Getting an HRT (hormone replacement therapy) letter is an important step for many transgender and gender diverse people who wish to medically transition. The letter is written by a mental health professional to confirm a diagnosis of gender dysphoria and recommend hormone therapy as an appropriate treatment.
The Main Steps to Getting an HRT Letter Are:
- Find a qualified mental health professional who has experience working with transgender clients. This may be a psychologist, therapist, psychiatrist or other licensed provider. Look for someone familiar with the WPATH Standards of Care guidelines. Get referrals from transgender support groups if possible.
- Schedule an intake appointment to share your gender identity, transition goals and mental health history. The professional will assess your individual situation. Multiple sessions may be needed before getting your letter.
- Provide information to support your gender dysphoria diagnosis. Be open about your experiences with gender identity and role, any related mental health struggles, how long you've felt this way, etc. Your therapist needs this background to make an informed decision about writing a recommendation.
- Obtain any required assessments if the mental health professional needs more information to confirm diagnosis/eligibility. This may include psychiatric evaluation, psychological testing or letters from other providers.
- Meet with your therapist regularly over a period of time so they can get to know you and track progress. WPATH guidelines suggest living in your identified gender role for at least 3 months before an HRT letter, but requirements vary.
- Ask your provider directly about getting the letter once you meet eligibility criteria. Or let them know upfront this is your goal so they can guide you through next steps. Be patient but self-advocate!
What Should the HRT Letter Include?
- Header with provider's name, credentials, license info, direct contact details
- Diagnosis of gender dysphoria using DSM-5 criteria
- Duration of therapeutic relationship or time assessing the patient
- Statement that hormone therapy is an appropriate next step to treat dysphoria
- List of recommended hormone medications/dosages
- Follow-up plan for continued behavioral health support
- Signature and date from mental health professional
Tips for Smoother Process:
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Educate yourself on the transition process and WPATH standards before your intake session. This shows the seriousness of your intentions.
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Start hair removal/voice therapy if desired. Taking tangible steps can support your readiness.
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Ask for calculator estimated date if the waitlist is long.
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Have an open discussion about the provider's approach and any concerns early on rather than getting disappointed later.
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See multiple providers for extra assessments if you want to expedite the process or hit barriers with one.
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Consider informed consent clinics that provide HRT without requiring a letter if you do not have access to a qualified mental health provider.
Getting an HRT letter takes effort but it is a major milestone toward living in your truth. Take it step-by-step, self-advocate along the way, and before you know it you'll have the recommendation in hand to pursue medical transition! Speak to your provider if you have any other questions.
