Surgical referral letters are one of the few safeguards that stand between those suffering from gender dysphoria and life-altering operations that seek to change their sex, but ideologically-motivated therapists have set out to make these letters as easily available as possible, viewing their work as a form of political activism rather than a serious medical precaution.
Many surgical clinics require that those who wish to undergo double mastectomies, hysterectomies, phalloplasties, or other operations aimed at change one’s sex must first receive a letter documenting their mental health. Ideologically-motivated pro-transgender activists, however, have dropped all pretenses that these letters are genuine attempts to discern the mental state of potential patients.
Licensed therapists identified by The Daily Wire instead openly refer to letter-writing as a form of “allyship” that can be performed as an act of resistance against alleged oppression. Moe Brown, who describes herself as “a Transgender Identified therapist, public speaker, and writer,” describes the letter-writing process as a form of political activism to be undertaken by allies.
Brown offers a continuing education course on surgical letter referrals with a description that reads, “For every clinician that identifies as an ally for the Transgender community, this course is necessary in order to expand your allyship and support as you may be the deciding factor in the medical transition of a transgender person.”
Seattle-based therapist Shaquille Sinclair, a self-described “queer Black Jamaican” who offers free transgender surgical referral letters and enjoys “working with queer/trans folks,” calls therapy a form of resistance.
“I frame the therapeutic space as entirely non-neutral. It is a place of resistance, or we get to recreate the ways we relate to systems,” Sinclair writes. He notes that his professional focuses include “abolitionism” and “black liberation” and also calls himself a “sex worker ally.”
This ideological bent is not limited to individual professionals. Organizations exist with the express intent of making these letters as readily available as possible. The Gender Affirming Letter Access Project (GALAP) opposes the requirement that people receive medical letters before undergoing sex change operations altogether, but has resolved to make letters readily accessible “before clinical practice shifts toward a more socially just model.”
GALAP describes itself as “a group of transgender, nonbinary, and allied mental health and medical providers” who advocate against the surgical letter requirement. “Putting mental health providers in a position of gatekeeping negatively impacts the client-provider relationship and leads to abuses of power,” GALAP says on its website, calling on mental health providers to “publicly commit to providing gender-affirming care for medical transition without undue gatekeeping practices.”
It is from this ideological position that GALAP operates, intending to make letters available free of charge while simultaneously advocating for letter requirements to be ditched altogether.
In other instances this ideological agenda also appears to be tethered to financial incentives. Aydin and Johnna Olson-Kennedy are a married couple in Los Angeles that have worked on both sides of the pipeline to sex change surgeries — providing both the surgical referral letters and the surgeries themselves.
Aydin, a licensed clinical social worker who identifies as transgender, writes letters to allow minors to undergo sex change operations for free, claiming that requiring letters at all is oppressive. “I believe the mandate for letters to access gender-affirming medical procedures is inherently discriminatory,” her site reads, adding that the requirement threatens to “reinforce systemic biases.” Aydin offers these letters free of charge, saying that she intends to “de-pathologize the transgender experience” and is committed to offering her “support and advocacy for the transgender community and their families.”
While Aydin Olson-Kennedy is trusted to assess the mental readiness of those who want to undergo sex change operations, she previously shared a fundraiser for a child with down syndrome to receive a double mastectomy.
Aydin’s wife, Johanna Olson-Kennedy, is the medical director of The Center for Transyouth Health at the Children’s Hospital Los Angeles, which sees children as young as three and has been called the largest trans youth clinic in the country. It has also partnered with the Los Angeles Unified School District to advertise its offerings to the parents of young children.
There’s also Sarah Eley, a mental health clinician who argued at a conference that mental health providers should act as “allies” when writing letters for people who want to undergo sex change surgeries. Rather than dispassionately assessing a patient’s mental health, Eley states that “our role is to really help them get to that next step in the process.”
Eley made it clear that she wants people to be able to access sex change operations as quickly as possible. “The less sessions the better,” she said, referring to mental health assessments in preparation for writing a medical letter. “In writing these letters we look at our own internal biases.” A presentation from Eley discusses “practicing allyship through letter assessments” and claims that sex change operations are often “life savers” before recommending books on “trans allyship.”
The ease of receiving surgical referral letters may have facilitated the drastic increase in operations that attempt to change people’s sex. One 2023 study found that the number of sex change operations performed in the United States tripled between 2016 and 2019. The number of children between the ages of 13 to 17 who’ve undergone double mastectomies has similarly grown, steadily increasing every year from 2019 to 2021. The number of children between the ages of 6 and 17 who’ve undergone hormone therapy has jumped from just over 1,900 in 2017 to over 4,200 in 2021, increasing every year in between.
While the scale of sex change operations has spiked in the United States, more liberal European countries like Sweden and England have taken steps to limit the availability of medical interventions that seek to change the sex of patients. The Scandinavian country stopped hormone therapy for minors with few exceptions while England’s National Health Service stopped prescribing puberty blockers.
Moe Brown, Shaquille Sinclair, and GALAP did not respond to requests for comment.
