Gender-Affirming Care Letters in Springfield and Across Missouri
Writing letters to help you on your gender journey.
Getting a letter for your gender-affirming surgery doesn’t have to be complex or costly
The path to feeling at home in your body has been long and full of challenges.
You've explored every option—from changing your name and pronouns to starting hormones—but something is still missing.
Now, you're exploring surgery options—top surgery, genital reconstruction, or facial procedures—and you’ve found the right surgeon.
What’s left is the letter you need to move forward. You want someone who understands your experience, who won’t question whether you’re “trans enough.”
Finding someone who can write a letter for you that won't cost you or make you go through weeks or months of therapy beforehand can be difficult.
But it doesn’t have to be a struggle anymore.
The support letter writing process is less scary than you might think.
Gender-affirming care letters—also known as "letters of recommendation," "support letters," "letters of medical necessity," or "transition letters"—are often required by insurance companies to confirm the need for gender-affirming surgery. These letters explain how the surgery impacts your life and ensure you understand the procedure and its aftercare.
While insurance may use these letters as part of a gatekeeping process, I work with an informed consent approach. My role isn’t to decide if you qualify for surgery, but to help you write a letter that brings you closer to the procedure that aligns with your true self.
The letter-writing process takes only one to two sessions maximum, requiring no extra therapy pre- or post-operation unless you desire extra support.
What to Expect:
We start by sitting down and just chatting.
We’ll discuss your gender experience, focusing on questions like: “When did you first feel your gender didn’t align with your body?”, “What have you done to feel more like your true gender?”, and “How does not living as your authentic self affect your daily life?”. There are no questions about your mental health history, nor any need to engage in therapy before the assessment. We only need to know what you're currently experiencing, specifically related to your desire for surgery.
Next, we discuss the surgery you want and your aftercare plan.
I trust you’re familiar with the procedure, its risks, and benefits. I’ll simply check in to ensure you fully understand them and discuss your aftercare plan, including transportation, home support, and any resources you may need.
Finally, we review the letter together to make sure it feels affirmative.
You’ll get to read over your letter and offer any further details you wish to add or take out of the letter. Your voice matters in this process!
Bridge Cunningham, LPC’s Qualifications:
Bridge Cunningham, MS, LPC (they/them) earned their Master’s of Science in Clinical Mental Health Counseling in 2022 from Eastern Illinois University. They are licensed to practice in the state of Missouri. Bridge has been working with transgender and gender-expansive clients since 2022, when they practiced in community mental health centers in southwest Missouri. Bridge Cunningham currently practices through Bridging the Gap Counseling, LLC, a private practice operating as an independent contractor within The Living Room Wellness Collective, a group of holistic mental health care providers who pride themselves on providing unapologetically inclusive care to all, regardless of gender, sexuality, race, or belief. Bridge is well-versed in The World Professional Association for Transgender Health (WPATH) Standards of Care - Version 8, and has completed multiple trainings regarding writing gender-affirming care letters with trainers such as Dr. Tess Kilwein of Unapologetic Psychology and Ari Groner, LCSW of The Juniper Center.
Getting your letter for gender-affirming care is within reach.
FAQs
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A: Nothing at all! If you wish to pay, we can discuss options. Otherwise, to improve the accessibility of care, I charge nothing for letters for non-clients.
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A: Great question! My job is only to write your letter (unless you’re already a client) to get you in and out and towards your affirming surgery process as quickly as possible! Here’s what you need:
Medical History information, such as who your primary care doctor is, when (month and year) you started any hormone treatment, and any health concerns that might impede surgery (smoking, alcohol use, etc.)
Obtain a surgeon willing and able to complete your surgery of choice, including going through a consultation.
Research your surgery of choice to understand the benefits, risks, and requirements of aftercare.
Determine your aftercare plan (transportation to and from surgery,
Contact your insurance to determine what coverage you will receive for your procedure.
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A: https://www.transhealthcare.org/
Local Facebook, Reddit, and other social media outlets can be a wonderful place to get recommendations from those who have directly worked with those surgeons.
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A: Due to licensing, I cannot offer letters outside the state of Missouri. However, here are some resources for finding people who can write letters in your state!
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A: Sadly, due to the way our current healthcare system works, you will need to meet a diagnosis for Gender Dysphoria for insurance companies to approve your procedure. According to the DSM-5-TR, here’s the criteria for gender dysphoria:
For at least six months, you’ve experienced stress and high discomfort from living in a body that does not match your sense of gender.
You experience a strong desire to get rid of or change your body’s characteristics to match your sense of gender.
You really want the physical characteristics of another gender (or lack of gender).
You wish to be socially perceived as the other gender.
Your internal life feels like another gender (how you think, feel, behave, etc.)
No other diagnoses will be given to you. If I could not diagnose you, I would - Because no matter how you express your gender, it isn’t an illness.