Our policy
Letters for gender-affirming care
If you need a letter for hormones, for surgery, or for changing a name or gender marker, ask us. This page says how we handle it, so you know before you ask.
You can ask at any point
At the first session or months in. You do not need to arrive with a timeline.
You read it first
Nothing is sent until you have read the draft and said where it goes.
From a licensed clinician
Letters come from your own clinician, whose California license is on every page.
The steps
How a letter works
Step 1: You ask
Say what the letter is for and who asked for it: a prescriber, a surgeon, an insurer or an agency.
Step 2: We read the request
Your clinician reads what the other side requires and tells you what we can and cannot include.
Step 3: We draft it with you
You see the words before anyone else does, and you can change what is wrong.
Step 4: We send it where you say
To you, or to the address you give us. We keep a copy in your record.
What a letter is not
Not a test of who you are
We do not ask you to prove your gender, and we do not hold a letter back until you have told your story.
Not a promise
We cannot promise that a prescriber, surgeon, insurer or agency will accept any letter. They decide for themselves.
Not a stand-alone stop
A letter is part of the work we do together, so we ask that you are a client of the practice first.
How letters are paid
Time, not a flat price
A letter is written in session time or billed by the hour. The fee is given to you in writing before we start.
We are out of network. A receipt for a letter can go to your plan along with your session receipts.
If you want a different clinician
Another practice may write a letter faster. If you would rather go there, we will tell you so.
Three questions about letters
How many sessions before a letter?
There is no set number. Your clinician and you decide together when you have talked enough for a letter to say what you need it to.
Do you write letters for a name change?
We write letters for a change of name or gender marker when you ask, and we tell you what the agency asks for.
What if my request is urgent?
Tell us the date when you write. We will say plainly whether we can meet it, and if we cannot, who else might.
Need a letter?
Write to us, and tell us only what you want to.