Recommendation Letters & Gender Dysphoria Diagnosis: Procedure and List

Who Needs a Gender Dysphoria Diagnosis for HRT? 

In Quebec, any family doctor –a general practitioner or GP— is within their right to prescribe hormone replacement therapy (HRT) without a gender dysphoria (GD) diagnosis . Additionally, the World Professional Association for Transgender Health (WPATH) standards of care does not recommend medical practitioners require patients to get a GD diagnosis before starting gender affirming care. Unfortunately, most GPs are unwilling to oversee medical transitions, and the few that will prescribe HRT often require patients to get a gender dysphoria diagnosis. 

Luckily, the McGill Wellness Hub’s only doctor willing to oversee trans patients’ transitions does not require a GD diagnosis to prescribe HRT.

If you are not a McGill student and want HRT without a GD diagnosis contact us directly via email (assistance.tpu@gmail.com) or Instagram DMs (@transpatients). We will do our best to connect you with a Montreal doctor that uses an informed consent model.

Recommendation Letters and other Requirement for Gender-Affirming Surgery

Here we will discuss the GRS Montreal, one of the few public clinics in Canada that does gender-affirming surgeries. Currently, if you want surgery at GRS you will need a recommendation letter. GRS Montreal accepts recommendation letters from ‘qualified health professionals’, which they have told us include doctors, nurses, psychologists, and social workers. For a full list of their requirements for each surgery, see page 11 of our copy of GRS Montreal’s 2023 information booklet. 

At the Centre de bien-être de McGill, there are psychologists, local wellness advisors, and other mental health professionals who will provide these letters. In our experience, the fastest way to get a letter is to contact a local wellness advisor directly and ask for an appointment to get a recommendation letter Another usually slower option is to see a psychologist. While the Hub sometimes has long waitlists for psychology appointments, it is our experience that if a patient just needs a couple appointments to get a letter, they are able to see a psychologist much faster than someone looking for ongoing care. In the past, some patients have also told us that Hub psychologists have written letters that were rejected by GRS Montreal for not meeting their standards, sometimes multiple times in a row. However it is our impression that there are at least a handful of mental health providers at the Hub who are experienced in writing these letters (see some of them listed below), and making sure you get someone with this experience to write your letter can significantly increase your chances of getting a letter that is unlikely to be rejected in a timely fashion. 

It is generally safest to get someone experienced in letter writing to write your letter. However, if you already have a psychologist following you and you decide to get them to write you a letter, you can consult this template, or see this one in french. A list of the criteria for various trans care procedures as provided by the World Professional Organization for Transgender Health (WPATH) can be found in Appendix C of the eighth and latest edition of the WPATH Standards of Care.

Any health professional is able to contact GRS Montreal for assistance with writing a letter and understanding the criteria; note that healthcare workers don’t generally like to tell the criteria to patients. 

If you have any questions about requirement or other parts of the process, in our experience GRS is pretty good about responding to emails and phone calls (514 288 2097), so for the most up to date information on surgeries, and what you documents need to have to be put on a surgery waitlist, email them at document@grsmontreal.com. Note that currently GRS requires you to supply them all the documents they request before you can be put on their waitlist. 

Possible Insurance Complications for Those Insured Out-Of-Province

Please note that if you are insured by a public insurance organization from outside of Quebec, you may need a recommendation letter from a professional registered to practice in the region you are insured in. For example, if you are an Ontario out-of-province student insured by Ontario’s public insurance (OHIP), you need a letter from a psychologist registered to practice in Ontario for OHIP to cover your surgery—even if you are getting the surgery outside of Ontario. 

However, psychologists registered to practice in a certain province are generally not supposed to provide services to clients outside of that province: you are supposed to be physically situated in Ontario in order to get a recommendation letter that your Ontario insurance will accept for your surgery in Quebec. Some patients have been able to get around this by finding an Ontario psychologist who is willing to provide them virtual care while the patient is situated in Quebec, even if they are not technically supposed to. Another option could be to find a psychologist in Quebec who is also registered to practice in Ontario. 

If you are stuck in this situation please contact us; we may be able to help you find a psychologist who will provide you with an adequate letter. This complication is not universal for those insured publically outside Quebec. To know whether this applies to you, we would suggest calling or emailing GRS Montreal, as they are pretty good about helping people with insurance issues. 

Gender Dysphoria Diagnosis for StudentCare Gender-Affirming Insurance Coverage, and Other Important Info on the Student Care Process

In fall 2023, all students at McGill (including international students) were given additional gender-affirming care coverage under SSMU and PGSS’s deal with StudentCare which represents GreenShield. Unless you have specifically opted out of this additional coverage, you should be covered. (See our index for all links on the coverage, including our FAQ). In short, the plan aims to cover you or your dependant’s gender affirming procedures not covered by the provinces or your other insurances. The plan has some substantial limitations we are hoping to change in the coming years -some things are left out like fertility preservation, there is a 5000$ limit per procedure, there is a lifetime maximum of 10 000$, and all procedures must be done in Canada. 

In order to be eligible for full reimbursement, you need a gender dysphoria diagnosis from a doctor or nurse practitioner, which is different from a recommendation letter. According to a StudentCare representative at Concordia, this diagnosis needs to be acquired BEFORE you get the procedure in order to be eligible for reimbursement. 

We have spoken to one patient who was able to get Dr. Perera (the one Hub doctor who provides gender affirming care) to provide them a gender dysphoria diagnosis for the purposes of StudentCare reimbursement. Unfortunately the patient told us that Dr. Perera said she was only comfortable doing this because she has been seeing the patient for at least 6 months, so it is likely that in the future Dr. Perera would be reluctant or unwilling to provide this service to any patients she has not been following for at least 6 months. This could effectively produce a 6 month waiting period for patients looking for care through the StudentCare coverage. While we have not been able to confirm this with someone from StudentCare, we assume that it is unlikely that StudentCare will accept diagnosis made by doctors outside of Canada. 

If you are worried that your claim will be rejected (especially for procedures listed under ‘focused’ in the GreenShield plan) we recommend you request pre-authorization from Greenshield before getting your procedure, to avoid a situation where you are expecting a reimbursement you are not getting. 

Note that there are some exceptional cases where the plan may cover procedures that are technically covered by your province or other insurances. For example, in British Columbia, breast augmentation is covered by the province, but only if your breasts are small enough and you have been on E for a specific amount of time. In this case if you don’t meet the requirements for coverage by the province of BC, StudentCare will cover your breast augmentation, but you may have to prove you have been denied by the province. 

How to Use this List 

This is a list of individuals and organizations in Montreal who provide trans-related psychologist’s letters. It is common for individuals on these sorts of lists  to not respond to inquiries, so we recommend you reach out to many of them using a template email to increase your chances of getting a response. 

We recommend you make a short email template explaining that you need a recommendation letter for a surgery or a letter diagnosing you with gender dysphoria and to contact many psychologists. Be sure to mention you are not looking for ongoing care, as many psychologists will be too busy to see you on an ongoing basis but may be willing to see you for one or two appointments if all you need is a letter.

This list is updated by patients like you who use it and share their experience with us! Feel free to reach out if you have any other information on psychiatrists, whether on this list or not.

The List

• The McGill Student Wellness Hub

• 2SLGBTQ+ Local Wellness advisor Margot Nossal (she/her)
  • LWA can provide recommendation letters, not formal diagnosis of gender dysphoria. 
  • One trans patient (who was seeing her for mental health counseling and not for a recommendation letter) said they had a great experience with Margot.
  • According to Margot, her process typically involves a first consultation, then she gathers the info from the consult into a draft letter that she shares with you to make sure you are comfortable with the letter. Then you have a second meeting (ideally booked a week after the first) where you go over the letter one last time and if all is well, you leave with two signed copies. 
  • Email: margot.nossal@mcgill.ca
  • McGill: Margot Nossal 
• Graduate Student Local Wellness Advisor Devon Simpson (they/them)
  • A patient reported that they had a very good experience with Devon In August 2021. The patient got a recommendation letter for their top surgery and was able to talk to Devon about their transition. This patient thinks Devon would be able to provide other patients with recommendation letters in 1-2 appointments.  
  • Email: devon.simpson@mcgill.ca
  • McGill: Devon Simpson 
• Hub Psychologist Julia Horowitz (she/her).
• A patient reported that she is experienced in writing letters for surgeries and that he only had to wait 2 weeks to meet with Julia .
• Hub Psychologist Marilyn Payne (she/her).
  • A trans patient was seeing her early spring 2022 for an unrelated reason, and tried asking about trans related psychological concerns, the psychologist emphasized that trans-related psychological care was not her speciality. Patient felt that some of the questions asked about their dysphoria were invasive and like she was ‘searching around in the dark’. 
  • A patient reported that she had never done a letter for top-surgery before them. The process took two appointments, but since she now has experience we hope it will only take one.
  • Email: marilyn.payne@mcgill.ca

• Psychologist Yann Zoldan
  • A patient we spoke to reported that in Fall 2022 he had a free 15 minute chat with Yann and that Yann agreed to write him a letter after just one additional (paid) appointment. 
  • Email: yann.zoldan.ccomtl@ssss.gouv.qc.ca 
  • Pride Therapy Network: Yann Zoldan (he/him)

• Psychologist Natalie Cohen
  • A patient reported that Natalie gave them a letter swiftly and without invasive questioning.
  • Email: nathalie@nathaliecohen.ca
  • Phone: 514-447-4929
  • Pride Therapy Network: Natalie Cohen (she/her)

• Psychologist Veronica Blackbourn
  • A patient reported that Veronica was able to get them a letter ‘pretty fast’ and ‘super respectfully’. 
  • Email: Veeblackbourn@gmail.com
  • Phone: 514-503-0885. 
  • Therapy Pride Network: Veronica Blackbourn (she/her) 

• Psychiatrist Dr. Norman Hoffman
  • A patient reported that after seeing a counselor at Medego Clinic, she was referred to Dr. Hoffman. After providing the letter template, she received a letter of support after a short visit.
  • Phone: 514-448-2800

• Psychiatrist Dr. Francois Legault
  • A patient reported that they received a letter of recommendation after a single 50-minute appointment with Dr. Legault at Sexologue a Montreal; the appointment cost $120.
  • The patient reported that Dr. Legault wanted to understand all the details of the letter from the patient, meaning knowing  the timeline, risks, and other details of the surgery (consult GRS Montreal for info).
  • Find him: https://sexologues.ca/

• Montreal Therapy Centre
  • This is currently the only sliding-scale payment option for anglophone therapy in Montreal.
  • If you look for a letter from the Centre, be very clear that you are a trans person and are looking for a referral letter.
  • Clinic Website: https://www.montrealtherapy.com/

• Contact individuals on the Therapy Pride Network
  • The following is a list of all the people on the website who say they will write letters. Many of them have marked that they are not taking new clients, but we recommend that you reach out to them anyways since the website looks like it has not been updated in a few years. Some psychologists will see you for an appointment just for a letter even if they are too booked to take new patients long term. This is just the people who explicitly say they will write letters, but you may want to contact other people listed on the website.
  • If you are already seeing someone on the Pride Therapy Network who cannot write a letter for HRT, they are able to refer you to another individual on the network who can write the letter.
  • Jackson Hagner (he/him).
    • Email: jackson@jacksonhagner.com
  • Matt McLaughlin (he/him).
    • Email: matt.mcl@protonmail.com 
    • His page also mentions he may be connected to ASTTeQ (a Quebec trans service) to help provide patients with free trans care. See his page for more on this.
  • Nate Fuks (he/him).
    • Phone: 514-303-9228. Email: nate.fuks@mcgill.ca
    • Although he does not specifically say on his page that he will write letters, a patient reported that he wrote one for her. This patient reported that he had a “very clinical approach”.
  • Javier Fuentes Bernal (they/them).
    • Email: javier.fuentes.bernal.ccomtl@ssss.gouv.qc.ca 
    • As of September 2022, Bernal’s practice is closed, according to a patient that reached out to them. However, they said they may be operating again “in a few months”.

• Contact individuals on the Quebec Trans-affirmative Provider List
  • This list is a list of over 150 Quebec psychologists who identify themselves as trans positive. At least 30 are located in Montreal. 
  • This excel sheet contains names, address, contact info, and whether or not the psychologist will write recommendation letters (most of them say they do). This list is also kept relatively well up to date.

• TPU Mégaliste des fournisseurs de THS à Montréal
  • This is a megalist of all the resources on HRT providers, but many of the lists mentioned are general trans resource lists, and include info on ‘trans-positive’ mental health professionals.