any support systems you have.
Your understanding of the procedure or treatment.
Any relevant mental health history.
This is also your space to ask questions and discuss anything you’d like clarified before moving forward.
Step 4: Receive Your Letter
Once the evaluation is complete and all requirements are met, your provider will prepare the letter. It will include:
The provider’s credentials and license number.
Confirmation that you meet criteria for the requested care.
A statement of support for your readiness and informed consent.
We can send the letter directly to you or forward it to your medical provider or surgeon — whichever works best. In most cases, we can complete letters within a few days of your appointment.
Why Choose Salinda Health?
We’re committed to making gender-affirming care as accessible and respectful as possible. When we work together, you can expect:
Fully virtual appointments.
Quick turnaround for letters.
No unnecessary hoops or delays.
Care that affirms and celebrates your identity.
Ready to Get Started?
Whether you’re preparing for surgery, starting hormones, or updating your legal documents, we’re here to support you through every step.
Email Amanda at office@salindahealth.com to schedule your evaluation.