Did you know that every year, about 48,000 individuals in the United States seek gender-affirming surgery? That’s a lot of people! And guess what? As a psychiatric nurse practitioner, some of your patients might seek your assistance along their journey.
Sometimes, a patient’s surgeon might ask you for a letter to verify the capacity of your patient to make informed consent around gender-affirming surgery. Basically, this letter is to show that the patient understands what gender-affirming surgery is all about.
This is more of a formality than anything else. You’re not deciding if your patient can have the surgery. That’s something they’ve probably been thinking about and planning for quite some time, together with their surgeon.
Why have a letter template?
Having a letter ready to go can be super helpful for you as a psychiatric nurse practitioner. You might not need to write this letter often, but when you do, it’s good to be prepared.
Your ability to get this letter to your patient’s surgeon quickly can really make a difference. Patients are also often very grateful for your advocacy and quick assistance with completing one of many steps along their journey.
This letter is just one way you can support them on their path to becoming their true self.
Unfortunately our time is limited as psychiatric nurse practitioners so additional requests aren’t always the most fun. But, to make things easier, here’s a template of a letter that you can use for any future patients who need this type of consent.
Gender-affirming surgery template
[DATE]
Patient Name: [NAME OF PATIENT]
Patient DOB: 00/00/0000
Dear Dr. [surgeons name],
[NAME OF PATIENT] is a patient of mine since [date of first visit]. I am writing this letter in support of [NAME OF PATIENT] undergoing [TYPE THE NAME OF THE SURGERY]
[metoidioplasty/vaginoplasty/phalloplasty/hysterectomy/oophorectomy/orchiectomy/bilateral reduction mammoplasty with chest reconstruction/ breast augmentation]. This is a medically necessary procedure.
[NAME OF PATIENT] experiences persistent gender dysphoria, and I am in support of this gender-confirming surgery as the next step in their transition process. I have determined that [NAME OF PATIENT] has capacity to make informed consent around gender-affirming surgery.
[Please provide relevant psychiatric history here including diagnosis, recent hospitalizations or suicide attempts, whether their symptoms are well controlled, and why the client is ready for surgery at this time in your opinion]
Their current medical hormone regimen includes [insert currently prescribed hormone] which they have been taking since [insert hormone start date].
OR
They are currently not taking hormones because they are contraindicated by the diagnosis of [insert diagnosis].
Please call me at (111) 111-1111 with any questions or to arrange follow-up care.
Sincerely,
[NAME OF PROVIDER]
[LICENSE NUMBER]
Sample letter example:
*Jane is not her real name
Dear Dr. A,
I have been treating Jane Doe* since October 2019 for major depressive disorder and gender dysphoria. She initially presented to me with a history of depression with symptoms fluctuating over the years since middle school. She had reported that over the past few months prior to meeting with me that her depression had been improving and, at the time, declined medication management services due to her improved mood and also upcoming orchiectomy surgery.
Much of Jane’s depression is tied to feeling her assigned gender at birth does not accurately fit her true gender. She identifies with she/her/hers pronouns.
In December 2019, Jane reported worsening of depression in context of her voice dropping and feeling her masculine traits were re-emerging. In January 2020, Jane was seen for an appointment with me indicating wanted to start medications to assist with her depression – sertraline 25mg daily was started and titrated to 150mg daily.
She did present as hopeful regarding an upcoming surgery in continuation with her gender transition. Her mental health is well controlled at this time. Jane has been working with a therapist as well as a community behavioral health worker.
Jane has experienced persistent gender incongruence that has resulted in psychological distress through much of her life.
Jane demonstrates clarity of judgment and insight regarding the surgery risks and benefits. She has the capacity to make fully informed decisions and to consent for treatment. Post-operative recovery plan includes ongoing social support through regular individual psychotherapy as well as medication management for her prescribed sertraline.
It is the overwhelming consensus among major medical organizations—including the American Medical Association, the American College of Physicians, the American Psychological Association, the American Psychiatric Association, the American Academy of Family Physicians, the Endocrine Society, the American College of Obstetricians and Gynecologists, and the World Professional Association for Transgender Health—that transition-related medical treatments are safe, effective, and medically necessary when clinically indicated to treat gender dysphoria.¹
Numerous studies have demonstrated the significant benefits of medical treatments for gender dysphoria. Major medical organizations such as those named above therefore support coverage of medically necessary transition-related care in accordance with the World Professional Association for Transgender Health’s most recent Standards of Care.
Surgery will allow Jane to experience a life where she feels more integrated with herself which will allow for greater confidence, self-esteem, and peace. Not receiving this treatment would likely have multiple negative impacts including worsening of her depression.
I am available for coordination of care and I welcome a phone call to establish this. If you have any questions at this time or at any point, please feel free to contact us at 123-123-1231.
Kind regards,
Claire Ellerbrock, DNP, PMHNP
¹For a compilation of statements from major medical associations on this issue, see: https://lambdalegal.org/publication/fs_professional-org-statements-supporting-trans-health/
