Demystifying the process of psychosocial assessment prior to receiving gender-affirming medical care

Psychosocial assessment by a qualified mental health provider, colloquially referred to as "getting a letter," is recommended for transgender and gender diverse (TGD) individuals seeking gender-affirming medical care (GAMC). This study used an online survey to examine the logistics and overall affective responses of TGD adults (n = 134) to this process. Findings revealed that, to varying degrees, participants were involved in several steps to obtaining the letter, including seeing the letter before it was sent to medical providers. Overall, participants reported generally positive experiences with the process of "getting a letter" based on the affective measures of empowerment, stigma, helpfulness, and harm, with transgender women feeling more empowered than transgender men in the process. Documenting the lived experiences of TGD adults seeking GAMC is a critical step on the path to realizing health equity.