HOW LETTERS WORK
IN IOWA

HOW MANY LETTERS YOU NEED

WPATH SOC8 recommends one qualified professional’s opinion for adults who meet the assessment criteria. When a letter is required, WPATH says one signature should generally be sufficient. Additional opinions may be needed for a specific clinical reason.

Ask your surgeon and insurer what documentation they require. You can bring me their requirements so I can match the documentation to them. Coordination with your surgeon’s office is included.

LETTERS FOR HORMONES

A separate letter is not a universal requirement. Ask your hormone provider and insurer what documentation they need.

If they require a letter, I can write one when the assessment supports it, usually in one visit.

WHERE CARE STANDS IN IOWA, 2026

• Adults. Letter visits here are for adults, by telehealth throughout Iowa or in person in Cedar Falls.
• Minors. Iowa Code section 147.164 (2023) prohibits specified gender transition procedures for minors. I see teens and adults for therapy.
• Coverage. Iowa Medicaid stopped covering gender-affirming surgery and hormone therapy effective July 1, 2025 (House File 1049, now Iowa Code section 249A.14). The law preserves reimbursement for other services that Medicaid otherwise covers. Check your plan’s requirements for the specific service.
• Community resources. Find community organizations and financial help on the community resources page.

WHAT A LETTER CONTAINS

My letters document the assessment: your identity and history in your words, the clinical findings, capacity for informed consent, and the documentation your surgeon or insurer requires.

You review and approve the draft before anything is signed or sent out. If an insurance reviewer asks for different wording later, updates and re-submissions are included at zero cost.

GETTING A LETTER

Letter visits are free, usually one visit, telehealth anywhere in Iowa or in person in Cedar Falls. You do not have to become my therapy client. How to book a letter visit.

QUESTIONS

How many letters do I need for surgery?

WPATH SOC8 recommends one qualified professional's opinion for adults who meet the assessment criteria. When a letter is required, WPATH says one signature should generally be sufficient; additional opinions may be needed for a specific clinical reason. Ask your surgeon and insurer what documentation they require, and bring those requirements to the visit.

Do I need a letter to start hormones?

A separate letter is not a universal requirement. Ask your hormone provider and insurer what documentation they need. If they require a letter, I can write one when the assessment supports it.

Who can get a letter here?

Letter visits here are for adults. I also see teens and adults for therapy.

What does the letter say?

A letter documents the clinical assessment: identity and history in your words, the assessment findings, capacity for informed consent, and the documentation your surgeon or insurer requires. You review and approve the draft before anything is signed or sent out.

Does an assessment guarantee a letter?

No. Letters are clinical documents provided when clinically indicated. When the clinical criteria are met, the letter goes out the same day.