Another question that comes up often pertains to clearance letters from mental health care professionals or other doctors. Doctors who perform SRS typically will require two referral letters from qualified professionals that have been assessing you in your local area. Dr. Cardenas does not require these letters for FFS or for the procedures that feminize the contours of the body. There are, however, a couple situations that might require a clearance letter. HIV+ patients, for example, must submit a letter from their specialist that confirms that they are successfully under treatment with an HIV medication meant to produce a low or undetectable viral load. Other chronic conditions could also require a clearance letter to ensure that the condition itself won’t subject the patient to an excessive risk during or after surgery.