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Letter for Gender-Affirming Surgery

Surgical readiness assessment

A referral letter from a qualified mental health professional may be required to confirm readiness for gender-affirming surgery. In order to provide a letter of recommendation to physicians who are able to perform surgery, a surgical readiness assessment can be conducted.

A surgical readiness assessment involves asking you about your thoughts, feelings, behaviours, beliefs, and other aspects of your gender identity, to gain an understanding about your readiness for surgery.

Results of the assessment cannot be guaranteed before meeting with you. However, our intention is to evaluate your needs and provide you with an outcome such as a letter, services, or referral, that reflects what seems to be in your best interest.

Whether or not you feel ready for surgery or have some reservations, we can provide you with a space to discuss this topic, so that you can explore the aspects of surgery, in order for you to come to a decision that you feel is right for you.

What can I expect from the assessment?

All decisions regarding healthcare, including gender-affirming surgery, are ultimately made by the client.
Nevertheless, we as mental health professionals, have a duty to assess and provide information to assist clients in making informed decisions and becoming adequately prepared.

Blake Psychology follows the WPATH Standards of Care for decisions regarding surgical readiness.
During the assessment, the practitioner is trying to understand your gender dysphoria.

They will ask about your expectations for treatment, support systems, and current mental health status, and ensure you understand informed consent.

During the assessment, you will be asked about:

  • How do you feel about your body and your gender identity?
  • The social, emotional, and financial implications of your surgery
  • Your medical and mental health history, medications, past surgeries, smoking status, exercise, nutrition, family history, etc.
  • A clear understanding of the surgical procedure, its risks, and its recovery afterwards
  • How family, friends, work, and school support systems can help you thrive during your gender transition
  • What personal resources or strategies can help support you
  • Your plan for your surgical aftercare

Do I need counselling in order to obtain the letter from you?

Counselling is not typically required to get approval for RAMQ-funded surgery although it can be very helpful for some people.

It may be required or recommended if:

  • You’re unsure whether surgery is for you
  • You do not have a plan in place to announce your transition to significant others, family members, friends, or in a work setting, or do not know how to announce your transition
  • You have significant mental health or substance abuse concerns
  • You’d like professional support during the transition or afterwards

Transgender health care is an interdisciplinary field, so your Blake Psychology practitioner might assist in coordinating services and referrals amongst a client’s overall care team.

What information does my letter of recommendation for gender-affirming surgery contain?

Referral letters include documentation of a client’s personal and treatment history, progress, and eligibility.

After your assessment appointment, the qualified assessor will make one of these recommendations:

  • Surgery is recommended
  • Surgery is not recommended at this time, or
  • Return for further assessment

The letter can be sent to physicians who are able to refer you to surgery, and clients are also entitled to receive a personal copy.

Please note that we cannot guarantee the issuing of a letter in advance. While you may wish for a letter that says something specific, letters are based on clinical judgment, and can only be written if the clinician has determined that it is appropriate.

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