Hello! And good work reaching out for what you need!

It can be so weird and scary to email a stranger to ask for a letter session. For that reason, I’d like to start by telling you a little about me. My name’s Moira, and I’m a white cis woman in her mid-40s.

• I’ve been fortunate to have attended several workshops on gender by Portland’s SMYRC/Bridge 13, took Lewis & Clark College’s first-ever graduate coursework on TGD identities (thanks, Mehera!), and choose to continually read and learn about gender as both a construct and a concrete reality. I am familiar with the WPATH’s 8th edition Standards of Care and am appreciative of the current SOC’s move away from using therapists as gatekeepers. (If you’re curious about the SOC, here’s a video I made on the history of gender affirming surgeries with information for therapists on how to write an ethical, affirming letter of recommendation for surgery.)
• I do not want finances to prevent access to medical care (also profiting from oppression is bad news!), so I’m also a pledge-signer with the Gender Affirming Letter Access Project.

• Via WPATH’s general education initiative, I’ve completed an additional rigorous curriculum. WPATH certification indicates that a provider has a working understanding of the multidisciplinary care team and the translation of the Standards of Care into practice. The extensive 50-hour core competencies-based training program includes course work and mentorship before sitting a certification exam, and ongoing education is required. WPATH certification rewards those members who are committing to stay on top of both the current evidence and consensus in the field through continuing education. It is the gold standard of trans-specific healthcare certification.

I am able to provide an assessment for a letter of recommendation for surgery (yup, the whole thing’s pro bono, and yup, I’ve done a couple hundred of accepted letters) if you are physically in the states of Oregon or Pennsylvania when we meet, and if you’re over 18. (I personally don’t have the requisite training to work with people under the age of 18, although many clinicians on the GALAP’s list are competent to work with minors.)

An assessment can take up to an hour, depending on the requirements of your insurance (if using) and your chosen surgeon. (If you don’t have a surgeon yet, I’m still happy to do an assessment, but just know that we might need to meet again after you find someone you like and they tell you they require, for example, a particular kind of mental health assessment, particular wording in the letter, or something else). During this assessment, we’ll go over your reasons for choosing surgery, your plan for the recovery period following surgery, to ensure you meet WPATH’s criteria for people seeking surgery, to discuss informed consent, and to consider any questions or concerns you’ll have about the process.

I am not available for in-person sessions at this time. Assessments can be done via video or phone call. I usually schedule these sessions on Saturday afternoons, and can also accommodate weekday evenings. When you email me, please let me know what times work best for you.

I cannot guarantee that at the end of our session that I will provide you with a letter of support. If I am able to provide this, you have options for how you’d like to proceed: 1) I can email you your signed letter, with the caveat that no one can guarantee that anything transmitted over the internet is definitively confidential, because the internet is a wacky place, 2) I can mail you your letter directly, or 3) if you’d prefer not to see your letter, I can mail you a form you can sign that says you’re ok with me mailing the letter directly to your chosen surgeon.

Often, people I meet with are curious about state-specific resources. As these are very common questions I receive, I’ll offer some links here:

Oregon:

• Update your gender marker on your driver’s license/state ID card
• Pro bono name change support for TGD people
• Affirming hair removal services (required for some surgical methods) in Portland (here and here and here)

Pennsylvania:

• Update your gender marker on your driver’s license/state ID card
• Pro bono name change (here and here) for TGD people
• Pro bono affirming hair removal services (required for some surgical methods) in Pittsburgh

If you’re in need of additional resources, feel very free to ask. I’m sorry that I cannot recommend particular surgeons nor particular techniques, because these are very personal decisions; I can help you figure out the kinds of questions you’d like to ask your surgeon when you see them for your surgical consult, if that’s helpful for you.

You’ve got my email – let me know how I can be of service, ok?