What a surgery readiness assessment is, and what it isn’t

A WPATH-aligned assessment is not a test of your gender. Here is what actually happens, how long it takes, and what the letter says.

By Brydan Xavier, Director and Principal Psychologist 25 September 2026 About 5 min read

tl;dr

At a glance.

It is not a test of your gender. It checks that you understand the surgery, can consent to it, and have support to recover well.
WPATH SOC8 usually asks for one letter. Some surgeons, hospitals and insurers still ask for two.
Check now whether your surgeon accepts a letter from a Registered Psychologist, or only from a Clinical Psychologist or psychiatrist.
It usually takes three to six sessions, then about two weeks to write. You read the report first.
Adults usually don’t need a letter to start hormones, under the informed consent model.

If you are planning gender-affirming surgery in Australia, your surgeon will probably ask for a letter from a mental health professional. For a lot of people, that request lands badly. It can sound like someone else gets to decide whether you are allowed to have the body you need.

We want to explain plainly what the assessment is for, because the reality is much less like a test than people fear.

It is not an assessment of your gender

We start from believing you. You are the expert on who you are. The assessment does not ask whether you are "trans enough", how long you have lived in your gender, how you dress, or whether you have always known. None of those things are in the standards, and none of them are our business.

What it does look at

The current international standards are the World Professional Association for Transgender Health's Standards of Care, version 8, known as SOC8, published in 2022. For adults, SOC8 asks the assessing professional to confirm that:

your gender incongruence is marked and has lasted over time
you meet the diagnostic criteria, where a diagnosis is needed to access care
you have the capacity to consent to the specific surgery
any other health conditions that could affect surgery or recovery are being managed well enough
for gonadectomy (removal of the testes or ovaries) or genital surgery, you have had at least six months of hormones that suit your goals, unless hormones are not wanted or not medically suitable

In plain terms: do you understand the surgery, can you make an informed decision about it, and is the support in place for you to recover well?

One letter, not two

Older standards asked for two letters for genital surgery. SOC8 says one letter from one qualified professional is usually enough. Some surgeons, hospitals and insurers in Australia still ask for two, so it is worth checking with yours before you start.

Check who your surgeon accepts letters from. Some surgeons accept a letter from a Registered Psychologist. Others only accept one from a Clinical Psychologist or a psychiatrist. Ask your surgeon’s rooms before you book an assessment, so your letter is accepted the first time. Our free planning worksheet has space to write down exactly what they need.

Therapy is not a requirement

SOC8 is clear that you should not have to complete a course of therapy before surgery. Therapy can be useful, and some people want it. But it is not a hoop.

What happens in the sessions

At The Liminal Clinic it usually takes three to six sessions, about two weeks apart. We talk about your story and your goals, the rest of your life and health, some questionnaires, and then planning: time off work, money, who will help at home, and how you will look after yourself afterwards.

The usual path, from first contact to support after surgery.

Other health conditions do not, on their own, rule you out. Anxiety, depression, trauma, ADHD and autism are common. Where something could make recovery harder, we plan for it together.

You read the report first

We write the report for your surgeon, and you read the draft before anyone else does. If something is factually wrong, we fix it. If you disagree with anything else, we talk it through. We use your name and pronouns throughout.

Start early

Allow two to three months in total. If your surgery date is booked, contact us at least four months before it if you can.

If you are not sure you even need a letter, ask us first. For hormones, most adults don’t: see Do you need a psychologist’s letter to start hormones? We would rather save you the sessions. You can read more on our gender-affirming care page.

Questions

Quick questions.

Does the assessment decide whether I am really trans?

No. We start from believing you. The assessment looks at your understanding of the surgery, your capacity to consent, your health and your support, which is what the standards ask for.

Will my surgeon accept your letter?

Surgeons differ. Some accept a letter from a Registered Psychologist, and some only accept a Clinical Psychologist or psychiatrist. Check with your surgeon first, then tell us what they need.

How long does it take?

Usually three to six sessions about two weeks apart, then about two weeks to write the report. Contact us at least four months before your surgery date if you can.

Is it covered by Medicare?

No. The report is part of your care, so it is GST-free. Current fees are on our fees page, and we give you a written quote first.

Do I need therapy before surgery?

No. SOC8 says therapy should not be a requirement. Support is there if you want it, before and after surgery.

Free guide: surgery readiness assessments.

Everything in one place: what WPATH SOC8 asks for, how the sessions work, Medicare and private health insurance, support services, and a planning worksheet to record your surgeon’s requirements.

New clientsGet the free guides

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