gender reassignment surgery age canada

How gender-affirming health care for kids works in Canada

Transgender youth and their health-care providers say the field is widely misunderstood.

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Robyn Hodgson says she's watched struggling young people heal, grow and ultimately thrive because of gender-affirming health care. 

"It genuinely is profound," Hodgson, a registered nurse and co-ordinator for the transgender and non-binary program at the InterCommunity Health Centre in London, Ont., said. 

"I'm in my 27th year, and I've worked in a lot of areas — and this has been the most rewarding area that I've ever worked in."

Gender-affirming health care — an approach that affirms a trans person's gender identity instead of trying to change it — is endorsed by medical associations in Canada and around the world, including the Canadian Psychological Association and the Canadian Pediatric Society.

But it's also a type of health care that's widely misunderstood, especially as it pertains to the treatment of young people, say the medical professionals who provide it and the patients who receive it. 

• CBC Kids News Explaining gender-affirming care to kids

"So many people make uninformed opinions," said Silas Cain, a 16-year-old transgender boy receiving gender-affirming care in Saskatoon. "They see a headline or they hear one person talking about it and they take it as fact, which is harmful in so many different contexts."

Here's what transgender youth, their caregivers and their health-care providers want you to know about what affirming care actually looks like for young people in Canada. 

How does it work?

Affirming care ranges from social and psychological support, like using someone's chosen pronouns; to transition-related medical treatments, such as puberty blockers and hormones, or gender-affirming surgeries.

Hodgson likens it to how society accommodates people who are left-handed.

"We've tried changing handedness in the school system, and people were struck in the knuckles with rulers," she said. "Trying to force people to live in a shell that is absolutely foreign to their experience is equally difficult."

What it’s like to fight for health care as a trans teen

Forcing kids into genders they don't identify with can have negative impacts on their well-being, says Rhea Mossman Sims, a nurse practitioner at Trans Health Klinic in Winnipeg.

"They can have a significant decrease in their self-esteem and they can also have a significant decrease in their general mental health, and there is a potential for suicidality," she said.

Do kids get medical treatment before puberty?

Canadian health-care providers broadly follow the World Professional Association for Transgender Health (WPATH) standards of care, which has guidelines for patients at different stages of their development.

For kids who haven't hit puberty, affirming care means letting them explore their gender in a supportive environment. That can mean using different pronouns, trying out a new name, or letting them pick different clothes or try a new haircut. 

"There is nothing medically that is done in a child [before signs of puberty]," Hodgson said.

For Cain, that started not at a health clinic, but at school when he found teachers who supported him as he explored different labels. 

"Trying out different pronouns and different names was affirming care for me at that time," he said. "Having a space to experiment is so important and so vital."

Can minors get surgery?

Surgical options, Hodgson says, aren't considered until "very, very late in care" — and almost never for patients under 18. 

"I can tell you, internationally, I do not know anybody that will perform any type of genital surgery on anyone under 18 years of age."

In some very rare cases, she says, older teenagers may be eligible for chest surgery — also known as top surgery — but only if they've already had "a significant duration of care," she said.

Are kids rushed into treatment?

Before puberty blockers or hormone therapy can be considered, WPATH guidelines recommend that all youth be assessed by a qualified health-care professional who has studied psycho-neurodevelopment in adolescence.

"I think that there is this assumption that people are rushing into medical care and there's no thoughtful contemplation or support," Hodgson said.

"It certainly hasn't been the experience of any of the providers that I know that are doing this care, nor of the trans population that's accessing care."

• Trans teens and youth say gender-affirming care is 'life-changing.' So why is it so hard to find in Canada?

Since 17-year-old Seelie Romard of Sydney, N.S., first started seeking gender-affirming treatment in 2021, he says he's visited a pediatrician, a physician who specializes in gender care, and a psychologist — all before being put on a waitlist for testosterone. 

"It took a really long time … just to make sure that I was, like, OK mentally, that I was in the right place, that I was informed," Seelie said. 

What are the effects of puberty blockers?

Patients in the early stages of puberty may be prescribed puberty blockers, which slow the pituitary gland from stimulating secondary sex hormones, putting puberty on pause.

"One of the nice things about blockers is that they can give you some time to continue to explore, rather than having to go through the puberty changes that would happen otherwise," Dr. Tania Culham, a physician with Trans Care B.C., said. 

Some countries have placed restrictions on puberty blockers until their long-term effects can be better studied.  England has restricted their use to minors enrolled in clinical trials , and the Norwegian Healthcare Investigation Board has recommended they be considered "exploratory" and "experimental."

Culham says they are widely considered safe, noting they have been used for more than 40 years to treat precocious puberty — puberty that starts too early — and about 20 years for transition-related care.

Some research has linked them to decreased bone density over time , so providers may limit how long a patient takes them, Sims said. Doctors also supplement treatment with vitamins and dietary guidance for bone health, Hodgson and Culham said.

Patients can pull the plug any time, Culham said, and their regular puberty will resume.

"The whole point of the puberty blocker is that they are reversible," Culham said.

What are the effects of hormone therapy?

Adolescents further along in puberty may consider taking estrogen or testosterone to help develop sex characteristics that better align with their identities. 

Cain started testosterone in July and says it's already having enormous benefits for his health and well-being. 

"Pretty much everyone that I've talked to — my teachers, my therapist, doctors — they all say that I look so much happier now than I did before," he said. "And I definitely feel much happier than I was before."

Because hormones can have long-term effects on fertility , Sims says health-care providers don't prescribe them until a patient has shown a persistent desire to transition, been fully informed about the side effects and been offered a chance to have their sperm or eggs preserved for future use.

"These decisions, in general, are not taken very lightly," she said.

How involved are parents?

According to WPATH, parents should be involved in decisions to pursue medical treatments whenever possible. In fact, Culham says a "family-centred care" leads to better outcomes in all pediatric care.

"As hard as it is sometimes for people to come out to their parents or caregivers or have these conversations, I know a lot of youth take a lot of great care bringing their families, parents, caregivers along," she said.

But that's not always possible. In Canada, under the Convention on the Rights of the Child and Children's Participatory Rights , some people under 18 may be designated "mature minors," capable of making their own health-care decisions.

That's how Tristen Roscoe, 17, of Halifax was able to access testosterone.

"I did tell her about it, but my mom wasn't happy," he said. "She didn't have to, like, sign anything or give the OK, which was good because I don't think she would have."

Roberta Cain, mother to 16-year-old Silas, says helping her son navigate the health-care system has been a "a real balancing act" between respecting his privacy and making sure she has the information she needs to support him. 

Ultimately, she says, it's worth it.

"My feeling is that the staff involved want the best for the kid," she said. "There's no other agenda than that."

ABOUT THE AUTHOR

Sheena Goodyear is a web journalist with CBC Radio's As It Happens in Toronto. She is equally comfortable tackling complex and emotionally difficult stories that hold truth to power, or spinning quirky yarns about the weird and wonderful things people get up to all over the world. She has a particular passion for highlighting stories from LGBTQ communities. Originally from Newfoundland and Labrador, her work has appeared on CBC News, Sun Media, the Globe & Mail, the Toronto Star, VICE News and more. You can reach her at [email protected]

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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.

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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.

Hundreds of trans teens under 18 have had breasts removed in Canada, new data show

Concerns have been raised about mastectomies in teens when uncertainties exist about long-term health effects and the possibility of regret

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As tensions rise over the medical care of trans children, a new analysis shows hundreds of adolescents in Canada have undergone female-to-male “top surgery” — double mastectomies  — over the past five years.

Hospitalizations and day surgery visits for bilateral mastectomies for gender reassignment surgery have risen sharply, from 536 in 2018-19, to 985 in fiscal 2022-23, according to data compiled for National Post by the Canadian Institute for Health Information.

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Of the 4,071 visits in total involving gender-affirming mastectomies or breast reductions reported since 2018, 602 involved youth 18 and under.

Of those, 303 involved teens 17 and younger. The youngest age was 14.

The numbers tell only part of the story. The CIHI data exclude Quebec hospitals as well as surgeries performed in private clinics like the McLean Clinic in Mississauga, which describes its surgeons as “industry pioneers” for top surgery — mastectomies and breast reductions in those assigned female at birth, and breast augmentation for those born male transitioning to female.

One specialist in transgender health issues said that, when applying for OHIP funding for people seeking top surgery, “50 to 70 per cent will go to McLean.”

Female-to-male chest surgery involves removing the breasts to achieve a flatter, more masculinized torso, to better align the person’s physical body with their gender identity and reduce gender dysphoria, defined as the persistent distress that can accompany the incongruence between the gender one identifies with and one’s gender at birth.

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

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If this was just about ... kids being allowed to wear what they want and say what they want and be called whatever name they want and it stopped there, who would care?

But concerns have been raised about intervening with permanent, body-altering surgeries in adolescents when uncertainties exist about the long-term health effects, the possibility of regret and whether their trans identity will be lifelong.

Last week thousands gathered in cities across the country for duelling protests over gender policies in schools. Earlier this month delegates to the federal Conservative party’s policy convention voted 69 per cent in favour of prohibiting “life altering medicinal or surgical interventions” on minors under 18 to treat gender confusion or dysphoria.

Sweden, the world’s first country to authorize legal gender transitions in 1972, last year began limiting mastectomies for teenage girls to research settings. “The uncertain state of knowledge calls for caution,” the head of Sweden’s National Board of Health and Welfare said in a statement reported by AFP.

Public coverage for the surgeries varies from province to province. Most cover the cost of the mastectomy itself, but not several thousand dollars or more in extra add on fees for “chest contouring,” liposuction procedures to give the body a more sculpted, masculine look.

The rise in surgeries reflects a dramatic shift in the sex ratio of children and teens being referred to specialized gender identity clinics across the country, from once predominantly young boys to children born female.

One study involving 174 trans and non-binary children and teens referred to 10 gender identity clinics in Canada found 34 per cent of those assigned female at birth were referred for top surgery. Most were 15 or 16 at the time of referral.

Ontario’s Health Ministry declined to respond when asked the number of OHIP approvals for gender-affirming mastectomies in the most recent year available, including the proportion in youth. The McLean Clinic said its surgeons were unable to accommodate a request for an interview.

According to CIHI, of the 536 hospital visits for transgender reassignment mastectomies in 2018-19, 76, or 14 per cent, involved 18-year-olds and younger.

That age group accounted for 18 per cent of visits for mastectomies (174 out of 991) reported in fiscal 2021-22, and 14 per cent of visits (135 out of 985) in 2022-23.

The percentage dipped last year as hospitals grappled with pandemic-driven surgical backlogs. “But the private clinics just kept churning them through,” said one doctor familiar with trans medicine who requested anonymity fearing professional repercussions.

“The fact that you can’t get the numbers from private clinics…. It’s very cloak-and-dagger,” the doctor said. “They’re still billing OHIP. That’s tax dollars. That should be publicly accessible information. We need to see these numbers and ask questions,” the doctor said.

“If this was just about the schools, and just about kids being allowed to wear what they want and say what they want and be called whatever name they want and it stopped there, who would care? But medicine got involved.”

For a double mastectomy, typically two incisions are made on the bottom border of the pectoral muscle or chest area, according to the McLean Clinic’s website. “The skin is then lifted to surgically remove the breast tissue underneath.” The nipples are removed, re-sized and repositioned by grafting “to suit the new masculine appearance of the chest.”

It’s a day-surgery procedure performed under general anesthesia that takes approximately two hours. Complications can include bruising, wound infections and scarring. People lose nipple sensation as well as the ability to breastfeed should they become pregnant.

The uncertain state of knowledge calls for caution

Major medical groups like the American Academy of Pediatrics have strongly endorsed a gender-affirming approach to care to promote “optimal physical, mental and social wellbeing.” Eligibility for gender-affirmative surgeries in teens should be determined on a case-by-case basis, the AAP said in a 2018 policy statement the organization recently reaffirmed, while at the same time calling for a review of the evidence to develop an “expanded set of guidance.”

The growth in referrals to specialized clinics could be due to greater awareness and social acceptance, and the teaching of gender identity in school, experts said. But it’s not clear why it’s concentrated in children and teens born female.

Denying or holding back access to gender-affirming care “can have negative consequences for some youth,” SickKids in Toronto said in a statement. “Decisions for care should be made by youth, their families and their health-care providers, who are best-positioned to support them.”

Trans teens are known to be at higher risk of harassment and cyberbullying, wrote the authors of a recent review on the surgical and ethical considerations of gender affirming surgery in teens. Early access to surgery may reduce the bullying, they said, or help facilitate “age-appropriate romantic and sexual development in adolescents who may otherwise be prevented from engaging in these activities due to gender dysphoria.”

But the evidence is largely anecdotal, they said. The handful of published studies on surgery in minors involved relatively short follow-up periods.

“What we do know is that regret does take place, and it does take place later on in life,” said one trans medicine specialist, who also agreed to speak on the condition of anonymity for fear of being labelled “transphobic.”

“If we know that people can come to this realization that maybe this may have not been the best decision for them, if that takes place after five years or 10 years, we don’t have all the information to allow patients to make an informed decision.”

For such a permanent decision as the removal of healthy breasts, “I’m always looking at the why, and because that hasn’t been answered yet, that’s what leads to my ambivalence,” the specialist said.

“What all this says to me is that we need to be much more thoughtful in our approach and in our assessments.”

National Post

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• Inside Pride homepage

Gender-affirming health coverage by Canadian province, territory

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This article is more than 2 years old and some information may not be up to date.

Gender and gender expression is incredibly individual and the healthcare needs of folks along this spectrum are just as varied and diverse.

There are generally three areas of transition: social (which may include coming out, using a different name, a different pronoun, changing style of dress, or using gender-affirming products like binders or pads), medical (which may include hormone therapies, hormone blockers and/or gender-affirming surgeries) and legal transition (which may include legally changing name, changing gender marker listed on legal documents and changing legal documents to reflect appropriate titles).

For instance, some transgender, intersex or gender diverse Canadians may require surgery to feel as though their true gender matches their external body. Others may need hormones or hormone blockers. Others may need laser hair removal or binders.

The World Professional Association of Transgender Health ( WPATH ) has standards of care but there is not a standard for coverage and prerequisites across Canada.

FULL COVERAGE:  Inside Pride

The ability for Canadians to access gender-affirming healthcare — including coverage, requirements and wait times — is different depending on what province/territory they live in and also whether they reside in urban or rural areas.

Yukon is considered the “gold standard” by advocates; the territory reduces the number of specialists required to sign off on procedures, removes the pathologizing term and requirement of a “gender dysphoria diagnosis,” and offers public health coverage for residents requiring rarely covered gender-affirming procedures like facial feminization, laser hair removal or tracheal shaves.

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All provinces and territories, for instance, provide health coverage for genital sex re-assignment surgery but most health departments require a psychiatrist and another “expert” to approve and refer for the procedure. Wait times for psychiatrists can be years-long in some communities.

Most provinces and territories require documented “gender dysphoria” for gender-affirming treatment, including access to hormones and any type of gender-affirming procedure. The International Classification of Diseases removed gender diversity from its list of psychiatric diagnoses, and it is no longer considered a psychiatric disorder.

Most provinces and territories do not offer coverage for mental health supports, including appointments with the required psychiatrists or experts.

While gender-affirming genital surgery is covered by most provinces/territories, there are only three clinics in which these procedures can be done: a private clinic in Montreal, Centre Metropolitain de Chirurgie , a small public clinic that’s part of the Women’s College Hospital in Toronto , and the Gender Surgery Program B.C. , a public clinic in B.C. (which only treats B.C. and Yukon residents).

British Columbia

Patients must work with primary care provider to have one or more surgical readiness assessment(s) completed with a qualified surgical assessor. Depending on the surgery, their primary care provider sends a referral, including completed readiness assessment (to urologist for orchiectomy; to obstetrician or gynecologist for hysterectomy and bilateral salpingo-oophorectomy), consultation with surgeon, and funding must be approved prior to surgery. 

• Chest construction (including reduction)
• Orchiectomy
• Hysterectomy with bilateral salpingo-oophorectomy
• Vaginoplasty
• Vulvoplasty
• Clitoral release
• Metoidioplasty
• Phalloplasty
• Travel Assistance Program for provincial travel assistance for services not available in own community
• Expenses for out-of-province surgical aftercare if medically required
• Psychiatry services
• Vocal feminization program (via free Changing Keys program)

CONDITONALLY/PARTIALLY COVERED:

• Breast construction/augmentation (reviewed on case-by-case basis and funded in some circumstances)
• Hormone therapy (coverage under Fair Pharmacare or other PharmaCare plans such as Plan C, which covers drug costs for those receiving income assistance; or coverage can be requested through Special Authority; or through an employer benefit plan)
• Those with PWD coverage can get binders, packers, breast forms with prescription/letter from MD or NP

NOT COVERED:

• Facial procedures like reduction of Adam’s apple, nose feminization, facial bone reduction, face lifts, rejuvenation of eyelid
• Pectoral implants
• Hair removal; hair reconstruction or restoration
• Liposuction or lipofilling
• Voice surgery
• Psychologists, social workers and registered clinical counsellors (work benefits, private insurance, some community organizations offer limited free counselling)
• Travel and accommodation costs to and from surgical centres (BC or MTL)
• Supportive garments and wound care supplies
• Other travel related costs like insurance or accommodation

Alberta Health provides funding for eligible Albertans diagnosed with gender dysphoria who meet program criteria for phalloplasty, metoidioplasty and vaginoplasty (provided at Centre Metropolitain de Chirurgie in Montreal). This program is available to Albertans who are diagnosed with gender dysphoria by two physicians (including psychiatrists) licensed in Alberta and who meet program criteria, which are based on World Professional Association of Transgender Health standards of care. Two licensed Alberta physicians (including psychiatrists) must apply for this funding on behalf of a patient and funding applications are reviewed upon receipt. “Top surgery” is an insured service under Alberta’s Schedule of Medical Benefits. Patients are referred by their primary care provider to an Alberta surgeon.

• Hysterectomy and ovary removal
• Breast augmentation and mastectomy (patient must get pre-approval from Alberta Health, must get surgeon or primary care provider to validate eligibility, patients must have one independent assessment by a psychiatrist or other physician with expertise, and be diagnosed with gender dysphoria.)
• Voice therapy

CONDITIONALLY/PARTIALLY COVERED:

• To qualify for breast augmentation as an insured service, patient must have “little to no breast growth as directly determined by the surgeon.”
• There are multiple hormone replacement therapy products available for transgender health on the Alberta Drug Benefit List (ADBL) for patients on government sponsored drug plans (Medroxyprogesterone, progesterone, conjugated estrogens, estradiol 17 B and testosterone). Endocrine therapies, such as gonadotropin releasing hormone therapy (GnRH), are available on the ADBL (leuprolide, goserelin and buserelin).
• Alternatives to GnRH therapy, such as spironolactone, are listed as an open benefit on the ADBL and available to transgender Albertans. Many of these products are an open benefit; however, some testosterone products and GnRH medications require a special authorization form to be completed by a prescriber, and special authorization criteria to be met, in order to be considered for coverage.
• Facial feminization
• Tracheal shave
• Voice pitch surgery
• Non-medical interventions like laser hair removal or electrolysis
• Take-home medications and equipment
• Personal expenses, meals and accommodation

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Yukon Insured Health Services expanded coverage in 2021 to include “comprehensive list of surgeries and other procedures” for the trans and gender diverse community, in accordance with WPATH standards.

“Last year, we expanded Yukon’s healthcare to cover surgeries and other procedures essential to gender transition. The new policy was recognized at that time as the most comprehensive health coverage for gender-affirming care in North America,” a government spokesperson told Global News.

To receive coverage, patients must have gender dysphoria and a referral from a mental health provider. A medical practitioner (including a nurse practitioner) can prescribe hormone therapy.

• Hormone therapy (medical practitioner must apply to benefits program on behalf of patient)
• Hysterectomy
• Salpingo-oophorectomy
• Chest contouring
• Body contouring
• Hair removal
• Medical and travel costs
• Facial feminization surgery ($30K-$50K)
• Vocal surgery
• Mental wellness services (through All Genders Yukon Society)
• Training for healthcare professionals (at no cost) to provide compassionate and culturally sensitive WPATH gender-inclusive care

PARTIALLY/CONDITIONALLY COVERED:

• Counselling services

Northwest Territories

In order to have gender-affirming procedures covered, patients must have well-documented gender dysphoria, assessment(s) by a clinical expert(s) and have 12 continuous months on hormone therapy (to qualify for coverage for genital surgeries). The diagnosis of gender dysphoria can be made by a primary care practitioner with “extensive experience or formal training in gender care.” A primary care practitioner who does not have extensive experience or formal training in gender care may refer the patient to a clinical expert to confirm the diagnosis.

• Breast surgery (augmentation) only covered when deemed medically necessary (when there failure to respond to hormone therapy or a congenital breast abnormality. Only few patients will fulfil these eligibility criteria)
• Outpatient medications, equipment/supplies (i.e. dressings, dilators)
• Meals, accommodations, and personal expenses
• Psychotherapy
• Fertility preservation techniques
• Liposuction/lipofilling
• Electrolysis/laser hair removal
• Cosmetic procedures arising from the original surgery to improve appearance

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. 

• Mental health services
• 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)
• 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)
• Hormone therapy (covered and can be prescribed by a physician or a nurse practitioner).
• Liposuction/body contouring
• Hair transplantation
• Voice training
• “Cosmetic” surgical revisions

Saskatchewan

Prior approval is required for coverage of gender-affirmation surgeries. Saskatchewan Health may cover up to 100 per cent of physician costs associated with some out-of-province procedures. Surgical interventions may be considered at the determination of the treating psychiatrist. The psychiatrist must contact one of the recognized authorities (list of eight Saskatchewan and Alberta doctors or Ontario Centre for Addiction and Mental Health). Saskatchewan residents can be referred to an in-province specialist for most common surgeries, such as a hysterectomy or mastectomy. Any physician or nurse practitioner can prescribe hormone therapy.

• Oophorectomy
• Vaginoplasty (with or without vaginal canal)
• Some hormones (those listed on Saskatchewan Formulary are eligible for co-pay for those with active provincial health card)
• Breast augmentation
• Body sculpting surgeries (implants, liposuction and other procedures)
• Facial feminization surgery
• Facial hair removal
• Laryngeal Chondroplasty
• Travel and accommodation costs
• Certain hormone therapy drugs
• Voice training/Voice pitch surgery

Manitoba requires a medical diagnosis of gender dysphoria for gender-affirming procedures, including hormone therapy. Covered surgeries require references from both medical and psychiatric experts. There are currently 14 mental health professionals (11 for adults and three for youth) of providers approved by to submit gender-reassignment surgery cases. If available, gender-affirming procedures are done in Manitoba. If not, they’re referred to another jurisdiction. For hormones, medical regulatory bodies determine who can prescribe hormone therapy and it may require consultation with a specialist.

• Chest masculinization
• Hysterectomy and oophorectomy
• Feminizing voice therapy
• Laser hair removal
• Breast augmentation (on a case-by-case basis)
• Hormone therapy (may be applicable for support as a non-insured benefit subject to the person’s eligibility for the Manitoba Pharmacare Program, or through a personal third-party insurance coverage.)

If a clinician is seeking services that are excluded by legislation and or regulation and/or do not meet the current standard of practice for the medical condition, the department, on a case-by-case basis, will seek independent medical advice in determining if such is an insured service. If a person feels that such a decision is not aligned to Manitoba’s legislation or regulations, they are permitted to bring forth a case through the Manitoba Appeals Board., which is independent of the department of Health.

• Electrolysis

Primary care providers can diagnose for gender dysphoria, prescribe hormones (nurse practitioners can also prescribe hormone therapy), refer for transition-related surgeries. Since 2016, any qualified provider can refer for transition-related surgery. Physicians, psychiatrists and endocrinologists can self-identify as a qualified provider.

• Assessment for hormone therapy
• Counselling
• Augmentation mammoplasty or mastectomy
• Private clinic stay and/or ministry-approved services outside Canada
• Clitoroplasty
• Labiaplasty
• Vaginectomy
• Testicular implants with scrotoplasty
• Penile implant
• Hormones (patients covered by Ontario Drug Benefit program can get injectable testosterone covered with submission of Exceptional Access Form)
• Anti-androgen and estradiol covered without EAP approval
• Chest contouring/masculinization
• Liposuction
• Hair transplants
• Voice modification surgery
• Chin, nose, cheek or buttock implants
• Facial feminization/masculinization
• Travel involved in obtaining surgery

Quebec residents with public health insurance plan RAMQ are covered for gender reassignment surgery and treatments if a doctor determines surgeries/treatments are necessary, at least one evaluation by a psychiatrist or clinical psychologist, two letters of reference from a psychiatrist, psychologist, sexologist, endocrinologist or family doctor.

• Double mastectomy with reconstruction
• Hormone therapy

An endocrinologist determines the hormone therapy regiment for the patient and a family physician may oversee ongoing treatment. For gender-affirmation surgeries , an assessment must be done by WPATH-trained staff and then a prior approval is obtained from Medicare for coverage. Patients must receive a diagnosis of gender dysphoria and receive signed letters from one to three psychiatrists. Any psychiatrists with WPATH training can do this. Once the request is approved, a surgical plan is put in place by the attending professionals.

• Mastectomy with chest masculinization (for trans-masculine patients)
• Vaginoplasty (including: penectomy, orchidectomy, construction of a vaginal cavity and the vulva)
• Vaginectomy, hysterectomy, salpingo-oophorectomy
• Mastectomy (with chest masculinization)
• Phalloplasty, erectile and testicular implants.
• Breast augmentation (for trans-feminine patients)
• Tracheal shaving
• Travel, accommodation or medications prescribed outside of hospital
• Voice and communication training
• Cosmetic surgical revisions

Nova Scotia

Gender-affirmation surgery (sex-reassignment surgery) is an insured benefit in Nova Scotia . An assessment by a physician, specialist, nurse practitioner, or healthcare professional with required competencies to assess, refer and treat gender dysphoric patients is required for coverage.

• Oophorectomy (only available in NS)
• Breast reduction
• Chest masculinization/mastectomy (in NS or Montreal Centre)
• Metoidplasty
• Vaginoplasty (only available at Centre Metropolitain de Chirurgie in Montreal)
• Counselling and psychotherapy is funded when provided in public institutions
• Hormone therapy is funded when provided in public institutions

Prince Edward Island

Any family doctor or nurse practitioner can prescribe hormone therapy. Patients can also be referred to the Gender Affirming Care clinic for hormone therapy. Access to gender-affirming care in PEI does not require a diagnosis of gender dysphoria. For surgery to be covered, patients must have a referral from a healthcare provider and must get pre-approval from Health PEI .  As of June 2021, Health PEI’s Gender Confirming Surgery Policy is under review. 

• Mastectomy with chest masculinization
• Erectile/testicular implant
• Scrotoplasty

PARTIAL/CONDITIONALLY COVERED:

• Hormone therapy (per the provincial drug formulary or as per a patients’ private insurance policy)

Newfoundland and Labrador

As of November 2019, health care providers who meet WPATH credentials can provide patients with surgical readiness assessments. Physicians and nurse practitioners with or without WPATH credentials can request transition-related surgery prior approval for funding. A psychiatric diagnosis of gender dysphoria is not required. Physicians and nurse practitioners can prescribe hormone therapy.

• Breast augmentation (when no breast development for 18 months of hormone therapy)
• Mastectomy with chest masculinization (excluding implants and liposuction)
• Vaginoplasty (includes orchiectomy, penectomy, labiaplasty, clitoroplasty; with or without construction of vaginal cavity)
• Phalloplasty (includes urethroplasty, scrotoplasty, vaginectomy, and insertion of testicular and approved penile implants)
• Insured out-of-province procedures not available in NFLD, at publicly funded facility, with prior approval
• Travel to access out-of-province procedures (airfare, accommodation, meals and local transportation. Some restrictions may apply)
• Hormone therapy may be covered through the Newfoundland and Labrador Prescription Drug Program. NLPDP covers eligible prescription medications for those who are an eligible Medical Care Plan (MCP) beneficiary.
• If the prescription is on the special authorization listing, a physician would have to apply for the product through the NLPDP special authorization process.

GENDER-AFFIRMATION SURGICAL PROCEDURES:

Phalloplasty: Creates penis (using grafting of tissue), scrotal sac and testes. It involves neophallus, urethroplasty (creation of urethra), vaginectomy (removal of the vagina or closure of vagina), glansplasty (creation of glans penis), scrotoplasty (creation of scrotum and insertion of testicular implants), and insertion of erectile device, if desired.

Vaginoplasty: surgery to create a vagina and vulva (including mons, labia, clitoris and urethral opening) and remove the penis, scrotal sac and testes.

Clitoral Release: a penis is created with the enlarged clitoral tissue.

Hysterectomy: removal of the uterus

Bilateral Salpingo-Oophorectomy (BSO): r emoval of both fallopian tubes and removal of both ovaries

Bilateral Salpingectomy: removal of both fallopian tubes

Bilateral Oophorectomy: removal of both ovaries

Metoidioplasty: a penis is created with the enlarged clitoral tissue. The urethra is extended to the tip of the penis.

Orchiectomy: removal of the testes (testicles) and spermatic cord.

In the month of June, Global News is exploring deeper issues related to the 2SLGBTQQIA+ community in our series,  Inside Pride , which looks at the importance of the acronym and the labels it represents.

Gender-affirmation surgeries: Summary and definition by Emily Mertz on Scribd

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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 .

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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.

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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;
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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.