GENDER AFFIRMING LETTERS
Individual Counseling & Therapy
Columbia, Mo & Jefferson City, Mo


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I have decided to medically transition, where do I begin?

Once you’ve decided to medically transition, you make an appointment to meet with your doctor to begin hormone replacement therapy (HRT) and/or receive a gender-affirming surgery consultation. However, the doctor may ask you to provide a letter from a mental health professional.

Why does this happen? Why do they need a letter?

Mostly, they want to know that you are mentally and emotionally prepared to undergo the changes that occur with HRT or gender-affirming surgery. Additionally, they would like to know that you have all of the information in regards to HRT and gender-affirming surgery in order for you to make the right decision for yourself.

Seeking out a counselor to provide a gender-affirming letter is a step in the right direction!

*Our team also offers gender counseling/gender therapy for those interested. Please note, gender therapy and the gender-affirming letter process are two different things!

Assessments for Gender-Affirming Letters

At The Counseling Hub, we want to help individuals reach their desired goals in affirming their gender identity. Using the WPATH (World Professional Association for Transgender Health) standards of care guidelines, we offer a one-time, two-hour assessment for clients seeking gender-confirmation letters.

The purpose of this assessment is to allow the counselor to be able to confidently write a letter of recommendation for HRT and/or gender-affirming surgery.

What should I expect from the assessment?

You can expect to be met with somebody who wants to support you in your transition. We are not interested in stopping this from happening, but we have to do our due diligence through the assessment process. It’s a double-edged sword for us. Happy to be able to help, and equally frustrated that our hands are tied in some distinct ways. Our goal is not to make this process more difficult for you, nor is it to be a barrier to your treatment. It’s to help and be able to confidently provide a letter in support of your transition.

On a more logistical note, here’s what you can expect from an assessment.

  • an intake/some paperwork prior to confirming your session (standard for our practice)

  • a one-time, two-hour session

And that’s it, really! After the session, you’ll hear from your clinician within one week regarding a letter.

What’s the difference between counseling/therapy and gender-affirming letters?

Depending on your needs or wants, it is important to decide if seeing a counselor for assessment or on-going gender counseling/gender therapy is right for you. Since the assessment process is a one-time, two-hour session, discussion will probably be limited to topics only relevant to the assessment (which covers a lot, but still might feel somewhat limited).

If you’re unsure of whether or not you want ongoing counseling, here are some tells that it might be a good fit for you.

You might consider on-going counseling for gender identity if you are…

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  • still in the process of questioning your gender identity

  • having difficulty coming out to family members, friends, and significant others

  • wanting to know more about transitioning and the impacts it might have on you or in your life

  • struggling with the effects of gender dysphoria (see below for explanation, if needed)

  • wanting to address mental health concerns related (or unrelated) to gender identity, such as depression, anxiety, or confidence

  • needing extra support through the process of transitioning

Wait, what’s gender dysphoria?

Often, trans individuals do not feel completely comfortable in their body. Gender dysphoria can arise within trans people when there is a disconnection between their perception of themselves/their identity versus their biological sex. Dysphoria does not only make a person uncomfortable, it can be extremely distressing and can affect all aspects of everyday life. It can be difficult to attend social situations or participate in activities. Sometimes, it’s even painful to look in the mirror.

Gender dysphoria can lead to a negative impact on a person’s mental health and well-being by creating anxiety and increasing depression, both of which can be related to an overwhelming sense of detachment with one’s body. Individual counseling can help to create (and/or maintain) coping skills to decrease the uncomfortable and harmful symptoms of gender dysphoria.

Okay, I think I’m ready to move forward. Now what?

Easy, now you reach out to us to let us know you’d like to move forward! You can either contact us via our contact page, or you can give us a ring at 573-586-3204. If we don’t pick up, leavae a voicemail and we’ll get back you asap. You can also click the button below to share your contact info. We’re happy to help in whatever way we can. Thank you for trusting us in your process!