FAA Medical Guide

To help you better navigate the medical special issuance process, we have created the following guide.
Please keep in mind the FAA medical process for transgender pilots has changed as of 1/27/2016.


The guide below may conflict with the FAA’s directives, so when in doubt, follow the FAA’s instructions and let us know of any changes so we can update this guide.


Please visit the Frequently Asked Questions page if you have any questions.
If you question is not listed, please Contact Us.

Gender Dysphoria

  • Renamed [to] Gender Dysphoria [previously Gender Identity Disorder]
    and moved from Item 41., G-U System to Item 48., General Systemic

(FAA AME GUIDE – Monthly Guide Updates 1/22/2016)

New Procedure (After 1/27/2016)


1) According to the new 2018 AME Guide if you meet all of following requirements (A and B), you will receive your medical on the spot from your AME with no further requirements.

a) If you have completed gender reassignment surgery 5 or more years ago; or if you have been treated with hormone therapy for 5 or more years. 

b)  And if there is no evidence of a mental health diagnosis and the pilot is doing well on current treatment


2) If you do not meet the above requirements your AME is required to defer your medical to AMCD. Please continue to the next step.


3) At this point you will be required to basically go through the same steps as in the old procedure, BUT there is a slight difference so please read on.


4)  You will need to have a psychological evaluation performed by a mental health professional, who is knowledgeable in transgender issues and WPATH guidelines. For specific instructions on how to have the psychological evaluation conducted, please visit our psychological evaluation guide.

a) One large change to this step is that they have dropped the requirement for a doctoral level professional. A Masters level, board certified, Psychologist, such as a Licensed Mental Health Counselor (LMHC) or equivalent is sufficient. Alternately, you can also have a Psychiatrist fill out the form (if you already have a relationship with one).

b) The other large change to this step is that they have removed the requirement for a written psychological evaluation, and have replaced it with the “FAA Gender Dysphoria Mental Health Status Report” form for your physician to fill out and return to the FAA. They can however write up a full evaluation still if they wish in place of the form. 


5) What the FAA is looking for in these reports is still basically the same as before. They want to make sure there is no history of suicide, neuro-cognitive dysfunction, drug use, or any psychological conditions which they deem disqualifying. 


6) Provide the completed “FAA Gender Dysphoria Mental Health Status Report” or psychological evaluation to your AME, or the AMCD if they have requested it.


7) At this point be prepared for the worst case scenario, you may temporarily have your medical revoked or suspended. The period after providing your information to your AME is when the process gets a bit confusing and frustrating.


8) You may receive a letter in the mail a week or so later from your Regional Flight Surgeon or AMCD/CAMI. This letter will probably state that Gender Identity Disorder (now called Gender Dysphoria) is considered a disqualifying condition and requires review by the Federal Air Surgeon through the special issuance process. This letter also might ask you to send in an “FAA Gender Dysphoria Mental Health Status Report” or psychological evaluation, even after you already provided it to your AME. Just follow the instructions and have your physicians mail your report or evaluation via certified mail to the address provided in the letter.

a) Note – If a document labeled “Specifications For Psychiatric and Psychological Evaluations” accompanies the letter, just disregard it, this document is outdated and does not reflect the actual FAA requirements for our evaluations. For some reason they are still sending out this canned response with false information.

b) If your RFS is giving you trouble about the requirements, and/or if you are repetitively receiving letters, asking for evaluations, even after you have already mailed them, have your physicians mail them directly to AMCD/CAMI via certified mail to the following address:

Federal Aviation Administration
Aerospace Medical Certification Division AAM-300
PO Box 26080
Oklahoma City, OK 73125-9914


9) At this point you are basically just waiting. Feel free to call AMCD/CAMI at (405) 954-4821 to follow up on the status of your case periodically.


10) If after 6 weeks you have not heard anything, or your case is not making any progress, we strongly recommend contacting your congressman or senator. Congressional and Senatorial inquiries are the single most effective way to have your medical processed at lightning speed. Please see our Congressional and Senatorial Inquiry Guide for more information on how to locate your representative, and tips on how to write an effective letter.


11) If you, like many people, have Republican representatives, they may or may not be receptive to making an inquiry for you. In this case we would suggest contacting the NCTE. They are a wonderful group of people. They are always very busy so please be patient with them if they take a few days to get back to you. The NCTE has contacts in the FAA for making inquiries into transgender cases that get held up.


12) As an absolute last case resort, if nothing previous has worked or yielded results. You can contact AMAS. It costs about $100 for a consultation, and rates starting at $1000 to take on your case. If you are apart of certain aviation unions (such as ALPA), they may contract AMAS for medical assistance and you pay nothing. They are very good at getting pilot medicals taken care of, for any medical obstacle.


13) Hopefully at this point you will have your new medical and Special Issuance letter, if not, please contact us and we will be glad to brainstorm solutions with you!



     Unfortunately the medical process for transgender pilots is far from streamlined and tends to hiccup along the way because many of the FAA staff have no idea how to process our medicals. Intervention by an outside entity like your congressperson or the NCTE is often necessary to get knowledgeable people on your case to move it along. If you have any questions about any step in the process please feel free to ask us and we will be glad to get you going in the right direction.

     With the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) we have made great strides. This critical manual no longer classifies being transgender as a “mental disorder”. This certainly has helped us in our case against the FAA; they no longer have any factual legs to stand on for this issue, and hopefully these discriminatory requirements will be abolished soon.


This information is not endorsed by the FAA or the United States Government. Information is based on other transgender pilots’ experiences with the process of FAA medical certification.