Eligibility & Documentation

Criteria, letters & readiness.

A clear, side-by-side overview of the WPATH Standards of Care Version 8 criteria we use to evaluate candidacy for facial feminization and transfeminine top surgery, together with what an effective mental-health letter must contain.

Why criteria matter

The criteria below are not gatekeeping—they are guardrails that protect both your clinical safety and your insurance coverage. The World Professional Association for Transgender Health (WPATH) Standards of Care, Version 8, published in 2022, are the framework virtually every U.S. payer—and our practice—follows.

When the criteria are met and clearly documented, prior authorization is far more likely to succeed and your surgical experience proceeds without delay. When elements are missing, our team will work with you and your mental- health provider to complete them.

Side by Side

Top surgery vs. FFS criteria.

Both procedures share the foundational requirements for gender-affirming surgery. FFS adds two additional criteria related to gender role and individual procedure assessment.

Top Surgery

Augmentation Mammoplasty

Adult age (18 or older).
Diagnosis of gender dysphoria that is marked and sustained.
Capacity to make fully informed decisions and provide consent.
One letter of assessment from a qualified mental health or licensed clinical professional within the past 12 months.
Other possible causes of apparent gender incongruence have been excluded.
Mental and physical health conditions assessed and optimized.
Stable on feminizing hormone therapy for at least 12 months unless contraindicated or not desired.
Existing chest appearance demonstrates significant variation from expected appearance for the affirmed gender.

II.

Facial Feminization

Combined FFS Procedures

Adult age (18 or older).
Diagnosis of gender dysphoria that is marked and sustained.
Capacity to make fully informed decisions and provide consent.
One letter of assessment from a qualified mental health or licensed clinical professional within the past 12 months.
Other possible causes of apparent gender incongruence have been excluded.
Mental and physical health conditions assessed and optimized.
Stable on feminizing hormone therapy for at least 12 months (unless contraindicated).
Gender identity has been present for at least 12 months and is well-documented.
Living in the affirmed gender role in places where it is safe to do so.
Existing facial appearance demonstrates significant variation from expected appearance for the affirmed gender (photographic evidence is part of the medical record).
Each requested procedure is considered separately for medical necessity.

Letter of Assessment

What your letter must include.

A single letter of assessment from a qualified clinician, completed within the past twelve months, is required for surgical authorization. We are happy to share a template with your clinician on request.

Need a referral?

Our nursing team maintains a referral list of LGBTQ+- affirming therapists in Michigan and via telehealth who can conduct a WPATH-aligned assessment. Contact us to request a copy.

Your clinician must meet:

Master's degree or higher in a clinical mental-health or licensed-clinician field, granted by an accredited institution.
Competency in the use of the DSM-5 for diagnosis.
Ability to identify and distinguish co-existing mental-health concerns from gender dysphoria.
Ability to assess capacity to consent for treatment.
Demonstrated experience evaluating gender dysphoria and gender diversity.
Continuing education in gender-affirming care.

The letter must contain:

Patient's name, identification, and date of evaluation.
Statement that the patient meets the DSM-5 criteria for gender dysphoria.
Description of the duration and nature of the clinician–patient relationship.
Confirmation that capacity for informed consent has been assessed and is intact.
Statement of medical necessity for the requested procedure(s).
Clinician's full name, credentials, license number, signature, and contact information.