Getting Your FTM/N Top Surgery Support Letter

Did you know that there are some FTM/N top surgeons (like Dr. Mosser) who use the informed consent model? This means that they don’t require a letter from a therapist and rely on the consultation process of getting to know the patient and from there assessing if they are able to make the decision to get top surgery for themselves.  

For folks who require a therapist letter because of FTM/N top surgery insurance approval or because their surgeon requires one we hope that the following information will make the process less daunting for you.  

It’s important to note here the therapists have an extremely valuable role in a large number of life transitions, including gender transition.  They provide stability of perspective, boundaries, support and structure to the many elements of thought that surround the big changes in life.  Therapy is always encouraged for anyone who would benefit from this expert support.  

How to Find a Therapist for a FTM/N Top Surgery Letter 

Finding the right therapist and form of counseling for you can be daunting, particularly for folks processing their gender identity. Though it can take time, finding someone you are comfortable with is worth the search. There are multiple online search engines for this with filters that include specialties, insurance coverage, and availability. The best place to start looking is here: WPATH members. Nearly everyone listed as a WPATH member will be a professional who is serious about trans care. 

If you have gender-affirming, LGBTQ-experienced therapists in your area then this will help tremendously. If not, not need to worry you can pick someone who is committed to learning, or look into support groups and online resources. 

If you cannot afford therapy, consider asking therapists or nearby LGBTQ centers if they have interns who could provide lower cost sessions. If you select a therapist and end up not liking them, you can always choose to stop seeing them. Most therapists provide a free consultation for you both to assess whether it’s a good fit.  

The FTM/N Top Surgery Letter: How to Ask the Right Questions 

To find out if the therapist would be a good fit for you in getting a letter for your FTM/N top surgery insurance approval or other therapeutic needs start by asking these useful questions during your initial consultation:  

  • If you are seeking a therapist exclusively to get a referral letter for FTM/N top surgery, ask them if they do this and what the process is 
  • How familiar are they with the WPATH Standards of Care? 
  • What experience do they have with folks who are transgender or non-binary?  
  • Do they take my insurance? 
  • If they don’t take your insurance ask:  Do you offer a sliding scale? (meaning they work with folks with lower income)  
  • Ask if they are directive (take the lead) or in-directive (let you take the lead). This will let you know if their communication style will work for you.  
  • If they are more influenced by cognitive behavioral or psychodynamic approaches (research what feels like it would be best for you) 

Getting Started: FTM/N Top Surgery & The Support Letter 

First, figure out if you have to have a top surgery approval therapist letter

  • If your FTM/N top surgeon uses the informed consent model and you’re not seeking insurance approval then you will most likely not need one (unless you’re a minor) 
  • Have an open conversation with your FTM/N top surgeon about what’s needed first 

Find a therapist who has experience working with transgender and non-binary folks 

  • It’s important to note that any therapist will suffice, but it may be beneficial to you to see someone who has experience working with the community. This is in part because they may inherently have a better understanding of the transgender experience then someone who hasn’t worked with trans folks before 
  • Probably the most important part of finding the right fit for a therapist is someone who makes you feel welcomed and safe 

While you’re waiting to have your first session with your therapist, start researching what the FTM/N top surgery therapy letter needs to contain  

  • If you’re seeking insurance coverage for FTMN/N top surgery give your insurance company a call and ask what type of policies do they have around FTM/N top surgery insurance  
  • Stay specific to the topic, for example if you were getting double incision top surgery you could say; “I’m seeking approval for an FTM/N double incision bilateral mastectomy and I want to know what you need in the therapist letter of approval”  
  • Don’t be discouraged by their responses, some insurance personnel haven’t been trained in detail about transgender healthcare policies. If you’re not getting helpful answers or the process of speaking to them becomes frustrating wait until your appointment with your therapist and they can guide you the rest of the way 

Be honest about your goals when speaking with your therapist, helpful things to mention for their knowledge would be 

  • The reason for your visit (therapist letter and what else you’d like to discuss) 
  • Your gender identity  
  • Your time frame of wanting to get surgery 
  • Your support system (they’ll want to know who would be helping you after top surgery) 
  • Think of anything else you’d want to explore to get the most out of your session 

Seeing a Therapist for FTM/N Top Surgery; Is Therapy for Me?  

Gender alignment or transition can be a complex experience. Emotionally processing the many potential social, legal, and medical changes can be a lot to handle. Whether or not you need a referral letter for insurance purposes, it may be useful to consider therapy. Despite the stigma that therapy is only for individuals in crisis or facing a debilitating mental illness, anyone can benefit from it. Therapy can be especially valuable to folks approaching or recovering from surgery. 

FTM/N Top Surgery & Dr. Mosser’s Approach to Informed Consent  

Dr. Mosser’s services are based on an informed consent model. This means that having a therapist and a therapist letter is not required to receive top surgery, unless you are 17 or younger. However, receiving insurance approval requires a letter from a mental health provider that meets  WPATH standards. These guidelines also contain a list of recommended content for your therapist to include in the referral letter. Read more about WPATH as it relates to gender confirming surgeries here. 

Though mental health care is not required by Dr. Mosser, he sees therapists as a valuable part of the transition process. Seeking congruence in your gender identity through medical intervention can add new levels of complexity to your gender journey due to the emotional and physical effects. Therapists can often times provide insight, emotional support and tools to help you take care of yourself throughout the medical alignment process. 

Postoperative Depression: Utilizing Your Therapist After Surgery 

The silver lining of establishing a relationship with a therapist before surgery is that they can be added support for after your surgery. Due to physiological and psychological factors, postoperative depression can occur and may last for a few weeks. We recommend scheduling a session with your therapist 10-14 days post-surgery, to have a ready source of emotional support if you end up needing it.   

Finding a Therapist For FTM/N Top Surgery in Conclusion 

Therapy can make a big difference in your emotional processing and wellbeing as you approach and heal from surgery. A couple highlights to remember: 

  • You don’t need therapy to get top surgery, but you do need a letter if seeking insurance approval, or are going to an FTM/N top surgeon who requires one 
  • Refer to this website to find a therapist WPATH members 
  • Interview your therapist to ensure they’re the right fit for you and have the ability to meet your goals 
  • Remember that is wise to have a therapy appointment scheduled for 10-14 days post-op to help with the emotional processing