1. Assessment for Endorsement Letters
Jess Guerriero, MSW

2. Endorsement Letters

3. PERSISTENT, WELL-DOCUMENTED GENDER DYSPHORIA
Does the person meet diagnostic criteria?
Describe your gender identity.
Do you experience dysphoria?
How long have you felt this way?
How has dysphoria impacted your work/school/interpersonal/emotional wellbeing?
What steps have you taken in relieving dysphoria?
What interventions are you seeking?
What impact do you imagine going on hormones and/or having surgery will have on your life?

4. ABILITY TO GIVE INFORMED CONSENT
Have they consented to mental health treatment?
What do they consider risks/benefits to hormones or surgery?
Have they spoken with a physician about reversible v. irreversible changes?

5. ASSESSMENT OF SAFETY Where do you live and with whom?
Do they know and are they supportive?
Where do you work?
How will recovery time affect your employment?
Are you aware of local trans resources?
Do you have any role models, or access to people who have received hormones or surgery?
How do you define safety?
How will receiving these procedures impact your safety?

6. MENTAL HEALTH CONCERNS
Have you been told that you have other diagnoses?
What do these look like in your life?
How have you worked to address them?
How do you plan on continuing to address them?
What impact, if any, do you anticipate hormone therapy having on any of these conditions?

7. SURGERY-SPECIFIC
How long have you been living/presenting as your identified gender?
What has that experience been like?
How do you see surgery continuing to improve your quality of life?
How long have you been on hormones?
What effects have been achieved?
What has been your reaction to those effects?
Have there been any complications?
What surgical procedures are you requesting and why?
**IF A PERSON DOES NOT WANT TO BE ON HORMONES, THIS IS A CONTRAINDICATION FOR HORMONE TREATMENT**