[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-280114-105":53,"doc-detail-280114-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","transgender-gender-non-binary-surgical-services-and-endorsements-referrals-and-mental-health-letters","Transgender & Gender Non-Binary Surgical Services and Endorsements - Referrals and Mental Health Letters","","University of Washington Medicine’s Transgender & Gender Non-Binary Health Program outlines referral, authorization, and documentation requirements for gender-affirming surgical services, including breast/chest, facial, vocal, and genital procedures. It specifies learning objectives covering surgical referrals, coverage requirements, surgical endorsements, and mental health assessments. The material summarizes WPATH and Washington standards, required criteria for eligibility, letter timing rules, and insurance-versus-recommendation considerations, plus a clinician referral directory and a step-by-step authorization pathway.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/transgender-gender-non-binary-surgical-services-and-endorsements-referrals-and-mental-health-letters/280114/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/transgender-gender-non-binary-surgical-services-and-endorsements-referrals-and-mental-health-letters/280114.png","ImageObject",442,249,{"name":88,"@type":89},"supergirl","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":15},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What eligibility criteria are required for breast/chest, facial, and vocal surgery?","Question",{"text":108,"@type":109},"The document lists persistent, well-documented gender dysphoria; capacity to make an informed decision and consent; age of majority (with pediatric/adolescent SOC for younger patients); and well-controlled significant medical or mental health concerns. Hormone therapy is not required as a prerequisite for eligibility.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What documentation must accompany a surgical referral for breast/chest surgery?",{"text":113,"@type":109},"A support letter from a primary care provider or the hormone prescriber (if applicable) and one mental health assessment letter from a licensed mental health provider are required. Letters must be written within 18 months of surgery.",{"name":115,"@type":106,"acceptedAnswer":116},"How does the authorization pathway determine when referrals and endorsements are appropriate?",{"text":117,"@type":109},"The pathway asks whether the patient is 18 or older, whether there is a gender dysphoria/gender identity disorder diagnosis, and whether the patient has received HRT or lived in a gender role congruent with their identity for at least one year. It also checks that GD/GID is documented for at least six months with other concerns reasonably well controlled, then confirms required mental health assessment and endorsement letters based on the surgery type.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},280114,1789533888,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":15,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":40,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":139},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Transgender and Gender Non-Binary Surgical Services and Endorsements  \nUNIVERSITY OF WASHINGTON MEDICINE’S  \nTRANSGENDER & GENDER NON-BINARY HEALTH PROGRAM  \nSEAN JOHNSON, LSWAIC  \nPRONOUNS: HE/HIM OR THEY/THEM  \nOctober 2020  \nLEARNING OBJECTIVES  \n􀂙 TGNB Surgical Referrals and Coverage Requirements  \n􀂙 TGNB Surgical Endorsements  \n􀂙 TGNB Mental health Assessments  \nTGNB Surgical Referrals, Support Letters and Coverage Requirements  \nThe likelihood of being treated for a mood or anxiety disorder was reduced by 8% for each year since last gender-affirming  \n(Bränström & Pachankis, 2019)  \n & Identity  Incongruence 11)  \nTwo or more of the following features, present for > 6 mths  \n􀂃 A strong desire to do away with primary or secondary sex characteristics  \n􀂃 A strong desire to have sex characteristics of another gender  \n􀂃 A strong desire to be treated as another gender  \n􀂃 A strong desire to be another gender  \n􀂃 A profound need for society to treat them as another gender  \n􀂃 A strong conviction that one has the typical feeling and reactions of another gender  \nWPATH and WA Standards for Gender  \nAffirming Surgery  \nCriteria for Breast/Chest, Facial, Vocal Surgery :  \n1. Persistent, well-documented gender dysphoria;  \n2. Capacity to make a fully informed decision and to consent for treatment;  \n3. Age of majority in a given country (if younger, follow the SOC for children and adolescents);  \n4. If significant medical or mental health concerns are present, they must be reasonably well controlled. Hormone therapy is not a pre-requisite.  \n*Although not an explicit criterion, it is recommended that MtF patients undergo feminizing hormone therapy (minimum 12 months) prior to breast augmentation surgery. The purpose is to maximize breast growth in order to obtain better surgical aesthetic.  \nDocumentation to accompany surgical referral:  \n• Letter of support from a primary care provider or whomever is prescribing hormones if applicable .  \n• 1 mental assessment letter from a licensed mental health provider.  \n*Letters must be written within 18 mths of surgery.  \nCriteria for genital surgery (two referrals) Hysterectomy, ovariectomy orchiectomy, metoidioplasty, phalloplasty, Vulvoplasty  \nSame criteria as Breast/Chest surgery (1-4)  \n*These criteria do not apply to patients who are having these surgical procedures for medical indications other than gender dysphoria, nor post-op repairs.  \n* if another indication is appropriate and would facilitate care sooner, fine to proceed on that basis.  \nDocumentation to accompany surgical referral:  \n• Letter of support from a primary care provider or whomever is prescribing hormones if applicable .  \n• 2 mental health assessment letters (2 MH providers)  \n-one from any licensed therapist  \n-one from doctorate level (PhD, PsyD or MD, i.e., psychiatrist)  \n*Insurance regulation vs WPATH recommendation  \n*Letters must be written within 18 mths of surgery.  \nSurgical Referrals  \nVulvovaginoplasty Surgery is coming in 2022!  \nThings to keep in mind for future referrals as they can take time:  \n• Fertility Preservation  \n• Electrolysis  \n• 2 nd Phd/MD level mental health assessment letter  \n\n| Surgery | Name | Phone | Location | Specialty |\n| --- | --- | --- | --- | --- |\n| Plastic | Russell Ettinger, MD | 206.520.5000 | Seattle Children’s Hospital, Burn and Plastic Surgery at Harborview | Chest/Breast, Facial surgery |\n| Plastic | Shane Morrison, MD, MS | 206.520.5000 | Seattle Children’s Hospital, Burn and Plastic Surgery at Harborview | Chest/Breast, Vulvovaginoplasty surgery |\n| Urology | Tom Walsh, MD, MS | 206.543.3640 | UW Medical Center-Roosevelt | Orchiectomies, post-op repair, fertility preservation |\n| Urology | Hunter Wessells, MD | 206.598.6358 | Urology Clinic at Harborview, UW Medical Center-Roosevelt | Orchiectomies, post-op repair, fertility preservation |\n| Urology | Alex Skokan, MD | 206.598.6358 | UW Medical Center-Roosevelt, Urology Clinic at Harborview | Vulvovaginoplasty, or","cbCaioluivabeFC2","https://ap.wps.com/l/cbCaioluivabeFC2","pdf",1695486,"English","# Learning Objectives\n## TGNB Surgical Referrals and Coverage Requirements\n## TGNB Surgical Endorsements\n## TGNB Mental Health Assessments\n# TGNB Surgical Referrals, Support Letters and Coverage Requirements\n## WPATH and WA Standards for Gender Affirming Surgery\n## Documentation to Accompany Surgical Referral\n# Surgical Referrals Directory\n## Surgical Authorization Pathway\n## Eligibility Questions and Letter Requirements\n## Procedure Categories","[{\"question\":\"What eligibility criteria are required for breast/chest, facial, and vocal surgery?\",\"answer\":\"The document lists persistent, well-documented gender dysphoria; capacity to make an informed decision and consent; age of majority (with pediatric/adolescent SOC for younger patients); and well-controlled significant medical or mental health concerns. Hormone therapy is not required as a prerequisite for eligibility.\"},{\"question\":\"What documentation must accompany a surgical referral for breast/chest surgery?\",\"answer\":\"A support letter from a primary care provider or the hormone prescriber (if applicable) and one mental health assessment letter from a licensed mental health provider are required. Letters must be written within 18 months of surgery.\"},{\"question\":\"How does the authorization pathway determine when referrals and endorsements are appropriate?\",\"answer\":\"The pathway asks whether the patient is 18 or older, whether there is a gender dysphoria/gender identity disorder diagnosis, and whether the patient has received HRT or lived in a gender role congruent with their identity for at least one year. It also checks that GD/GID is documented for at least six months with other concerns reasonably well controlled, then confirms required mental health assessment and endorsement letters based on the surgery type.\"}]","Transgender & Gender Non-Binary Surgical Services and Endorsements - Referrals and Mental Health Letters | PDF",6]