Is there any way I can have FTM chest surgery without a therapist referral?

Question

I consider myself a genderqueer individual and although I deeply want a more masculine physique, I do not want to transition. However, I've never wanted my breasts and I know my mental state would be greatly improved if I did not have my breasts. I know I don't need a therapist to tell me or anyone this but it seems as if there is no surgeon who will operate without a referral. So I ask, is there any surgeon who will perform FTM chest surgery without a therapist referral?

Rukmini S. Rednam, MD, FACS · Answer

Hello,The short answer to this is yes.  The main reason that you may be having difficult finding a surgeon is if you are trying to go through insurance.  ALL insurances plans that cover top surgery do require a letter from a mental health care professional for authorization.  If you are choosing to go out of pocket (cosmetic fee) then you should have less difficulty finding a surgeon. Though, many surgeons do follow the WPATH guidelines which recommend the same letter. In my practice I do not require my out of pocket top surgery patients to provide a letter unless I have specific concerns for my patient that I feel that they need to address before surgery. I do urge you to do your homework and find a board certified plastic surgeon with experience in Top surgery in order to get the safest and best results.Best of Luck!Dr. Rednam

Jaime Caloca, Jr., MD · Answer

I understand your situation and it is a common issue with some FTM chest Surgery patients. Although our protocol does include a consultation with a local therapist, it does not condition your right to get top surgery.

Babak Dadvand, MD · Answer

Hi csantiagoedwards,Thanks for the post. If you are trying to go through insurance for the surgery then you will likely need a referral letter from a therapist. If you are not going through insurance then the decision is solely between you and your surgeon. I routinely perform these surgeries without referrals from a therapist when not dealing with insurance companies. Sincerely,Dr. Dadvand

Tracy Kayan, MD · Answer

It is between you and your surgeon what procedure you want, but the issue is if you involve insurance companies, almost all require a letter of support from a mental health professional in order to consider you for coverage for the procedure. There is no way around that part unless you pay out of pocket for your surgery.

Alexes Hazen, MD · Answer

Hi. Thanks for your question. The issue is without a letter insurance WILL NOT pay for it. There are many folks in your situation - where they may not suffer or feel that they have gender dysphoria in the truest sense and so having therapy feels not quite right. If you are willing to pay for the surgery as “cosmetic” I am quite sure there are practitioners who would be willing to do the surgery. Hope this helps.
Alexes Hazen MD FACS

Is there any way I can have FTM chest surgery without a therapist referral?

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