Do I really need to be on hormones and get a letter from a mental professional to have feminization surgeries done?

We can certainly feminize the face without hormones, though certain procedures are safer if you are on hormones.  An in person or skype consultation is the best way to learn what is and is not possible.

Many surgeons use the WPATH guidelines to determine what patients need to have done before surgery, but there are no legal requirements.  Hormones can help your face look a little more feminine and help many patients grow some breast tissue.  There are patients that for medical reasons, like blood clots, are not hormone therapy and undergo these surgeries.  Facial feminization and breast surgery are not as irreversible as genital surgery, and many surgeons don't require letters from mental health providers.  These surgeries do make a big difference in your appearance, though.  For most patients I recommend they work with an experienced mental health provider who can help predict and plan for post surgery challenges at home and at their place of employment.  

Bryan Rolfes, MD

Facial cosmetic surgery for facial feminization does not usually require prior hormones or more mental professional assessment than any other patient coming in for facelift, rhinoplasty etc. Best wishes