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.
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. This means that it's 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).
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 your responsibility 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 letter-writing session and will pre-write some of the letter in advance.
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 the forms and review the letter together.
After the letter is complete, Sarah will fax the letter to your medical provider.
*You Bloom Therapy provides services related to mental health and sex therapy under LMSW licensure. You Bloom Therapy is not licensed to provide medical advice. Information on this website is for information purposes only and is not to replace consultation with your medical provider.