What will my first visit for gender affirming care be like at Whitman-Walker?
At your first medical appointment, you will be asked to complete a basic history with your doctor or medical team member. You will also be asked to complete lab work to begin the process of establishing yourself as a patient of the health center. Our medical team will introduce you to some of Whitman-Walker’s support services. You can expect to formally start and discuss hormones and surgical processes—two things many folks look forward to in their gender affirming care with us—during or after your second medical visit.
Do I have to be in mental health care for hormones?
Mental Health therapy is not an absolute requirement for hormones. Many Whitman-Walker patients do not need or request mental health services. It is important to note that a past history of mental health or substance use history will not always make a referral to a Behavioral Health Specialist necessary. However, your doctor or medical team member will assess for any risk for relapse and your current mental health stability. Based on this assessment, your doctor may feel that a mental health assessment is needed. Together, you and your doctor will discuss why they feel an assessment is needed and any specific concerns around hormones. These concerns will be shared with the mental health provider – who you will be meeting with – for the assessment to guarantee
the best coordinated care and address concerns as efficiently as possible. Our goal is to provide you with complete care and, in turn, positive health outcomes.
What surgeries does Whitman-Walker offer referrals for?
Whitman-Walker offers referrals for the following procedures related to gender dysphoria: chest reconstructive surgeries including breast augmentation and mastectomy; facial feminizing procedures including tracheal shave, rhinoplasty, mandibular lift, and forehead drop; hysterectomy; phalloplasty; metoidioplasty; vaginoplasty; orchiectomy. Whitman-Walker does not offer referrals for body contouring.
What is the process for getting my referral and letters at Whitman-Walker Health?
Once you’ve had a medical appointment to review recent clinical labs and discuss a surgical referral with your medical provider, you’ll be linked to a Trans Care Navigator. Through a phone call, the Trans Care Navigator will coordinate and explain the referral process to you, hear your questions, schedule visits with a Behavioral Health Specialist to collect information for your letter of support, and keep you posted on progress until it’s time to schedule a consult with the surgeon. We don’t refer you to a surgeon’s office unless your supportive paperwork is ready as that’s a sign of everything being in place for insurance coverage and for the surgeon to move forward. If you’re paying out-of-pocket, you can move through this process at your own pace and likely won’t need letters of support from Whitman-Walker. If your out-of-pocket surgeon still wants letters from Whitman-Walker, your process will look similarly. This process can take a couple of months to complete, depending on your medical health status and how much information a Behavioral Health Specialist might need.
How many mental health sessions will I need to schedule before getting my letters?
For above-the-waist surgeries, you will meet with a mental health provider for a minimum of two sessions. For below-the-waist surgeries, you will meet with a mental health provider for a minimum of four sessions, which includes three sessions with a Behavioral Health Specialist and one session with a doctoral level mental health provider. These sessions will include reviewing your mental health history, exploring your experience of Gender Dysphoria, and working on a thorough surgery preparation and recovery plan. Please note it is very important that you attend these appointments. If you miss two appointments and do not call within 24 hours to cancel, you’ll have to wait three months before you can be rescheduled. If you reschedule your appointment more than two times, you will also have to wait three months to reschedule. These restrictions have been put in place to increase the clinical availability of our mental health providers so that we can serve the high volume of patients seeking gender affirming surgery.
How many letters do I need for surgery?
Any surgery that is above your waist, or above your genitals, will require one letter from a Behavioral Health clinician and one letter from your medical provider. Any surgery that is below your waist will require one letter that is co-signed by two independent Behavioral Health clinicians and one letter from your medical provider.
What happens if my surgery gets denied?
If your surgery is denied, our Trans Care Navigator will speak with you about appealing that denial with our Legal Services team. The Trans Care Navigator will need your consent to get you linked to that department. From there, you will learn about your situation regarding surgery denial, what an appeal will look like with Whitman-Walker support, and wait to hear whether your case is assigned to a lawyer. Not every denial requires ongoing legal support. Sometimes our lawyers are able to troubleshoot with surgeons to simply re-submit the prior authorization.
What surgeons do you recommend I work with?
We keep a list of surgeons we commonly refer to, and we encourage everyone to do some research to learn about surgeons in the area. For folks with DC Medicaid plans, we keep a tighter list of close partners at local hospital systems. We do not have a formal referral network with any one hospital system or private practice surgeon, and really want you to get what you need out of your own relationship with a surgeon.
I am under 18, can I get gender affirming care at Whitman-Walker? Do I have to tell my parents?
Whitman-Walker serves youth ages 13-24 years old. To start hormones, the first step is a visit with your Whitman-Walker primary care provider. To schedule this appointment, you will need parental consent. After discussing your medical history – and once your medical provider feels that you are medically ready to begin hormones -you will be referred for mental health assessment with a mental health provider. This assessment may include a minimum of 3-6 sessions, and may include the recommendation to continue ongoing therapy or a psychiatry referral. We also provide individual and group therapy, and free trauma-focused mental health care to youth who have experienced or witnessed a crime. Youth do not need parental consent to engage in mental health
services. However, you and your mental health provider will discuss how your parents or caregivers may be involved in your care. Therapy includes a variety of techniques including art, music, and sand play. To learn more about Youth Mental Health, please call 202.207.2361.
Do you have a list of area support groups?
See our list of Gender Affirming Support groups in the DC, Maryland and Virginia area here.