gender reassignment surgery cost in canada

Ontario.ca needs JavaScript to function properly and provide you with a fast, stable experience.

To have a better experience, you need to:

• Go to your browser's settings
• Enable JavaScript

Gender confirming surgery

How to apply for gender confirming surgery (also known as sex reassignment surgery) in Ontario. If you are eligible, this service is covered under OHIP .

As of March 1, you can seek an assessment for surgery from qualified health care providers across the province.

On this page Skip this page navigation

Affirming gender identity.

Gender confirming surgery (also known as sex reassignment or gender affirming surgery) does more than change a person’s body. It affirms how they think and feel about their own gender and what it means to who they are.

Ontario is funding surgery as an option for people who experience discomfort or distress with their sex or gender at birth.

How to qualify

Ontario funds two types of gender-confirming surgery: genital and chest.

To qualify for funding, you must:

• be assessed and recommended for surgery by either one or two healthcare providers (e.g. a qualified doctor, nurse practitioner, registered nurse, psychologist or registered social worker)
• have a referral for surgery completed and submitted to the Ministry of Health and Long-Term Care by a physician or nurse practitioner; and
• have the surgery approved by the Ministry of Health and Long-Term Care before the surgery takes place

Approval for genital surgery

To be approved for genital surgery, you’ll need:

• one of the assessments must be from a doctor or nurse practitioner
• you have a diagnosis of persistent gender dysphoria
• have completed 12 continuous months of hormone therapy (unless hormones are not recommended)
• you have lived 12 continuous months in the gender role you identify with (for genital surgery only)

If you have surgery before getting approval from the ministry, the cost of the surgery will not be covered.

Approval for chest surgery

To be approved for chest surgery you’ll need:

• have a diagnosis of persistent gender dysphoria
• have completed 12 months of continuous hormone therapy with no breast enlargement (unless hormones are not recommended) if you’re seeking breast augmentation

After being approved for chest surgery, your family doctor or nurse practitioner can refer you to a specialist who can perform the surgery.

Apply for surgery

To apply for gender confirming surgery, your doctor or nurse practitioner needs to fill out and submit the application along with the assessments and recommendations for surgery, to the Ministry of Health and Long-Term Care. The application is for patients seeking services in Ontario, out of province but within Canada or outside of the country.

Your doctor or nurse practitioner will let you know if your application is approved.

Once you receive approval from the ministry, talk with your health care provider to get ready for the surgery

Additional resources

You can find useful information from organizations, such as:

• find out about their ongoing project, Trans Health Connection
• consult their service directory
• find out about the Gender Identity Clinic (Adult)

Information for healthcare providers

Find out more about your role in providing gender-confirming surgery funded by Ontario.

Frequently asked questions

• Do I have to have genital reconstructive surgery before changing my gender status on my legal documents?
• Will my surgery be reimbursed by my province’s health insurance?
• From what age can I have gender affirming surgery?
• What documents do I need to provide if I want to have surgery?
• I am intersexed and would like to undergo gender reassignment surgery. What documents do I need to provide?
• My file is complete; I am following WPATH’s Standards of Care and I have provided all of the documents requested by my surgeon. How long will I have to wait to be given a surgery date?
• How long before surgery do I have to provide my lab results?
• What are the possible complications involved with my surgical procedure?
• Will I lose the ability to achieve orgasm after surgery?
• I don’t speak French. Do the physicians and staff at GrS Montréal speak English?
• Will I have an opportunity to speak with the GrS Montréal team before my surgery?
• My blood is infected with HIV. Can I still have surgery?
• If I have an STI, can I still have surgery?
• Can I contract or transmit an STI even if I have undergone genital reconstructive surgery?
• Can I be operated on if I am overweight?
• Can I undergo surgery if I take drugs?
• How long before and after surgery do I have to stop consuming alcohol and stop smoking?
• Should I stop taking my hormones before surgery?
• Will the dosage of my hormones need to be adjusted after surgery?
• How do I prepare for surgery?
• How do I plan my transportation to and from my procedure?
• I am afraid to experience pain after my surgery. Will I be given medication?
• Why do I need to stay for a few days at the Asclépiade convalescent home after my surgery?
• If my recovery is difficult, can I get psychological support at your hospital?
• I would like to undergo surgery at GrS Montréal. Should I be accompanied during my stay?
• What are the rules regarding visitors?
• Will I have access to entertainment during my stay?
• Will I require the aid of a nurse after my surgery?
• Once I am back home after surgery, what should I do if I need help?
• Can I drive my car after surgery?
• How long will my convalescence last after surgery and when can I return to work?
• When can I start to swim again after my surgical procedure?

No, if you are a resident of Quebec, it is no longer mandatory to have genital reconstruction surgery in order to change your gender status in legal documents.

For more information, visit the Directeur de l’état civil’s website: https://www.etatcivil.gouv.qc.ca/en/change-sexe.html

If you are not a Quebec resident, you can find information in the Being Trans section of our website or from your provincial or state government.

*If necessary, we will provide you with the official documents (affidavit) required to support your efforts.

Most Canadian provinces cover the cost of gender reassignment surgery. However, feminizing surgeries considered cosmetic, such as breast augmentation , voice surgery , Adam’s Apple reduction , and facial feminization , are not currently covered by all health insurance programs. Each Canadian province has its own reimbursement program. You can find information specific to your province in the Being Trans section of our website or of your provincial government.   

If you are a U.S. citizen or from elsewhere in the world, check with the health department of your state or provincial government and/or your own insurance company.

*Some health insurance programs cover certain fees associated with your surgery while others do not.

According to WPATH 's Standards of Care, an individual must be of the age of majority in the country of reference (Canada) to be allowed to undergo gender reassignment surgery. Therefore, the required age for genital reconstructive surgery is 18 years of age and 16 for masculinization of the torso surgery (mastectomy).  

The documents required are linked to the type of surgery you are interested in undergoing. The basic required documents are those that allow surgeons to confirm that you have met WPATH’s Standards of Care. Additional documents, like proof of good health from your doctor, will be requested to ensure safe surgical proceedings.

Consult the WPATH document  for more information.

The documents required are the same set out by WPATH’s Standards of Care . GrS Montréal surgeons may ask you for additional documentation and/or test results in order to ensure safe surgical proceedings. 

Once your preoperative medical file has been confirmed, a GrS Montréal staff member will contact you to provide you with a preliminary surgery date, taking into account your own availability and that of the operating room.

Although you will have been assigned a date, you must send us the required lab results by the deadline you will be provided with. Once the results of these tests have been validated, your surgery date will be confirmed.   

GrS Montreal must have received these results at least 2 months before the surgery otherwise it could be postponed.

It is important to keep in mind that complications rarely occur. Generally, minor problems are the most common. Complications may make recovery time longer, but they do not necessarily affect final results.

While risk is involved in all surgeries, GrS Montréal physicians work continually to prevent them through the development and maintenance of safe surgical practices. Additionally, pre and postoperative treatment and follow-up plans allow for early detection and management of complications that may arise. In the case of complications, our doctors will provide you with all of the necessary information to help you eliminate all problems as quickly as possible. 

Risks and complications are not directly related to the scale of the surgical procedure involved and are sometimes difficult to prevent despite precautions taken. Severe allergic reactions to medication, cardiac arrhythmia, hypertension, hemorrhage, embolism, the reopening of wounds or slow healing, injuries to other parts of the body, loss of feeling, bruising and swelling, wide and thick scars, and unsatisfactory outcomes are common complications in all surgeries. You will be provided with all details related to the complications specific to your surgery.      

The majority of patients retain their ability to achieve orgasm after surgery, but there is still a risk that sexual function or the ability to have an orgasm will be affected. GrS Montréal surgeons are very experienced and use techniques that allow the patient to retain her or his sensations of sexual pleasure. Your health history (smoking, diet, alcohol, etc.) can also affect healing and, in this way, alter the sensitivity of your genitals.

Our staff speaks French and English. We are also able to provide you with documents concerning your surgical procedure in these two languages.

If you do not speak French or English, it is still possible to have surgery at the CMC. In the past, we have accompanied deaf and mute patients, as well as patients whose mother tongue is neither French nor English. From the beginning of the preoperative period, we will accompany you in the process to obtain an interpreter or translator.  

You can contact us at any time in order to communicate confidentially with a member of the GrS Montréal team. Once your file is complete, a member of the nursing staff in the preoperative clinic will contact you. 

Yes, it is possible to have surgery as HIV is not a contraindication to surgery. However, it is important to mention your infection to us and to provide us with the results of your viral load when you want to plan your surgery. Your viral load lab results must be labelled “undetectable”. Antivirals are the only way to achieve this label.   

Yes, surgery is possible even if you have contracted an STI in the past. However, if you currently have an STI, it is recommended you be healed before having surgery. Your symptoms must be treated. if a fever is present, surgery will be postponed.  

After surgery, you remain at risk of contracting or transmitting infections transmitted sexually and by blood. Consult your family doctor for information about available protection.

Resources:  https://www.sexandu.ca/

Your weight and diet can significantly influence your healing, the results of your surgery, your ability to take care of yourself. It is preferable to have attained a healthy weight by the time of your surgery (a BMI between 18.5 and 25). If your BMI is below or above the normal range, your situation will be assessed and you will be informed of your possibilities for surgery. GrS Montréal can direct you to resources that can help you achieve your weight loss or weight gain goals.

  Calculate your BMI

Access to our establishment is forbidden to anyone with drugs or alcohol in their possession, or are under the influence of these substances.

Drug use can affect patient safety during surgery. All drug use should be reported to us during the planning stages of your surgery. Your surgeon and anesthesiologist must have this information to ensure the surgery is safe for you.

Alcohol: You must avoid drinking alcohol during the 2 weeks before surgery. Mixing alcohol and medications can cause unpredictable and undesired reactions.

Tobacco and nicotine substitutes:  We highly recommend you stop smoking or using nicotine substitutes during the 6 weeks before and after the procedure, with the exception of phalloplasty surgery, for which you must stop smoking 6 months before and after the procedure in order to optimize the vascularization of the graft of the phallus as well as nerve regeneration. Toxic substances found in tobacco can:

• Tighten small blood vessels and thus negatively affect the results of your surgery and the healing of your wounds;
• Cause nausea upon waking up, vomiting, and excessive coughing, which increase the risk of bleeding after surgery;
• Resource https://defitabac.qc.ca/en

According to the law to provide a healthy environment, it is strictly prohibited to smoke on the premises, with the exception of specifically designated smoking areas. These areas are located at least nine (9) meters from all of the facility’s doors. Violating this rule can make you subject to fines ranging from $250 to $750 for a first infraction and from $500 to $1500 for a recurrence. Cigarette butts must be disposed of in designated metal containers.

Three (3) weeks before surgery, you should stop taking feminizing hormones such as estrogen, progesterone, as well as cyproterone acetate (Androcur®). You can continue taking your anti-androgens (Finasteride®, Spironolactone®).

Masculinizing hormones such as testosterone: you will need to continue taking these according to your usual schedule.

If you are taking feminizing hormones and antiandrogen drugs , make an appointment with your prescribing physician 2 months after a genital reconstructive surgery such as vaginoplasty , vaginoplasty without vaginal cavity , and orchiectomy .

If you are taking masculinizing hormones , you do not need to make a follow-up appointment.

Once your surgery date has been confirmed, we will provide you with documentation containing all the details required to be well-prepares for your surgical procedure and your stay. 

If you are traveling by train or airplane, a transportation service is available at no additional cost. If you are not hospitalized (day surgery), you must be accompanied at the time of departure.

*If it is impossible for you to be accompanied, please let us know as early as possible so that we may put necessary resources in place.

If you are hospitalized, you must leave your room by 8:00 am on the day of your departure so that we can make it available to the next patient. For this reason, we ask that you plan your flight or train departure for the morning. If you are not hospitalized (day surgery), the nurse will tell you when you can leave the facility.

The majority of patients experience pain after surgery. Its intensity varies from one person to another and the experience of pain is unique to each person. To relieve pain, surgeons prescribe a daily medication such as an anti-inflammatory and a non-opioid analgesic. If your pain persists, take a narcotic analgesic in addition to your regular medication. We cannot predict how long the pain will last, but it should decrease in intensity as your healing progresses.

Depending on the type of surgery, your surgeon will, when needed, renew your narcotic analgesic prescription during your medical leave. Should you require more medication, make an appointment with your family doctor.  

Your stay at Asclépiade is necessary because you will receive the majority of your care and postoperative treatments there. Your convalescence allows you to recover under 24-hour a day surveillance by the nursing staff. If complications arise, your surgeon will immediately take charge of you. Finally, the nursing staff will also teach you all that you will need to know to continue your care yourself when you return home. 

The nurses at the CMC and Asclépiade can provide frontline psychological support and decide with you if additional support is necessary. We do not have any mental health professionals in place in our facility. It is therefore important to maintain contact with health professionals involved with your care and bring their contact information with you.

We highly recommend that you be accompanied by a family member or friend during your stay to support and comfort you during this unique event. Our staff will work with you and your companion to create the most positive experience possible. In addition, the presence of a companion during teaching periods can facilitate the understanding and integration of care into your daily routine. 

At the CMC:

Visiting hours are Monday to Friday from 9 :00 am to 8 :00 pm;

In order to ensure the rest, comfort, and tranquility of all of our clients, we ask you to limit your visitors to 2, 1 visitor at a time in the room. Young children are not allowed to visit;

Visitors are not authorized to enter the operating or recovery rooms;

In order to prevent infections, visitors are not allowed to sit on patients’ beds;

In order to avoid interference with medical equipment, cellphone use is prohibited between 6:00 am and 5:00 pm. Outside of these hours, we ask that you put your device on vibrate, speak quietly, and avoid long conversations.

At Asclépiade:

• Visiting hours are Monday to Sunday from 2:00 pm to 8:00 pm;
• In order to respect the privacy of patients and to prevent infections, visitors are prohibited from entering the rooms;
• Cellphones are permitted at all times but we ask that you put your device on vibrate, speak quietly, and avoid long conversations.

Yes, each room has its own television, and wireless internet service is offered for free. In order to respect the other patients in convalescence, we ask that you bring a pair of earphones with you for your own personal use.

If you wish, you may bring music, your laptop, books, or other forms of entertainment.

Usually, no. All patients who undergo surgery receive a personalized follow-up service by email or telephone to ensure that their recovery, as well as the management of their health, is going well. You will also receive educational guides for your reference at home.

If nursing care at home is required, the Nurse Navigator can make the request for you or communicate with your treating physician about how to ensure the continuity of your care. The GrS Montreal team is always available to work with the health professionals involved in order to facilitate the management of your care.

Once you are back at home, you can communicate with your surgeons through the nurse at Asclépiade.

In case of medical emergency, you must go to the emergency room of your nearest hospital or call the emergency telephone number in your area. The emergency doctor can communicate with your surgeon through Asclépiade so that you can be cared for properly and effectively. The GrS Montreal team is ready to work in tandem with other health professionals involved in your medical care.

For genital surgeries and surgeries of the torso, we recommend that you wait 2 weeks before driving a motor vehicle. After surgery of the torso, you must be able to perform unpredictable arm movements in an unconstrained manner. For genital surgeries, you must avoid placing too much pressure on your genitals, which may cause pain. Once you resume driving, begin with short distances. If you must drive a long distance, make frequent stops to walk a little and to urinate. Walking and emptying your bladder reduces pressure on the genitals.

It is prohibited to drive a motor vehicle after surgery if you are taking narcotic analgesics. 

For more information about the recovery time involved in each surgery, visit the Surgeries section of our website. Your surgeon can provide you with a sick leave letter for your employer and your insurance company.

*Please note that recovery time depends on the progress of your healing and the type of work that you do. Estimated convalescence times are for informational purposes only. 

You can resume swimming when your wounds related to your procedure are completely healed. Normally, it is necessary to plan for a complete healing time of about 4 to 6 weeks.

Transition Related Surgery

As you all know, these are unprecedented times. Currently our Transition-Related Surgery (TRS) Program at Women’s College Hospital is focusing our efforts on catching up on the backlog of cancelled surgeries and consultations after our program was on hold for several months. We recognize that this is an incredibly difficult time and that there will be significant negative impacts on our trans, non-binary and gender diverse communities as a result of this situation.

We believe that TRS is an essential and life-saving service. We are also part of the health care system that must respond to our current situation by doing what we can to keep you, your family, and your loved ones safe. We will be in touch with you when we are able to schedule an appointment. We appreciate your patience with delayed response times.

If you have questions about the referral process, please first review the “For Providers” tab below for detailed explanation of the elements required in a surgical referral.

If you are inquiring about the status of your referral, please first reach out to your referring physician. Upon receipt of any referral, we always send a response to your referring physician indicating that the referral has either been: accepted, declined or incomplete (requires further information). If your referring provider has not received such a response letter, please have them re-send the referral.

Transgender healthcare access issues are prominent in Canada and worldwide, with significant health gaps in access to skilled primary, emergency and specialty care services, which may include, for some individuals, access to medically necessary surgical services.

In response to a significant wait list for surgical referrals and lack of access to surgical services in publicly funded hospitals, Women’s College Hospital (WCH) has partnered with Sherbourne Health Centre including Rainbow Health Ontario (RHO), and the Centre for Addiction and Mental Health (CAMH), along with a group of committed individuals from the community, to form the Trans Health Expansion Partnership (THEx).

THEx supports the expansion of health services for trans individuals and communities across Ontario. Under the umbrella of THEx, the Transition Related Surgery Sub-committee led by WCH, is charged with the goal of creating an accessible, and quality surgical program.

WCH is dedicated to supporting the health and wellness of our transgender and gender diverse clients. The surgical team of the Transition-Related Surgery (TRS) Program includes specialists in plastic surgery, urology, gynecology and anesthesiology as well as nurse practitioners, nurses and other health care providers. This program represents the first public hospital-based surgical program in Canada focused on providing safe and timely access to transition-related surgical care.

At WCH, we are dedicated to offering the safest proven surgical options for TRS. Working in partnership with our patients, we bring expertise, experience and a commitment to the highest quality of care and patient experience.

If you have questions about the TRS Program, the team can be reached at 416-323-6148 or [email protected] .

Surgeries Available

Through training and recruitment of clinical staff with specialized expertise, we are building a comprehensive trans surgical program. At this time, the following surgeries are available at Women’s College Hospital.

• Mastectomy with Chest contouring*
• Breast Augmentation**
• Hysterectomy
• Bilateral salpingo-oopherectomy
• Orchiectomy
• Scrotectomy
• Vaginoplasty
• Vulvaplasty

*currently not covered by OHIP, there is a $1500 +HST cost for this procedure

**currently covered by OHIP following 12 months continuous hormone therapy with no breast growth defined as Tanner Stage 1

Yonah Krakowsky, MD FRCS(C), TRS Medical Director Emery Potter, NP-PHC, BSCN, MN, TRS Program Nurse Practitioner Nahir Anashara, Nurse Practitioner Olivia Drodge, TRS Physiotherapist

Plastic Surgery

John semple md, msc, frcs(c), facs .

Dr. John Semple is Head, Division of Plastic Surgery at Women’s College Hospital and Professor in the Department of Surgery, Faculty of Medicine at the University of Toronto.  Areas of specialty and interest include Breast Surgery, Breast reconstruction, Tissue engineering, Lymphedema, Mobile health technology and high-altitude meteorology and global waning in the Himalaya.

Mitchell Brown MD, MEd, FRCS(C) 

Dr. Mitchell Brown is a Professor of Surgery in the Department of Surgery at the University of Toronto.  Founder and co-course director of the Toronto Annual Breast Surgery Symposium and Breast Reconstruction Awareness (BRA)Day.  Dr. Brown specializes in aesthetic and reconstructive breast surgery, body contouring and facial aesthetic surgery.

Dr. Kathleen Armstrong

Dr. Kathleen Armstrong is an award winning teacher and expert in gender affirming top surgeries. She completed fellowship training with Dr. Hugh McLean at the McLean Clinic and performs over 250 top surgeries per year. She has extensive experience as an educator having participated in medical student and resident education for the last 10 years in various roles. In her role within the Division of Plastic, Reconstructive & Aesthetic Surgery at the University of Toronto, she trains medical students, residents and fellows in top surgery providing core lectures, office based and technical experience. She has a MSc in Health Services Research specializing in Health Economics. Her presentations have garnered various awards and she has published in multiple prestigious journals including CMAJ, JAMA and JAMA Surgery. As an Early Career Researcher at Women’s College Research Institute, she aligns her surgical and research interests to focus on gender affirming surgeries.

Urologic surgery

Ethan grober md, med, frcs(c) .

Dr. Ethan Grober is the Division Head Urology and Assistant Professor at the University of Toronto, Department of Surgery.  Dr. Grober’s clinical activities focus on vasectomy reversal microsurgery, male reproductive and sexual medicine and testosterone deficiency.  His research interests include the assessment of technical competence and operative judgement, the integration and evaluation of new technologies in surgery and the validation of surgical simulation and laboratory-based surgical skills training.

Yonah Krakowsky, MD FRCS(C)

Dr. Yonah Krakowsky is the Division Head of Trans Surgery and a Surgeon-Educator at the University of Toronto.  His clinical and research interests are in peyronies disease, erectile dysfunction, female sexual medicine and increasing access for Trans Surgery in Canada.

Lisa Allen, MD, FRCS(C)

Women’s College Hospital 76 Grenville Street Floor 5 Toronto, ON M5S 1B2

Phone : 416-323-6148 Email : [email protected]

OHIP funded Transition Related Surgery (TRS) is applied for by qualified health care professionals. This includes providers who are trained in the assessment, diagnosis, and treatment of gender dysphoria in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care. This may include a Physician or Nurse Practitioner (NP) as well as a Registered Nurse, Psychologist or Registered Social Worker with a Master’s degree. If you are one of the aforementioned professionals interested in becoming a qualified provider, please see our Community Resource page for more information. 

Making a Referral

To make a referral please submit.

• Transition Related Surgery Referral Form
• Prior Approval Funding Confirmation Letter -   Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf). (unless previously discussed with TRS Program NP)
• Comprehensive   referral template (.docx)  or brief referral with TRS planning visit notes

Before making your referral ensure

The patient meets OHIP eligibility for surgery (unless contraindicated)

You have provided the patient with comprehensive TRS planning visit(s)

Once you receive the OHIP approval form, have completed the referral and have attached a completed cover page, please fax the referral to: 416 323-6310. If you have any questions about the referral or referral process please call: 416 323-6400 x 4339 or x5333.

Once the referral is received, it will be assessed by someone from the TRS team. If incomplete, it will be returned by fax requesting the missing information.

If the referral is complete, it will then be sent to the appropriate surgeon’s secretary and they will be in contact once they have an appointment available.

For OHIP Funding

The TRS Frequently Asked Questions (.pdf) is a guide to the assessment and referral process for Ministry of Health and Long-Term Care Approval for OHIP funding. The resource is intended for persons considering transition-related surgery in Ontario, and the people supporting them.

The Ministry of Health and Long-Term Care’s  website  outlines the Ontario Health Insurance Plan (OHIP) funding criteria for transition- related surgeries. There is a specific form, the  Request for Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf) , you must complete in the current referral system to gain access to OHIP coverage. This form can be found  here.

The form is completed and faxed to the MOHLTC at (613)536-3188 once

• The patient is confirmed to meet the criteria for surgery
• TRS planning visits  have been completed and the patient wishes to move forward with surgery
• A surgeon has been chosen (see Our Team)

Once the form is faxed to the MOHLTC, they will fax back a letter with the decision (typically within 1-4 weeks). This Prior Approval Funding Confirmation Letter will be sent to the patient and the referring provider. The form will not be sent to the surgical team as of November 1st, 2019.

Criteria for Surgery

Criteria for surgery must be met prior to referral to a surgeon/program. The criteria for surgery are outlined in the box below. Please ensure your client has met these criteria, unless contraindicated, and please make comments on your referral letter. Criteria for all surgeries, including what is listed in the table, must include  persistent and well documented gender dysphoria, capacity to make a fully informed decision and consent to treatment. 

Surgery Planned Visits

For upper body surgeries including mastectomy with chest contouring and augmentation mammoplasty, only one provider (physician or nurse practitioner) is required to complete surgery planning visit(s) and complete the  Request for Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf).

For lower body surgeries, including but not limited to orchiectomy, hysterectomy, phalloplasty, metoidioplasty and vaginoplasty, two providers are required to complete separate surgery planning visits and complete the Request for Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf). One of the providers must be a physician or Nurse Practitioner and the other may be any of the listed qualified providers.

TRS planning visits are to be completed as you wish, however, to assist you we have created a list of key topics to discuss and include during these appointments. Documentation should confirm that these topics have been reviewed.

Gender History

Discuss the patients current gender identity and process of transition.

Confirm persistent Gender Dysphoria, the patients experience with transition so far, medical and social steps taken or considered Include Eligibility as per the Ministry of Health and Long Term Care and the World Professional Association of Transgender Health (i.e. duration of hormones, gender role experience)

Goals for surgery

Why does the patient want surgery? How will surgery help the patient achieve their gender goals/reduce dysphoria? Are their expectations for surgery realistic? Aware of alternative non-surgical and surgical options If relevant, discussion around fertility and options for preservation reviewed

Detailed surgery discussion/capacity for informed consent

Description of desired surgery, realistic outcomes, risks, side effects (irreversibility), alternate options. (A more detailed and focused discussion about surgical details will take place between the surgeon and client)

Readiness (medical and psychosocial)

How well controlled are medical and mental health conditions Smoking, alcohol, substance use Supports in place (including financial), and aftercare planning

Criteria for Transition Related Surgery

Criteria for surgery must be met prior to referral to a surgeon/program. The criteria for surgery are outlined in the box below. Please ensure your client has met these criteria, unless contraindicated, and please make comments on your referral letter. Criteria for all surgeries, including what is listed in the table, must include  persistent and well documented gender dysphoria, capacity to make a fully informed decision and consent to treatment. 

Provider Resources

If you would like more information on how to become a provider qualified to make referrals for Trans Related Surgery please see the  RHO website  for trainings and information

For information on the referral process for surgery in Ontario see  Rainbow Health Ontario’s Frequently Asked Questions.

For information about specific transition related surgeries, please see these surgical info summary sheets.

RHO provides a weekly mentorship call from Wednesday from 12-1. Providers are encouraged to call in to ask any trans related health care questions. Register at the bottom of the page on their website.

If you are looking for a primary or secondary provider to support trans pre-surgical planning visits you can make a referral to CAMH .

Visit the  RHO Newsroom  to be kept up-to-date as our program and website expands to include helpful resources and ensure access to care.

Referral Process for Patients

If you wish to access Ontario Health Insurance Plan (OHIP) funded TRS, please make an appointment with your physician or nurse practitioner. TRS planning visits can occur in a primary care setting, with a specialist or at the CAMH Gender Identity Clinic (or in combination depending on your needs and local resources). TRS planning visits will take place with your health care team. You may be asked to see one or two providers depending on the surgery you are requesting. In addition to a physician or nurse practitioner, this might include a social worker, a registered nurse or a psychologist

Your health care provider will arrange or provide the necessary surgery planning visits prior to referral for surgery. In these appointments the provider will ensure that you have met all the OHIP funded surgery criteria in addition to having an in depth conversation with you about your goals, different surgical and non-surgical options, risks and benefits of surgery and other relevant medical and mental health issues.

Once you have completed your TRS planning visit(s), your health care providers will complete a special medical form seeking OHIP funding for transition- related surgeries. Once this is approved, a referral will be made to your chosen surgeon. If the referral is complete and accepted, you will receive a call to set up an initial appointment with the surgeon. The TRS Frequently Asked Questions (.pdf) is a guide to the assessment and referral process for Ministry of Health and Long-Term Care Approval for OHIP funding. The resource is intended for persons considering transition-related surgery in Ontario, and the people supporting them.

The first appointment is a surgical consultation. At this visit you will meet with your surgeon and possibly the Nurse Practitioner or Social Worker. During this visit, we will take a comprehensive history, there will be a detailed discussion about surgery, a physical exam will take place, photos may or may not be taken and consent to communicate with your primary care team will be sought. A pre-op medical questionnaire will be completed.

After this consult visit, if surgery is the next step, the surgeons secretary will follow up with you in order to book surgery. Once surgery is booked, you will get another appointment for pre-admission clinic. This visit typically occurs in the week or two before surgery.

At the pre-admission visit you will be given more details about your surgery, pre-operative instructions, review an after-care plan and you may be given information to take home. You may also meet with anesthesia and possibly pharmacy or internal medicine at this visit.

You are expected to have someone to pick you up from surgery and stay with you for 24 hours afterwards. If you do not have such a person, we will discuss options available to you including the ARC program at SHC.

Post Surgical Resources – Vaginoplasty

• Consent for vaginoplasty
• VaginoplastyGuidebook
• Vaginoplasty Surgery Timeline
• Post-Operative Vaginoplasty Guide to the First Year
• Digital Care Coach
• The role of pelvic floor physiotherapy
• Pre-surgery exercises
• Dilation instructions
• Dilation assistance
• Getting the pelvic floor ready for dilation
• Hypergranulation tissue
• ILU Abdominal massage
• Kegels and Stretches
• Medication Schedule
• Support from a Social Worker
• Common Vaginoplasty Complications
• Understanding what Recovery may look like
• Accessing Vaginoplasty Surgery in Ontario

Post-Surgical Resources – Chest Surgery

• Chest Surgery timeline
• Track Your Drains
• Chest Masculinization Guidebook
• Accessing Chest Surgery in Ontario

The Financial Cost of Being Transgender in Canada

Part 2: we focus on some of the financial challenges faced by the transgender community, both hidden and open.

Work and Money Under Canada’s Federal Employment Act , employers “shall implement employment equity by identifying and eliminating employment barriers against persons in designated groups”. The four designated groups are women, aboriginal peoples, persons with disabilities, and members of visible minorities. Neither sexual orientation nor gender identity are protected classes. However, transgender Canadians are not without anti-discrimination protections. Gender and sexual minority people are named in and protected by Section 3(1) of the Canadian Human Rights Act . Still, there’s a gap between theory and practice. Egale , a Canadian advocacy group and a leader in research on the nation’s LGBTIQ2S issues, has perhaps the most up-to-date and comprehensive data on this matter. In their 2020 report on workplace discrimination , Egale notes that LGBTIQ2S Canadians continue to face widespread inequity, particularly in terms of access to safe work, and inequity is more pronounced for transgender, Two Spirit, and gender non-conforming people. This is borne out by the Trans PULSE 2011 report on workplace discrimination , which found that just 37% of transgender Ontarians were working full-time, while 20% were unemployed or on disability. The higher rates of un- or under-employment in these populations “are despite having an overall higher rate of qualifications.” A reported 71% have some college or university but approximately half earn $15,000 or less per year. As with the broader community, the effects of workplace discrimination go far beyond wage loss. Employment can provide access to good housing and educational opportunities, as well as benefits like medical, mental health care, and dental coverage, bonuses, paid leave and vacations, and investment power in the form of RRSP contribution room and matching employer contributions. Health Care Canadians enjoy universal healthcare—but just how universal is it? Among the services not covered are prescription drugs, dentistry, and mental health care. For those without employer plans, these expenses can be out of reach, particularly for low income Canadians. The Standing Committee on Health released a report in 2019 on the health of LGBTIQ2S Canadians and found that between 20% and 30% of transgender people who needed emergency services did not go to the ER, and of those who did, 52% had negative experiences. Refusal of service, inappropriate or invasive questions, misgendering, and other forms of discrimination all contribute to a health care system that can be hostile to transgender people. In this context, it’s not surprising that transgender Canadians underuse available health care services. For a more comprehensive discussion of the costs of health care refer to part one  of this series. Specific to the transgender community, there are two aspects of health care worth a closer look: fertility and adoption, and gender affirmation. Fertility and Adoption In addition to adoption and reproductive technologies like intra-uterine insemination (IUI), surrogacy, or in vitro fertilization (IVF), there are fertility preservation strategies for transgender people who have eggs or sperm. For those who have eggs , in addition to IUI or IVF, embryo or egg freezing and storage, prior to hormone therapy (if applicable) may be an option. The costs of this procedure varies by clinic but are estimated to be about $10,000 to extract and $300 per year to store. If and when the time comes to transfer, there is an addition fee of around $2,000. For those who have sperm , banking for future use may a good option. As always, costs vary but the sperm extraction is usually in the neighbourhood of $2,000 with an additional $450 to freeze and around $400 per year to store. There may also be extra handling fees. Gender Affirmation Although medical interventions are only one aspect of the transition process, and not necessary to claim a transgender identity, many trans folks opt for one or all of the following: counselling, hormone therapy, or surgery. Visits with psychologists or clinical counsellors are not covered by basic health care but may be within some employer or extended plans. That said, there some programs across the country, such as Gender Journeys through Sherbourne Health Centre in Toronto, that offer free group sessions for transgender or questioning Canadians. For those without local resources or who want to go the private route, fees for psychologists or counsellors run anywhere between $100 and $300 per hour. Hormone therapies include the administration of testosterone, estrogen, and hormone blockers, all of which are designed to alter secondary sex characteristics such as body hair, voice, and fat distribution. Some Canadians with employer benefits or extended health care plans, or those on disability or social assistance, may be eligible for funding towards their hormone therapies but these are generally an out-of-pocket expense. Gender affirming surgeries include “top surgeries” such as a mastectomy or breast implants and “bottom surgeries” like a hysterectomy, vaginectomy, vulvoplasty, orchiectomy, metoidioplasty, scrotoplasty, and phalloplasty. Coverage for these procedures varies but many are available under provincial health care plans. Extended insurance might broaden the coverage. Other costs to consider that are not typically covered are facial feminization or masculinization procedures, vocal coaching, prosthetics, hair removal, and body contouring. Identity Documentation Should a transgender person want to change their name, it will cost between $100 and $137, depending on province of residence. Afterwards, or in the case of changing a gender marker, they’ll need to update their identification. Again, the fees differ according to location but in Ontario, the cost for a replacement birth certificate is $35. A replacement driver’s license is $35.75. Note: *LGBTIQ2S is an acronym for lesbian, gay, bisexual, transgender, intersex, queer, and Two Spirit. It is uniquely Canadian, and may be understood in place of LGBT+. **In this piece, transgender is used to identify people within the “trans umbrella”. That is, people who identify as transgender, transsexual, genderqueer, non-binary, agender, bigender, and Two Spirit, among other identities of transgender experience. Importantly, a person may claim these identities independent of medical interventions like surgery or hormones, or of legal documentation such as name or sex designation markers.

To view this article, become a Morningstar Basic member.

Do you want to take control of your finances.

Find The Tools Here

These companies have come out with actions that speak louder than words

Now it's only the small investors who fall prey

The pandemic has amplified systemic injustices facing minority groups, women, immigrants, and ...

Activate your money for sustainability and impact

Investors need to step up in Nova Scotia lobster fishing rights issue 

• ...Search the Article Archive

Here’s the new list of Morningstar’s top underpriced stock picks to buy.

Here are some good options in an otherwise tough category.

With interest rate cuts around the corner, now could be the best time to go long Canadian bonds, ...

Fee-focused Canadian investors have been steadily selling commission-based share classes for bala...

These are the best – and worst - upgrades to improve your Canadian home’s resale value amid high ...

About Author

Keph Senett  Keph Senett is a Canadian freelance writer specializing in sport and community development, travel and culture, human rights, and personal finance--and the intersections between these interests. 

• Company Website
• Our Signature Methodologies

Connect With Us

• Global Contacts
• Advertising Opportunities

Terms of Use        Privacy Policy       Disclosures        Accessibility

The Morningstar Star Rating for Stocks is assigned based on an analyst's estimate of a stocks fair value. It is projection/opinion and not a statement of fact. Morningstar assigns star ratings based on an analyst’s estimate of a stock's fair value. Four components drive the Star Rating: (1) our assessment of the firm’s economic moat, (2) our estimate of the stock’s fair value, (3) our uncertainty around that fair value estimate and (4) the current market price. This process culminates in a single-point star rating that is updated daily. A 5-star represents a belief that the stock is a good value at its current price; a 1-star stock isn't. If our base-case assumptions are true the market price will converge on our fair value estimate over time, generally within three years. Investments in securities are subject to market and other risks. Past performance of a security may or may not be sustained in future and is no indication of future performance. For detail information about the Morningstar Star Rating for Stocks, please visit here

The Morningstar Medalist Rating is the summary expression of Morningstar’s forward-looking analysis of investment strategies as offered via specific vehicles using a rating scale of Gold, Silver, Bronze, Neutral, and Negative. The Medalist Ratings indicate which investments Morningstar believes are likely to outperform a relevant index or peer group average on a risk-adjusted basis over time. Investment products are evaluated on three key pillars (People, Parent, and Process) which, when coupled with a fee assessment, forms the basis for Morningstar’s conviction in those products’ investment merits and determines the Medalist Rating they’re assigned. Pillar ratings take the form of Low, Below Average, Average, Above Average, and High. Pillars may be evaluated via an analyst’s qualitative assessment (either directly to a vehicle the analyst covers or indirectly when the pillar ratings of a covered vehicle are mapped to a related uncovered vehicle) or using algorithmic techniques. Vehicles are sorted by their expected performance into rating groups defined by their Morningstar Category and their active or passive status. When analysts directly cover a vehicle, they assign the three pillar ratings based on their qualitative assessment, subject to the oversight of the Analyst Rating Committee, and monitor and reevaluate them at least every 14 months. When the vehicles are covered either indirectly by analysts or by algorithm, the ratings are assigned monthly. For more detailed information about these ratings, including their methodology, please go to here

• CSPS Executive
• Why Choose a Plastic Surgeon?
• Testimonials
• Locate a Surgeon
• Choosing a Plastic Surgeon
• Birth Conditions
• Breast Reconstruction
• Breast Reduction
• Burn Reconstruction
• Hand Surgery
• Skin Cancer
• Body & Wound
• Blepharoplasty (Eyelid Lift)
• Body Contouring
• Breast Augmentation
• Breast Lift
• Liposuction
• Rhinoplasty (Nose Job)
• Soft Tissue Fillers
• Skin Resurfacing
• Laser Hair and Tattoo Removal
• Moles, Cysts and Skin Blemishes
• Apply to be a Member
• Registration
• Scientific Program
• Scientific Award Winners
• Call for Abstracts
• Abstract Reviewer Login
• Code of Ethics
• Training Programs
• Young Surgeons
• Fellowships
• International Meetings
• Canadian Wait Times Alliance
• Plastic Surgery Education Network
• Lifetime Achievement Award
• Clinical or Outcomes Research Grant
• Philanthropic donations
• Global Surgery Map
• Global Surgery Map Submissions

Gender-Affirming Surgery

• Members only
• Past Scientific Programs
• Practice Opportunities
• Women Plastic Surgeons of Canada
• President’s Medal
• Board of Directors
• Visiting Professor Funding
• Humanitarian Missions

Plastic surgeons provide gender-affirming surgeries for the treatment of gender dysphoria with the aim of helping a person physically actualize their internal sense of self. The goals of these procedures are therefore patient specific and can vary beyond the gender binary.

Gender-affirming surgeries can be grouped into four main domains: facial, chest, body and genital procedures. Talking to your plastic surgeon about your individual transition will help direct which surgery options are best for you. Below are some commonly performed procedures, however, all patients should discuss both variations and the spectrum of options with their surgeon individually to make sure their chosen procedures match their individual needs and goals.

Please click here ( https://www.wpath.org/publications/soc ) for information from the World Professional Association of Transgender Health (WPATH) on information on preparing for Gender-affirming surgery.

Facial Gender-Affirming Surgery

Facial procedures can either masculinize or feminize the appearance of the face.

To enhance a feminine appearance, both bony anatomy and soft tissue augmentation can be done. Hairline lowering, forehead shortening and forehead contouring are typically done in a combination to achieve an overall feminine appearance of the upper face. Alterations to the middle face include rhinoplasty and upper lip lifts. Fat grafting can also be used to create fuller and softer cheeks. For the lower face, the jawline can be softened and reduced with mandible contouring. Finally, the thyroid cartilage can be reduced to feminize the appearance of the “Adam’s apple” and voice procedures can be used to increased vocal pitch.

Due to the effects of gender-affirming hormones therapy (testosterone) on the skin and facial hair growth, facial masculinization surgery is much less common. Some examples of surgical procedures include facial implants for augmentation of the jawline or chin.

Gender-Affirming Chest Surgery

Gender-affirming mastectomy is the most commonly performed gender-affirming surgical procedure, often referred to as “top surgery”. The most frequently performed technique is the “double incision with free nipple graft” where the breast tissue and excess skin is removed in addition to removing, re-sizing, re-shaping and replacing the nipples as free grafts. Some patients choose not to keep their nipples. Alternative techniques exist when minimal skin removal is needed. Additionally, chest reduction surgery is an option for patients who wish to keep some of their breast tissue.

Breast augmentation is available for patients who aim to increase their breast size. A minimum of 12 months of gender-affirming hormone therapy with estrogen should take place prior to considering or evaluating an individual for breast augmentation. Usually, silicone implants are used. Your surgeon will discuss variation in scar placement techniques.

Genital Gender-Affirming Surgery

For individuals assigned male at birth, options for orchiectomy (testicle removal) in isolation or in combination with vulvar procedures can be done for gender affirmation. Vulvar procedures include either a vulvoplasty or a vaginoplasty. Vulvoplasty refers to creation of an external vulva without a vaginal canal while vaginoplasty similarly creates the external genitalia in addition to a vaginal canal capable of receptive penetrative intercourse. The preoperative preparation for these surgeries varies and may influence your choice of treatment. Vaginoplasty typically requires extensive pre-operative hair removal and a post-operative dilation regimen.

Genital gender-affirming surgery for individual’s with assigned female at birth anatomy falls into two main categories: metoidioplasty and phalloplasty. In both categories the main differentiating factor between the various surgical options is the desire to stand to urinate. While metoidioplasty is done using only pre-existing genital tissue, phalloplasty requires tissue to be transferred from somewhere else on the body to construct the penis. Phalloplasty surgery is often done over multiple stages meaning more than one surgery is required to obtain a functioning phallus capable of standing urination. Many variations of phalloplasty exist. The traditional phalloplasty includes urethral lengthening with the goal of standing urination. Other variations of phalloplasty, referred to as “shaft-only” phalloplasty are increasingly performed. Shaft-only phalloplasty refers to the creation of a phallus without lengthening the uretha. Options in addition to a shaft only phalloplasty include vaginectomy, perineal urostomy, clitoral burial and scrotoplasty, depending on patient goals and individual preference.

Gender-Affirming Body Contouring

Gender-affirming body contouring includes liposuction or fat grating to change the distribution of adipose tissue in the body. Liposuction is done to help narrow the hips and alter the shape of the body. Conversely fat grafting can help augment the buttock and hips to accentuate curves.

Breast Reconstruction Awareness Day - BRA-Day

BRA Day is an initiative designed to promote education, awareness and access for women who may wish to consider post-mastectomy breast reconstruction.

Only physicians who are certified in Plastic Surgery are Plastic Surgeons. There is no foolproof way to choose a Plastic Surgeon or to guarantee your results. However, there are a few basics, which can help you to decide.

Medical Professionals

The Canadian Society of Plastic Surgeons comprises nearly 500 Plastic Surgeons and is focused on sharing knowledge and expertise, improving quality of care, and advancing the practice of plastic surgery in Canada.

• 2021 CSPS Conference Archives
• Global Outreach
• History of the CSPS
• Reconstructive Procedures
• Aesthetic Procedures
• President’s Medal
• Membership Application
• Pay Member Dues
• Annual Meeting
• Information for Plastic Surgeons
• Continuing Professional Development
• Dr. Kimit Rai Family Scholarship
• Privacy Policy

Mailing Address

Street address.

• Contactez-nous
• Politique de confidentialité

Find a Surgeon

Search by U.S. State, Procedure and Insurance Search by Country and Procedure Browse the Global Surgeon Maps

Gender Surgeons in Canada

Dr. eric bensimon.

Dr. Eric Bensimon has dedicated his career to helping trans women seeking FFS. With over 15 years experience, Dr. Eric Bensimon is one of the world’s most experienced surgeons practicing Facial Feminization Surgery.

Dr. Krista Genoway

Dr. Genoway is a board-certified plastic and reconstructive surgeon in Vancouver, Canada. Dr. Genoway started performing gender-affirming Breast Augmentation and Top Surgery in 2016, followed by Vaginoplasty and Phalloplasty when the Gender Surgery Program B.C. launched in September, 2019.

Dr. Pierre Brassard

Dr. Brassard is Canada’s most experienced Gender Surgeon. Dr. Brassard and his team perform more than 200 gender-affirming surgeries a year at Centre Métropolitain de Chirurgie in Montréal, Quebec, Canada.

Dr. Maud Bélanger

Dr. Nicholas Cormier

Dr. Jennifer Klok

Dr. Marietta Zorn

Dr. jayson dool.

Dr. Philip Solomon

Dr. shaun tregoning, dr. homan cheng.

Dr. Ashlin Alexander

Dr. Mario Jarmuske

Dr. valérie julie brousseau.

Dr. Rick Jaggi

Dr. louis boileau.

Does not accept Nova Scotia Medical Services Insurance (MSI).

Dr. Michael Jacoby

Dr. lorne brown.

Dr. William De Haas

Dr. Kirsten Westburg

Dr. stephanie olivier, dr. robert turner, dr. jason gray, dr. christopher taylor.

• Before & After Aesthetics
• Out of Town Patients

You must be at least 19 years old to view this site.

Are you at least 19 years old?

Sorry, you are not old enough to view this site.

Book a Consultation

Don’t hesitate to contact McLean Clinic today to learn more about double incision top surgery and other types of FTM top surgery. A member of our staff will be more than happy to assist you.

How Long It Takes to Get Gender-Affirming Surgery Across Canada

Share article.

In the recent years, transgender health care in Canada has seen dramatic improvements. More provinces have expanded their public healthcare packages to accommodate gender-affirming surgeries, including FTM/N top surgery or genital reconstruction procedures, for gender dysphoria treatment. However, access and availability of transition-related treatments are still far from reach for most members of the LGBTQ+ community because of the long wait times. 

What's the average waiting time to get a gender-affirming surgery in Canada? The country's first study on transgender patients' experiences published in 2017 by researchers from the University of British Columbia revealed it's anywhere from one month to nine years. The results of the study showed frustrating inconsistencies in trans patients' experience across the country.

In this article, we break down the study's key findings to pinpoint where the bottleneck is coming from and what's causing the delay in delivering life-saving surgical procedures for the Canadian LGBTQ+ population .

1. Surgery Readiness Assessment

The application process towards a gender-affirming surgery in Canada is divided into several steps. The first one is a surgery readiness assessment. Whether you are getting a transition-related operation done from a publicly funded or private clinic , a surgical readiness assessment is required by most surgeons to ensure that a potential patient is prepared and will get the best results post-surgery.

According to Trans Care BC , the primary criteria for most types of gender-affirming surgery in British Columbia are:

• Persistent gender dysphoria 
• Capacity to consent to the procedure  
• Medical and mental health conditions are reasonably well-controlled
• Being of the age of majority (In BC, the age of majority is 19. If you're under 19, your surgeon may recommend additional surgery readiness assessment steps).

The Assessment Process

Before even receiving a readiness assessment, the individual needs to follow several processes to qualify for one. This can range from:

Getting referred to an assessor through your primary care provider: 

• They can send a referral for a surgical readiness assessment directly to a qualified assessor, or
• Can send a request to your province's health care office who can refer you to a qualified assessor in your community, or
• They are a qualified assessor who can carry out the assessment themselves.

Depending on the type of gender-reaffirming surgery, one or two assessments carried out by different assessors may be required. Surgical readiness assessments can be covered if they are qualified assessors working in the publicly-funded health care system. You can also have them conducted by qualified private assessors, such as psychologists or clinical counsellors.

Getting assessed:

Once you've been referred, you have to wait for a schedule for your surgical readiness assessment. The actual appointment lasts between one to two hours, where you'll discuss your gender identity , medical history, and surgical aftercare plan . In some cases, you may be asked to come back to provide additional information.

Get a recommendation:

The qualified assessor may or may not recommend you for surgery or recommend you return for further assessment. They would send their recommendation directly to your primary care physician, who will send you a referral for surgery.

Waiting Time for Surgery Readiness Assessment

In British Columbia, most people (60%) easily or very easily got referred to an assessor, and half of these trans people (50%) did not have to spend any money on their assessment appointment(s). 

Half (50%) of the respondents in BC waited 150 days or less between the referral and their most recent surgery readiness assessment appointment. This is in contrast to the average of 180 days other patients in the country reported. However, BC's wait time also had unusual fluctuations, with some people waiting for a single day to as long as 1,825 days or more than five years.

On the other hand, the average wait time between referral and assessment in BC also differed according to the types of gender-affirming surgery planned.

• Vaginoplasty - 212 days
• Labiaplasty - 255 days
• Chest surgery - 318 days
• Orchiectomy - 322 days
• Hysterectomy-336 days
• Tracheal shave* - 364 days
• Phalloplasty- 383 days
• Breast augmentation -572 days
• Facial feminization - 607 days

2. Funding Approval

Data suggests that for all types of gender-affirming surgery in Canada, 71% had their surgery paid for, at least partially, through a government health care plan . The vast majority (93%) only had one source of funding. Almost seven out of 10 Canadians had their transition-related surgery funded with a public health plan, and one in three people said they used their own money as their sole source for surgery funding.

Unfortunately, not everyone receives approval for the life-changing surgery they had in mind. Aside from having an existing medical condition that increases the risk of being on general anesthesia, many hopefuls are deemed ineligible due to two primary reasons:

• Breast augmentation criteria  MSP criteria specifies that the patient should have been on hormone replacement therapy for at least 18 months (unless not clinically indicated) and that there's been less than an AA cup of breast growth or significant asymmetric breast growth greater than one and a half cup size difference. Most respondents feel that these are not enough to make them feel good or feminine enough about their bodies
• BMI (body mass index) Many gender-affirming surgeons have BMI eligibility criteria of 35 and below. They say they will not operate on an individual above this BMI due to hospital or clinical restrictions, clinical safety, and patient results.

3. Waiting for Surgery

After getting approved for funding, the vast majority of participants (84%) said they did not have any problem getting a referral to a surgeon for gender-affirming surgery. More than half (57%) also said they were able to choose the surgeon they wanted.

The average wait time between getting an approval and surgery date was less than 12 months or less for half of the surgeries in BC. In other parts of Canada, the wait time was eight months or less for half the surgeries.

The researchers said each patient's experiences were so diverse, with waiting times ranging from a month up to 108 months or nine years. The longest wait times were reported in the following gender-reaffirming surgeries in Canada:

• Orchiectomy
• Breast augmentation
• Phalloplasty
• Chest surgery

Interestingly, the researchers also noted that 50% of the people taking the survey were currently waiting for their surgery and/or had a scheduled surgery date, and had already been waiting for at least 17 months. Half of the people who were now waiting for surgery but did not have a scheduled surgery date had been waiting 11 months or more when they took the survey.

What's Taking So Long?

Elizabeth Saewyc, one of the lead authors on the study, gave VICE a few valid points regarding what her thoughts were on the potential causes of the long waiting process for accessing gender-affirming surgery in Canada .

• Different training in general physicians and frontline medical staff  
• Saewyc says the wait time during the pre-approval stage could be due to doctors who are clueless about where to begin, contributing to the "lack of clarity in the pathway" and impeding the transition process for trans patients.  
• Capacity issue  
• There's a lack of surgeons and specialists in the field, which is why it takes time before one can get an appointment with, say, a top surgeon. 
• Lack of specialty clinics
• For "bottom" surgeries, like vaginoplasty and phalloplasty, Canadians are limited in choice to only one clinic located in Montreal.

Wait Times Worsened by the COVID-19 Pandemic

The long wait times for gender-affirming surgery in Canada have been exacerbated exponentially by the unexpected arrival of the COVID-19 pandemic. Both public and private hospitals and clinics had to cancel scheduled surgeries and other transition-related procedures to adhere to stringent lockdown restrictions placed in different countries worldwide. Currently, we see many health care providers tackling their backlogs with surgeries booked up to 2022.

The Negative Impact of Long Wait Times

One of the biggest concerns caused by the long wait times in gender-affirming surgery in Canada would be its detrimental effects on the mental health of the LGBTQ+ population , who are already at an increased risk for:

• Depression  
• Obsessive-compulsive and phobic disorders
• Substance use
• Post-traumatic stress disorder
• Suicide and self-harm

This is cemented in a quote by N. Nicole Nussbaum, former president of Canadian Professional Association for Transgender Health and staff lawyer at Legal Aid Ontario, "Trans people are at the highest risk of suicide and self-harm between the period that they've mentally decided to transition and when they complete their medical transition ."

For inquiries about gender-affirming surgery in Canada or to learn more about what an FTM top surgery at McLean Clinic is like , don’t hesitate to reach out to us. A member of our team will be more than happy to answer your questions.

Contact McLean Clinic today!

Related Articles

The Average Cost of Top Surgery Across Canada

10 Reasons Why Toronto is the Most LGBTQ+ Friendly City

A Brief History of Toronto’s Gay Village

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• COVID-19 Vaccines
• Occupational Therapy
• Healthy Aging
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

Gender Confirmation Surgery (GCS)

What is Gender Confirmation Surgery?

• Transfeminine Tr

Transmasculine Transition

• Traveling Abroad

Choosing a Surgeon

Gender confirmation surgery (GCS), known clinically as genitoplasty, are procedures that surgically confirm a person's gender by altering the genitalia and other physical features to align with their desired physical characteristics. Gender confirmation surgeries are also called gender affirmation procedures. These are both respectful terms.

Gender dysphoria , an experience of misalignment between gender and sex, is becoming more widely diagnosed.  People diagnosed with gender dysphoria are often referred to as "transgender," though one does not necessarily need to experience gender dysphoria to be a member of the transgender community. It is important to note there is controversy around the gender dysphoria diagnosis. Many disapprove of it, noting that the diagnosis suggests that being transgender is an illness.

Ellen Lindner / Verywell

Transfeminine Transition

Transfeminine is a term inclusive of trans women and non-binary trans people assigned male at birth.

Gender confirmation procedures that a transfeminine person may undergo include:

• Penectomy is the surgical removal of external male genitalia.
• Orchiectomy is the surgical removal of the testes.
• Vaginoplasty is the surgical creation of a vagina.
• Feminizing genitoplasty creates internal female genitalia.
• Breast implants create breasts.
• Gluteoplasty increases buttock volume.
• Chondrolaryngoplasty is a procedure on the throat that can minimize the appearance of Adam's apple .

Feminizing hormones are commonly used for at least 12 months prior to breast augmentation to maximize breast growth and achieve a better surgical outcome. They are also often used for approximately 12 months prior to feminizing genital surgeries.

Facial feminization surgery (FFS) is often done to soften the lines of the face. FFS can include softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. Each person is unique and the procedures that are done are based on the individual's need and budget,

Transmasculine is a term inclusive of trans men and non-binary trans people assigned female at birth.

Gender confirmation procedures that a transmasculine person may undergo include:

• Masculinizing genitoplasty is the surgical creation of external genitalia. This procedure uses the tissue of the labia to create a penis.
• Phalloplasty is the surgical construction of a penis using a skin graft from the forearm, thigh, or upper back.
• Metoidioplasty is the creation of a penis from the hormonally enlarged clitoris.
• Scrotoplasty is the creation of a scrotum.

Procedures that change the genitalia are performed with other procedures, which may be extensive.

The change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy (surgical removal of the breasts), hysterectomy (surgical removal of the uterus), and perhaps additional cosmetic procedures intended to masculinize the appearance.

Paying For Gender Confirmation Surgery

Medicare and some health insurance providers in the United States may cover a portion of the cost of gender confirmation surgery.

It is unlawful to discriminate or withhold healthcare based on sex or gender. However, many plans do have exclusions.

For most transgender individuals, the burden of financing the procedure(s) is the main difficulty in obtaining treatment. The cost of transitioning can often exceed $100,000 in the United States, depending upon the procedures needed.

A typical genitoplasty alone averages about $18,000. Rhinoplasty, or a nose job, averaged $5,409 in 2019.  

Traveling Abroad for GCS

Some patients seek gender confirmation surgery overseas, as the procedures can be less expensive in some other countries. It is important to remember that traveling to a foreign country for surgery, also known as surgery tourism, can be very risky.

Regardless of where the surgery will be performed, it is essential that your surgeon is skilled in the procedure being performed and that your surgery will be performed in a reputable facility that offers high-quality care.

When choosing a surgeon , it is important to do your research, whether the surgery is performed in the U.S. or elsewhere. Talk to people who have already had the procedure and ask about their experience and their surgeon.

Before and after photos don't tell the whole story, and can easily be altered, so consider asking for a patient reference with whom you can speak.

It is important to remember that surgeons have specialties and to stick with your surgeon's specialty. For example, you may choose to have one surgeon perform a genitoplasty, but another to perform facial surgeries. This may result in more expenses, but it can result in a better outcome.

A Word From Verywell

Gender confirmation surgery is very complex, and the procedures that one person needs to achieve their desired result can be very different from what another person wants.

Each individual's goals for their appearance will be different. For example, one individual may feel strongly that breast implants are essential to having a desirable and feminine appearance, while a different person may not feel that breast size is a concern. A personalized approach is essential to satisfaction because personal appearance is so highly individualized.

Davy Z, Toze M. What is gender dysphoria? A critical systematic narrative review . Transgend Health . 2018;3(1):159-169. doi:10.1089/trgh.2018.0014

Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature . Plast Reconstr Surg. 2016;137(6):1759-70. doi:10.1097/PRS.0000000000002171

Hadj-moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing Genital Gender Confirmation Surgery . Sex Med Rev . 2019;7(1):141-155. doi:10.1016/j.sxmr.2018.06.004

Dowshen NL, Christensen J, Gruschow SM. Health Insurance Coverage of Recommended Gender-Affirming Health Care Services for Transgender Youth: Shopping Online for Coverage Information . Transgend Health . 2019;4(1):131-135. doi:10.1089/trgh.2018.0055

American Society of Plastic Surgeons. Rhinoplasty nose surgery .

Rights Group: More U.S. Companies Covering Cost of Gender Reassignment Surgery. CNS News. http://cnsnews.com/news/article/rights-group-more-us-companies-covering-cost-gender-reassignment-surgery

The Sex Change Capital of the US. CBS News. http://www.cbsnews.com/2100-3445_162-4423154.html

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

Frequently Asked Questions Regarding Change of Sex Designation For Trans Persons

Home » GET INFORMED » Talk Rights » Frequently Asked Questions Regarding Change of Sex Designation For Trans Persons

May 19, 2015

Like all content on this website, this document is not legal advice and is provided solely for the purpose of public information and education. If you are facing a legal issue or have a question about your specific situation, you should consider seeking independent legal advice. You can find a list of legal clinics and other resources to help you here.

The CCLA is a national organization that works to protect and promote fundamental human rights and civil liberties. To fulfill this mandate, the CCLA focuses on litigation, law reform, advocacy and public education. Our organization is not a legal clinic. As such, we are typically not in a position to provide members of the public with legal advice or direct legal representation. However, we do try to provide general legal information and appropriate referrals where possible. For questions about this document, email publicenquiries [at] ccla [dot] org.

How can Trans Persons Change the Sex Designation on their Birth Certificate?

This guide is focused on issues relating to how trans persons can change the sex designation on their birth certificates. For information on how trans persons can legally change the name used on their identification documents,  see this guide .

This page is intended to help trans persons with issues related to changing the sex designation on their birth certificates. As such, some of this information may not be helpful to those seeking to change their birth certificates for another reason.

Note: Every effort has been made to ensure comprehensiveness and accuracy (as of May 2015). However, this FAQ may not fully reflect the current state of the law.

We use the term “trans” to include anyone who does not identify with the sex designation they were assigned at birth.

Questions addressed in this FAQ:

Why might I want to change the sex designation on my birth certificate?

Should i have to have surgery in order to change the sex designation on my birth certificate, are sex designations on birth certificates even necessary, how can i change the sex designation on my birth certificate, where do i apply to change the sex designation on my birth certificate, what proof do i need to show in order to change the sex designation on my birth certificate do i need to show proof of surgery, can i apply if i am younger than 18 or 19, can i apply even if i was born outside of my current province/territory.

You can download a PDF of this document here:  CCLA Change of Sex Designation FAQ .

Many trans persons consider the sex they were assigned at birth to be inaccurate. If this is you, changing the sex designation on your birth certificate may be important for your well-being. It is also important for legal reasons as well.

In order to enjoy a greater degree of safety and freedom from discrimination, you may want to have identification documents that match the gender with which you identify and present yourself. The information on most identification documents is drawn from birth certificates, so changing your birth certificate is often a necessary first step. “Sex” is a category on most driver’s licenses, passports and health cards, and so you may find yourself being forced to discuss your gender identity – sometimes even your genitals – with a stranger. This is even worse when that stranger is empowered to make decisions that greatly affect you, such as whether to write you a traffic ticket, offer you a job, refer you for medical treatment, or let you enter the country.

Trans persons face widespread discrimination and high rates of violence. Of trans Ontarians  surveyed  by the Trans PULSE Project, 26% reported being hit or beaten up because they were trans, 73% reported being made fun of, and 39% reported being turned down for a job. In 2010, Trans PULSE  estimated  that 50% of trans Ontarians had seriously considered suicide at some point in their lives because of the discrimination they faced. Involuntary outing on a regular basis, such as by having an inaccurate gender specified on your identification documents, eliminates one of the few mechanisms you may have to protect yourself from transphobia.

In 2014, a judge in Alberta considered the constitutionality of the provincial law that regulated gender markers on birth certificates. The judge  struck down  that law, because it was contrary to the  Canadian Charter of Rights and Freedoms . In doing so, the judge cited a  prior decision  of the Ontario Human Rights Tribunal. That decision detailed some of the discrimination faced by trans persons (referred to here as “transgendered” [sic]):

“[T]ransgendered persons as a group tend to face very high rates of verbal harassment and physical assault and are sometimes even murdered because of their transgendered status. […] [I]t is very difficult for a transgendered person to find employment, […] there are very high rates of unemployment among transgendered people generally, and […] many transgendered people are fired once they are exposed in the workplace as being transgendered.”

These concerns also extend to young trans persons, who may be forced to endure bullying by their peers if the sex designation on school records does not match their gender identity.

Many trans persons want the benefits of official documents that correspond to their identity but may not want to undergo surgery. They may be content with the use of hormones or simply by presenting themselves consistently with their gender identity.

Gender reassignment surgery can be expensive, difficult to access, and carries the risks associated with any surgery. In addition, it has been reported to  typically cause sterility . Gabrielle Bouchard of the Montreal-based Centre for Gender Advocacy has said the surgical requirement in order for official documents to be changed  amounts to mandatory sterilization.  The surgery requirement also emphasizes biological sex characteristics rather than gender identity. Even after surgery has been performed, a second doctor must sometimes “confirm” the surgery. C.F., the plaintiff in the  Alberta  court case mentioned earlier,  told the  Edmonton Journal :

“What this legislation requires is that you not only submit to dangerous, risky surgery, but then actually attend for a humiliating genital inspection before two separate physicians, both of whom will make a value judgment about whether your genitals are sufficiently female[.] It’s like something from ages gone by. It’s very disturbing stuff.”

Due to these types of concerns, there have been and continue to be legal challenges to the various provincial legislation that require reassignment surgery in order to change sex designation. In the  Ontario  and  Alberta   decisions discussed earlier, the requirement for gender reassignment surgery was found to be discriminatory. As a result of these rulings, several provinces, including Alberta, British Columbia, Manitoba, Ontario, and Quebec, have taken steps to amend their laws to remove reassignment surgery from the requirements necessary in order for you to change your sex designation. Nova Scotia has also indicated that it plans to amend its legislation to remove the surgery requirement.

Some activists have argued for the removal of sex designations from identification documents altogether, on the basis that gender identity is not a binary classification. The binary does not accommodate people who do not identify with a binary gender classification.

Ongoing cases challenging legislation in  British Columbia ,  Saskatchewan  and  Quebec  are seeking the removal of sex designations from birth certificates. So far, although several provinces have removed the surgery requirement, no province has taken the step of removing sex designations altogether or providing for a third non-binary option.

In contrast, several countries, including  Australia and Germany , now allow persons to designate their sex on their passport with an “X”. However, some trans rights advocates argue that the “X” continues to out trans persons, and is used as an excuse for not eliminating the surgery requirement. An  Australian  court has ordered the government to register a third category of sex designations on birth certificates and name change certificates.

For more on the possibility of non-binary gender designations, see the BC Law Institute’s  report , where the Institute highlights the implications and consequences of different solutions to providing a non-binary sex designation in Canada.

All provinces and territories except Nunavut have procedures for changing sex designations when a person has undergone gender reassignment surgery.

The rules for changing the sex designation on a birth certificate vary from province to province. They are also changing rapidly. In all provinces except Quebec, where the  Civil Code  governs these issues, the law concerning birth registration is found in the provincial  Vital Statistics Act  and associated regulations. These laws and regulations can be consulted for free on  http://canlii.org . Note that a province may have policies that are not in the legislation. For more information about requirements, check with the government agency responsible for birth certificates in your province or territory (listed below), or with a trans advocacy organization, such as  Egale Canada .

Many provinces require letters from a mental health professional in order to change a person’s gender marker or name. Such a letter may also be required to access sex reassignment surgery.

Online government information is limited outside British Columbia, Manitoba and Ontario. Where specific information regarding change of sex designation is unavailable on a province’s website, the links below provide contact information for the appropriate agency.

Until recently, all provinces and territories required you to have gender reassignment surgery if you wanted to change the sex designation on your birth certificate. Ontario became the first province to drop this requirement in 2012 when, as mentioned previously, its human rights tribunal  ruled  the requirement was discriminatory. The Alberta Court of Queen’s Bench handed down a similar  ruling  in April 2014. Ontario has not officially amended their legislation, but are now registering changes without proof of surgery as a matter of policy. British Columbia, Alberta and Manitoba are the only provinces that have formally amended their legislation to eliminate the surgery requirement. In Alberta, the new requirements are set out in  regulations .

New Brunswick, Newfoundland and Labrador, PEI and Saskatchewan   all require applicants to document that they have undergone gender reassignment surgery, usually by having at least two physicians – the surgeon who performed the surgery and another who did not – certify that fact. Quebec and Nova Scotia also currently require proof of surgery, but changes to the law are on their way (see below). In Quebec, the second physician must practice medicine in Quebec. In New Brunswick and the Northwest Territories, the second physician must be licensed in any Canadian jurisdiction.

The law in this area is changing rapidly as legislation is amended and court challenges are brought regarding surgery requirements. Consulting the relevant statutes will not always give a full picture of the current requirements or upcoming amendments. For current information, contact a trans advocacy organization, such as  Egale Canada .

You must provide:

A declaration, which provides your date of birth, and states that you identify with and maintain the gender identity that corresponds with your desired sex designation; and

Confirmation from a licensed doctor or psychologist licensed in Alberta or another jurisdiction that the sex designation on your birth certificate does not correspond with your gender identityBritish ColumbiaNo proof of surgery required;

A declaration, which states you have assumed, identify with and intend to maintain the gender identity that corresponds with your desired sex designation; and

Confirmation from a doctor or psychologist licensed in BC or the province or territory where you live that the sex designation on your birth certificate does not correspond with your gender identityManitobaNo proof of surgery required;

A declaration, which states you identify with the requested sex designation, you are currently living full-time in a manner consistent with the requested sex designation and you intend to continue doing so; and

A supporting letter from a health care professional licensed in Canada or where you live that your gender identity corresponds with the requested sex designationNew BrunswickProof of surgery requiredNewfoundland and LabradorProof of surgery requiredNova ScotiaProof of surgery still required, but a bill to eliminate the requirement has received royal assent. Under the new law, which is not yet in force, you will written statements from themselves and a member of a profession to be prescribed in the regulations that confirm your gender identity.OntarioNo proof of surgery required;

A declaration, which states your gender identity); and

A note from a doctor or psychologist licensed to practice in Canada that confirms your gender identityPrince Edward IslandProof of surgery requiredQuebecProof of surgery required, but change is pending;

The requirements under the new law have not been set yet.SaskatchewanProof of surgery requiredNorthwest TerritoriesProof of surgery requiredYukonProof of surgery requiredNunavutThere is no provision in the  Vital Statistics Act  for changing sex designation, even with surgery

Sex reassignment surgery is generally not performed on those under the provincial age of majority, as all clinics in Canada that currently perform reassignment surgery conform to the recognized  Standards of Care . These Standards, which are regarding health care for trans persons, forbid irreversible interventions (such as surgery) on patients before they reach the age of majority. As a result, if you are a minor in Canada, you generally cannot change your sex designation in provinces or territories where proof of surgery is required.

In provinces that do not require surgery, the age requirements vary:

Note that legal challenges to the minimum age requirements are currently proceeding in several provinces, including  Quebec  and  Saskatchewan . Click  here  to listen to an interesting radio interview with a 10 year old who would like to change the sex designation on her birth certificate.

Under new law (not yet in force) : No age minimum, but if you are under 16, you must have parental/guardian permission or apply to the Supreme Court of Nova Scotia for an order dispensing with the requirement of parental consent.OntarioNo age minimum, but if you are under 16, you must have parental/guardian permissionPrince Edward IslandNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (18), you must have parental/guardian permissionQuebecAge minimum is 18.SaskatchewanNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (18), you must have parental/guardian permissionNorthwest TerritoriesNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (19), you must have parental/guardian permissionNunavutThere is no provision in the  Vital Statistics Act  for changing sex designationYukonNo age minimum, but surgery is required and will not be performed if you are under 18; in addition, if you are under the age of majority (19), you must have parental/guardian permission

British Columbia, Ontario and Northwest Territories will change sex designations only for births registered in their respective provinces. Some provinces will register a change of sex and then transmit it to the jurisdiction where the birth was registered.

Under new law (not yet in force) : Legislation requires that the applicant was born in Nova Scotia.OntarioLegislation requires that the applicant was born in OntarioPrince Edward IslandApplicants born outside of Prince Edward Island may apply, and the province will transmit their request to the jurisdiction where their birth was registered.SaskatchewanNo explicit requirement that the applicant was born in SaskatchewanQuebec Under the new law (not yet in force) : Legislation requires that the applicant was born in Canada and resides in Quebec, or that the applicant was born in Quebec and resides in a place where change of sex designation is unavailable or impossibleNorthwest TerritoriesLegislation requires that the applicant was born in Northwest TerritoriesNunavutThere is no provision in the  Vital Statistics Act  for changing sex designationYukonApplicants born outside of Yukon may apply, and the province will transmit their request to the jurisdiction where their birth was registered

For more information:

The Trans PULSE Project prepared a report for the Canadian Human Rights Commission on sex designation in federal and provincial IDs in 2012. The report was prepared for hearings on Bill C-279, a proposal to add gender identity and expression to the  Canadian Human Rights Act  and to hate crime provisions of the  Criminal Code . The report can be found  here .

In 2014, the British Columbia Law Institute prepared a report for the Uniform Law Conference of Canada on the state of the Canadian law regarding change of sex designation, and regarding options for reform in 2014. The report can be found  here .

About the Canadian Civil Liberties Association

The CCLA is an independent, non-profit organization with supporters from across the country. Founded in 1964, the CCLA is a national human rights organization committed to defending the rights, dignity, safety, and freedoms of all people in Canada.

For the Media

For further comments, please contact us at  [email protected] .

For Live Updates

Please keep referring to  this page  and to our social media platforms. We are on  Instagram ,  Facebook , and  Twitter .

Guest Author

Recommended for you.

Explainer: Alberta’s Controversial Critical Infrastructure Defence Act

Comments are closed.

400-124 Merton Street Toronto, ON M4S 2Z2 (416) 363-0321

STAY INFORMED

• Join Our Mailing List
• Get Involved
• Privacy Policy
• Social Media Policy

Charitable Registration Number: 754802288 RR0001

© 2024 CCLA.

• Race Religion & Ethnicity
• Indigenous Peoples
• Freedom of Expression
• Freedom of Religion
• Freedom of Association
• Right to Protest
• Democratic Rights
• Police Powers, Use of Force & Police Accountability
• Fair Trial, Due Process & Sentencing
• Prisons, Jails and Community Supervision
• Privacy Law Reform
• Surveillance & Technology
• Search & Seizure
• National Security
• Visit CCLET.org
• Bill 28 & Notwithstanding Clause
• Emergencies Act
• Federal Strip Searches
• Fighting Solitary Confinement
• Free Speech
• Racial Profiling
• Reproductive Rights
• Strip Searches in Ontario Prisons
• Toronto’s Smart City
• Vaccine Passports
• Press Releases
• In the News
• Our Mission
• How We Work
• Our History
• CCLA & The Charter of Rights and Freedoms
• The National Council
• Job Opportunities
• Financials and Annual Reports
• Clayton Ruby Fund
• Donation FAQs
• Make a Bequest in Your Will
• Law Students
• General Volunteering
• Run a Fundraiser
• Walk for Freedom
• Talk Rights
• Know Your Rights Guides & Other Resources
• Français du Canada

This story is over 5 years old.

How long it takes to get gender-affirming surgery across canada.

ONE EMAIL. ONE STORY. EVERY WEEK. SIGN UP FOR THE VICE NEWSLETTER.

By signing up, you agree to the Terms of Use and Privacy Policy & to receive electronic communications from Vice Media Group, which may include marketing promotions, advertisements and sponsored content.

Wait times for bottom surgery in Canada can be as long as eight years. The impact on individuals can be deadly

The story of a 30-something Albertan shows how broken the Canadian system is. It may also be a gross violation of their human rights

Credit: Getty Images; Elham Numan/Xtra

“It’s harrowing.” 

That’s how Ash describes the process of trying to access gender-confirming bottom surgery in their home province of Alberta. (Ash is not their real name. In order to protect them from possible retaliation by Alberta Health, Xtra has agreed to use a pseudonym.)

Almost three years after Ash, who is now in their 30s, got a referral from their family doctor to one of the province’s gender clinics, they still haven’t received provincial approval for this medically necessary operation—and it will likely be another nine months before they hear from the province. Even then, they’re not guaranteed to get approved at all. All it takes is one bureaucrat at Alberta Health to say no and they’re back to square one.

If Ash is approved for surgery, they’re still facing a wait of up to four years at the one clinic in all of Canada that performs bottom surgeries for trans Albertans. All told, even if Ash is approved soon, they’ll be facing a wait of about eight years total to receive care.

“It’s awful waking up every day and just feeling this weight, this misfortune of … having the wrong body parts that could be fixed,” Ash says. “Some days you wake up, and the only way to continue moving forward with your day is just to completely dissociate from yourself, which, of course, impacts how you go about interacting with other people. People do notice.”

Get free Xtra newsletters

Xtra is being blocked on Facebook and Instagram for Canadians as part of Meta’s response to Bill C18. Stay connected, and tell a friend.

Often, dissociating is the only way they can keep functioning. “The dissociation isn’t something that can be helped; it’s either that, or I let in the full emotion, discomfort, tangible pain of my existence.” 

Ash received no mental health supports from Alberta Health Services during the years they were waiting for the gender clinic to process their referral. The waiting game they are currently playing with Alberta Health has caused them major depression, which they have had to hide for fear that their application for bottom surgery funding will be denied—a legitimate concern given that Alberta Health criteria prevents people with symptomatic depression from receiving funding.

The relational cost of that depression has been severe. “The depression, dysphoria and the dissociation I use as a defence mechanism have completely destroyed my marriage,” they say. “A relationship in which one individual is physically in limbo for such a long period of time simply can’t be maintained in a healthy way.” 

All the while, they feel they’ve been “watching their life go by,” and worry constantly about whether they will receive bottom surgery at all.

 “Is one person along the way with more power than me going to decide that, actually no, this person doesn’t deserve this surgery?” they ask. 

Ash’s story is one told many times over across the country. The story of trans healthcare in Canada is one of lack of access, gatekeeping and provincial inaction. Many argue that these systemic problems may also be a gross violation of human rights.

A bureaucratic nightmare just to start access

Getting vaginoplasty and phalloplasty—more commonly known as “bottom surgery” or gender confirmation surgery—is an intensively bureaucratic process in Canada, one that involves a complicated interplay between public and private health agencies. A recent improvement in the bureaucratic tangle in Alberta reveals just how complicated it is to navigate the system in Canada.

In 2022, Alberta Health quietly revised its criteria for approving trans patients for gender confirmation surgery. Previously, approval required a psychiatrist’s diagnosis and referral, a slow process given the few qualified psychiatrists in the province. Now, any physician can make the required diagnosis of gender dysphoria, and any “ practitioner with extensive training or clinical experience in assessing and managing the needs of the transgender population ” may make a valid referral. 

It would be difficult to overstate the sea change in trans health policy this revision represents. 

Alberta Health Services operates a gender clinic in each of Alberta’s major cities: The Gender Program in Edmonton and the Adult Gender Clinic in Calgary . Both offer comprehensive medical, psychological and social support for people experiencing gender dysphoria. Until this year, both were also the only places in the province where trans people could reliably obtain referrals for gender-affirming bottom surgery. 

The problem with the gender clinic model is, of course, facilitating access to the gender clinics themselves. At Edmonton’s Gender Program, the wait time for adults was between four and eight months in September 2022. At Calgary’s Adult Gender Clinic, wait times are currently closer to two years. And those are just the wait times to begin the process of securing the necessary documentation and referral for bottom surgery approval. 

Xtra reached out to Alberta minister of health Adriana LaGrange to ask what the province was doing to reduce wait times at the gender clinics and received no response from the minister’s office as of press time. 

However, by allowing any qualified physician to refer trans patients for bottom surgery—not just those psychiatrists who work at a gender clinic—Alberta is allowing patients to bypass the backlogged gender clinics, throwing open the door to vaginoplasty and phalloplasty access. Not a small thing in what is arguably Canada’s most conservative province. Indeed, this puts Alberta ahead of neighbouring Saskatchewan , which only accepts funding applications that include a referral from one of four provincially recognized physicians; and, in this respect, even British Columbia , which still requires trans people seeking bottom surgery to obtain a surgical recommendation from a pre-approved list of clinicians.

This doesn’t mean, however, that the fight for trans healthcare in Alberta has been easy, or that it’s over. By removing one bottleneck, the policy change in Alberta smacks hard against an even bigger bottleneck: there are only three clinics in the whole country that offer bottom surgery and two of them are off-limits to out-of-province residents. That means most Canadians, including those from Alberta, are funnelled into one clinic in Montreal where wait times can be up to four years long. 

Accessing funding is one thing, accessing surgery is something very different

Like most provinces, Alberta outsources gender confirmation surgeries to a private hospital in Montreal: the Centre Métropolitain de Chirurgie (CMC).

Founded in 1973 , the CMC is the only private hospital in Quebec and one of only a handful of such hospitals in Canada. (Though privately run, the hospital accepts provincial health coverage, meaning patients access surgery for free.) Currently owned by Dr. Pierre Brassard, the CMC performs upward of 1,000 gender confirmation surgeries every year. It has been the exclusive provider of bottom surgery for Albertans since 1990, as well as, until recently, for most trans Canadians. The latest available data , published in 2019, indicates that in the three previous years, 90 percent of the patients who came to the CMC for gender-affirming surgery hailed from Canada with: 26 percent coming from Quebec, 35 percent from Ontario, 26 percent from the Western provinces and six percent from the Maritimes. 

The CMC offers patients everything from a preoperative stay at the hospital’s partner hotel in Laval, Quebec, to a postoperative stay at the Asclépiade , the only hospital-affiliated convalescent home in the world dedicated specifically to the care of trans patients who have received bottom surgery, to the care of five surgeons specializing in some or all aspects of gender confirmation surgery.

But the wait-list to access gender confirmation surgery at the CMC is notoriously long. The hospital did not respond to a request from Xtra to confirm current average wait times for the operation. However, reporting by the CBC in March 2023 found that the current wait time to access surgery is currently more than four years from the time the CMC receives a referral from a provincial funding body, regardless of which province is submitting the referral.

And as Alberta increases the accessibility of public funding for bottom surgery, that wait time is likely to increase. That’s exactly what happened when Ontario similarly opened up the funding gates in 2016. In that province, the loosened referral rules caused a nearly threefold jump in the number of gender confirmation surgeries funded each year, from 158 in 2015 to 414 three years later. 

Long wait times have been an issue for trans Albertans since the province began funding bottom surgery on an ad hoc basis in 1984 . That year, at the urging of trans healthcare advocate Dr. Lorne Warneke , the province sent three trans patients to Belgium for their surgeries. 

In April 2022, the University of Calgary’s Public Interest Law Clinic (PILC) authored a report on the history and state of trans healthcare in Alberta. That report, which is not public, but has been provided to Xtra by the PILC, drew on internal government records obtained from Alberta Health through a 2018 Freedom of Information and Protection of Privacy request. It shows that, from the beginning, gender-confirmation surgery has been underfunded and inaccessible.

For the first decade that funding was available, from 1984 to 1994, there was no official policy or system for facilitating access to this medically necessary procedure. “It is most likely,” the report concludes, “that Dr. Warneke was pushing each application through the system [himself].”

It was only in 1996 , when Warneke founded the Edmonton Gender Program , that the Alberta government launched an official program to fund bottom surgeries out of the CMC. For the first 12 years that the program was in operation, however, funding was strictly limited to 16 surgeries per year—far short of the demand from trans Albertans. Just five months into the province’s 2008–2009 budgetary year, that quota had already been filled and trans patients were being wait-listed for surgeries in the following year. 

Then, in order to save $700,000 a year—or roughly $0.18 per Albertan based on the population at the time—Alberta Health announced in April 2009 that it would be discontinuing funding for gender confirmation surgeries as an austerity measure. As Ron Liepert, minister of health and wellness at the time, put it in a speech to the provincial legislature, the decision to defund the program “was not based on medical decisions.”

The province never truly followed through on its plan to eliminate funding for bottom surgery; funding kept flowing in a limited capacity, and in 2012, Alberta officially reinstated the program with an annual budget of $1.1 million. That would be enough to cover approximately 25 bottom surgeries per year. In 2016 and 2017, that number grew to 38 surgeries; and in 2018 and 2019, the province funded 83 surgeries, a more than fivefold increase from the original 16 surgery cap. 

As the number of surgeries increased, so, too, did wait times. While Edmonton’s Gender Program saw 580 patients in 2019 (the most recent year for which data is available), more than 650 other patients were on the wait-list for an initial consultation. 

In September 2019, the clinic’s director, Dr. Michael Marshall, publicly resigned, citing the clinic’s financial precarity as his reason for leaving. With one exception, he and his entire staff were dependent on University of Alberta grants—not provincial healthcare dollars—for their funding. “Securing grants as a means of providing care is not sustainable,” Dr. Marshall told Global News at the time.

The two other clinics in Canada don’t accept out-of-province patients

The CMC does not have a monopoly on the provision of bottom surgery in Canada. 

In 2019 , the Women’s College Hospital in Toronto —a public healthcare institution—began offering vaginoplasty to trans Ontarians. That came two years after the hospital launched the Trans Health Expansion Partnership, an undertaking in partnership with Sherbourne Health Centre, the Centre for Addiction and Mental Health and community consultants meant to increase the availability of transition-related healthcare across Ontario. 

Also in 2019 , British Columbia began offering its trans residents access to bottom surgeries at the Vancouver General Hospital. This made it the first province in Western Canada to offer gender-confirmation surgeries for both transmasculine and transfeminine people.

Ontario’s gender-affirming surgical clinic “has the capacity to perform 40 vaginoplasty surgeries in an average year,” according to Emery Potter, nurse practitioner and clinical lead of the Women’s College Hospital’s Transition-Related Surgery program. Last year, the program received 75 referrals for vaginoplasty—almost twice as many as the hospital had the capacity to perform, evidencing the high demand for the health services the program offers.

In B.C., patients move toward bottom surgery in stages. “The first phase includes an intake and consult,” Vancouver Coastal Health told Xtra via email. At this stage, “the wait time is typically 12 to 18 months.” Patients then have the choice to pursue pre-surgery hair removal, which takes about 12 to 18 months by itself; or “intra-operative hair removal” (permanent hair removal during bottom surgery), which can reduce their wait time considerably. Either way, “Once patients are deemed ready, the provincial objective is to ensure that patients wait no longer than six months for surgery.” In the most recent fiscal year, 2022–2023, Vancouver Coastal Health performed 44 vaginoplasties under this program.

Perhaps accounting for their shorter wait times, neither clinic accepts out-of-province patients. (British Columbia’s program does accept referrals from patients in the Yukon, however.) This means that trans people in Canada’s other provinces and territories must still brave the much lengthier wait-list at the CMC, or pay out-of-pocket costs of upward of CAD 13,000 to 20,000  to receive their bottom surgery in another country, like Thailand, for example.

The latter speaks to a deeper problem with the state of healthcare for trans people in Canada. The country has, with two major exceptions, effectively privatized vaginoplasty and phalloplasty. Those with the money to do so can access these procedures fast by going elsewhere. Those without must go to the back of a very long line.

For many trans people, delayed access to gender-affirming bottom surgery is more than an inconvenience. It’s a matter of life or death. 

The suicide rate among Canada’s trans population is notoriously high. Compared to the cis lesbian, gay and bisexual population as a whole, trans Canadians are twice as likely to consider or attempt suicide. In 2019 alone, 31 percent of trans Canadians considered suicide and six percent attempted it.

Adequate access to gender-affirming care can help to reduce that risk. Gender-affirming surgeries demonstrably reduce psychological distress and suicidal ideation, according to research undertaken by Harvard University’s T.H. Chan School of Public Health. And a 2020 Dutch study found that, among trans youth, accessing gender-affirming medical care reduced rates of suicidal thoughts compared to those seen in the cis population.

One Alberta trans woman, Donna Battaglia, told CBC News in March that the wait time to access vaginoplasty in Montreal drove her close to suicide twice. She ended up receiving the operation from a local surgeon who agreed to provide it in tandem with cancer-correction surgery. But there is currently no official mechanism for trans people to obtain any gender-affirming bottom surgery at an in-province clinic because neither gender-affirming vaginoplasty nor phalloplasty are listed on Alberta’s Schedule of Medical Benefits —the list of services that Alberta’s public healthcare program will fund with public money. So while there are surgeons in the province capable of performing bottom surgeries, they don’t usually do so.

All of which raises a pointed legal question.

Might it be a violation of trans Canadians’ human rights to deny them ready access to life-saving genital surgeries like vaginoplasty and phalloplasty?

Are the provinces violating trans Canadians’ human rights?

There’s no free-standing right to healthcare in Canada . But there is a right to be free from healthcare discrimination on the basis of one’s gender identity .

Calgary psychiatrist Joe Raiche thinks Alberta Health has violated that right. He helped develop the city’s Adult Gender Clinic and, in February 2017, filed a human rights complaint against Alberta Health alleging discrimination against the province’s trans population.

The quota in place at the time—which limited funding to 25 bottom surgeries per budgetary year—created a “funding bottleneck,” Raiche argued in his complaint, “since there are always more than 25 Albertans perpetually applying for surgery in a given year.” 

“By virtue of being transgender, certain Albertans will be discriminated against as they not only need to wait for medical care/surgery (uniformly seen in healthcare), but also need to wait an additional time specifically for funding (not seen in other areas of healthcare). A medical diagnosis of gender dysphoria is the only condition where an additional barrier exists based solely on waiting for funding. This amounts to discrimination based on gender identity, as only transgender patients will experience this additional burden.”

Government records provided to Xtra by the Calgary lawyer who worked with Raiche, Drew Yewchuk , indicate that Alberta Health chose to eliminate the cap on bottom surgery funding rather than fight Raiche in front of the Alberta Human Rights Commission Tribunal. Indeed, an internal government memo submitted in November 2017 to the assistant deputy minister of health indicated that “in response to public calls to reduce the wait time for [bottom surgery] funding approval from transgender Albertans, the media and some of Alberta’s referring psychiatrists, including [Raiche’s] Human Rights challenge, decreasing and eliminating the wait time for [Final Stage Gender Reassignment Surgery]  FSGRS funding approval is a program priority.”

In other words, the combination of public outcry and human rights litigation was enough to force the province to dramatically restructure its program for providing trans healthcare. That should offer some hope to trans activists and their allies: change is possible.

And change is needed. Alberta Health may have lifted the formal quota on the number of surgeries it will fund each year, but it still only allocates $1.1 million toward bottom surgeries annually. That would be enough to cover approximately 40 vaginoplasties, Raiche tells Xtra . But the money also has to cover phalloplasties, which can cost four to five times as much. In practice, this means funding for bottom surgery continues to be strictly limited in a province whose population is now estimated to be over 4.5 million residents.

That $1.1 million funding cap needs to go, Raiche says, and vaginoplasty and phalloplasty need to be listed in the provincial Schedule of Medical Benefits . Doing so would place both surgeries on par with other publicly funded operations like gallbladder removal or urethral repair and “allow [Albertans] to have a funding system in place that’s scalable and expands or contracts depending on the needs of the population … at the time.” 

Xtra asked Adriana LaGrange why gender-confirming vaginoplasty and phalloplasty are not in the Schedule, as well as when they would be added to it. Spokesperson Andrew Livingstone declined to say when that would happen. 

Ideally, there needs to be surgeons in the province performing bottom surgeries under the Alberta Health Services umbrella. 

Alberta is moving in the right direction by increasing the availability of public funding for gender-confirmation surgeries. But its progress will remain minimal so long as the province continues to send trans patients out of province. It, along with every other province and territory without its own bottom surgery clinic, needs to follow the lead of Ontario and British Columbia and open up a local clinic for the provision of this surgery.

“There are no legal barriers to Alberta providing such a service in the province,” according to University of Calgary law professor and health law expert Lorian Hardcastle . As far as funding goes, “it is extremely easy for the government to make changes and add new insured services to the Schedule of Medical Benefits.” 

The absence of a bottom surgery clinic in the province “seems to be the product of policy choices either by government” or Alberta Health Services (AHS). “These policy choices may be deliberate decisions that the government or AHS has consciously made to send patients out of province, or it may be policy inaction.”

Indeed, “it would be interesting to know,” Hardcastle says, “what AHS has done to try to encourage or facilitate the opening of such a clinic.” 

The answer, it seems, is nothing.

According to Raiche, in 2019 a multidisciplinary group of Alberta physicians—including psychiatrists, surgeons, endocrinologists and primary care providers—put together a proposal for an in-province centre for gender-confirmation surgery. Alberta Health Services rejected that proposal due to “budgetary constraints.”

“It’s not that Alberta doesn’t have the providers or the clinicians necessary,” Raiche says. “I think we have a really strong network of particular surgeons who are very passionate and committed to trans care. It is just a financial funding decision that, right now, Alberta Health would rather choose to pay for people to go to Montreal as opposed to working together with AHS to create a surgical program here.”

Indeed, when Xtra asked LaGrange what Alberta Health is doing to facilitate the opening of a bottom surgery clinic in the province, the minister’s office declined to say.

Inaction from provincial governments ultimately means that trans Canadians will face more suffering.

Canada’s provinces are, with two exceptions, failing their trans residents. By relying on a backlogged clinic in Montreal to provide a medically necessary and life-saving operation, the provinces are putting trans people’s health, safety and well-being at risk. 

• “ Alberta Healthcare Insurance Bulletin ,” Aug. 20, 2012
• “ Funding for Transition Surgeries ,” Alberta Health Services, 2023
• “ The Gender Program ,” Alberta Health Services, 2023
• “ Adult Gender Clinic ,” Alberta Health Services, 2023
• “ Saskatchewan Medical Transition Guide ,” Saskatchewan Trans Health Coalition, Jan. 2019
• “ Surgical Care Planning ,” Trans Care B.C., 2023
• “ CENTRE MÉTROPOLITAIN DE CHIRURGIE—CMC ,” TransAvenue, Nov. 8, 2019
• “ D'où viennent les patients du Centre Métropolitain de Chirurgie? ” TransAvenue, Dec. 16, 2019
• “ La maison de convalescence Asclepiade fête ses 15 ans! ” TransAvenue, Sept. 22, 2022
• “ Advocates push for gender surgery funding within Alberta amid years-long backlog in Montreal ,”  Katarina Szulc, CBC, March 16, 2023
• “ Toronto’s Women’s College Hospital launches new program for gender-reassignment surgery ,” Kelly Grant, Globe and Mail, June 17, 2019
• “ Dr. Lorne Warneke remembered as pivotal LGBTQ pioneer in Alberta ,” CBC News, Sept. 3, 2020
• “ Trans rights trailblazer reflects on 50 years of social change ,” Kristen Bauer, University of Alberta, Sept. 25, 2017
• “ Province of Alberta 27th legislative Session ,” April 14, 2009
• “ Head of program’s resignation raises questions about accessibility to transgender care in Alberta ,” Jill Croteau, Global News, Sept. 16, 2019
• “ The Gender Surgery Program B.C. ” Vancouver Coastal Health, 2023
• “‘ It’s wonderful’: Community reacts to news B.C. will offer gender-affirming lower surgeries ,” Micki Cowan, CBC, Nov. 16, 2018
• “ Price List ,” Transgender Thailand, 2023
• “ Transgender people and suicide fact sheet ,” Mental Health Commission of Canada, May 10, 2019
• “ Mental health benefits associated with gender-affirming surgery ,” Harvard, 2021
• “ Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers ,” Journal of Adolescent Health, June 2020
• “ Alberta Health Care Insurance Plan: schedule of medical benefits as of 01 April 2023 ,” Alberta government, April 1, 2021
• “ Alberta’s population expected to hit 5 million later this decade, possibly as early as 2025 ,” Robson Fletcher, CBC, July 7, 2023

Sources And Methodology

Charlotte Dalwood is an English-speaking freelance journalist and JD student based in Calgary, AB. Her other publications include a monthly column on 2SLGBTQ+ and legal issues for rabble.ca.

Read More About:

Corrections or feedback.

Keep Reading

What you need need to know about gender-affirming care for youth

Could this week’s Supreme Court abortion pill case affect gender-affirming care?

Raising the bar: How an Edmonton gym is making exercise accessible

Ohio’s trans healthcare ban sets dangerous precedent ahead of 2024 election

Connect with the writer.

Communication not private: Your email will be forwarded to the writer by an Xtra editor.

Court to decide if Ontario must pay for surgery to make vagina if patient also wants to keep penis

A non-binary Ontario resident is locked in a legal battle over public funding for surgery to create a vagina while leaving the penis intact

You can save this article by registering for free here . Or sign-in if you have an account.

Article content

In a lengthy legal battle that could lead to more requests for individually customized and unorthodox gender-affirming surgeries, an Ontario resident is seeking publicly funded surgery to construct a vagina while preserving the penis.

The case, now before the courts, reflects a small but growing demand for niche surgeries for people who identify as non-binary, meaning neither exclusively female nor exclusively male.

Enjoy the latest local, national and international news.

• Exclusive articles by Conrad Black, Barbara Kay, Rex Murphy and others. Plus, special edition NP Platformed and First Reading newsletters and virtual events.
• Unlimited online access to National Post and 15 news sites with one account.
• National Post ePaper, an electronic replica of the print edition to view on any device, share and comment on.
• Daily puzzles including the New York Times Crossword.
• Support local journalism.

Create an account or sign in to continue with your reading experience.

• Access articles from across Canada with one account.
• Share your thoughts and join the conversation in the comments.
• Enjoy additional articles per month.
• Get email updates from your favourite authors.

Don't have an account? Create Account

To critics, the procedures are risky experiments that illustrate “how far off the rails” gender-affirming medicine has gone and the excesses of “consumer-driven gender embodiment.”

“Our public health-care system is at the breaking point and really needs to focus on procedures that are medically necessary,” Pamela Buffone, founder of the parents’ group Canadian Gender Report, said in an email to the National Post.

“Is this type of surgery health care? The patient will not be physically healthier because of the operation, which is likely to result in complications and the need for corrective surgeries and further demands on the health system.”

LGBTQ rights groups say such surgeries can profoundly improve a person’s quality of life and reduce the distress and deep sense of unease from gender dysphoria. Health-care providers shouldn’t make assumptions about what care may be medically necessary, Egale Canada argued in a written submission to the court.

“Ultimately OHIP’s interpretation (of a vaginoplasty) is exclusionary and discriminates against nonbinary people on the basis of their gender identity,” Egale said. If there is any ambiguity in what should be publicly covered, it should be resolved in favour of the claimant, they said.

As National Post columnist Jamie Sarkonak first reported in September , the case involves 33-year-old K.S., as she is identified in court documents, who was born male but who identifies as female dominant and uses a feminine name.

Ontario’s Health Insurance Plan (OHIP) originally denied K.S.’s request in 2022 for funding for a penile sparing vaginoplasty, a procedure that isn’t available in Canada. The surgery was to be performed at the Crane Center for Transgender Surgery in Austin, Texas.

Is this type of surgery health care?

According to legal documents, K.S. argued that “to ignore ‘the other third’ of her and how she presents would be invalidating; she is ‘both,’ not exclusively one or the other but literally a mix.”

OHIP argued that, while it may be of medical benefit to K.S., a vaginoplasty without penectomy (removal of the penis) is considered an experimental procedure and isn’t listed as an insured service under its schedule of benefits.

K.S. complained to Ontario’s Health Services Appeal and Review Board, which overturned OHIP’s decision, ruling that a vaginoplasty is among the 11 external genital surgeries listed for public coverage, and that it shouldn’t inherently include a penectomy.

Get a dash of perspective along with the trending news of the day in a very readable format.

• There was an error, please provide a valid email address.

By signing up you consent to receive the above newsletter from Postmedia Network Inc.

A welcome email is on its way. If you don't see it, please check your junk folder.

The next issue of NP Posted will soon be in your inbox.

We encountered an issue signing you up. Please try again

OHIP, in turn, appealed the review board’s decision to Ontario’s Superior Court of Justice. The case was heard in late February. “We do not yet have a decision — it could still be months,” K.S.’s lawyer, John McIntyre, said in an email.

K.S., who has experienced gender dysphoria since a teen, doesn’t completely align with either the male or female genders, the appeal board heard. Her doctor, an Ottawa endocrinologist, supported K.S.’s request for a specific type of bottom surgery.

“It is very important for (K.S.)  to have a vagina for her personal interpretation of her gender expression but she also wishes to maintain her penis,” the doctor wrote in a letter to OHIP supporting the request for prior funding approval. “(K.S.) is transfeminine but not completely on the ‘feminine” end of the spectrum (and) for this reason it’s important for her to have a vagina while maintaining a penis.”

K.S. argued that forcing a non-binary person to undergo binary surgery — male to female, or female to male — would only exacerbate her gender dysphoria and would be akin to an act of conversion therapy, which has been banned in Canada since 2022.

She also wishes to preserve her penis for sexual health reasons and out of concern the “urological rerouting” could create urinary incontinence problems, a recognized complication.

In its decision, the health services appeal tribunal referenced standards of care as set out by the influential World Professional Association for Transgender Health, or WPATH, which considers a penile sparing vaginoplasty a valid treatment option for non-binary people. The board said it adopted the trans care group’s logic that “gender diverse presentations may lead to individually customized surgical requests some may consider ‘non-standard.'”

The Ontario health ministry said it doesn’t comment on matters still before the courts.

K.S. declined to comment when contacted through her lawyer.

In a similar case reported last year by the Globe and Mail, OHIP initially denied coverage to a 41-year-old Ottawa public servant who identifies as transmasculine non-binary and who was seeking the surgical construction of a penis without the removal of the vagina and uterus.

Nathaniel Le May and his lawyers argued that phalloplasty, on its own, is listed as an insured service, and that OHIP was wrong in interpreting that it was only insured if also accompanied by a vaginectomy. The additional procedures, they also argued,  amounted to coerced sterilization.

Two days before the case was set to be heard by the appeal board, OHIP reversed its decision and agreed to fund the surgery.

“My outcome is the same as K.S. We will both have a penis and a vagina,” Le May said in an email to the National Post.

“Why is it considered experimental in her case to have a vagina and a penis, but not in my case? Why did OHIP concede that it is an insured service for me but continue to fight that hers is not? OHIP is being inconsistent,” Le May said.

The Crane Center in Texas offers several non-binary surgical options. “We offer everything you could think of,” Dr. Curtis Crane, a plastic surgeon and reconstructive urologist with fellowship training in transgender surgery, said during a Facebook live Q&A session for patients three years ago. “I can’t think of a time that a patient has come up with a surgical request that I haven’t been able to fulfill.”

Hundreds of messages recently leaked from WPATH’s internal forum included discussions about an anticipated “wave” of requests for non-binary affirming surgeries such as mastectomies without nipples, “nullification” (removal of all external genitalia, just smooth skin) and phallus-preserving vaginoplasty — “non-standard” procedures resulting in bodies that one therapist said “either don’t exist in nature or represent the first of their kind and therefore probably have few examples of best practices.”

Crane argues that vaginoplasty without penectomy surgery is not experimental. “I probably do 10 or so a year; it’s not uncommon,” he said in an interview with National Post. Bodies with mixed genitalia “absolutely do exist in nature,” he added. “There are disorders of differentiation of sexual genitalia that will leave both parts.”

Techniques vary, but with the standard male-to-female vaginoplasty — penile inversion vaginoplasty — a vaginal canal is created and lined using penile tissue. “Next you would move on to surgically dissecting out the phallus, shortening the urethra and making a clitoris,” Crane said.

With penile preservation vaginoplasty, the vagina can be created using scrotal tissue or tissue from other parts of the body, like the abdomen or colon.

Crane said some patients seeking vaginoplasty get sexual gratification from their phallus and don’t want to have to sit to urinate.

“There are all kinds of reasons. I don’t say one reason is not a good enough reason. It’s the patient’s body,” he said. During the Facebook session, Crane said, “It’s kind of assault to make a patient remove an organ that they’re enjoying.”

But Dr. Yonah Krakowsky, a staff urologist at Women’s College Hospital in Toronto and medical lead of the hospital’s transition-related surgeries program, told the review board that phallus-sparing vaginoplasties are considered experimental by most surgeons, published reports on the “functional or psychological outcomes” are lacking and that the surgical technique used in the process is poorly understood.

Crane said he couldn’t recall, “off the top of my head,” the cost of a penile preserving vaginoplasty. When Sarkonak, the Post’s columnist, called the Texas clinic, she was told gender-affirming surgeries can range from US$10,000 to US$70,000, depending on what’s done.

“If someone just has an agenda to say, ‘no,’ (to public funding), you can never compete with that,” Crane said. “And unfortunately, that’s what it is the majority of the time: ‘I’m just gonna say no, because I don’t like this.’”

Others said it’s hard to justify the public coverage when Canadians across the country are facing lengthy wait lists for standard surgeries, and standard diagnostic tests.

“It’s hard to call this actual health care,” said Dr. Roy Eappen, a Montreal endocrinologist and senior fellow at Do No Harm, a medical and policy advocacy group. “There is no evidence that it improves anything physically, and the evidence that it helps mental health is not there either.”

“I can’t see the justification for paying. This is not something that really exists in nature and there is a very high complication rate for these kinds of surgeries,” Eappen said.

“WPATH wants to separate this all from any psychiatric diagnosis and call this ‘consumer driven.’ If that’s the case, then you can pay for it.”

While more people are identifying as non-binary, Crane said there are “plenty” of non-binary people who don’t want any surgery.

Eappen agreed. “I don’t know how many of them will want this kind of surgery. But I think this (case) would encourage them to ask. And I’m not sure we’re actually doing anyone a favour.”

National Post

Postmedia is committed to maintaining a lively but civil forum for discussion. Please keep comments relevant and respectful. Comments may take up to an hour to appear on the site. You will receive an email if there is a reply to your comment, an update to a thread you follow or if a user you follow comments. Visit our Community Guidelines for more information.

Telford testifies PMO saw errors in foreign interference intelligence; unaware of some allegations

Gen. rick hillier: ideology masking as leadership killed the canadian dream, pm's six-day indo-pacific trip cost $2m, including $200k in catering.

Montreal suburb passes non-confidence measure on federal Liberals' Israel stance

Air canada boeing 737 makes emergency landing in idaho after warning light goes on, how to get rid of ants from your home, without hiring someone.

Cinnamon, ant traps and diatomaceous earth to the rescue

ANINE BING and Reebok just released a collab — and it's too good to miss

Iconic sport and activewear brand Reebok has teamed up with Los Angeles-based 'cool-girl' clothing company ANINE BING to create a retro-inspired collection that's 100 per cent covetable.

Advertisement 2 Story continues below This advertisement has not loaded yet, but your article continues below.

Editor favourites: Our top finds this month

Products we couldn’t get enough of this March

Trying Puzzmo puzzles as a dedicated NYT Games user

Puzzmo is refining the newspaper game experience

Ride or relax in style with our favourite bike shorts

From functional fitness to mainstream fashion, add this multi-faceted garment to your collection

This website uses cookies to personalize your content (including ads), and allows us to analyze our traffic. Read more about cookies here . By continuing to use our site, you agree to our Terms of Service and Privacy Policy .

You've reached the 20 article limit.

You can manage saved articles in your account.

and save up to 100 articles!

Looks like you've reached your saved article limit!

You can manage your saved articles in your account and clicking the X located at the bottom right of the article.

• Share full article

Advertisement

Supported by

Four Takeaways From the Vatican’s Document on Human Dignity

The document restated the Roman Catholic Church’s rejection of abortion, gender fluidity and transition surgery.

By Jason Horowitz and Elisabetta Povoledo

Jason Horowitz reported from Rome, and Elisabetta Povoledo from Verbania, Italy.

The document issued on Monday by the Vatican puts human dignity at the center of Catholic life , but in doing so, it broaches some of the most difficult and sensitive social issues, those that Pope Francis has spent his papacy avoiding.

On Monday, though, his church leaned hard into them in the document, called “Infinite Dignity.” It argued that the exploitation of the poor, the outcast and the vulnerable amounted to an erosion of human dignity. But it was the restating of the church’s rejection of abortion, the death penalty and euthanasia, and especially gender fluidity, transition surgery and surrogacy, that church liberals worried would be used as ammunition by the right.

Here are four takeaways.

The pope’s inclusivity has limits.

Pope Francis’ inclusive message, which has included allowing L.G.B.T.Q. Catholics to receive blessings from priests and transgender people to be baptized and act as godparents , has a limit: Catholic doctrine.

The pope’s conservative critics have for a decade argued that his tendency to speak off the cuff and in overly welcoming ways toward L.G.B.T.Q. people, the divorced and remarried, along with others who sin in the church’s eyes, had sent the wrong signal.

But the document released on Monday, and remarks by Cardinal Víctor Manuel Fernández, the prefect of the Vatican department with oversight over doctrine, underlined that the pope’s message was just that — a signal that the church was more open to the world, but that the substance, what it considers immutable “truth,” remained the same.

That dissonance, though, between Francis’ style and his defense of Catholic doctrine was highlighted by the document, and for many supporters of great change within the church, it amounted to a declaration that they would not get what they want.

As if to highlight that tension, Cardinal Fernández responded to a question on Monday about the church’s teaching that homosexual acts are “intrinsically disordered” — what many supporters of L.G.B.T.Q. faithful consider the insurmountable obstacle to true acceptance — by saying that the problem may be the terminology, not the meaning.

It was, he said, a “very strong expression” and that perhaps “more suitable words” could be found to express the thought that homosexual sex could not produce the “mystery” of childbirth.

Gender fluidity erodes human dignity, the document says.

The Vatican argues that gender fluidity, or the idea that people can decide their own sex, erodes human dignity because it blurs the difference between men and women, which it considers a gift from God.

Francis, while personally welcoming to transgender people — he has met many throughout his papacy — is convinced that powerful lobbies are pushing what the Vatican calls “gender theory” as a form of “cultural colonization” on more traditionalist societies.

This ideology, the Vatican said in the document issued on Monday, “envisages a society without sexual differences, thereby eliminating the anthropological basis of the family.” It was unacceptable, the Vatican said, that such ideologies managed to “assert themselves as absolute and unquestionable, even dictating how children should be raised.”

The Vatican ties surrogacy to commercialization.

The Vatican document reiterates its opposition to surrogacy, arguing that even though the process may fulfill the wishes of couples longing to have children, it does so at the cost of a wider human dignity because it reduces women, in the Vatican’s view, to simply carriers and children to what Francis has called products of “commercialization.”

The church’s opposition to surrogacy and in vitro fertilization stems from its ethical and theological teachings on the issue of life. Though Francis has made it clear that while the church opposes surrogacy, children born from surrogacy can be baptized.

“First and foremost, the practice of surrogacy violates the dignity of the child,” who “has the right to have a fully human (and not artificially induced) origin and to receive the gift of a life that manifests both the dignity of the giver and that of the receiver,” the document states.

“Surrogacy also violates the dignity of the woman, whether she is coerced into it or chooses to subject herself to it freely,” as it detaches the women “from the child growing in her and becomes a mere means subservient to the arbitrary gain or desire of others.”

The sex a person is born with is seen as a gift from God.

The Vatican document is adamant in its rejection of transition surgeries, what it calls “Sex Change.” It argues that the physical sex a person is born with — male or female — is an equal gift from God, who has made the human in his image. It is not a gift you can give back, the Vatican says.

Changing sex, the church argues, is to put individualism before “the need to respect the natural order of the human person,” and “any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception.”

The church, however, made an exception for people with “genital abnormalities that are already evident at birth or that develop later,” which could be resolved through “health care professionals” because it would “not constitute a sex change in the sense intended here.”

Jason Horowitz is the Rome bureau chief for The Times, covering Italy, the Vatican, Greece and other parts of Southern Europe. More about Jason Horowitz

Elisabetta Povoledo is a reporter based in Rome, covering Italy, the Vatican and the culture of the region. She has been a journalist for 35 years. More about Elisabetta Povoledo