Gender Affirming Letters

Low Barrier Gender Affirming Letters. $0+ sliding scale mental health provider support letters for gender-affirming care from Trans-Wa

What is a “gender affirming letter?”
A letter written by a mental health professional that argues that a specific gender-affirming medical procedure, such as surgery or hair removal, is “medically necessary”. Doctors and insurance companies often require these letters to provide care.

Please note that most surgeons won’t do any gender-affirming surgery until you’ve been on HRT (hormones) for at least 1 year, regardless of support letters. Masculinizing top surgery/mastectomy is an exception.

Does Trans-Wa write gender affirming letters?
Yes, as of February 2026. We offer virtual appointments to anyone who is trans or gender-expansive and physically located in Washington State. Usually, we can write a strong letter after one 50-minute appointment.

How much does it cost and do you accept insurance?
We aren’t able to accept insurance. We use a self-select sliding scale. When we set up the appointment, we will ask you to choose the amount you can comfortably pay, between $0-200. We suggest a minimum of $30.

How can I schedule an appointment?
To request an appointment, please email us at services@transwa.org. Email isn’t very secure, so please don’t include sensitive health information.

What can I expect at the appointment?
We will ask you about your experience of gender, your mental health, and why you’re seeking the procedure. We aim to respect your experience and your privacy, but you may find some of the questions uncomfortable or invasive. We can discuss with you the reason for the questions and the pros and cons of including that information in your letter. Our goal is to help you get the gender affirming care you think is right for you.

We will give you the opportunity to review the letter and ask for changes before we sign the finished letter for delivery to your doctor and/or insurance company.

Who will be at my appointment?
A provider holding current LSWAIC licensure will be in your appointment. While they are supervised by a fully licensed LISCW, this supervisor will not be in the appointment. Additionally, at Trans-Wa we have many Practicum-Based Staff (graduate-level “interns” or PBS) who are currently completing a Master’s of Social Work degree. As part of their education to become a therapist, we allow PBS to observe, co-lead, and/or assist in writing letters for gender affirming letter appointments.   

If you opt in, this means that a second provider will be in your appointment and have access to the information you share. 

You may opt out of having a second provider present.