Discover information and resources on gender-affirming surgery. Explore different types of surgeries and learn how to access them.

What is Gender Affirming Surgery?

Gender-affirming surgeries play a crucial role in aligning primary or secondary sex characteristics with one’s gender identity. Many trans and gender diverse people are happy with their bodies, or find comfort with their bodies through non-surgical means such as hormone therapy, social transition, and forms of self-expression. Only you can decide whether surgery is right for you.

All About...

Surgery Access Info and Coverage

New Brunswick
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Québec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
Yukon
Northwest Territories
Nunavut
Process for Accessing Surgery

Folks considering gender-affirming surgery that is covered by Medicare are required to approach their family physician, nurse practitioner, and/or mental health professional to undergo a surgical readiness assessment, which involves the following steps:

 

Step 1: Gather Basic Surgery Information (i.e., timeline, surgery type, requirements)

Step 2: Primary Clinical Criteria (i.e., informed consent, aftercare / follow-up plan)

Step 3: Patient Expectations (i.e., goals, preparing, and understanding outcomes)

Step 4: Patient Supports and Planning (i.e., post-surgical plan)

Step 5: Following the completion of a surgical readiness assessment a PCP and/or psychologist determines that someone is clinically eligible for surgery and completes the Gender Confirming Surgery Prior Approval Request form.

Step 6: Once prepared the request form is sent to the Executive Director of Addictions and Mental Health, who in turn forwards it to New Brunswick Medicare for consideration

Step 7: Upon approval, a surgical plan is put in place by the patient's medical team

Coverage

Covered by New Brunswick:

  • Subcutaneous mastectomy & chest contouring (partially covered)
  • Hysterectomy with bilateral salpingo-oophorectomy
  • Orchidectomy
  • Vaginoplasty (including vulvoplasty)
  • Clitoral release
  • Metoidioplasty
  • Phalloplasty
  • Urethra construction
  • Testicular implants
  • Penile implant

Not covered by New Brunswick:

  • Breast construction
  • Facial surgery
  • Tracheal shave
  • Voice surgery
  • Pectoral augmentation
  • Liposuction or lipofilling
  • Travel
Process for Accessing Surgery

If you’re interested in accessing gender affirming surgery, you can contact a doctor, nurse practitioner, specialist or any other health care provider with clinical competencies as outlined in the WPATH Standards of Care, for a psychosocial assessment. 

 

Step 1: You will need a licensed Nova Scotia doctor (family doctor or specialist), Nurse Practitioner or Health Care Provider to complete the GAS application form and apply to MSI on your behalf. 

Step 2: Once you’ve been assessed for surgery, you and your primary care provider need to complete the Gender Affirming Surgery Application before you schedule or plan surgery. Your primary care provider will submit the application to MSI for pre-approval of coverage. In addition to the application, you will need a psychosocial assessment letter and a post-operative care letter from your physician or nurse practitioner for out-of-province surgeries.

Step 3: MSI will inform you when your application is approved. 

Step 4: MSI will provide you with a surgery date and other information about your procedure.

Coverage

Covered by Nova Scotia:

  • Breast augmentation
  • Breast/chest reduction
  • Chest masculinization/mastectomy
  • Hysterectomy
  • Metoidioplasty
  • Oophorectomy
  • Orchiectomy
  • Penectomy
  • Phalloplasty
  • Vaginoplasty

Not covered by Nova Scotia:

  • Gender affirming surgical services outside of Canada
  • Procedures sometimes performed with gender affirming surgery, including facial feminization, liposuction, tracheal shave and voice pitch surgery
  • Gender affirming surgical services received outside Nova Scotia without prior approval from MSI
  • Any services not insured by MSI
  • Any take-home medications, equipment, meals and other personal expenses
Process for Accessing Surgery

Folks considering gender-affirming surgery that is covered are required complete the following steps:

Step 1: Complete prior approval form with your Physician or Nurse Practitioner 

Step 2: PEI Physician or Nurse Practitioner will submit through Medicare a request for a surgery referral. 

Step 3: Request for surgery is reviewed by an Out of Province Coordinator who will then forward the completed approval form and necessary attachments to Health PEI's Medical Consultant for review and opinion.

Step 4: If approved Health PEI will provide a copy of the approval letter to you and your primary care physician and your surgery date will be set. 

Coverage

Covered by PEI:

  • Clitoral release
  • Erectile/testicular implant
  • Hysterectomy  
  • Mastectomy with chest masculinization
  • Metoidioplasty
  • Oophorectomy
  • Phalloplasty
  • Scrotoplasty
  • Vaginectomy
  • Clitoroplasty
  • Labiaplasty
  • Orchiectomy (also referred to as orchidectomy)
  • Penectomy
  • Vaginoplasty

 

Not Covered by PEI:

  • Gender affirming surgical services outside of Canada
  • Procedures sometimes performed with gender affirming surgery, including facial feminization, liposuction, tracheal shave and voice pitch surgery
Process for Accessing Surgery

Folks considering gender-affirming surgery that is covered are required complete the following steps: 

Step 1: The completed Request for Prior Approval forms must be forwarded to MCP for review and approval prior to surgery

Step 2: After review by MCP, the physician (or nurse practitioner) will receive documentation confirming whether or not the proposed procedure and facility is approved

Step 3: If approved, the patient can be referred to the approved TRS surgeon/facility, enclosing the TRS Prior Approval Request and letter of approval

Step 4: If a Newfoundland and Labrador based surgeon completed the TRS Prior Approval form and submitted all required documents as indicated and is acting as the attending surgeon, there are no further steps necessary if approval has been given

Coverage

Covered by NFLD: 

  • Breast augmentation when there is breast aplasia (no breast development) after 18 continuous months of hormone therapy
  • Mastectomy with chest masculinization (excluding implants and liposuction, which are not covered)
  • Hysterectomy
  • Orchiectomy
  • Salpingo-oophorectomy
  • Vaginoplasty (includes orchiectomy, penectomy, labiaplasty, clitoroplasty; with or without construction of the vaginal cavity)
  • Metoidioplasty
  • Phalloplasty (includes urethroplasty, scrotoplasty, vaginectomy, and insertion of testicular and approved penile implants)

Not covered by NFLD:

  • TRS services received without prior approval from MCP.
  • TRS services not listed in “What’s Covered” above. 
  • Facial feminization, liposuction, tracheal shave
  • Hair transplantation, voice training and voice pitch surgery Cosmetic surgical revisions.
  • Any services which are not insured by MCP. Cosmetic procedures are non-insured services.
Process for Accessing Surgery

The following procedures are not trans-specific and referrals can be made by an MD:

  • Chest reduction
  • Mastectomy (does not include chest masculinization)
  • Hysterectomy
  • Oophorectomy
  • Orchidectomy (if independently of vagino/vulvoplsaty)

 

For referrals to GRS-Montreal, additional documentation will be required:

  • Health status information form, filled out and signed by the physician, Click here
  • Preoperative questionnaire, filled out and signed by the patient, Click here
  • Consent form for use of images, filled out and signed by the patient, Click here
  • Consent to access and disclose information relating to my health (Programme provincial de chirurgie pour la dysphorie de genre), filled out and signed by the patient, Click here
  • Supplementary Health Status Questionnaire for Phalloplasty RFF, Click here

 

For more information: grsmontreal.com/en/home.html

Coverage

Funded by Quebec:

  • Phalloplasty
  • Metoidioplasty
  • Vaginoplasty
  • Double mastectomy with reconstruction
  • Chest masculinization
  • Chest reduction 
  • Hysterectomy
  • Oophorectomy 

 

Not funded by Quebec:

  • Breast augmentation
  • Facial feminization surgery
  • Tracheal shave
Process for Accessing Surgery

Step 1: Receive a surgical readiness assessment from a certified health professional. A qualified healthcare provider can be a: Physician, Nurse Practitioner, Registered Nurse, Psychologist, or Registered Social Worker (Master’s Degree).

 

Step 1a: Upper Surgery (Specifically chest) Needs 1 supporting assessment, that has to be from a qualified Physician or Nurse Practitioner

 

Step 1b: Lower Surgery (Genital Surgery) needs 2 supporting assessments: 1 assessment from a qualified Physician or Nurse Practitioner AND A 2nd assessment from a qualified Physician, Nurse Practitioner, Psychologist or Registered Social Worker with a Masters Degree.

 

Step 2: Apply for prior approval funding through the Ministry of Health

Step 3: Submit a referral to the surgeon along with the Funding Approval Notice from the Ministry.

Coverage

Funded by Ontario

  • Mastectomy (no chest contouring/masculinization)
  • Augmentation mammoplasty (when no breast enlargement has occurred, following 12 continuous months of hormone therapy (unless hormones are not appropriate for the person))
  • Phalloplasty
  • Erectile and/or testicular implant
  • Vaginectomy
  • Orchiedectomy
  • Clitoroplasty
  • Scrotoplasty
  • Metoidioplasty
  • Labiaplasty
  • Salpingo-oophorectomy
  • Hysterectomy
  • Vaginoplasty
  • Private clinic stays
  • Ministry-approved services outside Canada

Not funded by Ontario:

  • Liposuction
  • Electrolysis
  • Chest contouring/masculinization
  • Laser hair removal
  • Hair transplants
  • Tracheal shave
  • Voice modification surgery
  • Chin, nose, cheek, or buttock implants
  • Facial feminization/masculinization 
  • Travel involved in obtaining surgery
Process for Accessing Surgery

The main clinic for folks ages 16+ seeking gender affirming care is the Trans Health Klinic (located in Winnipeg). Patients can self-refer using this form.

 

Trans Health Klinic surgical referral process:

  • Step 1: Must be a client at the Trans Health Klinic to request voice training, hair removal, top/upper surgery, bottom/lower surgery
  • Step 2: Request a referral from a trans health practitioner during a visit
  • Step 3: Trans health practitioner may refer a client to an in-house psychologist for a surgical readiness assessment (1 year wait time) OR the client can seek a private psychologist (we have a list that clients can see)
  • Step 4: Client will attend their surgical readiness assessment
  • Step 5: Psychologist and trans health practitioners will write their referral letters
  • Step 6: Referral letters will be sent to an approved Manitoba health surgeon or GRS Montreal surgeon and Manitoba Health
Coverage

Funded by Manitoba:

  • Laser hair removal (face & neck and for phalloplasty skin grafts)
  • Breast augmentation
  • Chest reduction
  • Chest masculinization
  • Orchiectomy
  • Hysterectomy with/without oophorectomy
  • Vaginoplasty
  • Phalloplasty
  • Metoidioplasty
  • Clients must pay up front for their transportation costs to Montreal. However, they can keep receipts & plane tickets for reimbursement by Manitoba Health.

Not funded by Manitoba

  • Tracheal shaves
  • Facial feminization surgery
Process for Accessing Surgery

Saskatchewan has two streams for accessing gender-affirming surgery, one for in-province surgery and one for out-of-province surgery. TransSask currently has two Trans Health Navigators that can help with this process. 

 

The steps to access in-province surgery:

Step 1: Make the decision to seek the surgical intervention - Research surgical techniques

Step 2: Physical and mental health assessment

Step 3: The doctor who conducted your physical and mental health assessment refers you to a surgeon.

Step 4: Surgical date is scheduled

 

The steps to access out-of-province surgery:

Step 1: Make the decision to seek the surgical intervention - Research surgical techniques

Step 2: Talk to a doctor (probably your GP) about accessing the surgical intervention

Step 3: Primary Assessment and Referral Letter

Step 4: Secondary Assessment and Referral Letter

Step 5: Get Funding Approval

Step 6: Surgical date is scheduled

Coverage

Funded by Saskatchewan :

  • Phalloplasty
  • Metoidioplasty
  • Vaginoplasty 
  • Breast Augmentation (only in some circumstances)
  • Double Mastectomy
  • Orchiectomy
  • Hysterectomy with bilateral salpingo-oophorectomy

 

Not Funded by Saskatchewan:

  • Breast Augmentation
  • Chest Contouring
  • Procedures such as facial feminization, tracheal shave and voice pitch surgery
  • Non-medical interventions such as massage therapy and laser hair removal or electrolysis
  • Take-home medications and equipment
  • Personal expenses, meals and accommodation
Process for Accessing Surgery

Alberta Health has two streams for accessing gender-affirming surgery, one for in-province surgery and one for out-of-province surgery. For surgeries provided in province folks can expect the following steps: 

  • Step 1: Consult with your primary care provider and receive a referral OR directly contact your desired surgeon in Alberta. 
  • Step 2: Surgical care planning appointment
  • Step 3: Have your primary care provider or surgeon complete the Prior Approval Form 
  • Step 5: Receive approval and prepare for surgery

 

The Final Stage Gender Reassignment Surgery Program (the “GRS Program”) is for out-of-province surgery and requires the following steps:

  • Patients must undergo two independent assessments by Psychiatrists or other physicians and be diagnosed with gender dysphoria.
  • A practitioner registered under the Health Professions Act, will help you apply to the Health Insurance Programs Branch of Alberta Health by completing the application for funding form.
  • Begin surgical planning process with your primary care provider and surgeon
Coverage

Funded by Alberta Health:

  • Phalloplasty
  • Metoidioplasty
  • Vaginoplasty 
  • Breast Augmentation (only in some circumstances)
  • Mastectomy
  • Orchiectomy
  • Hysterectomy with bilateral salpingo-oophorectomy

 

Not Funded by Alberta Health:

  • Procedures such as facial feminization, tracheal shave and voice pitch surgery
  • Non-medical interventions such as massage therapy and laser hair removal or electrolysis
  • Take-home medications and equipment
  • Personal expenses, meals and accommodation
Process for Accessing Surgery

Surgical care planning is a process that helps ensure you are prepared and supported before, during, and after your surgery. Part of this process includes assessing whether you meet the WPATH criteria required for the surgery and whether you are ready for surgery. The clinician who works with you on surgical care planning will write the surgical recommendation. In BC there are 5 general steps for accessing gender-affirming surgery:

  • Step 1: Arrange surgical care planning
  • Step 2: Surgical care planning appointment
  • Step 3: Receive a surgical recommendation
  • Step 4: Be referred for surgery
  • Step 5: Prepare for surgery
Coverage

Medical Services Plan (MSP) covers:

  • Breast construction (breast augmentation) - only publicly funded in certain circumstances. 
  • Chest construction (including chest reduction)
  • Orchiectomy
  • Hysterectomy with bilateral salpingo-oophorectomy
  • Vaginoplasty
  • Vulvoplasty
  • Clitoral release
  • Metoidioplasty 
  • Phalloplasty

MSP does NOT cover:

  • Facial procedures (such as reduction of the Adam's apple, nose feminization, facial bone reduction, face lifts, rejuvenation of the eyelid);
  • Pectoral implants;
  • Hair reconstruction or restoration;
  • Liposuction or lipofilling;
  • Voice surgery.
  • Travel and accommodation costs to and from surgical centres (in BC, Montreal and out-of-country) 
  • Supportive garments and wound care supplies for post-surgery.
  • Other travel related costs: travel insurance, accommodation, accompaniment's travel and accommodation cost.
Process for Accessing Surgery

Folks considering gender-affirming surgery that is covered are required complete the following steps:

Step 1: a surgical readiness assessment, written by a qualified assessor;

Step 2: letter from a health care practitioner that requests coverage for gender-affirming surgery on behalf of the client. The letter must include: 1) written confirmation of a diagnosis of gender incongruence; and an 2) assessment from a qualified assessor.

Step 3: Be referred for surgery

Step 4: Prepare for surgery

Coverage

Covered by the Yukon:

  • upper and lower body surgeries;
  • facial surgeries;
  • body contouring;
  • voice feminization surgery;
  • hair removal

 

The coverage for surgeries must be pre-approved, unless it occurs in a public health care facility in the Yukon.

Process for Accessing Surgery

Folks considering gender-affirming surgery that is covered are required complete the following steps:

Step 1: Obtain a diagnosis of gender dysphoria from a primary care practitioner. 

Step 2: Patient is referred to NWT clinical expert for consultation re: assessment, confirming diagnosis and outlining management of gender dysphoria.

Step 3: Complete a surgical assessment. One assessment needed for breast/chest surgery and two independent assessments needed for genital surgery.

Step 4: Submit a prior approval form for NWT health care coverage for out-of-territory services

Coverage

Covered by the NWT:

  • Mastectomy
  • Breast augmentation (under certain circumstances)
  • Vaginoplasty
  • Metoidioplasty 
  • Phalloplasty 
  • Clitoral release
  • Hysterectomies
  • Orchiectomy

Not Covered by the NWT: 

  • The cost of outpatient medications, equipment/supplies (i.e. dressings, dilators), meals, accommodations, and personal expenses.
  • Treatments or services received outside of Canada.
  • Chest contouring, facial feminization, tracheal shave and voice pitch surgery.
  • Non-medical interventions required prior to, or following, genital surgery including, but not limited to, liposuction, lipofilling, electrolysis, or laser hair removal.
Process for Accessing Surgery

To be eligible for transition-related services, Nunavut residents must have well-documented gender dysphoria, diagnosed and confirmed by a clinical expert, be assessed and referred by a clinical expert, and a surgical readiness assessment must be completed by a clinical expert. Some procedures have additional eligibility criteria. There is no specific process in Nunavut for how to access surgery.

Coverage

Covered in NVT:

  • Chest surgery/contouring (requires surgical readiness assessment and referral from clinical expert)
  • Breast augmentation (requires surgical readiness assessment, referral from clinical expert, and patient must be on feminizing hormone therapy for continuous 12 months)
  • Genital surgery (requires two surgical readiness assessments by clinical experts, patient must be on hormone therapy for continuous 12 months, and patient must be living in gender role congruent with gender identity for 12 continuous months)
  • hysterectomy
  • vaginoplasty
  • phalloplasty
  • Genital reconstruction (requires two surgical readiness assessments by clinical experts, patient must be on hormone therapy for continuous 12 months, and patient must be living in gender role congruent with gender identity for 12 continuous months)

 

Not covered by NVT:

  • Facial feminization
  • Liposuction/body contouring
  • Tracheal shave
  • Hair transplantation
  • Voice pitch surgery
  • “Cosmetic” surgical revisions

Types of Surgery

Further Resources

Looking for more information on surgery? Here are some key resources from our resource directory.

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