Pre-Surgery Evaluations
iPSYCHS believes that any transgender, gender diverse, non-binary, or two-spirit individual should be supported to obtain gender-affirming surgical procedures. Surgeries are medically necessary treatments to reduce Gender Dysphoria. They also allow patients to have more instances of Gender Euphoria, and to be able to function in life as their affirmed self, with less barriers.
Our therapists have specialized training which qualifies them to provide gender affirming surgical assessments. Questions will be asked to help understand a patient’s gender journey in order to document what is needed for insurance coverage and to meet the surgeon’s requirements. We will not question a patient’s gender identity, as we recognize gender identity is an internal construct. We aim to make the process go as quickly as possible. We do require patients to receive therapy in order to receive a comprehensive assessment.
Gender Reassignment
Therapists will be asked by insurance companies and surgeons to write letters prior to a patient receiving gender-confirming surgery.
· When considering writing letters, the therapist considers what the goals are in terms of assessing the patient’s capacity to make a decision.
· Mental health clinicians can provide capacity evaluations for TGNC surgical procedures just as they would any surgical procedure.
· Remember that capacity is based on the evaluation of a clinician/therapist and competency is decided by legal authority.
Capacity
Capacity involves four major components:
· The patient understands the information about the surgery, retains the information for long enough to make a decision, weighs the information in making the decision, and communicates that decision in a clear and consistent manner.
· The patient’s decision-making capacity is not a static state. The letter will only reflect the presence of capacity at the time of the evaluation.
· The goal of the letter is not to identify if the patient is transgender or not. While many insurance companies and surgeons will ask for this, identifying where one is on the gender spectrum is very personal and cannot be determined by a therapist nor disclosed.
· The letter will include the surgical procedure being performed, a brief mental health history, and a statement as to why the person is ready for surgery at this time.
