(Female to Male and Male to Female)

The following are the published 'Standards of Care' assessment requirements which lead to a letter of recommendation for hormones, SRS, top surgery, breast augmentation, reconstruction and facial feminization, as outlined and suggested by the ‘World Professional Association for Transgender Health (WPATH).  The guidelines used and adhered to by this service, though closely followed, are flexible to individual need and circumstances. Further in accordance with the requirements of these and other assessment guideline all carefully assessed letters of recommendation issued through this service are accepted worldwide and issued by professionally qualified gender specialists, as a result only one letter is normally required.


To be considered for the letter of recommendation for hormones, the World Professional Association for Transgender Health 'Standards of Care' requires several elegibility and readiness criteria to receive hormone regime therapy HRT: the client must:

  1. Must be at the least be 18 years of age
  2. Understand the positive and negative effects of hormones, what they can and cannot do medically and understand there social benefits and above the risks
  3. Have either a minimum of three months of therapy or a documented three month real-life experience
  4. Show stable or improved mental health
  5. Demonstrate ability to take hormones in a responsible manner [source: WPATH Standards of Care].


The Real-Life Experience suggests that an individual enters into the lifestyle of his or her preferred gender. The candidate is preferred to maintain their employment or attend school full or part-time. (circumstances permitting) legally change his or her first name to one that is gender appropriate and prove that socially people other than the gender specialist or medical doctor know of his or her desired gender.

Towards 12 months (this can vary from surgeon to surgeon) of continuous and successful hormone therapy and under going a Real-Life Experience, the individual is eligible for genital surgery (SRS).

In regard to this service, only one letter of recommendation is normally required, as it is written by a professionally qualified gender and mental health specialist. This letter can also be supplemented by a letter from an earlier or ongoing mental health professional, the hormone-prescribing physician, or a general practitioner, but are not an essential requirement to be accepted for surgery. It is the clients total 'right' to choose there own surgeon, gynecologist, urologist, plastic surgeon or general surgeon who form their gender reassignment team.

Dr. Graham L Peveller
Gender Specialist





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