How do I get my gender affirmation HRT Letter?

How do I get my HRT letter, or do I even need one anymore?

Availability of resources for the transgender and gender non-conforming community frustrate me to no end sometimes. I often have clients call telling me they have been looking for a hormone replacement doctor or their letter for a year.

Some doctors still require a letter. WPATH standards now state the letter is suggested. I recognize the reality that doctors in Georgia and other states  still need a letter in hand to begin hormones. I do provide that service. I decided to begin online therapy so even more people would have access to affirming care.

How do I find a Doctor and Therapist for Hormones?

But what happens if you sit down to your computer and are looking to start HRT? If you feel comfortable, you can start by asking your own primary care doctor for suggestions. You could start by searching the internet for terms like “hormone replacement therapy for transgender”. You could search for “LGBTQ doctor” as well. Or you can search for a therapist using tools like Psychology Today. You can narrow your search by filtering for only people who work with the key word transgender. I like it when therapist’s profile specifically mention that they work with the community.

If you can find a therapist who works with the transgender community, like myself, they should be able to point you to the available resources in your state. Another great option is to contact your local PFLAG office. Even if you are in a rural area, they should be able to point you in the right direction.

Some good questions to ask your therapist are: 1. How many sessions do I need to attend to receive my HRT letter? 2. What is the cost of writing the letter? 3. After I have my HRT letter, can I continue seeing you if needed? 4. What format do you follow to write letters?

WPATH and ICATH Standards:

Some doctors ask for a suggested minimum time to see a therapist to accept your letter, but this shouldn’t be a long-term process. In other words, this should not take months on end to get your letter. There may be a longer process for a surgery letter depending on the point you are at. There are a couple of standards that can be followed. Both ICATH (Informed Consent for access to Transgender Health) and WPATH (World Professional Association for Transgender Health) present different suggestions for care.

Informed Consent

ICATH brings up the topic of informed consent. This basically means that you don’t need a letter before starting hormones. The doctor will inform you about the process, risks and limitations and you sign your acknowledgment. That’s great. I believe in informed consent. Informed consent speaks to the fact that this is your own body and your own choice.  I believe in that fully.

However, sometimes in some states, it can be a process to find a doctor for informed consent. That certainly doesn’t mean you should not even try. You should do what works best for you on your own journey. In looking for a doctor that follows ICATH, you would need to ask them if they require a letter or follow informed consent.

What Questions will I be Asked?

Your therapist will probably ask you some general demographic questions such as your birth gender and name and your gender you are transitioning to.  They may ask you how long you have felt this way and the history of feeling this way. There are other discussions about your aftercare, and also the risks associated with starting hormones.  If you have more detailed questions about risks and what to expect, that should be discussed by your doctor.  Therapists aren’t medical doctors, we are concerned with the emotional process of your transition.

Next Steps

If you come to the point where you do need a letter, there are therapists that provide this. If you are in my state, I welcome you to contact me. I also encourage you to use the suggested search terms, or reach out to LGBTQIA knowledgeable organizations in your area for recommendations.

And finally, as a disclaimer, I am not a medical doctor.  My blog posts generally come from my own knowledge and experience with the process through research, my training and professional organizations and my work with my clients.  Also, there are organizations and individuals working to educate and advocate for community for informed consent.

4 thoughts on “How do I get my gender affirmation HRT Letter?”

  1. Elizabeth Charlotte Madison (Aaron Duncan) says:

    Do you take insurance? I have Medicare and Medicaid, currently humana, but will be changing to bcbs, because they pay for surgeries. But I need an assessment therapist for hrt letter. Since you believe in informed consent. I understand why doctors want letters, but I feel in my case, not starting hrt could be more harmful without starting it. I understand hrt can add to depression, but what doesn’t these days. One day I could be the one who dies from supposedly new wonder anti depressant as the warnings say is possible. I want the effects hrt will give me, the fat redistribution, softening of features, breast development. But seems you need 1 yr on hrt before breast argumentation. And now that I’m out, comfortable and not suicidal. I want to further my transformation. I get free fitness membership and with the fear of transgender females in locker rooms, having breast will soften that, plus mor clothing options. These are the reasons, being on hrt overrides the wpath concern of added fear they have of depression worsening. I’ve been a recluse for past 2 yrs. Now I want my outside body. Making transgender ppl wait is good and all but not everyone should be lumped into same category. Thank you

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