4. Documentation that the individual has completed a minimum of 12 months of successful continuous full time real-life experiences in their new gender, across a wide range of life experiences and events that may occur throughout the year (e.g., family events, holidays, vacations, season-specific work or school experiences).
Note:
- The medical documentation should include the start date of living full time in the new gender.
- Verification via communication with individuals who have related to the individual in an identity-congruent gender role, or requesting documentation of a legal name change, may be reasonable in some cases; and
5. Regular participation in psychotherapy throughout the real-life experience when recommended by a treating medical or behavioral health practitioner; and
6. If the individual has significant, outstanding medical or mental health conditions present, they must be reasonably well controlled. If the individual is diagnosed with sever psychiatric disorders and impaired reality testing (e.g., psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder), an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated; and
7. Two referrals from qualified mental health professionals ** who have performed a person-centered independent assessment of the individual. If the first referral is from the individual’s psychotherapist, the second referral should be from a person who has only had an evaluative role with the individual. Two separate letters, or one letter signed by both (e.g., if practicing within the same clinic) are required; and
8. One referral from a medical professional (MD, DO, or Advanced Practice Registered Nurse [APRN]).