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Evaluation and letter of Support for Gender-Affirming Medical Treatment

Healthy Synergy, LLC currently offers a 90-minute evaluation designed to support people needing a letter to access gender-affirming medical treatments. This service includes coordination of care with medical providers and any other mental health professionals part of the care team. We understand the importance of taking this step and feel honored that you are trusting Healthy Synergy, LLC with your evaluation. The following contains important information about our gender-affirming medical treatment letter evaluation and business policies.


Healthy Synergy, LLC recognizes the harmful barriers and challenges many transgender and gender-nonconforming (TGNC) persons face while trying to access gender-affirming medical treatment and affirmative care overall. Trauma within the medical model (including behavioral health) continues even with incremental historical changes. Clinicians at Healthy Synergy, LLC aim to use an informed consent model that recognizes client empowerment and choice as well as supports clients accessing gender-affirming care in the current medical model. Given the nuanced nature of these areas, your clinician will review care recommendations from the perspective of advocating and supporting clients in awareness of resources available in order to facilitate best outcomes. Recommendations to be addressed prior to surgery are specifically related to areas of immediate safety concerns and coincide with mental health professional legal and ethical codes rather than historic gatekeeping practices. As part of this evaluation service, clinicians will provide the allotted hours of consultation and coordination of care to support clients in the process of accessing gender-affirming medical treatment. Healthy Synergy, LLC recognizes that many clients may not need or desire any further coordination of care and will be empowered to access those as needed per their own volition. Healthy Synergy, LLC views its role as supporting the TGNC community in navigating the pathogenic medical model by promoting a salutogenic, health- and wellness-based approach and awareness in the evaluation and consultation process. 

“Being true to oneself creates the integrity and self-respect we need to have if we are to extend that respect to others.” 
― Jamison Green, Becoming a Visible Man

This evaluation is not a therapy service, and clients seeking gender-affirming medical treatment evaluation letters do not need to be ongoing therapy patients. Clients who only require an evaluation are not considered therapy patients; therefore, no therapy relationship is automatically established after the evaluation is completed. It is an ethical standard that clinicians do not refer a client to themselves. A client who is interested in initiating a therapy relationship post evaluation will be provided referrals and given the option to return to Healthy Synergy, LLC if desired. Review of recommendations for ongoing support may be included as part of the evaluation. Healthy Synergy, LLC cannot prescribe medications.

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Possible Outcomes

Possible outcomes* from the evaluation process include: 


1. A letter that supports/affirms a client’s decision to undergo a gender-affirming medical/surgical procedure and indicates that there are no ongoing concerns or needs that must be addressed prior to the medical/surgical procedure. Consultation to coordinate care with the medical professional completing the procedure will be offered and contingent upon client’s written authorization. 


2. A letter that supports/affirms a client’s decision to undergo a gender-affirming medical/surgical procedure along with completion of care recommendations prior to the procedure in order to facilitate best outcomes. Some of these considerations to be addressed and supported prior to the medical/surgical procedure include: 

  • Current homelessness or lack of stable housing for aftercare (Housing and shelter resources will be provided, and clinician may coordinate with any authorized individuals on options for housing and aftercare needs)

  • Active risk/danger to self or others (During the evaluation, risk/danger to self and others will be reviewed. Your clinician will also review risks as well as benefits and considerations for improvement in mental health and/or alleviation of dysphoria and passive suicidal ideation symptoms with access to gender-affirming medical treatment)

  • Active psychosis (Similarly, resources and recommendations for best outcomes will be provided)


3. A letter is not provided due to a) your choice to decline a letter or evaluation or b) concerns of contraindication if recommendations for supporting client safety are not met within a specified scope of time following the initial evaluation. Resources and referrals will be provided to the client to address safety and housing needs prior to the medical/surgery procedure; clients may coordinate with the clinician to complete a follow-up at that time and/or request re-evaluation depending on time between initial evaluation and completion of recommendations. Referrals for additional clinicians who may complete gender-affirming medical treatment letter evaluations will also be provided in initial evaluation packet to support client choice and empowerment in evaluation process. 

*These possible outcomes are indicated for adults only. Families seeking assistance for accessing gender-affirming medical treatment for a minor have additional recommendations in accordance with WPATH Standards of Care and state laws. Resources for minors and their families can be found at the Phoenix Children's Hospital, Arizona Trans Youth & Parent Organization (AZTYPO), One*N*Ten, and Trans Spectrum of AZ (TSAZ).  

Payment & Clinicians

PAYMENTS & FEES: Clients are expected to pay for the evaluation at the time of service using check, HSA/FSA, or credit card. The fee for a returned check is $35. The price for a 90-minute evaluation is $60; this service includes the evaluation, the documentation process, and 1 hour of consultation for coordination of care. After that, if any additional follow-up or coordination of care is needed to support recommendations and best outcomes, an additional $60 will be charged for up to 3 additional hours of coordination/consultation. Any further services and rates would need to be reviewed with the clinician. You have the right to be informed of all the fees that you are required to pay.


Two of our Healthy Synergy, LLC clinicians currently offer gender-affirming medical treatment letter evaluations and coordination of care in line with the World Professional Association for Transgender Health (WPATH) competency requirements and recommendations as stated in the WPATH Standards of Care (SOC) Version 8. View our notice of clinician competency per the SOC (v.8) recommendations for assessing adults here.

If you are interested in scheduling an evaluation, you can outreach either provider directly or use our contact page. 

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Review a guide for local and national resources here. Resources for grants and financial assistance accessing gender-affirming medical care are also available via Point of Pride's Annual Transgender Surgery Fund, The Jim Collins Foundation, and Genderbands. 

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