Letters for Gender-Affirming Care

Availability and Scheduling

If you are requesting a letter for gender-affirming care, you may check MacKenzie's availability by clicking "Request Appointment" below and looking for GALAP appointments with MacKenzie Stuart, LMFT. MacKenzie offers two slots for letter writing a month. If there are no slots with her available or you require a letter sooner than my next available slot, please revisit the GALAP directory to contact other providers. You must be in California at the time of our appointment.

Obtaining a Letter

MacKenzie is happy to work with people who need letters for gender-affirming care like hormone replacement therapy (HRT) or surgery. She has written dozens of letters on behalf of trans and nonbinary folks that have been accepted by surgeons and insurance companies.

Here's the process: Once you've scheduled an appointment, Metaphor Therapy will send you some opening paperwork that lays out the shape of MacKenzie's therapeutic practice so you can consent to be seen by her and she can learn what kind of letter you need. You'll return that paperwork within one week to confirm your appointment. MacKenzie will use this information to begin drafting your letter before your meeting.

One week before your appointment, Metaphor Therapy will message you via SimplePractice to confirm your meeting. If we don't hear back, we'll assume you've found another provider to write your letter and open the time up for others so please keep an eye out for that message.

MacKenzie meets with folks requesting a letter for one 30-50 minute conversation/session via a HIPPA-compatible telehealth video platform. You must be in California at the time of your appointment. During your meeting, you and MacKenzie will talk about any questions or concerns you might have and she'll learn a little about you. This meeting isn't a test of your knowledge or whether you're "trans/nonbinary/agender enough" for gender-affirming care. If MacKenzie asks you a question and you don't have an answer, she'll offer information, suggestions, or referrals if they're relevant. Her role is to ensure you're able to make your own medical decisions with confidence.

After your meeting, MacKenzie will complete the letter and send it to you for your review and edits, incorporate those, and send the letter back to you within one week. If your medical providers need to follow up with her for some reason, she'll coordinate with you first and speak with them in support of what she's written. MacKenzie is available to update letters as needed if your surgeon or insurance company request edits.


MacKenzie is a GALAP pledge signer, and the letter writing process, including your meeting time, is offered free of charge. She won't charge you for your time together because she doesn't charge people for letter writing, only insurance companies. Metaphor Therapy will try to bill your insurance if you have it. If they accept, you will be responsible for your copay, but if your insurance rejects the claim, that is not an issue.

MacKenzie Stuart, LMFT is a Gender Affirming Letter Access Project (GALAP) pledge signer.