Purpose Gender-affirming surgery has been clearly shown as very effective in reducing mental health symptoms for TGD individuals experiencing gender dysphoria. However, a mental health evaluation approval letter is often required prior to such surgery. The present community-based participatory research qualitative study investigated the experiences of TGD people regarding the required approval letter.Method Participants included 20 TGD adults who participated in semi-structured interviews. Interview transcriptions were analyzed using thematic analysis.Results The interviews revealed that the letter requirement introduces barriers to surgery that delay needed surgery, including a scarcity of willing mental health professionals, high costs associated with receiving the letter, and the unnecessary nature of the requirement. Furthermore, the letter requirement stigmatizes TGD identities and introduces uncertainty, leading to heightened distress. Delay of needed surgery synergistically interacts with distress over the letter requirement, contributing to mental health disparities.Conclusion It is recommended that this gatekeeping requirement be abandoned for adults seeking gender-affirming care in favor of an informed consent model that is used for other similar surgeries for non-TGD people.
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Kwon et al. (2026) studied this question.
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