Gender Affirming Care and GAS Letters
Gender affirming healthcare quite literally saves lives; studies show it lowers rates of suicidal ideation as well as reported psychological distress according to the Harvard T.H. Chan School of Public Health.
Concerns about age, cultural and social factors, safety, and fully-informed consent, in addition to regulations around it, can bring a level of controversy to this type of healthcare. While it’s not unheard of for persons who undergo these types of procedures to experience regret about having done so, it’s incredibly rare (less than 1% according to 27 different studies).
Surgery is not the only gender-affirming care option to consider. There are many options aside from surgical ones to address gender identity that may feel more approachable or accessible. Some options, including hormone replacement therapy (HRT) have effects that can be reversible if the treatment is discontinued.
Hormone blockers are a subset of hormone therapy that are taken prior to puberty that offer a chance to explore gender identity and give a person and their families more time to prepare and plan for more long-term changes that could be made. When a person stops taking the hormone blockers, puberty will continue as usual.
HRT can also involve either taking estrogen or testosterone in order to help one’s body, appearance, and sex characteristics align more with their gender identity. HRT is often covered by most major insurance plans, but organizations like Planned Parenthood will also work with the individual to help find a way to get the treatment covered even if insurance is not an option.
Other non-surgical options can include voice therapy, which can teach a person to express their gender through their voice, and laser hair removal.
There are a number of different surgical options for gender affirming surgery.
Just like every surgery, even when done routinely and by professionals it still carries risks. Most importantly, the recovery from these surgeries can be long and challenging, so it is essential to consider after-care plans including identifying people who can support you through recovery.
In order to pursue gender affirming surgery, a person may need a Gender Affirming Surgery (GAS) Letter, or depending on procedure desired, two different letters might be needed from two different providers (i.e. one from a licensed mental health professional and one from a primary care provider)..
A GAS letter is a medical document provided by a mental health professional that confirms an
individual meets the criteria for the gender affirming surgery they are seeking. It provides details about an individual’s diagnosis, identity, treatment history, aftercare support, and reasons for seeking surgery.
First and foremost, a GAS letter acknowledges the capacity for the individual to make this decision and the need for the specific surgery or surgeries being requested–including their impact on the individual’s mental health.
Unfortunately, requirements for GAS letters can be used in the healthcare system as a barrier to receiving life-saving treatments. Many providers are not provided training or education about how to write GAS letters, are hesitant to do so, charge high fees, or have strict requirements about eligibility to receive a letter.
The World Professional Association for Transgender Health (WPATH) informs the requirements made by insurance for GAS letters. WPATH is an organization whose mission is dedicated to the treatment of transgender and gender variant individuals. Although these standards change over time, in general the letters include information such as:
● The date the letter was written
● What type(s) of surgery are being requested
● The individual’s gender identity and sex assigned at birth
● Any relevant mental health or physical diagnosis
● The individual’s affirmed name and pronouns
● The qualifications and contact information of the writer of the letter
● Any efforts made toward social transition or other affirming treatment (ie. HRT)
● Plans and resources the individual has in place for after-care from surgery
● An acknowledgement that the individual is aware of risks and has considered the impact
of recovery
At Sage Stone Counseling, we believe reducing this barrier to care in whatever ways we can is essential. All of our staff receive training in how to write GAS letters, and we will not charge you to write them. You don’t need to be a current client with us or pursue therapy services with us in order to request a GAS letter.
In order to receive a GAS letter, simply reach out to us through our intake phone or email, and we will schedule you for a meeting with one of our clinicians. We will discuss expectations, identity, history, and a support plan with you either in-person or on a video call.
The clinician who meets with you will explain what you can expect in terms of:
Expectations and Goals for GAS letter
Uses for GAS letter
When your GAS letter will be completed and sent to you
How to share the letter with your providers
Expiration date of letter
How to contact us if your letter needs updated or changed
We believe and honor that you know what is best for your body.
We believe you understand your identity better than anyone else.
We understand the system can be hard to navigate, and we’re here to help.
Contact us today if you’d like to learn more about our services and how we can support you on your journey towards healing and recovery. You deserve validation, understanding, and compassionate care.
At Sage Stone Counseling, we hold that everyone should have the right to mental health care. We focus on providing affirming and safe therapeutic space to marginalized groups of all kinds, and are here to help.
