Gender-Affirming Surgery Referral Assessments

I provide gender-affirming surgery referral assessments and referral letters for transgender and gender-diverse adults across the UK.

I am Marianne Oakes (BACP Member No. 159445), a qualified Gender Specialist Therapeutic Counsellor with more than ten years’ experience supporting transgender and gender-diverse clients through social and medical transition. My qualifications and professional registration can be viewed publicly via the BACP Register.

Assessments are conducted in accordance with recognised professional and ethical standards and are tailored to the requirements of individual surgeons and procedures where appropriate.

I work with both binary and non-binary transgender clients and recognise that gender-affirming surgery pathways are not the same for every individual. Assessments are approached collaboratively and respectfully, with consideration for each person’s identity, goals, individual circumstances, and understanding of the procedure and recovery process.

Referral assessments may support applications for procedures such as top surgery, breast augmentation, vaginoplasty, phalloplasty, metoidioplasty, facial feminisation surgery (FFS), and other forms of gender-affirming surgical care.

A surgery referral assessment provides an opportunity to discuss your transition journey, goals for surgery, emotional wellbeing, support networks, and understanding of the procedure and recovery process.

Assessments are conducted online in a supportive and respectful environment, allowing space for discussion, questions, and thoughtful consideration of individual needs and circumstances.

The purpose of the assessment is not to judge or challenge a person’s identity, but to ensure that any referral documentation accurately reflects their needs, goals, and readiness for gender-affirming surgical care.

In most cases, a single appointment is sufficient for a gender-affirming surgery referral assessment. However, some surgeons or individual circumstances may require additional sessions or supporting documentation.

Yes. Evolve Online Counselling primarily provides surgery referral assessments online via secure video appointment, allowing access for transgender and gender-diverse clients across the UK. Face-to-face appointments may also be available in certain circumstances, although this can be limited by geographical location.

Referral letters are usually completed and returned as a PDF document within five working days of the assessment appointment.

Most gender-affirming surgeons require at least one referral letter before surgery can proceed. Requirements can vary depending on the surgeon, procedure, and country where surgery is taking place. Some surgeons may require two independent referral letters, particularly for certain procedures. It is always advisable to confirm requirements directly with your chosen surgeon or clinic before booking an assessment.

Yes. Surgery referral assessments are available for both binary and non-binary transgender clients seeking gender-affirming surgical care.

Assessments are tailored to the individual and recognise that gender-affirming treatment pathways are not the same for every person.

Yes. Referral letters can support applications for gender-affirming surgery both within the UK and internationally. Many overseas clinics accept UK referral letters, although some countries or surgical providers may request additional assessments or a second referral letter. It is important to check the specific requirements of your chosen clinic or surgeon.

Referral letters typically include information relating to:

• gender history and transition journey,
• current goals for surgery,
• understanding of the procedure and recovery process,
• emotional wellbeing and mental health,
• capacity for informed consent,
• and whether recognised criteria for gender dysphoria and gender-affirming surgery are met where required.

Letters are written in accordance with recognised professional and ethical standards and may reference WPATH-informed criteria where appropriate.

If a second referral letter is required, I am able to recommend other experienced counsellors, psychologists, and clinical psychologists who work within transgender healthcare and gender-affirming surgical pathways.

Surgery referral assessments are charged at £270 for a full assessment appointment and referral letter.

This includes:

• the assessment appointment,
• preparation of the referral letter,
• and a PDF copy of the completed documentation.

If additional documentation or further appointments are required by a surgeon or clinic, this will be discussed in advance.

Before your appointment, it can be helpful to:

• confirm your surgeon’s referral requirements,
• think about your goals for surgery,
• consider any questions you may wish to ask,
• and ensure you have a quiet, private space for the online appointment.

There is no expectation to “prove” your identity or transition experience. Assessments are approached respectfully and collaboratively, with recognition that every person’s pathway is individual.

If you would like to arrange a gender-affirming surgery referral assessment, or if you have questions about the process, please get in touch using the contact form below or by email.

Online appointments are available for clients across the UK.

I aim to respond to enquiries within 2 working days.

Appointments can be booked online here: