If you see a provider for gender affirming care, your first step is asking them how their office handles surgery referrals. Many programs follow similar steps to the below.

SELECTING A PROVIDER: Click the links above to see lists of surgeons who provide gender affirming procedures. You can have a surgical consultation with more than one surgeon if you would like to have options.

It is recommended to have a referral sent by a provider with letters of support (below) included in the referral rather than calling yourself to schedule the consult. However, you may want to call the surgeon’s office to ask questions like:

• What is your waitlist?
• Do you have specific letter requirements aside from my insurance company’s requirements?
• How early in advance do you need the letters?
• How should I/my providers send the letters to you?

You should also outreach your insurance provider to ensure the surgeons you are interested in are in network with your insurance. You can also ask your insurance company what their requirements are for covering gender affirming surgery.

LETTERS OF SUPPORT:

You will need to work on getting letters of support/referral from your providers. Different surgeries, surgeons, and insurance companies have different letter requirements. Usually, patients will need to ask their therapist for a behavioral health letter. If you do not have a provider who can write you a letter, check out The Gender Affirming Letter Access Project or Van Ethan Levy’s Provider List.

Letter Requirements

• Most top surgeries require 1 Behavioral Health letter and 1 Medical Letter
• Most bottom surgeries require 2 Behavioral Health letters and 1 Medical Letter

SCHEDULING THE APPOINTMENT:

Once the referral is placed, the surgeon’s office will reach out to schedule an appointment. You can also call the surgeon’s office to schedule the appointment if you have not heard from them following your referral being sent.

FIRST APPOINTMENT:

You will have your first appointment with the surgeon to discuss risks and benefits of surgery as well as different surgical options. If both you and the surgeon agree to proceed with the surgery, your surgeon’s office will start the process of obtaining insurance coverage for your surgery.

If it has been a long time since you obtained your initial letter(s), your surgeon may require an updated letter of support.

SURGERY & RECOVERY!
Recovery depends on the surgery you have, and it is important to have a plan for supporting yourself mentally, physically, and financially after surgery. You will have regular follow up with your surgeon after your surgery as well! 

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Surgery Readiness Assessment Questions to Consider

It may be helpful to think about your answers to the following questions prior to pursuing surgery.

1. Why do you want gender affirming surgery? Provide at list 3 reasons. This question may seem self-evident, but often providers like using the patient’s own words if they are asked by insurance companies to justify the need for surgery.
2. What are your goals or expected outcomes from having surgery? Be specific.
3. Have you had surgery before? How were your past experiences with surgery?
4. What concerns or fears do you have about going forward with surgery?
5. What complications are possible from your gender affirmation surgery?
6. How do you balance the desire for surgery with your concerns/fears and the risk of complications?
7. Recovery after surgery often involves taking time out of work/school, limiting activity, and often involves physical pain, multiple follow-up appointments, and time when the outcome does not look as you would expect it to (there may be bruising, swelling, etc). How do you envision you will do in recovery? Do you have any questions about the recovery process? How will you cope emotionally if the recovery goes different than you expect?
8. Do you have supports in place, including people to drive you to/from surgery, people you can go to for emotional support during recovery, and people who can help with essential things at home until you are able to return to full activity?
9. What other questions do you have for the surgeon that would help you in determining if this surgery is right for you or to help you prepare for the procedure?