Sample Letter For Hormone Therapy - Garden Of Peace


Sample Letter For Hormone Therapy:
To Whom It May Concern:
This letter is to serve as documentation that my client, ___________* has completed ___ sessions of psychotherapy at
_________________ in ________, ______ to explore their gender prior to beginning hormone therapy. Having engaged in
psychotherapy from ____ to _______ 200__, ________ is eager to initiate hormone therapy in order to begin gender
___________ is ___-years old and s/he/they (or preferred pronoun) is currently (pertinent information about job or
college/schooling). _____________ has been strongly and persistently aware of the desire to be fe/male/gender non-
conforming/gender queer (or gender identity) creating a severe mind/body conflict. _____________ referred
her/himself/themselves (or preferred pronoun) to explore and resolve this conflict. This letter verifies that s/he/they
(or preferred pronoun) is psychologically ready to proceed with hormonal therapy, as per the following clinical
S/he/they (or preferred pronoun) described her/his/their (or preferred pronoun) childhood as (pertinent
background information to the present relevant to the transition). With regard to gender history, ______ reported
that (pertinent background information that pertains to childhood issues such as being female)
(Pertinent background information about family, such as acceptance of the transition or otherwise). (Pertinent
background information about 'coming out' as transsexual)
Over the course of the treatment, ___________ has demonstrated more than adequate knowledge of the benefits and
potential risks of hormone therapy. S/he/they (or preferred pronoun) is also aware that heredity may limit
her/his/their (or preferred pronoun) tissue response to hormones and that the maximum physical effects of the
hormones may take several years to become evident. Additionally, _______________ is educated about the procedures,
requirements, and is capable of making informed decisions regarding ongoing gender reassignment treatment.
Over the course of treatment, _____________ acknowledged that her/his/their (or preferred pronoun) decision to
transition has resulted in a significant reduction of personal distress surrounding gender identity. Diagnostically,
____________ meets criteria for Gender Dysphoria. There is an absence of problems related to mood, anxiety, or
substance abuse. The client does not evidence any symptoms of psychosis or disturbances in personality. It is
recommended that the client continue with the psychotherapy as s/he/they (or preferred pronoun) begin
her/his/their (or preferred pronoun) gender transition in order to address any issues that may surface. Given that
the client's insight and judgment are within normal range, it seems likely that any prescribed medication will be
taken in a responsible manner.
The client has met all the eligibility and readiness criteria outlined in the official World Professional Association for
Transgender Health Standards of Care for the treatment of individuals diagnosed with Gender Dysphoria. Given the
preceding report, I certify ____________ to be a fit candidate for hormone therapy. Please feel free to contact me at
(***-***-****) if there are any further questions regarding this client.
[Therapist name], [qualifications]
*Note: Name to be used throughout the letter should be the client’s legal name.


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