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The process for beginning your surgical journey with Dr. Satterwhite or Dr. Gurujal and the team at Align is simple and accommodating.

Insurance Information We Need:

Step One

Schedule a private consultation in the comfort of the Align Surgical San Francisco office. If an in-person consultation is difficult, then a phone consultation can be arranged.

Step Two

Mark your surgery date on your calendar.

Step Three

Our office and insurance team will begin the insurance authorization process at least 2-3 months prior to your surgery date.

Step Four

Obtain letters of support for your transition from mental health professionals and hormone prescribers you are working with. These should be dated within 1 year of the operation. If you have any medical conditions, then specific letters of medical clearance may need to be obtained, as well as labs and specific studies. We will advise you at your initial consultation.

Step Five

Receive your comprehensive surgical confirmation packet in the mail 30-60 days prior to your surgery with pre-operative and post-operative instructions.

Step Six

Pay your balance, if paying out of pocket.

Letter requirements:

Insurance carriers will require letters of support from mental health professionals and hormone therapy providers familiar with your transition goals. Our office requires these letters on file at least 1 year prior to surgery in order to allow enough time to request revisions or additions. All letters must be signed by the provider with their license number printed on their letterhead. The letters must be written by the person in charge, not their intern or other subordinate.

For top surgery, breast augmentation, facial feminization procedures, and body contouring procedures, you will need a letter from a licensed mental health specialist, such as an LCSW, MFT, LMFT, CSW, Ph.D., Psy.D., etc.

For FTM, MTF, gender non-conforming, and gender variant bottom surgery, you will need a total of 3 letters. Two letters need to come from 2 different licensed mental health specialists, with 1 letter being from a provider who has worked closely with you in an evaluative role. At least one of these letters should be from a mental health provider with a doctorate level degree (i.e. Ph.D., Psy.D., etc.). A third letter should be from your hormone provider.

Process & Fees Information

Mental health provider letters must include:

  • Patient’s legal and preferred names
  • Date of birth
  • Date that relationship with patient began
  • Frequency of contact
  • A statement that the client has well-documented, persistent gender dysphoria and exhibits all of the following:
    • The desire to live and be accepted as a member of their chosen gender, with the wish to conform their body to this new gender identity through surgery and hormone therapy
    • They have been persistently living with their transgender identity for at least 1 year.
    • The gender dysphoria is not a symptom of another mental health issue
    • The gender dysphoria is causing distress, depression, or impairment in social, occupational and other areas of functioning
    • The patient has completed at least 1 year of real life experience in their chosen gender role
    • The patient has undergone hormone therapy for at least 1 year (recommended for top and bottom surgery only)
    • A statement that the patient has the ability to fully consent to treatment and can make fully formed decisions
    • The patient is willing to comply with long-term follow up requirements and post-operative expectations
    • Any medical or mental health issues are adequately under control
    • Any substance abuse issues have been under control for at least 6 months
    • The provider must state their experience in dealing with gender dysphoria clients

The hormone provider letter must include:

  • Patient’s legal and preferred names
  • Date of birth
  • Date that provider-patient relationship began
  • Frequency of contact
  • Date hormone therapy began
  • Frequency of treatment with hormones
  • That the patient has undergone hormone therapy for 12 months
  • If the patient has any contraindications to hormone therapy, they must be noted
(415) 530-5335



View Update Virtual Consultation

We remain open to continue serving the transgender community

With the safety and well-being of our patients and staff as our highest goal, Dr. Satterwhite and Dr. Gurujal are determined to provide needed medical care and planning.

VIRTUAL CONSULTATIONS: we continue to be busy with phone and video visits providing access to all patients interested in gender confirming surgery

FOLLOW UPS: we continue to provide needed care for our existing patients by phone and video, and in person when medically appropriate

SURGERY: we are currently performing surgery with proper safety measures in place

Please do not hesitate to reach out to us with any questions. To the best of our ability, we pledge to keeping you safe, healthy, connected, and informed during COVID-19.

With best wishes, Your Align Surgical Team

Virtual Consultation

Align Surgical wants to know how we can help

We feel deeply for the disruption that coronavirus has likely caused to your lives. Amidst the restrictions in place, we realize that virtual consults, follow ups, and booking future surgical dates may not meet all your needs.

If there is more we can do for you as a medical practice, we want to know.

Please reach out and let us know other ways we can help. We have set up points of contact at 415-530-5335 and [email protected] to hear your suggestions.

We are here to listen.

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