i am the father of a trans son. he has been on T for almost a year and presents as a male. he is beginning to feel better about his body, but the binding is really a concern. he is in counseling to get approved for top surgery. he took the assessments and the counselor claims he "still has work to do." we've talked to a surgeon locally who does top surgeries and he is open and willing to do it, but is waiting for the paper saying it's okay to do so.

my question is two-fold: first, what is the specific law that requires this "approval" (we live in tennessee, if that matters...and is this requirement for a psychological approval a state requirement or federal one?) and second, what are the benchmarks for this approval?

he has been told by his counselor that he is being "pushy" about finding out when he can get the surgery. i have my suspicions about the practice he is going to for this counseling...i've met with them once and they seem to be really good at twisting things around to make anyone look like they "still have work to do."

i guess a further question is how to find a counseling practice that is reputable. i've checked with a local trans group's resources and the practice is listed and recommended...but i don't know that i trust them.

so i am interested to know if this approval process is a law, what is the specific law, and what is the objective goal to be reached that is needed for the surgery.

thanks!

First off, thank you for being a great dad and supporting your son. You are making a huge difference in his life by standing with him.

my question is two-fold: first, what is the specific law that requires this "approval" (we live in tennessee, if that matters...and is this requirement for a psychological approval a state requirement or federal one?) and second, what are the benchmarks for this approval?

These are great questions.

The requirement for the support letter is a requirement of the surgeon. There is no law. These letters help to legally protect a surgeon. Some surgeons don't require them and will operate on informed consent.

There are also no official benchmarks for approval by a mental health professional. The WPATH criteria are recommendations, but not requirements:

1. Persistent, well-documented gender dysphoria
2. Capacity to make a fully informed decision and to consent for treatment
3. Be of the age of majority in the country of surgery (and follow SOC rules for children and adolescents)
4. Significant medical or mental health concerns, if present, must be reasonably well controlled at the time of surgery

Personally, I had one 3-hour appointment with a psychologist to get a support letter. The appointment included formal testing and discussion.

Trust your gut instincts. If you feel that they are unnecessarily delaying your son's transition, perhaps you could speak with them about your concerns, or seek another therapist.

Hope this helps!

When my son came out two years ago, he was already seeing a psychologist whom I respected. However, this professional had no experience in the transgender area and finally told us she didn't think she would ever be comfortable writing a letter so that he could start on testosterone or eventually have surgery. I immediately searched for another therapist who told me in advance that she would feel comfortable writing such a letter after having counseling sessions with him. So she did write a letter. Now that he's finally 18 (and his father can't stop him from having surgery), he also has the endocrinologist's support, and she has written a letter to the surgeon he plans to use for his top surgery.
I hope you are able to find someone in your area to help you and your son.