As per the World Professional Association for Transgender Health's Standards of Care, 7th Ed, referral letters - for hormone therapy, puberty blockers and/or gender affirming surgical procedures - can be written by masters-level, mental health professionals.
Please include the following content within your client's referral letter.
Your client's letter and a HIPAA release signed by the patient can be faxed to 718.894.0301
1. The patient's general identifying characteristics.
2. The initial and evolving gender, sexual and other psychiatric diagnose. Any psychiatric medications MUST be accompanied with a diagnosis. This area should discuss the patient's initial cross-gender feelings.
3. The duration of their professional relationship including the type of psychotherapy or evaluation that the patient underwent, frequency of visits and patient compliance.
4. The eligibility criteria that have been met and the mental health professional's rationale for hormone therapy.
5. The degree to which the patient has followed the Standards of Care to date and the likelihood of future compliance (Main areas of transition should be covered here and should include history of gender presentation at work/school and home, name change, prior hormone therapy or puberty blockers. This section should also discuss any spousal or parental obligations.). If the patient is a minor, you must include a statement that all parents/guardians are supportive & prepared to sign “consent for treatment”, agreed to this approach & will attend initial office visit and that the author will continue to see the minor patient on a regular basis.
6. The author should list their experience treating transgender clients. This should include years experience, number of clients treated and currency of training in transgender issues. The author should list any transgender organization memberships and if they are part of a gender team.
7. That the sender welcomes a phone call to verify the fact that they actually wrote the letter as described in this document.
Please contact us if you have any questions.
Phone/Fax: 718.894.0301 | Email: info@HealthyTransitionsLLC.org