Presurgical Evaluations & Gender Affirming Surgery Letters in Texas
Getting a WPATH letter can feel like one more hurdle in an already challenging process. My goal is to make the evaluation straightforward and supportive. Virtual sessions across Texas with Caitlin Senger, LPC, Gender ASSET 2.0 trained.
Preparing for Gender Embodiment Surgery & Need a WPATH Letter?
If you are an adult preparing for gender-affirming surgery, your surgeon or insurance provider may require a mental health presurgical evaluation and letter of support as part of the process. While standards of care have evolved, these requirements are still common.
Navigating this process can sometimes feel confusing or overwhelming. I offer presurgical evaluations and letters of support via telehealth for adults across Texas. Let’s talk about what this process looks like so you know what to expect every step of the way.
What is a Presurgical Evaluation?
A presurgical evaluation is a conversation with a licensed mental health professional to discuss your readiness for gender affirming surgery. Many surgeons and health insurance companies follow WPATH guidelines and require a letter from a mental health professional confirming you have met the standards of care.
Some procedures require one letter while others may require two letters. The purpose of this evaluation is to ensure you have support, clarity and informed decision-making throughout the surgical process.
WPATH Standards of Care
These are the standards many surgeons and insurance companies use to assess readiness for surgery. I’ll use them to guide your evaluation and letter. During the evaluation, we’ll explore your gender journey, surgery and recovery plans to help me assess how these standards apply to you.
You have persistent gender incongruence
You are able to give informed consent
Any significant mental health concerns are reasonably well managed
You understand the risks, benefits and expectations of surgery
What to Expect During the Presurgical Evaluation & Letter Writing Process
At Cosmic Daisy Counseling, the surgery letter process is super straightforward:
We complete the Gender ASSET 2.0 assessment and talk through your gender embodiment goals, surgical plans and readiness.
We review expectations for surgery, recovery plan and recommendations
If we determine you are ready for surgery, I prepare a letter that meets surgeon or insurance documentation requirements and send it directly to you within a week from the evaluation.
You will complete a release of information form so I can communicate with your surgeon if there are any questions about the letter or your readiness for surgery.
For most clients, the process can be completed in one session (at most two), depending on needs and how fast we complete the assessment. If you already work with a therapist, you can continue your ongoing care while I provide the evaluation and letter.
Meet Caitlin Senger, LPC, PMH-C
Hi, I’m Caitlin. I’m a licensed professional counselor with additional training in gender-affirming care and presurgical evaluations through Gender ASSET 2.0.
A presurgical evaluation is about more than checking a box for your surgeon or insurance company. I want you to have space to talk honestly about what you’re looking forward to, what you’re nervous about and what you’re hoping surgery will change for you.
I’ve completed Gender ASSET 2.0, an advanced training focused on presurgical evaluations and letters of support for transgender and gender-diverse people. I can also help you think through the emotional side of surgery, recovery and what comes next.
You can explore my Gender Expansive Resource Guide for affirming resources and community support.
As a member of the LGBTQIA+ community myself, I know how important it is to feel comfortable with the person evaluating you. My goal is for the evaluation to feel like a conversation while still providing the documentation your surgeon needs.
Credentials
Licensed Professional Counselor (LPC), State of Texas, License #85043
Certified in Perinatal Mental Health (PMH-C)
Gender ASSET 2.0 trained
Lived Experience
Advanced Training in EMDR
Online Presurgical Evaluations & Letter Writing Across Texas
If you’re preparing for gender-affirming surgery, you shouldn’t have to travel across Texas to find a provider who understands the process.
I offer telehealth presurgical evaluations and letters of support for adults anywhere in Texas whether you’re in Austin, Dallas, Houston, San Antonio, El Paso or somewhere in between.
For some people, meeting online also offers more privacy and flexibility. You get to choose where you complete your evaluation, from a space where you feel comfortable.
Historically, transgender people have often had to prove themselves in medical settings in ways that cisgender people just don’t. Experiences like this can make the idea of a presurgical evaluation feel intimidating.
Living in Texas can also add an extra layer of stress. Public conversations and legislation around trans rights can create uncertainty about accessing care and feeling understood.
At Cosmic Daisy Counseling, presurgical evaluations are approached with respect and transparency. The goal is to provide the documentation surgeons require, ensure you understand the procedure and recovery process and offer space to talk through the emotional aspects of surgery.
The Reality of Seeking Care in Texas
Already Have a Therapist? Keep Your Therapist & Get Your WPATH Letter Here
You don’t have to leave your current therapist to get a WPATH letter.
If you already have a therapist you trust, you can keep working with them while I handle the presurgical evaluation and letter. We’ll focus on the Gender ASSET 2.0 assessment, your gender embodiment goals, your surgical plans, and making sure you have a clear understanding of what to expect throughout the process.
With your permission, I can connect with your therapist or surgeon if questions come up along the way. You don’t have to start over with a new therapist just to complete the evaluation and get your letter.
Increasing Accessibility
Access to gender affirming care shouldn’t depend on whether someone can afford the paperwork required to move forward. To help make this process more accessible, I offer one free presurgical evaluation and surgery letter each month for someone in the community.
If cost is a barrier for you, feel free to reach out and ask if the pro bono spot is available that month. My hope is to make this step toward your gender embodiment goals a little more accessible for those who need it.
Getting Started
1
Optional Free
15 Minute Consult
We'll talk about what brings you in, answer any questions you have about the evaluation and letter process, and make sure it feels like the right fit. You can ask anything you need to before deciding whether to move forward. If you need your letter fast and feel we are a good fit, you can skip this step and schedule the evaluation.
2
Presurgical Evaluation
We’ll explore your gender journey, your goals for surgery and what you’re hoping surgery will change. We’ll also talk about your expectations for surgery, plans for recovery and relevant history. If you need support beyond the evaluation, I can also share resources such as voice coaches, hair removal providers and other gender-affirming supports.
3
Letter of Support
After your evaluation, I’ll complete your letter outside of session and send it directly to you. The letter writing process can take up to a week. During the wait, I will have you complete a release of information so I can communicate with your surgeon if needed. There’s no additional fee for the letter, it’s included with the presurgical evaluation.
Fees
15-Minute Consultation
$0
Monthly Pro Bono Evaluation & Letter
(50 Minutes)
$0
Presurgical Evaluation & Letter
(50 Minutes)
$170
*Most clients at Cosmic Daisy pay privately. This means no mental health diagnosis on record, no insurance dictating your care and complete confidentiality, a meaningful protection for LGBTQIA+ clients in Texas right now. I'm in-network with Curative & Employer Health Network (EHN). I can provide superbills for all other insurance plans.