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Cosmetic Surgery

Who Can Write A Top Surgery Letter?

Louise D.

For many trans people getting their gender-affirming top surgery can be a significant milestone and can help with their dysphoria. However, the process of getting to the surgery itself can be daunting. With this article, we hope to make the path just a little bit clearer.

We need to state that not all surgeons will require a top surgery letter. Although, if you are still a minor, or your surgeon is requesting a letter for your gender-affirming top surgery, then it is crucial that you find a therapist who is determined to help you on your journey, one who knows what questions to ask and what path to follow to ensure you have a smooth journey through your transition. There needs to be a dedication from medical providers to provide adequate support for trans people along their transition journey.

What is arguably most important is to find someone who understands and follows WPATH standards of treatment. If they are not familiar with these standards, you will likely find that some are eager to learn.

It should not be a problem if you find a therapist you like, but who needs to read up on standards of care. Then, you might be paving the way for transgender care in your area. Many therapists are dedicated to gender expression and used to continued education, so learning about gender-affirming treatments is an attainable goal for therapists.

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Seeking Gender Affirming Interventions

More so now than ever before, many people are experiencing some form of gender dysphoria. This can be challenging to deal with. Luckily, the way that the healthcare system is set up in many countries, the advised treatment for gender identity dysphoria is gender-affirming interventions. This essentially means that both mental health care and medical treatment is on your side in ways that it has not been in the past.

Previously, the goal has been to offer therapy in hopes of reordering your thoughts so that they align with your sex assigned at birth. But with the dawn of the modern age, such futile ventures have fallen away. Now the goal is to help you become the best possible version of yourself that you can. And the only acceptable path for that is through gender-affirming interventions.

For some people, this is simply a social transition (living as the gender you identify with and assuming the gender role you most identify with) or gender-affirming hormone therapy. But for transgender people, it might go a little further than that to include a top surgery and even a bottom surgery. Along with some other surgeries to masculinize or feminize the body to fit your gender identity.

We have come a long way from the days of ‘homophobia’ and ‘gender identity disorder’ finding themselves front and center in the DSM. Gender identity is not a mental illness anymore. Your mental health professional will likely be determined to help you achieve your affirmation goals instead of trying to ‘treat your disorder’ as they might have been in the past.

Gender therapy today aims to help a transgender person come to terms with gender dysphoria through gender-affirming measures.

Mental Health Professionals

It is so essential that you find the right therapist for you. The importance of this is often overlooked, and many people develop a negative outlook on therapy because they end up with a therapist who was not right for them. Therapists play a critical role in the transition of many transgender people.

Therapists provide a safe environment for people to express themselves; they provide boundaries, stable perspectives, and support. They can even guide you in finding the right support groups to suit your needs. Another skill that therapists have that can be of great value is taking these huge changes that you want to happen in your life and breaking them down into more manageable goals. They can easily take a mountain and help you to break it down into little molehills.

Many health care providers are likely to advise you to attend some form of therapy during your transition, not only for a letter but also just so that you can have access to support when you need it. However, we also need to acknowledge that many transgender people might not require gender therapy specifically but can deal with other types of mental illness not related to their gender identity that might require intervention.

When looking for a therapist, it is essential to remember to find one that you ‘click’ with. Most therapists will be dedicated to helping you, but if you are specifically looking for a gender therapist, you can check out the WPATH member checklist available online.

If a therapist is a member of WPATH, they are likely experienced gender therapists, or they are trying to become experience gender therapists. However, remember that even if someone is an experienced gender therapist, it is vital that you not walk away from sessions feeling uncomfortable most of the time (once or twice might be okay, but not most of the time). If this happens, it might be time to ask yourself whether this is the right therapist for you.

If you do not have insurance, it is a good idea to ask around about possible psychology interns who might be offering services at lower costs. Interns are closely supervised and can be a viable option for people who cannot afford the cost of a fully qualified therapist.

Questions to Ask When Selecting a Therapist

  • If your only goal is to get a letter from the therapist, it is vital to ask them from the start whether they offer letters as part of their services. It is within their right not to, for several reasons. Remember that just because a therapist does not provide these letters does not mean that they are not trans-inclusive, their motivation might be related to their scope of practice or level of expertise, and in most cases, they will be able to refer to a colleague who can, and does, offer this type of service.
  • You can ask them whether they are a gender therapist, and if not, how familiar are they with WPATH standards of care?
  • Find out whether they take your insurance, and if not, whether they know of someone in the area who does.
  • If no one in the area takes your insurance, you can ask therapists whether their fees work on a sliding scale or whether they offer reduced prices for lower-income patients. You will find that many mental health care providers have some form of reduced rate available.
  • It is okay to ask them what experience they have with gender identity issues or transgender patients. If they have limited knowledge, you can ask them whether they would be willing to explore gender therapy. Finding someone who doesn’t have much experience, but is willing to learn, can be very valuable.
  • You can also ask them how directive they are in their process. This will help you to understand how therapy will work. Either they will be the one taking the lead, or they will expect you to take the lead.

When selecting a therapist, you might need to ask them what therapeutic approach they prefer. This will help you gauge whether the therapist will work for you or not. Sometimes it is not enough for them to be concerned with your well-being. It is also essential that their therapeutic approach fits your personality and needs.

Cognitive Behavioral Focus

This approach is very practical and works actively on giving you tools to use in your daily life to cope. These kinds of therapists can be quite directive and can challenge negative impact thinking patterns in their patients. They are very solution-focused.

Psychodynamic Focus

This approach is far less directive and involves a lot of introspection and helping a patient to understand their inner thoughts and processes. There is a lot of talking and reflection involved, and they are likely to help you explore more than just your gender identity.

These are not the only two forms of therapy, but they are the two most popular cornerstone forms. Other forms are likely to find their roots in one of these.

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Mental Health Concerns

When you first start your search for a mental health care provider, you will need to remember that other mental health conditions play a role in your life. These other conditions likely have nothing to do with your gender, but that does not mean that they can be overlooked.

You might not be readily aware of them, but a gender therapist might note these conditions and offer mental health care services to address them. This might be frustrating to you, but therapists need to make these observations and help and support you where they can.

The last thing they want is a comorbid condition to ruin your experience of gender expression and affirmation.

Hormone Replacement Therapy

There has been a huge increase in accessibility to hormone treatment in recent years. It is not uncommon for even an older medical provider to have become familiar with puberty blockers or other forms of gender-affirming care in the last few years of practice and continuing education measures that are standard for clinicians.

Even a clinician who is not a gender specialist can help you with gender-affirming care, such as puberty blockers.

Remember that some affirming therapies necessitate diagnosis of gender dysphoria before insurance companies cover costs and before clinicians can administer treatments. So be prepared for some gender questions during a professional consultation.

Surgery Support Letter

Before you go on a hunt to find a therapist for a top surgery support letter, you will need to determine whether you need one. Some surgeons follow an informed consent model, which does not require a support letter, but does require a lot of consultation with your doctor.

Some offer a free consultation for this purpose. This type of consultation will take the form of one or more informational sessions to establish whether you are in the right place to undergo surgery.

If your surgeon requires a letter, you will need to have an informational session with a gender therapist or other mental health provider.

It can be beneficial for you to look up what the letter should include before finding a mental health provider familiar with gender-affirming treatments. General therapists who do not work as gender therapists might still be able to help. Even a therapist who has limited knowledge about gender therapy can learn and consult with colleagues who have more experience.

It is essential, to be honest with your therapist about your goals for seeking therapy in this first place. Trying to mislead a therapist or telling them what they want to hear will not speed up the process; it is likely to drag it out. Even a therapist who does not work at a gender clinic who is not a specialist in gender therapy will be able to identify any inconsistencies or dishonesties.

This is a large part of therapist training, and many therapists have personal experience with dishonesty in therapy. Tell them what you need, your goals, and your expectations, so that they can help you faster. Remember, their goal will also include gender expression and to help you identify and reach any goals in your journey.

Informed Consent

Informed consent is a concept that has existed in the medical and mental health professions for quite some time. It underlines a rule stating that consenting patients should be given enough information by their healthcare provider to make an informed decision about their health.

This means that a doctor or therapist cannot lie to patients. They are also required to tell you the truth about interventions and give you enough information to understand what is going on and, more or less, what to expect. They also need to be realistic about your expectations and have a responsibility to address any unrealistic expectations that you might have.

This is a vital part of modern healthcare, both in medicine and mental health.

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