Delivered within 48 hours • $185 flat • Accepted by surgeons and insurers.
If you’re preparing for top surgery, bottom surgery, facial feminization, or another gender-affirming procedure in Virginia, you’ll need a support letter from a licensed clinician.
98% Approval • Flat $185 Fee • Effective Letters
Same day appointments. $185 fee.
One confirmation call.
All letters arrive in 48 hours or less.
Hundreds of approvals across the country. Letters that open doors.
9 years of writing successful surgery letters and supporting clients from Norfolk to Bristol.
Aligned with SOC-8 and DSM-5 standards.
Online intake. Single 20-min call.
Letters are accepted by surgeons and insurance nationwide.
Everyone gets a tailored letter of support.
Aligned with SOC-8 and DSM-5 standards, written to meet every requirement Virginia surgeons and insurers expect.
One gentle intake, one brief telehealth session, one flat fee — $185 at booking. Most clients receive their letter the same day.
Hundreds of successful clients with a 98%+ first-try approval rate. Surgeons and insurers across Virginia and the U.S. accept these letters.
Personalized, affirming, and advocacy-driven. Not cookie-cutter. Your story, written in a way that clears the system.
You came out.
You found your surgeon.
You’re already living your truth.
And now the process stops without a letter. It shouldn’t be this way.
You’re ready for surgery. The only thing standing in your way is a piece of paper.
Every delay costs: time, savings, surgery slots, peace of mind.
Virginia providers don’t always make it easy.
Too many clients hit the same wall: You need a letter. You can’t get one fast.
That’s where I come in.
Refusals.
Delays.
Gatekeeping.
That ends here.
In one focused Telehealth session, you get a WPATH-compliant letter of medical necessity. Delivered within 48 hours, insurer-approved, written by an ally who actually says yes.
Picture your surgeon’s office saying, “We’ve got your letter, let’s schedule.”
No more calls for proof. Just a date on the calendar and a plan you can trust.
Every week without this letter risks more: lost surgery slots, expired approvals, deeper dysphoria. You deserve better.
Virginia Gender Affirming Surgery Letters – FAQ
Do I need a WPATH letter for surgery?
Yes. Surgeons and insurers require a WPATH compliant letter of medical necessity for top, bottom, and many facial surgeries. My letters meet WPATH Standards of Care v8 and DSM-5 criteria, so they are accepted nationwide. In Virginia, some providers still ask for extra requirements that are not part of WPATH. My letters are written to clear those hurdles the first time.
How fast can I get my letter?
Most clients receive their letter the same day as their session. Delivery is guaranteed within 48 hours. Read more about my gender assessment process.
What does it cost?
The flat fee is $185, paid at booking. That includes your session, your letter, and free revisions or insurer appeals for 365 days.
Do I have to be on hormones?
No. WPATH does not require a history of hormones before surgery. Your readiness is not defined by whether you have started HRT. That said, some surgeons and insurers in Virginia still ask for hormone history as part of their approval process. I craft each letter to match the exact requirements of your surgeon and insurance so you are not stalled by unnecessary gatekeeping.
What if my surgery needs two letters?
Genital surgeries often do. I provide one and help coordinate the second if required.
Will insurance accept this letter?
Yes. My letters include the diagnostic codes and wording insurers require. My approval rate is over 98 percent on the first submission. Virginia clients often use Anthem Blue Cross or Sentara Health, and these insurers sometimes reject letters if the language is incomplete. My letters are written to meet their policies so appeals are rare, and if needed, I handle them at no extra charge. Please note: I cannot provide superbills for reimbursement in Virginia because I am not considered an out-of-network provider under Virginia regulations.
Is telehealth valid?
Yes. Surgeons and insurers treat telehealth letters the same as in person. In Virginia this is especially important because many clients live far from affirming providers. Whether you are in Richmond or a rural county, your virtual letter carries the same weight as one written face to face.
A Note From Troy:
I’m Troy Johnson, LCSW, and I built Queer Talk Therapy because I know how many doors get slammed in your face when you’re trans and asking for something as basic as a letter. Too many clients come to me after months of hearing “no” from doctors and therapists who should have said yes. That’s gatekeeping disguised as care, and I refuse to play that game.
For nearly a decade I’ve written letters that cleared the way for surgeries, advocated with insurers, and taught other clinicians how to stop dragging their feet with trans clients. My promise is simple: one session, a letter that works, and a process that feels like advocacy and celebration, not interrogation.
This work isn’t just paperwork for me. It’s about dignity, access, and moving you closer to the body and life you already know is yours. If you’re ready, I’m ready. Let’s get you your letter.
If you have a quick question about Queer Talk’s approach to LGBT therapy in Chicago, you can reach out a number of ways.
Troy Johnson, LCSW • Licensed Clinical Social Worker (ID, IL, KY, MA, PA, UT, VA) • MSW, University of Kentucky • Founder, Queer Talk Therapy
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