In this talk from the 2021 Advancing Excellence in Transgender Health conference, Sarah reviews areas to cover when conducting an assessment of mental health and readiness for gender-affirming surgery referral letter requests. The session is presented through a lens of social justice, and from the perspective of providing trauma-informed and gender-affirming care. Aspects of the client-provider power differential and gatekeeping role are discussed. Participants will learn what questions to include in the assessment and how to ask clients such questions in order to support clients’ goal(s) for gender- affirming surgeries, and identify insurance-based eligibility criteria for emotional and practical readiness for gender-affirming surgeries.