(For reference only)
[Referral Letter for PWH Gender Clinic Sample]
Dear Gender Identity Disorder Clinic,
Re: [Name of the patient in English and Chinese, HKID#]
We are referring the above named patient to your expertise, as we believe they are suffering from Gender Dysphoria [or Gender Identity Disorder]. Thank you for your time and for placing them in your care.
Regards,
[Real Life Experience Letter Sample 1]
To: Whom it may concern
Dear Sir/Madam,
Re: [Name of the patient in English and Chinese, HKID#]
This is to certify that the above named suffered from [Female-to-Male/Male-to-Female] transsexualism and gender dysphoria. [She/He] is now undergoing preoperative assessment including real-life experience. Please kindly facilitate [her/his] use of [male/female] toilet.
Thank you!
[Real Life Experience Letter Sample 2]
To: Whom it may concern
Dear Sir/Madam,
Re: [Name of the patient in English and Chinese, HKID#]
Previously known as: [previous name on HKID]
This person is under my care for Gender Identity Disorder [Male to Female/Female to Male] Transsexualism. [She/He] is now living exclusively in [female/male] role.
[Change of name and gender Letter Sample (not currently available HK)]
To: Whom it may concern
Dear Sir/Madam,
Re: [Name of the patient in English and Chinese, HKID#]
[Name of the patient] is suspected having gender dysphoria, undergoing assessment in [name of the clinic]. [Name of the patient] is on real life experience as a [female/male] role and intends to continue doing this permanently. [She/He] has changed her name legally.
I would support her application for a new driver’s licence in her female name, with her gender code changed to female.
Thank you!
[SRS Referral Letter Sample]
To: Dr. xxx, Dept of Surgery, Routonjee Hospital/Prince of Wales Hospital
Dear Dr. xxx,
Re: [Name of the patient in English and Chinese, HKID#]
I am writing to refer the above named for sexual reassignment surgery.
The above named started receiving psychiatric assessment in the psychiatric clinic of [name of hospital] since [year]. [He/She] diagnosed to have gender identity disorder and he is now undergoing real life experience for [number of years] years. [He/She] coped well in both social and work aspect and he/she has no other psychiatric co-morbiditiy. [He/She] was also assessed by clinical psychologist on [date] and commented to have adequate coping and psychological preparation for the coming procedures. He/She is now on own source of hormonal treatment for more than [number of years] years also.
Please kindly offer an appointment for assessment of sexual reassignment surgery.
[Hormonal Therapy Referral Letter (FtM) Sample]
To: Department of Medicine (Endocrine)
Dear Consultant in-charge,
Re: [Name of the patient in English and Chinese, HKID#] Reason for referral: Hormonal therapy
Thank you for seeing the above-named patient.
She has been diagnosed with Gender Identity Disorder and does not suffer from any mood disorder, psychosis or there psychiatric illness.
She requests to receive testosterone injections in order to have a more male appearance. She would also like to receive injections to stop her menstruation (pending assessment by O&G for hysterectomy / sapling-oophorectomy).
She is fit for consent.
Please see her and offer her your expert assessment.
[SRS/Hormonal Therapy Referral Letter (FtM) Sample]
Dear Sir/Madam,
Re: [Name of the patient in English and Chinese, HKID#]
I assessed the above-named patient on [date].
She has been diagnosed with Gender Identity Disorder.
She does not suffer from any mood disorder, psychosis or other psychiatric illness.
She has been referred to the falling clinics at [hospital]:
- Endocrine (for consideration of testosterone injections)
- Gynaecology (for consideration of hysterectomy/salpingo-oophorectomy)
- Surgery (breast clinic) (for consideration of breast reduction)
