If you’re planning a gender-affirming surgery, you may have heard that a “referral letter” is required. This is a clinical document written by a qualified mental health professional to support your surgical care — and it’s one of the services I offer.
Across the UK, Europe and many other parts of the world, clinics and surgeons often request this type of letter as part of their standard pre-operative protocol. In most cases, it’s not about questioning your identity — but rather about documenting your process and ensuring everything is in place for a safe and supported procedure.
You shouldn’t have to prove who you are. But when systems demand it, you deserve a process that treats you with dignity. That’s what I offer.
Why are these letters needed?
Each clinic has its own criteria, but the reasons are usually legal, medical and ethical. Most providers require:
* A letter written by a licensed mental health professional (such as a psychologist or psychiatrist),
* A clinical overview of your gender history, current wellbeing and transition process,
* Evidence of informed decision-making and personal readiness for surgery.
In short: they need to know that you’re prepared — practically, emotionally and legally — and that a qualified professional has confirmed this in a formal document.
Who can write a surgery referral letter?
Psychologists are among the few professionals internationally recognised to write this type of legal clinical document. I am a psychologist registered and based in Brazil (CRP 06/180170), with full legal authorisation to provide online psychological care under Brazilian regulation. You can verify my registration here: https://cadastro.cfp.org.br/
I’m also a member of the World Professional Association for Transgender Health (WPATH), the leading global organisation for trans healthcare. You can verify my membership here: https://app.wpath.org/provider/20787
Writing referral letters is part of my daily work. I’ve supported clients in the UK, Ireland, Belgium, Germany, France, Sweden, Norway, Portugal, the Netherlands, the US and beyond — and I make sure each one is carefully tailored to the clinic’s requirements and to the person’s process.
How does it work?
If you’re seeking a referral letter, the first step is to book a consultation with me. During this session, we’ll explore your history, current situation and surgical goals. From there, I’ll evaluate your case with the same clinical responsibility I bring to every part of my work.
If a referral letter is appropriate, I will draft it with attention to every detail — using the correct language, pronouns and references expected by the receiving clinic, while also centring your individuality and dignity.
Each letter includes my full credentials, signature, registration number and contact details, and can be sent directly to your clinic. I will send the e-signed letter to your email within 24 hours after our consultation.
A final note
Surgery referral letters are not about proving you are trans. They’re about navigating the systems that exist — and doing so with support, ethics and respect.
If you’d like to explore this option with me, feel free to book a consultation or send a message to contact@fedoralaroza.com. I’ll be happy to guide you through the process.