Hello and welcome. If you are reading this page I am guessing you are taking an important step in your journey and are looking for a letter of support. My staff and I write surgical or medical referral letters consistent with WPATH guidelines for conducting such assessments since this is the standard of care which most surgeons follow. In some cases, we may also tailor our recommendations to further demonstrate medical necessity for insurance coverage (e.g. if your insurance is using older versions of WPATH or has their own specific guidelines, they may require specific questions/statements).  

Philosophically, I do not believe people should have to “prove” who they are to me as it relates to their personal identity.  As a cisgender, endosex man it is not my place to determine what is “enough” to be a certain gender; there are many ways to understand and express our gender. Similarly, there is no universal, right or wrong way to transition gender.  Rather, during our session/s, my staff or I will focus on learning more about your unique gender history, gaining an understanding of how surgical or medical treatment might help improve your health and functioning and discussing the ways it may reduce dysphoria/increase euphoria.  We will also assess your capacity to make medical decisions and, as needed, ensure that you have everything prepared so that you have the best possible outcome. For children and adolescents, this discussion includes conversations with parents or guardians and other medical professionals who may assist in shared decision-making processes.

I do not guarantee completion of evaluation by a certain number of sessions since some people may have more or less complex backgrounds, may have done more or less research or may need more or less guidance. However, typically one or two sessions is sufficient. In some instances I might make a recommendation prior to writing a letter of support.  For example, if someone smokes cigarettes or is dependent on another substance I would recommend they engage in smoking cessation or abstain from the substance for a month (which is consistent with typical surgeon requirements prior to surgery) but anything like that would be something we would discuss as part of our session/s.

Additionally, my practice offers a limited number of pro-bono (i.e. free) evaluations for uninsured or underinsured individuals. These are conducted by psychology associates who practice under my supervision. I sign off on these letters and they meet criteria for a doctoral level evaluation. Given the lack of doctoral-level providers, we try to prioritize individuals who are seeking a second, doc-level letter. To see about availability or get on the waitlist, please e-mail info@maloufcounseling.com and let us know you are looking for a Pro Bono Surgical Eval.