Your first virtual or in-office consultation with Dr. Mosser will determine whether your existing physical and mental health can withstand the strain and stress of surgery.  In addition, you will also receive information on the pros, cons, and risks of each surgical technique. All of these will help you make an informed decision as you transition via surgery — from your choice of anesthetic to specific techniques that will be used during operation.

During consultations, we’re often asked this question:

Is a letter from a mental health care professional required prior to all FTM and MTF surgeries?

Dr. Mosser doesn’t consider it to be an absolute requirement for FTM chest surgery or body contouring surgery except for individuals younger than 18 years of age, who do need 2 letters of support.  However, this is not to say that he doesn’t believe in the extremely high value of the therapeutic process.  He believes that therapy is of immeasurable benefit during transition, and he is always appreciative to see a therapeutic process accompany the transition journey.

However, insurance companies deem these approval letters as necessary. This is worth noting if  your insurance company will cover the costs.

Getting these letters may call for multiple appointments as most, if not all, insurance companies require mental health providers to state in the letters that they have an ongoing “provider and patient relationship with the patient”.  In addition it’s good for the letter to state that there is a diagnosis of gender dysphoria and that the patient (you) meet WPATH standards for FTM chest surgery.

This may take several visits to your health care providers so we recommend that you get in touch with us when you’re still considering surgery. Our team can assist you in requiring these letters and guide you in exploring these options.

What’s in a Referral Letter?

Digging in a bit deeper, the most current edition of the Standards of Care (SOC) by the World Professional Association for Transgender Health (WPATH) released last 2011 recommends the following content for referral letters:

  1. The client’s general identifying characteristics;
  2. Results of the client’s psychosocial assessment, including any diagnoses;
  3. The duration of the mental health professional’s relationship with the client, including the type of evaluation and therapy or counseling to date;
  4. An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting the patient’s request for surgery;
  5. A statement that informed consent has been obtained from the patient;
  6. A statement that the mental health professional is available for coordination of care and welcomes a phone call to establish this.


At our San Francisco practice, we understand that deciding and going through gender confirmation surgery may be costly and time-consuming for many. This is why we always make an effort to provide extremely high standards of patient care and roll out the red carpet for each patient to ensure first class transgender surgery experience.

Schedule a virtual consultation today to learn more about your gender confirmation surgery requirements. We look forward to rolling the red carpet for you!