Blessing or BS? The therapy experiences of transgender and gender nonconforming clients obtaining referral letters for gender affirming medical treatment.

Brown, Holly; Rostosky, Sharon S.; Reese, Robert J.; Gunderson, Christopher J.; Kwok, Cheryl; Ryser-Oatman, Todd

doi:10.1037/pro0000274

Cited by 21 publications

(26 citation statements)

References 26 publications

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“…The necessity of preoperative mental health referral letters before gGAS has been heavily debated. [16][17][18] Some authors have suggested alternative patient-centered approaches to determining readiness for gGAS. 19 Regardless of whether one supports using mental health referral letters at all in the surgical transition process (such as before the first stage of primary gGAS), our patient experience has shown that additional referral letter requirements for staged or revision gGAS is particularly burdensome and unnecessary.…”

Section: Discussionmentioning

confidence: 99%

“…The necessity of preoperative mental health referral letters before gGAS has been heavily debated 16‐18 . Some authors have suggested alternative patient‐centered approaches to determining readiness for gGAS 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Critics of mental health referral letters have argued that preoperative mental health letters overall serve as a barrier to care, with minimal clinical benefit. [16][17][18][19] This study specifically examines the burden of mental health referral letters for secondary surgeries, including second-or third-stage operations for staged and revision procedures. We assess the concordance between WPATH recommendations and U.S. health plans' referral letter requirements by analyzing the patient-care experience at our academic, tertiary care center and by reviewing the policies of the largest national healthcare insurance companies and plans.…”

Section: Standards Of Care (Soc) For the Health Of Transsexual Transgender Andmentioning

confidence: 99%

“…On the other hand, many viruses, such as mumps virus, HIV and HSV, 7,14 have been found to impair semen quality, and they may directly interact with spermatozoa or affect spermatogenesis by inducing local inflammation. [15][16][17] Previous studies found that SARS, 1 of the 3 epidemic coronaviruses to emerge in the past 20 years and that shows similar clinical presentations to COVID-19, 18 could cause orchitis 19 and focal testicular atrophy. 20 Considering the tens of millions of COVID-19 cases and that men are more vulnerable to COVID-19 than women, [21][22][23] it is imperative to determine the effect of COVID-19 on male reproduction.…”

Section: Introductionmentioning

confidence: 99%

“…Critics of mental health referral letters have argued that preoperative mental health letters overall serve as a barrier to care, with minimal clinical benefit 16‐19 …”

Section: Introductionmentioning

confidence: 99%

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Requirement of mental health referral letters for staged and revision genital gender‐affirming surgeries: An unsanctioned barrier to care

et al. 2021

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Background:The World Professional Association for Transgender Health (WPATH) recommends referral letters from two mental health providers within one year of gender-affirming genital surgery (gGAS) to ensure patient readiness before primary surgeries. Many U.S. health insurance plans will not authorize second-and third-stage surgeries or revision surgeries without two referral letters. Such requirements are not supported by WPATH guidelines.Objectives: This study investigates insurance requirements for referral letters and their negative impact on care. Materials and methods:We retrospectively reviewed all gGAS cases over a 4-year period at our tertiary care medical center. Referral letter requirements for insurance authorization were documented. The nation's largest insurance companies, including commercial, state-, and federally funded plans, were contacted to confirm requirements. We prospectively recorded time needed to complete insurance authorization for a patient subset. WPATH publications were reviewed.Results: Nearly all reviewed U.S. health insurance plans required annually updated referral letters for each gGAS procedure, including staged and revision surgeries. No updated letters changed clinical management. Referral letter requirements delayed care. WPATH states that letters should not be needed for staged surgeries. Some plans required letters even for initial surgical consultation, a practice not supported by WPATH. Discussion and Conclusion:Insurance companies' requirements for referral letters impede care and contradict WPATH guidelines. We advocate that, at minimum, referral letters should not be required for surgical consultations or for staged or revision surgeries after a patient has already had first-stage primary gGAS. Universal referral letter requirements provide minimal clinical value, delay care, increase costs, and exacerbate gender dysphoria by invalidating gender transition. As with all procedures, surgeons themselves should be responsible for assessing patients' surgical readiness. Significant changes in mental health status or social situation should prompt How to cite this article: Yuan N, Chung T, Ray EC, Sioni C, Jimenez-Eichelberger A, Garcia MM. Requirement of mental health referral letters for staged and revision genital gender-affirming surgeries: An unsanctioned barrier to care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Standards Of Care (Soc) For the Health Of Transsexual Transgender Andmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Critics of mental health referral letters have argued that preoperative mental health letters overall serve as a barrier to care, with minimal clinical benefit 16‐19 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations