Gender Affirming Surgery Letter Template: A Complete Guide for Patients and Professionals

A gender affirming surgery letter template is a professional document written to support a patient seeking gender-affirming medical care. Often required by insurance providers, surgeons, or mental health professionals, this letter provides essential medical, psychological, and social context to justify the necessity of the surgery.

Writing such a letter can feel overwhelming, whether you’re a healthcare provider, therapist, or patient advocating for care. This guide explains the key elements of a gender affirming surgery letter, offers tips on what to include and avoid, and provides ready-to-use templates. By the end, you’ll feel confident in preparing a letter that is professional, clear, and effective.

Key Elements / Guidelines

When preparing a gender affirming surgery letter template, it’s essential to cover certain core components. Each element ensures the letter communicates the necessary details while remaining professional and concise.

• Greeting: Start with a formal salutation.
  Example: Dear Dr. [Surgeon’s Name],

• Purpose Statement: Clearly state why the letter is being written.
  Example: I am writing to support [Patient Name]’s request for gender affirming surgery.

• Patient Identification: Include relevant identifying details without violating privacy standards.
  Example: [Patient Name], born on [DOB], has been under my care since [date].

• Clinical Background: Summarize the patient’s medical and psychological history related to gender dysphoria.
  Example: [Patient Name] has been diagnosed with gender dysphoria and has undergone counseling and hormone therapy as part of their transition.

• Recommendation Statement: Explicitly state that the surgery is medically necessary.
  Example: Based on my evaluation, I recommend gender affirming surgery to improve [Patient Name]’s mental health and well-being.

• Supporting Evidence: Reference assessments, therapy sessions, or prior medical interventions that support the surgery.

• Closing & Signature: End with a professional sign-off including credentials and contact information.
  Example: Sincerely, [Provider Name], [Credentials], [Practice Name]

Following these key elements ensures that the letter meets both medical and insurance requirements while remaining supportive and professional.

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Tips / Do’s and Don’ts

Crafting an effective gender affirming surgery letter requires attention to tone, content, and clarity. Here are essential do’s and don’ts:

Do’s

• Be Clear and Concise: Provide all necessary information without excessive detail to maintain readability.

• Use Professional Language: Keep the tone formal and respectful, as this letter is often submitted to insurers or medical boards.

• Include Clinical Justification: Reference medical and psychological evidence to support the recommendation.

• Personalize the Letter: Include patient-specific details to demonstrate individualized assessment.

Don’ts

• Avoid Subjective Opinions: Focus on medical necessity rather than personal judgments.

• Do Not Overshare Personal Details: Only include relevant medical or therapeutic information.

• Avoid Ambiguity: Clearly state the recommendation to prevent insurance delays.

These tips help ensure the letter is authoritative, clear, and compelling for all parties involved.

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Sample Templates

Here are three practical examples of gender affirming surgery letter templates that can be adapted for individual patients and providers.

Gender Affirming Surgery Letter for Insurance Approval

Use this template when submitting a letter to an insurance provider to obtain prior authorization.

Subject: Request for Gender Affirming Surgery – [Patient Name]

Dear [Insurance Provider Name],

I am writing to provide medical documentation supporting [Patient Name]’s request for gender affirming surgery. [Patient Name], born on [DOB], has been diagnosed with gender dysphoria and has been under my care since [Date].

They have undergone comprehensive evaluation and hormone therapy as part of their transition. Based on my professional assessment, gender affirming surgery is medically necessary to address persistent gender dysphoria and associated mental health concerns.

Please feel free to contact me for further information regarding [Patient Name]’s medical history and treatment plan.

Sincerely,
[Provider Name], [Credentials]
[Practice Name]
[Contact Information]

Therapist Recommendation Letter Template

Ideal for mental health professionals supporting a patient’s surgical request.

Subject: Recommendation for Gender Affirming Surgery – [Patient Name]

Dear [Surgeon/Insurance Name],

I have been providing mental health support to [Patient Name] since [Date]. During this period, we have addressed issues related to gender dysphoria, mental health, and social transition.

[Patient Name] demonstrates a consistent and persistent desire to undergo gender affirming surgery. It is my professional opinion that this procedure is medically necessary for their psychological well-being and overall quality of life.

Please consider this letter as formal support for [Patient Name]’s surgical plan.

Sincerely,
[Therapist Name], [Credentials]
[Practice Name]
[Contact Information]

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Letter Template for Self-Advocacy

Patients can also draft a template for discussion with providers or insurance, to ensure all necessary points are covered.

Subject: Request for Gender Affirming Surgery Documentation

Dear [Provider Name],

I am requesting documentation to support my gender affirming surgery. I have been diagnosed with gender dysphoria and have been participating in counseling and hormone therapy since [Date]. My goal is to undergo [specific surgery] to align my physical body with my gender identity and improve my mental health.

I kindly request a letter detailing the medical necessity of this procedure to facilitate insurance approval and surgical planning.

Thank you for your support,
[Your Name]
[Date of Birth]
[Contact Information]

These templates provide a solid foundation and can be customized to each patient’s unique journey.

Formatting Tips

Proper presentation enhances credibility and readability. Consider the following formatting guidelines:

• Font & Size: Use standard fonts such as Arial or Times New Roman, size 11–12.

• Spacing: Maintain single or 1.15 line spacing with clear paragraph breaks.

• File Format: Submit letters in PDF format for professionalism and compatibility.

• Formal vs. Casual Tone: Always use formal language for providers and insurers. Casual notes are acceptable only for patient self-advocacy drafts.

• Header Information: Include patient name, DOB, and date of letter at the top for clarity.

Proper formatting ensures the letter looks professional and reduces delays in processing.

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FAQs

How do I write a professional gender affirming surgery letter template?

Keep the letter structured with a greeting, purpose, patient identification, clinical background, and clear recommendation. Include evidence from assessments and therapy sessions.

What should I avoid when creating a gender affirming surgery letter template?

Avoid personal opinions, unnecessary emotional content, or excessive detail unrelated to medical necessity. Keep it professional, concise, and supportive.

Can I submit a gender affirming surgery letter by email?

Yes, letters can be submitted digitally. Ensure the file is a clean PDF, with a clear subject line and professional signature included.

Who can write a gender affirming surgery letter?

Typically, licensed mental health professionals, primary care providers, or surgeons involved in the patient’s care can draft these letters. Patient advocacy letters may also be used to supplement professional documentation.

How long should the letter be?

Most letters are 1–2 pages, enough to convey medical necessity, patient history, and professional recommendation without overwhelming the reader.

Conclusion

A gender affirming surgery letter template is a critical tool in supporting patients through their transition. By following structured guidelines, including essential medical details, and using professional formatting, providers and patients can create letters that are clear, persuasive, and effective.

These templates and tips help empower patients and professionals alike, ensuring that gender affirming care is accessible and well-documented.

Explore more professional templates on MsCareerGirl.com and bookmark this guide for future reference to streamline your healthcare advocacy.