Letter Program for those seeking Hormone Replacement Therapy (HRT)
& Gender Affirming Surgery

*If you are a client of Prospect Therapy, you can get your letter through your clinician for no additional charge- please reach out to your therapist directly for fastest service. This program is for people seeking a letter and do not want ongoing therapy services or who cannot afford services at this time. If you would like to begin therapy services and also want a letter, please mention that in your inquiry form.*

DO I NEED A LETTER?

First of all, it sucks that you need letters to make decisions about your own healthcare and your own body.

In California, if you are over 18 and are seeking hormone replacement therapy (HRT) to support your transition - you don't need a letter. Some providers may still require a letter as part of their policy, but it is not required by California law.

You can find a medical provider (physician, ob-gyn, endocrinologist, advanced practice nurse, physician assistant) who is familiar with gender dysphoria and who can evaluate your ability to provide informed consent to HRT. They can prescribe you hormones to support your transition without needing a letter from a therapist. If you need some names of providers (or if you are a provider) who offer this service, please contact us.

If you are seeking gender affirming surgery, your surgeon may require more than one letter. This is true whether you are planning to use insurance or not. Some surgeons’ offices will explain what needs to be in your letter. Our letters are written with WPATH 8 standards and meet most requirements, but we’re happy to add additional information if your surgeon requests it!

Please note we are master’s level therapists, not doctorate level psychologists or psychiatrists. You may need one of each. But it’s cool - we know people we can connect you with.

OK I NEED A LETTER, CAN YOU HELP ME? WHAT DO YOU CHARGE?

Yes, if you are a resident of California. After several years of only offering free letters, we now have three options depending on your timeframe/budget to best accommodate everyone's needs:

Express Service ($150): Letter within 7 business days; includes free revisions for the next year. You'll get your appt date when booking and your letter (emailed pdf) by the end of the day of your appt.

Standard Service ($75): Letter within 3-4 weeks; includes free revisions for the next year. You'll get your appt date when booking and your letter (emailed pdf) within 48 hours of your appt.

Budget Service ($0, Free!): Letter within 2-4 months; includes free revisions for the next year. You'll get an estimated date range for your appt, but scheduling won't occur until we contact you within that date range. You'll get your letter (emailed pdf) within 48 hours of your appt.

Please submit your request below with your timeline. Once you submit a request, our Letter Access Coordinator Nik will email you back with next steps, usually within a few days. Nik will be able to tell you more specifics about the current waitlist and your expected timeline. Regardless of which route you choose, your letter will be the same high quality! You only need to consider the paid options if you are needing your letter ASAP.

WHAT ARE YOU GOING TO ASK ME?

We’re not here to decide if you are “trans enough.” Just that you are an adequate candidate for the procedure or medical support you are seeking and have prepared a reasonable amount (Have you planned out aftercare, are you able to take care of basic needs while recovering, are you familiar with the expected risks and benefits of the procedure, etc.).

We will ask questions about your gender journey and transition, but please know there are no objectively right or wrong answers, just the truth of your experience. We are required to tell insurance about your transition so far, but this can be the very first step!

Between your consultation and our appointment, we can usually cover everything we need. In order to ethically gather the information that needs to be in your letter, we may need to meet with you for more than one session.

WHAT IF I DON’T LIVE IN CALIFORNIA?

Prospect Therapy clinicians are only able to provide services to people in California.

The Gender Affirming Letter Access Project is a nationwide network of clinicians who offer sessions and letters at no charge. Many offer online sessions if you reside within their state but are not local to their office.

SO IF THIS SERVICE IS FREE- ARE THE CLINICIANS WRITING THE LETTERS WORKING FOR FREE?

Our clinicians are paid for all of their work! While this service is completely free to you, our clinicians are compensated for their time writing letters by Prospect Therapy: it’s a win-win!

If you’d like to make a donation towards our letter program (and potentially increase the number of letters we can offer per month), you can do so on Venmo.