Getting a Referral Letter for Gender Confirmation Surgery in Michigan

Congratulations on taking the next step towards your gender confirmation surgery! At Eunoia Mental Health, we acknowledge that getting a referral letter for gender confirmation surgery is an unnecessary barrier and we stand with trans leaders who recommend that a letter not be required for procedures. However, we are here to make the process as smooth as possible where it is still required.

Who Might Need a Referral Letter?
If you are looking to get top surgery, bottom surgery, a hysterectomy, facial feminization/masculinization surgery, or other procedure related to your transition, you may need a letter of referral from a mental health professional. Most insurances require at least one letter in order to have these procedures covered. In Michigan, a letter is not usually required to begin HRT, but some providers may request you obtain a letter from a mental health professional to begin care.

What Happens During a Referral Letter Assessment?
When meeting for a referral letter, a clinician will gather information about your transition so far and why you are interested in getting this procedure. Here at EMH, we like to keep these sessions as short as possible, only gathering the information needed to write the letter. Information that may be gathered includes:
– What procedure you’d like to have
– What doctor you are working with, if you have had a consultation for this procedure
– Dysphoria around area of the body you are looking to modify
– Transition so far (hormones, other procedures, coming out to others, pronouns/name change, etc.)
– Ways in which this procedure will help you
– Understanding of procedure and acknowledgment of risks
– Who may support you through the surgery/recovery process

Who Can Provide a Referral Letter?
Any licensed mental health professional can supply a letter, however, it is important to find a clinician who is knowledgeable about the process and who has additional training in transgender care. You can ask someone about their experience writing letters or working with trans people before booking an assessment with them.

How do I Schedule a Referral Letter Assessment?

You can schedule an assessment at Eunoia Mental Health by emailing As long as we are in-network, you should be able to use your insurance for the assessment. We are honored to help you in this exciting process!

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