Letters for Gender-Affirming Care

Availability and Scheduling

If you are requesting a letter for gender-affirming care, you may check my availability and schedule a time for us to meet by clicking "Request Appointment" below. I offer at least two slots for letterwriting a month, but if there are no slots available or you require a letter sooner than my next available slot, please revisit the GALAP directory to contact other providers.

Obtaining a Letter

I am happy to work with people who need letters for gender-affirming care like hormone replacement therapy (HRT) or surgery. I have written dozens of letters on behalf of trans and nonbinary folks that have been accepted by surgeons and insurance companies.

Here's the process: Once we've scheduled an appointment, I'll send you some opening paperwork that lays out the shape of my therapeutic practice so you can consent to be seen by me. I usually meet with folks requesting a letter for one 30-50 minute conversation/session via my HIPPA-compatible telehealth video platform. During our meeting, we'll talk about any questions or concerns you might have and I'll learn a little about you. This meeting isn't a test of your knowledge or whether you're "trans/nonbinary/agender enough" for gender-affirming care. If I ask you a question and you don't have an answer, I'll offer information, suggestions, or referrals if they're relevant. Then I draft a letter and send it to you for your review and edits, incorporate those, and send the letter back to you within one week. If your medical providers need to follow up with me for some reason, I'll coordinate with you first and speak with them in support of what I've written. I am available to update letters as needed if your surgeon or insurance company requests edits.


I am a GALAP pledge signer, and the letterwriting process, including our meeting time, is offered free of charge. I won't charge you for our time together because I don't charge people for letterwriting, only insurance companies. I will try to bill your insurance if you have it. If they accept, you will be responsible for your copay, but if your insurance rejects the claim, that is not an issue.

MacKenzie Stuart, LMFT is a Gender Affirming Letter Access Project (GALAP) pledge signer.