There are two approaches to clearance for MTF/N or FTM/N chest reconstruction surgery. In the first approach, a therapist works with the patient and through this process concludes with the patient that surgery is the next reasonable step for transition. This leads to a ‘letter of clearance’ written by the therapist, approving the patient to move forward with surgery. While the most recent standards of care from WPATH do not require a letter for top surgery, the standards do require letters for certain type of surgery such as genital reassignment surgery (often referred to as “bottom surgery”).
The second approach views top surgery as similar to other types of reconstructive surgery. Taking this approach, full discussion between the surgeon and patient is sufficient for the patient to make an educated decision whether to proceed with surgery. This second approach, in which a letter from a therapist is not required, is called the “informed consent model.”
Dr. Mosser follows the informed consent model and generally does not require letters for FTM/N or MTF/N top surgery, or other body masculinization or feminization procedures (except in the case of individuals 17 years of age or younger). This is not to imply that Dr. Mosser does not value the therapeutic process. Therapists trained in the experience of gender transition can be an extreme asset on this complex and sometimes stressful journey. Often, therapists have a breadth of experience that can help patients through a wide variety of issues related to their transition, some of which may be unforeseen.
So, letters are welcome and valuable but often not required for surgery. If you are an insightful, mature individual 18 years or older, with an adequate support system and are capable of informed consent based on an educated experience of the risks and benefits of surgery, Dr. Mosser does not require a therapist letter. If you are interested in having surgery covered by insurance, the insurance company may require a therapist’s letter in order to grant insurance approval for surgery.