What You Need to Know About Letters of Readiness (LOR) for Gender-Affirming Medical Care
For gender-expansive individuals seeking gender-affirming medical care, navigating the requirements can feel daunting. One of the most common steps in this journey is obtaining a letter of readiness (LOR) from a licensed mental health professional. If you’ve begun researching the process, you may have encountered confusing or conflicting information about these letters—such as who can write them, how many are needed, and what they should include. In this blog, I aim to clear up some of the confusion and guide you through the essentials of LORs, helping to ensure you feel informed and prepared for this important part of your healthcare process.
What is a Letter of Readiness (LOR)?
A letter of readiness (LOR) is a typed document provided by a licensed mental health professional. This can include master’s level clinicians such as Associate Clinical Social Workers (APSW/LCSW), Licensed Professional Counselors (LPC-IT/LPC), or Marriage and Family Therapists (MFT-IT/LMFT), as well as doctoral-level clinicians such as those with PsyD, PhD, or DSW degrees. The primary purpose of the letter is to confirm that the client is prepared and informed to undergo gender-affirming medical care.
The LOR provides important statements regarding:
The client’s mental health diagnoses, if applicable.
The client’s capacity to make informed and voluntary decisions.
The client's understanding of both the risks and benefits of pursuing gender-affirming medical procedures.
A summary of the client’s gender journey, offering insights into how long they have been exploring their gender identity and their reasons for seeking medical care.
These components are important because they not only satisfy insurance requirements but also help affirm the mental readiness of the client. The letter serves as a formal step that both protects and empowers individuals as they take the next step in their gender journey.
Why Do I Need a Letter of Readiness?
The main reason you need an LOR is that insurance companies often require one before approving gender-affirming medical procedures. The letter provides insurance companies with assurance that the care being requested is not only medically necessary but also that the client is mentally prepared for surgery or hormone therapy.
Gender-affirming medical procedures can involve significant changes to the body, and the emotional and psychological readiness of the client is crucial. The LOR helps ensure that the client has taken time to process these changes, understands the risks and benefits, and is aware of the long-term impact on their physical and mental well-being.
Additionally, the LOR serves to enhance the safety and effectiveness of the surgery. By ensuring that individuals are fully informed and mentally ready, the risk of regret or emotional distress after surgery may be reduced.
How Many Letters of Readiness Do I Need?
The number of LORs required for gender-affirming medical care varies depending on several factors, including the type of care you are pursuing, your age, and your insurance provider’s specific guidelines. Below are some general guidelines:
For adults seeking hormone replacement therapy (HRT): Typically, no LOR is required. However, some providers or insurance companies may request one for their records.
For adults seeking gender-affirming top surgery or facial feminization surgery: Usually, one LOR is required, though some insurance companies may require two.
For adults seeking gender-affirming bottom surgery (such as vaginoplasty, phalloplasty, or metoidioplasty): Two LORs are generally required.
For youth (17 years old or younger) seeking hormone replacement therapy: Typically, one LOR is required.
For youth (17 years old or younger) seeking gender-affirming surgery: One or two LORs may be required, depending on the type of surgery and the specific guidelines of the insurance provider.
It is important to note that if you require two LORs, they must come from two different licensed professionals. This ensures that multiple professionals have assessed your readiness and agreed that you are prepared for gender-affirming medical care.
Do Letters of Readiness Expire?
Yes, LORs do expire. Generally, they are valid for one year from the date they are written. For example, if your letter is dated June 21, 2024, it will expire on June 21, 2025. After this date, insurance will require a new letter, which means you will need to meet again with your mental health provider to obtain an updated version.
The expiration of LORs can sometimes cause delays in care if not properly managed. To avoid potential postponement or cancellation of your surgery or gender-affirming medical appointment, it's advisable to schedule a follow-up with your letter writer a few months before your planned procedure. This gives you ample time to receive an updated letter and avoid any disruptions in your medical care.
If your surgery or appointment is scheduled well after your LOR expires, reaching out to your mental health professional early can help ensure that there are no gaps in your documentation. A good rule of thumb is to check in with your provider three to four months before your scheduled surgery or medical procedure. This way, you can proactively update your LOR and minimize the risk of delays.
Common Concerns About Letters of Readiness
What if I don’t agree with what’s written in my LOR? If you disagree with any part of your LOR, it’s essential to have an open conversation with your mental health provider. It’s your letter, and it should accurately reflect your journey and readiness. Make sure that your therapist understands your experiences and goals for seeking gender-affirming care.
What if I move or switch therapists? If you switch therapists or relocate, it’s important to make sure that your new therapist is aware of your situation and has access to your previous records, including the original LOR if applicable. If two letters are required, the second therapist must write the new one.
Can my LOR be denied by insurance? In some rare cases, insurance companies may dispute the contents of an LOR. Should this happen, consult with your healthcare team and insurance representative to clarify the reasons and to see if adjustments or appeals can be made.
Taking the Next Step
Understanding the process of obtaining a letter of readiness for gender-affirming care is one of many steps in your journey, but it’s an important one. While it can feel like a lot of bureaucratic red tape, the LOR ultimately serves to protect your readiness and provide support during this life-changing process. If you’re unsure about the next steps or how to obtain an LOR, don’t hesitate to reach out to licensed professionals in your area who specialize in gender-affirming care.
It’s also beneficial to have a good support network in place, whether that includes friends, family, or an online community. You don’t have to navigate this alone. There are many mental health professionals and support groups who can guide you through the process, ensuring you feel confident and supported at each step.
To learn more about LORs and other aspects of gender-affirming medical care, consider checking out these resources:
What is a Letter of Readiness for Gender-Affirming Surgery
Remember, your journey toward gender-affirming care is deeply personal, and the requirements, while sometimes cumbersome, are designed to ensure you have the best support system possible. Stay informed, communicate openly with your providers, and know that there are people ready to help you every step of the way.