At Evolve Online Counselling, I provide professional gender-affirming surgery referral assessments and supporting letters for transgender, non-binary and gender-diverse adults across the UK.

I'm Marianne Oakes (Dip Couns, MBACP), a qualified Gender Specialist Therapeutic Counsellor with over ten years' experience supporting transgender and gender-diverse individuals through social and medical transition.

As a registered member of the British Association for Counselling and Psychotherapy (BACP), Membership No. 159445, my professional registration can be verified through the BACP Register.

My approach is compassionate, respectful and individualised. I recognise that everyone's experience of gender identity and transition is different, and that there is no single pathway to gender-affirming surgery.

I provide online assessments and referral letters for a range of gender-affirming procedures, including:

• Top surgery (bilateral mastectomy)
• Breast augmentation
• Vaginoplasty
• Phalloplasty
• Metoidioplasty
• Facial feminisation surgery (FFS)
• Other gender-affirming surgical procedures

Assessments are available to both binary and non-binary transgender adults, including individuals who are not taking hormone therapy.

Important: Referral requirements vary between surgeons and clinics. Please confirm that your chosen surgical provider will accept a referral from a BACP-registered counsellor before booking.

£270 – Assessment and Referral Letter Included

The fee includes:

• An individual online assessment appointment
• Preparation of your personalised surgical referral letter
• Relevant diagnostic and clinical information, where appropriately established and required
• Assessment against applicable WPATH-informed criteria, where requested
• A completed PDF referral letter, usually provided within five working days

If your surgeon requires additional assessments or documentation, this will be discussed with you in advance.

Your appointment provides an opportunity to discuss your experiences, goals and preparation for gender-affirming surgery in a confidential and supportive environment.

We will explore your gender history, your reasons for seeking surgery, your understanding of the procedure and recovery, your emotional wellbeing and the support available to you.

The assessment is collaborative and respectful. You will not be expected to prove or justify your gender identity.

Its purpose is to establish the relevant information needed for an appropriate surgical referral and to ensure that the letter accurately reflects your individual circumstances.

Most clients require just one assessment appointment. Occasionally, additional sessions or supporting documentation may be necessary, depending on individual circumstances or your surgeon's requirements.

Yes. Assessments are primarily conducted through secure online video appointments, making the service accessible to adults throughout the UK.

Limited face-to-face appointments may be available depending on location and circumstances.

Referral letters are usually completed and sent as a PDF within five working days of your assessment, provided all necessary information is available.

Requirements depend on your chosen surgeon, procedure and clinic. Some providers require one referral letter, while others request two independent assessments or reports from particular healthcare professionals.

I strongly recommend confirming your surgeon's requirements before booking.

Yes. I work with both binary and non-binary transgender adults.

Your assessment will reflect your individual identity, experiences and surgical goals. There is no expectation that everyone follows the same transition pathway.

Not necessarily. Hormone therapy is not a universal requirement for every gender-affirming procedure.

However, individual surgeons may have specific eligibility criteria. Please check these before arranging your assessment.

Potentially, yes. Referral letters may be accepted by surgical providers outside the UK.

However, requirements vary internationally, and some clinics may request additional documentation or assessments from particular professionals.

Please confirm acceptance with your chosen overseas provider before booking.

Depending on the procedure and the surgeon's requirements, your referral letter may include:

• Your gender history and transition experience
• Your reasons for seeking surgery
• Your understanding of the procedure and recovery
• Relevant emotional wellbeing and mental health information
• Consideration of informed consent and decision-making capacity
• Diagnostic information where appropriately established and required
• Assessment against relevant WPATH-informed criteria

Every letter is prepared individually, reflecting your circumstances and the requirements of the intended surgical provider.

If you need a second independent referral, I can recommend other experienced professionals working in transgender healthcare, including counsellors, psychologists and clinical psychologists.

Before attending your appointment, I recommend confirming your surgeon's referral requirements and considering any questions you may have about the assessment.

You'll also need a quiet, private space for your online appointment.

There is no need to prepare a detailed account of your life or feel that you must demonstrate a particular transition experience.

My aim is to make the assessment process as comfortable, straightforward and respectful as possible.

If you're considering gender-affirming surgery and need a professional referral letter, I'm here to help you understand the process and take the next step.

Assessment and referral letter: £270

Online appointments are available across the UK, and I aim to respond to enquiries within two working days.

You can book your assessment online or contact me if you'd like to discuss your surgeon's requirements before arranging an appointment.

Book your surgical referral assessment