Referral Letters & Resources
This page refers to WPATH referral letters that are sometimes required to access gender-affirming medical care. If you are in need of a referral letter, please read this entire page to prepare for your assessment with us.
Because gatekeeping is not in line with our personal or professional ethics, we offer letter-writing assessments and corresponding referral letters on a pay-what-you-can basis (including $0 if finances are a barrier), no questions asked.
This is a limited scope service. One assessment session and one letter are included in this service. You do not need to be in therapy with us in order to have an assessment completed and letter provided. If you would like to have ongoing therapy through us, please let us know during your consultation call or by filling out our contact form.
We utilize the Informed Consent model which presumes that you are a self-determined person with insight and awareness about how to use your bodily autonomy. As we are operating within a medical system that continues to use gatekeeping, we aim to help this process be as painless as possible and seek to provide you with support and resources as you need.
For the letter, we must write that you are mentally, emotionally, practically, and financially prepared for the intervention, as well as being aware of the risks, benefits, and implications. We will review these during your assessment session, though it is also important for you to have done research in advance regarding what to expect. We recommend this site to review the guidelines, potential complications, and expected outcomes for your anticipated medical service (hormones or surgery).
I’m not here to determine if you are trans "enough." I envision a future where people do not need to obtain assessments and letters from mental health providers in order to access gender-affirming medical care. That said, it is the current reality. I can provide the assessment and letter; however, I cannot and do not guarantee any specific outcome or result after I provide you with the letter.
Hormone Therapy
Informed Consent hormone therapy (no referral letter required) is available in Michigan through:
These videos demonstrates the injection process for intramuscular or IM vs. subcutaneous or Sub-Q injections. Find information about GoodRx coupons for testosterone, spironolactone, and estradiol.
Surgery
Provider Requirements:
For chest surgery (removal or augmentation) or gonadectomy (hysterectomy or orchiectomy), you must have an identified surgeon and ideally had an appointment or consultation with your surgeon.
For facial surgery or genital reconstruction, you must have identified a surgeon and had a surgical consultation prior to the letter-writing assessment session, because there are too many unique variables that must be discussed with a surgeon in order to be able to provide informed consent.
Assessment Requirements:
It is important for you to have done your research about the intended medical procedure (risks, benefits, implications) and provider before your assessment session.
For questions to ask during a surgical consult visit here.
For information about variations of chest reconstruction (removal), visit here.
For information about variations of chest reconstruction (augmentation), visit here.
For information about variations of genital reconstruction for people who were born with primarily internal genitals, check out these links on vaginectomy, metoidoplasty, phalloplasty, and scrotoplasty.
For information about variations of genital reconstruction for people who were born with primarily external genitals, check out these links on vulvoplasty, penile inversion vaginoplasty, peritoneal vaginoplasty, and rectosigmoid vaginoplasty.
Financial Resources:
Next Steps
If you have read the above information and would like to move forward, the next step is to complete the required forms for your assessment session. Fill out the contact form and select Gender Affirming Referral Letter under Session Type. Within 48 business hours you will receive a response from Sarah at You Bloom Therapy with information about filling out the forms, availability, and scheduling.
All forms must be completed prior to the scheduling the assessment session. Sarah will use this information to guide the assessment session and letter-writing.
After the forms are submitted, you'll receive an email to schedule your assessment session.
Assessment appointments are held on a HIPAA-secure video telehealth platform. You will receive the link when you schedule the appointment. Both audio and video are required for the appointment.
During the assessment session we'll review any necessary pieces of information from your intake forms, and discuss any other support you may need.
After the letter is complete, Sarah will send you a copy of the letter and can fax the letter to your medical provider at your request.
Disclaimer: You Bloom Therapy provides services related to mental health and sex therapy under LMSW and LCSW licensure. You Bloom Therapy is not licensed to provide medical advice. The information contained in this website concerning gender affirming care assessments, letters, and procedures has been taken from public sources and is meant to give general information to the public for educational purposes only. All such information is provided as-is with no warranty, express or implied, regarding its accuracy. The information was obtained May of 2023, but laws, regulations and procedures change, and You Bloom Therapy is under no obligation to monitor these changes or to update this information. It is your responsibility to seek out and comply with all applicable laws, regulation and procedures. Please also note that the information provided is not specific to your individual situation. If you have any questions or concerns, including any questions or concerns regarding your individual circumstances, you should speak with your medical provider or reach out to You Bloom Therapy to set up a consultation. Use of this website does not, in and of itself or in conjunction with any other circumstance, create a therapist-client relationship between you and You Bloom Therapy or any of its representatives. By using this website, you acknowledge and consent to the above and knowingly and intentionally waive and release any claims, causes of action, losses or damages you may have against You Bloom Therapy arising out of the information made available to you through this website.