Ask a Gender Therapist: “I Want to Transition – Do I Have to See a Therapist?”

In this week’s edition of the Ask a Gender Therapist Video Q&A Series I address…

“I Want to Transition – Do I Have to See a Therapist?”

As always the transcript is below. Be sure to send me your questions through the Contact Me page on this site!


Welcome to Ask a Gender Therapist! This is a video series in which I answer your transgender questions from the point of view of a gender therapist. My name is Dara Hoffman-Fox, I am your host and I’m a Licensed Professional Counselor in the state of Colorado.

This week’s question comes from Alyx. And Alyx says…

“Do you have to go to a gender therapist in order to transition? Because therapy is normally expensive.”

I have definitely gotten this question before. The short answer is that currently, here in 2014, it definitely depends.

So let’s break it down, what does it depend on?

The first thing it depends on is where you live.

The second thing it depends on is what physician you will be using and what surgeon you will be using.

I did go ahead and jump to the conclusion that Alyx was referring to medically transitioning, but we will also touch upon socially transitioning as well.

Let’s start off, as always, with the WPATH Standards of Care. The most recent version, Version 7 of the Standards of Care, says that is strongly suggested that someone does see a qualified mental health professional if they are going to be starting medical transition. But, it does say it is also ok if the medical professional you are going to is trained in behavioral health and/or they work as part of a multiple disciplinary team, meaning there is probably someone there who would do an evaluation with you.

The reason I say it depends on where you live is because you might live in an area in which the number of physicians that you would be choosing from are plentiful or you might live in an area where might be just one physician that you have to choose from.

So what you have to find out first of all is does the physician you want to go see for Hormone Replacement Therapy (HRT) requires that you visit a gender therapist to get a letter of support from that therapist.

The first thing you need to do when you research and try to find a physician in your area who will provide you with HRT, you need to call their office and just go ahead and ask. Ask them, “Does your physician require an HRT letter?” If they say yes then that means you have to go through the process of finding a gender therapist (you can watch a video that I made previously about this subject called How to Find a Gender Therapist).

If it turns out you don’t need a gender therapist then you can go ahead and make your appointment with that physician. More than likely, that physician will be asking you questions about your mental health or they will have a nurse practitioner do that.

The other thing that physician might do is have you fill out and sign something called ‘informed consent’. This is a topic I will cover in the next “Ask a Gender Therapist” video. Because this is also a way for physicians to make sure you are informed and you know what you are getting into. And because you signed this paper they keep it on file so that way, they are legally protected. But like I said, that’s a conversation for another video.

So if you find a physician who does require an HRT letter, there are still a few things you can keep in mind so it will be less of an expense to you when you go to see that gender therapist.

The first thing I would recommend is, when you go to find a gender therapist is that they know about the WPATH Standards of Care. You can get a copy of it off the internet as a PDF and print it out and email it to them so they know that there are specific changes that have been made to the Standards of Care.

Make sure that therapist knows there is a difference between you going in to get psychotherapy and going in to get an assessment for Gender Dysphoria. If you go in and you are saying “I need an assessment for Gender Dysphoria,” more than likely that therapist will see you for a fairly short number of sessions because they are basically assessing whether or not you have Gender Dysphoria. Then they need to write your letter and that process is finished.

That is different than going in for counseling or going in for psychotherapy. You can do that if you want, like I said, the WPATH says it is strongly suggested to get psychotherapy or counseling. But if you are just there for the assessment, you shouldn’t have to go for too many sessions.

Also, remind that therapist that in the Standards of Care, there is no recommended minimum number of sessions that you have to go in for. It’s about at what point does the therapist feel they have the information they need and have talked to you about the Standards of Care so they can put all of that information in that HRT letter that is needed.

The other thing you can do is ask the therapist if they have an intern who could see you, meaning that the intern could see you at a lower cost. The therapist would be supervising the intern so you could get the HRT letter. The therapist would end up writing the letter and signing it, but perhaps being able to see the intern at a lower cost could be of help.

The last suggestion I have is to see if you have a local Gender Identity Center or a local Pride Center. You can ask them if they provide low cost counseling to help you out with your HRT letter.

That is the summary of what you can do if it turns out you are visiting a physician who does require a letter, but still make it as affordable as possible.

Let me touch real quickly on surgeons. At this point the Standards of Care say pretty much the same thing, where it is strongly suggested that you go to a mental health professional to get the assessment and get the letter. Then bring it to the surgeon. For top surgery you need one letter while for genital surgery you need two letters. But the Standards of Care say that, like for HRT, if the surgeon is trained in behavioral health and/or has a team that can make that assessment, you don’t have to have that letter.

From my experience, I have noticed that for top surgery some surgeons do require the letter and some don’t. So far as I have seen, for genital surgery, surgeons are requiring both letters. That may change in the future, but for now, that is something to be prepared for, that you’re going to need to visit therapists to be able to have that done.

I wanted to touch on the social transition aspect as well. Here’s the thing: there are federal laws, there are state laws, there are county laws, there are city laws, and they are all different. I’m talking about the United States. Globally there are different laws in all the different countries.

So you have to find out what is going on in the state and even the city in which you live. Unfortunately, it can be a little bit of a mess currently, and at some point, hopefully everything will be streamlined.

But in the meantime, what I suggest you do is go to the Lambda Legal site. That is where you can find information specifically about your particular state. Also at Lambda Legal is a tool kit you can find that will help you with what your legal rights are in the particular part of the country that you live.

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The reason that, socially, there are so many ways that this is going is because everybody is able to make their own laws. Like I said, you might have to take some time to sift through all of that, but hopefully those links can give you a head start.

So Alyx, I appreciate your question and I bet a lot of other people appreciate it as well.

Just want to let everyone know that my new website is finally up! So what that means is that my blog, Conversations with a Gender Therapist, is now a part of the new website. What you would do is go to and what I would highly suggest you do is on the top right hand corner of the page where it says ‘Free Updates and News’ and if you give me your email address I will be sure to let you know when I put up new posts and I will send you a newsletter with different things that maybe don’t appear on the website or on the blogs.

I’d love to have you as part of my tribe so we can continue to learn and grow together!

And lastly, if you have a question for the Ask a Gender Therapist series, be sure to email that to

Take care!

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  • Tammi

    February 12, 2015 at 3:49 AM Reply

    This was very informative ,thank you

  • Jo Tandy

    October 4, 2015 at 4:32 PM Reply

    Thank You, I learned so much

  • Enzo

    August 13, 2016 at 3:06 PM Reply

    Hello, I was wondering if it’s *required* to see a therapist in order to start taking testosterone?

  • Enzo

    January 6, 2017 at 1:17 PM Reply

    I do want to start taking T soon, but i was wondering if i’d have to see a therapist before actually taking testosterone ?

  • George Massey

    April 20, 2017 at 1:16 PM Reply

    I’ve been looking into this for a few weeks now and my question is, how long will it take for a patient to get on going gender reassignment?

    • Dara Hoffman-Fox

      April 21, 2017 at 2:14 PM Reply

      Surgeons generally require that the patient has been “living as their true gender identity in all areas of life” for one year.

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