Surgical referral letters may be required for surgical procedures, per insurance guidelines. Separate letter(s) are required for each surgery sought (this is an insurance requirement).

Patients may undergo an assessment by and provide a referral letter from their own outside mental health or medical providers. At present, we have limited capacity to provide these referral letters at UCSF.

The UCSF Gender Affirming Health Program adheres to the guidelines for surgical assessment as described in the World Professional Association for Transgender Health Standards of Care, 8th Version. The guidelines are focused on undergoing an assessment by a qualified provider with at least a master's degree. This can be a medical or mental health provider. If the person conducting this assessment is outside of UCSF, they should write a referral letter. Currently, insurance companies require one formal letter for each procedure performed. Some insurance companies may require two letters for some genital procedures.

Surgical assessment considerations

Beyond the specific criteria set forth by the WPATH Standards of Care, there are two other important areas for the assessment of anyone undergoing major surgery, for any reason.

1. Ensuring realistic expectations of what surgery can and can not do, being emotionally prepared for the realities of potential complications or less-than-satisfactory outcomes.
2. Ensure adequate support during the pre- and post-surgery period. This includes having someone to take you to and from surgery and be with you after surgery to assist with recovery needs. This could include anything from obtaining supplies at the pharmacy to preparing meals and assisting with domestic needs. For those who do not have someone to fill these roles, arrangements can be made for home health assistance or even short-term placement in a skilled nursing facility.

Referral letter template

Referral letters should use the Gender Affirming Health Program (GAHP) surgery letter template. Please make specific note of the following important factors:

• Housing status: City, with whom, stability, access to private bathroom
• Documentation of any relevant disability, such as limitations in mobility, learning, etc…
• Presence of adequate support during the pre- and post-surgery period. This includes having someone to take the patient to and from surgery, and be with them after surgery to assist with recovery needs. This could include anything from shopping for groceries, obtaining supplies at the pharmacy, preparing meals and assisting with domestic needs. Patients who experience barriers in these areas will be referred to our social worker to explore strategies for addressing these needs. Referring outside mental health providers should highlight such areas of need in their referral letter.

​Social worker support

All surgical patients will also meet with our social worker (in person, via video, or via phone)

• Our social worker can assist with supporting needs identified in the referral letter
• Complete the Social Work Assessment packet before meeting with the social worker

Referral letters & supporting documentation

Referral letters and supporting documentation should be sent to:

UCSF Gender Affirming Health Program
1725 Montgomery St.
Suite 250
San Francisco, CA 94111
Tel: 415-885-7770
Fax: 415-353-3399
Email: [email protected]