Depending on where you live, what kind of access to trans health care you have, and your own personal transition, therapy may or may not be a part of transition, although it is more often than not. There are some trans health clinics that operate on informed consent for prescribing hormones to patients, however, most endocrinologists require clearance from a therapist before prescribing hormones.


Callen-Lorde Health Center is one example of a clinic with a trans health care program that does not require a letter from a therapist for adult patients – most clinics of this type are located in large, urban areas.

For most folks who transition and do not have access to a clinic that prescribes by informed consent, the process includes getting clearance by a therapist before your endocrinologist will prescribe hormones. The amount of time each person will need to spend in therapy really depends on the person and the therapist – there is not necessarily a set requirement for the amount of therapy needed for clearance.

According to the WPATH Standards of Care V7, pgs. 28-29:

The SOC do not recommend a minimum number of psychotherapy sessions prior to hormone therapy or surgery. The reasons for this are multifaceted (Lev, 2009). First, a minimum number of sessions tends to be construed as a hurdle, which discourages the genuine opportunity for personal growth. Second, mental health professionals can offer important support to clients throughout all phases of exploration of gender identity, gender expression, and possible transition – not just prior to any possible medical interventions. Third, clients differ in their abilities to attain similar goals in a specified time period.

You can view a copy of the WPATH Standards of Care V7 document here.

While therapy is not always required, and while you may only be required to do a few sessions in order to get clearance for hormone therapy, it is a good idea to consider the benefits of continuing therapy beyond the minimum requirements. Transition can be overwhelming, stressful, and scary, and having a safe space to really explore new things and have someone to help you jump hurdles as they come can be really empowering and helpful.

Our society has placed a huge stigma around anything having to do with mental health, including going to therapy. Going to therapy doesn’t mean you’re weak, or crazy, and it doesn’t mean you have anything wrong with you. Therapy, for me, has been a place where I can get stuff off my chest, and has provided me a tool that is empowering me to just be the best version of my self. Think of therapy as a feedback system – it’s an opportunity to be the best you can be. Sometimes it is needed – sometimes it is not necessarily needed, but can really help us be at our best. Everyone has different goals with therapy, and I believe that everyone can get something positive out of therapy no matter what your situation is.

Be sure to check out the resources section to help you locate trans-friendly therapists and therapists specializing in trans care.