Gender-Affirming Surgery Letters

Your identity isn’t up for debate—your access to care shouldn’t be either

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Young woman smiling with confidence representing affirmation and relief after receiving gender-affirming surgery letter support from Guidance Teletherapy

Support That Affirms Your Identity, Not Questions It

Accessing gender-affirming care shouldn’t feel like jumping through hoops. At Guidance Teletherapy, we provide thoughtful, respectful assessments and letters to support gender-affirming surgery and related medical care—for trans, nonbinary, and gender-expansive clients age 16 and up. We believe your identity is not up for debate. Our goal is to document your lived experience in a way that meets clinical standards without putting you through unnecessary hurdles. No pathologizing. No proving. Just care that aligns with who you are and what you need.

How We Work With Surgery Letter Requests

All assessments are conducted by clinicians with training in gender-affirming therapy and letter-writing. These are 1-session assessments via HIPAA-compliant telehealth. We honor client autonomy and do not see this process as gatekeeping. The only reasons a letter may not be issued are logistical (e.g., insurance coverage) or due to the client deciding not to proceed. Here’s how it works:

  • You’ll meet with a licensed clinician for one comprehensive assessment

  • If criteria are met, a letter will be issued for your medical provider or insurance

  • If adjustments are needed for insurance wording, your clinician will revise the letter at no extra charge

  • The session is billable whether or not a letter is issued

A Few Notes About Insurance + Fees

  • Clinician rates vary, and some may take insurance for this service

  • A letter may still be issued even if your insurance denies reimbursement—this is a separate issue from your eligibility

  • If your plan offers out-of-network benefits, we can provide a superbill upon request (PPO only)

  • One session is typically sufficient unless additional documentation or support is needed

  • No extra charge for editing letters due to insurance pushback

For the most accurate fee or coverage information, we recommend reaching out to your preferred clinician directly via our team page.

We are not what other people say we are. We are who we know ourselves to be.
And we are what we love. That’s okay.

—Laverne Cox

Meet Our Gender-Affirming Care Providers

The following clinicians are trained to provide letters and support for gender-affirming medical care:

Ariel Landrum, LMFT

CA, KS, NV, FL, CO, OR, UT & ID

FAQs About Gender-Affirming Surgery Letters

  • No. These assessments are available as standalone services.

  • Nope. We don’t gatekeep based on appearance, pronouns, or transition timeline.

  • That’s a financial decision, not a clinical one. A letter may still be issued, and we’ll work with you on how to use it moving forward.

  • We’ll revise the letter at no cost to make sure it meets their standards—without compromising your dignity.

You Deserve Affirming Care That Doesn’t Make You Jump Through Hoops

We see you. We believe you. And we’ll help you take the next step in your transition with care that honors who you are.

Request a Letter Assessment