The short answer is - it depends. Requirements vary based on your location, health insurance plan, and medical provider's office policies. Many major health organizations no longer explicitly require letters from mental health professionals to begin hormone therapy, but some clinics still request them.
When evaluating you for hormone therapy, your doctor will want to ensure you meet key diagnostic criteria for gender dysphoria according to standard guidelines. They will also evaluate your medical history and risk factors to determine if HRT is appropriate for you. While not always an absolute requirement nowadays, a letter from a therapist or mental health professional can still be quite helpful for starting the process.
Reasons a letter may be requested
- Provides documentation that you meet criteria for a diagnosis of gender dysphoria
- Verifies you have undertaken key steps in medical transition
- Confirms you have adequately explored gender identity with a mental health professional
- Helps obtain prior authorization from health insurance plans
Many insurance plans still require a letter detailing your diagnosis, treatment to-date, and confirming that hormone therapy is a medically necessary intervention for you.
So even if your doctor doesn't need a letter, your insurance company might.
What should the letter include?
An evaluation letter from your licensed mental health provider should contain key details like:
- Your personal details - name, date of birth
- Diagnostic code for gender dysphoria
- Duration you have experienced dysphoria
- Treatments undertaken so far
- Confirmation hormone therapy is a reasonable next step
- List of hormones being recommended
The letter will carry more weight if the mental health professional has extensive experience working with gender variant clients. Some clinics even provide a template letter for therapists to complete.
Alternatives to a letter
If needing a letter presents an obstacle, some options include:
- Ask your regular doctor to assess if you meet criteria
- Use an informed consent model clinic that doesn't require letters
- Access hormones from virtual health startups like Renewal Hormone Center that use telemedicine models
Informed consent is a increasingly popular alternative approach where providers ensure you fully understand the benefits and risks of HRT, without requiring a letter. By giving your informed consent, you take responsibility for initiating treatment once your provider decides you can make an educated decision.
In summary, while a formal letter from a mental health professional may still be needed under some circumstances, it is no longer considered an absolute mandatory requirement by major health associations. Open and honest discussions with your doctor can help determine if hormones are right for you or if a diagnosis letter could help move the process forward.