gender reassignment surgery ottawa

Transition-Related Surgery

Transition-related surgery (TRS) refers to a range of surgical options that can help people feel that their physical characteristics more closely reflect their gender identity or expression. These options can support one in feeling more comfortable in their body and may help to improve your mental wellness.

In order to receive provincially-funded transition-related surgeries, you will need a surgery assessment from one or two health providers, depending on the surgery, one of which being a qualified primary care provider like a Physician or Nurse Practitioner. 

If you have a primary care provider and would like to start a discussion with them about transition-related surgery, you can click here for tips on how to start that conversation. 

If you do not have a primary care provider and would like to access transition-related surgery, you can reach out to Centretown Community Health Centre’s Trans Health Program to get connected with surgery referral support.

Provincially Funded Transition-Related Surgeries

Disclaimer: this section uses medical terminology.

Upper Surgery (Chest or Breast Augmentation) needs one assessment by a qualified Physician or Nurse Practitioner. Lower Surgery (Genital Surgery) needs an additional assessment from any qualified Physician, Nurse Practitioner, Psychologist, or Registered Social Worker (Master’s Degree).

Under the Ministry of Health and Long-Term Care (MOHLTC), the following surgical procedures are provincially-funded:

For “Assigned Male at Birth” individuals:

• Vaginoplasty 
• Orchiectomy
• Augmentation Mammoplasty a (breast enlargement)*

*Patient must have completed twelve continuous months of hormone therapy with no breast enlargement unless hormones are contraindicated

For “Assigned Female at Birth” individuals:

• Hysterectomy
• Clitoral release with vaginectomy
• Metoidioplasty
• Phalloplasty
• Testicular implants with scrotoplasty
• Penile implant

Eligibility

Prior to beginning the referral process for transition-related surgeries, the following eligibility criteria must be met: 

• Has a diagnosis of persistent gender dysphoria 
• For breast augmentation surgery: Has completed 12 continuous months of hormone therapy with no breast enlargement (unless hormones are not appropriate for the person)
• For External Genital Surgery Only: Has completed 12 continuous months living as gender(s)

Not Covered

As of right now, OHIP does not cover the following procedures identified as medically necessary by the World Professional Association for Transgender Health:

• Liposuction
• Electrolysis
• Chest contouring/masculinization
• LASER hair removal
• Hair transplants
• Tracheal shave
• Voice modification surgery
• Chin, nose, cheek or buttock implants
• Facial feminization/masculinization

*OHIP does not cover travel costs involved in obtaining surgery. If you are in financial need and must travel to obtain an OHIP approved procedure, Hope Air can provide free air travel and accommodation. You can learn more about this option here.

For an overview of transition-related surgeries, risks, benefits and additional information, review Rainbow Health Ontario’s TRS Summary Sheets here .

The Referral Process

Step 1: Connect with Qualified Providers. 

The MOHLTC requires 2 qualified providers submit a “Request for Prior Approval for Funding of Sex Reassignment Surgery” form (can be found on the “Clinical Resources” section of our resource library ).

Who is a qualified provider? 

The MOHLTC criteria for a qualified provider includes Physicians, Nurse Practitioners, Registered Nurses, Psychologists and Registered Social Workers. Eligible providers are expected to self-assess if providing transition-related surgical referrals is within the scope of their practice. There is no single training course that “qualifies” a provider, but providers are encouraged to undertake professional development and training activities to build their capacity on trans health services.

If your primary care provider is not able to submit a Prior Approval form on your behalf, Centretown Community Health Centre can help.

Step 2: Participate in a Transition-Related Surgery (TRS) Planning Visit

A TRS planning visit is a collaborative visit between a patient and a qualified provider to discuss TRS and how to optimize the patient’s experience and outcome. Topics discussed include reviewing World Professional Association for Transgender Health (WPATH) and MOHLTC criteria, confirming the diagnosis of gender dysphoria, reviewing the stability of medical and mental health conditions, confirming surgery-specific informed consent and planning aftercare.

Step 3:  Complete the Prior Approval Form

Following your Transition-Related Surgery Planning Visit, your provider can complete, sign, and submit the “Request for Prior Approval for Funding of Sex-Reassignment Surgery” (also known as the “Prior Approval” form) to the MOHLTC.

The number of qualified providers who must complete independent TRS surgery planning visits and sign a Prior Approval form is based on the type of surgery requested. 

Upper body surgery requires a TRS planning visit(s) by one qualified provider (either a P hysician or Nurse Practitioner). 

Gonadal or external genital surgery requires independent TRS planning visits with two qualified providers, one of whom must be a Physician or Nurse Practitioner, while the second can be a Physician, Nurse Practitioner, Registered Nurse, Psychologist, or a Registered Social Worker with a Masters of Social Work. 

Once the application is submitted, the MOHLTC will then send a response letter with the outcome of the funding application. 

If approval is not received, your qualified provider can contact the MOHLTC to provide additional information, the application can be resubmitted, and/or an internal review of the initial application can be requested by your provider.

Step 4: TRS Referral Letter Sent to TRS Surgeon 

Once an approval letter is received from the MOHLTC, your provider can send a referral letter to the transition-related surgery surgeon. TRS referral letters are often more in-depth than typical referral notes and often include details about your TRS planning visits. Surgeons will often request additional documentation, including medication lists, lab results and other information.

Step 5: Complete TRS and After Care 

Once referred to a TRS surgeon, you will be contacted by the surgeon or clinic to sort out additional details, and will receive more information as your surgery date nears.

In partnership with:

New Ottawa gender-affirming surgery clinic a first in Ontario

Ottawa hospital clinic accepting referrals for facial, top and bottom surgeries.

Social Sharing

A new clinic at The Ottawa Hospital aims to be a game changer for those seeking gender-affirming care in the nation's capital.

The hospital says it will offer facial, top and bottom surgeries, becoming the first in Ontario to do all three.

Previously, a Montreal-based clinic was the only facility in the country to offer that trifecta, according to the hospital's news release . 

"It was about one of the best headlines I've read in some time," said Holly Brown, who leads the trans health team at Ottawa's Centretown Community Health Centre. 

"I have been doing advocacy dedicated toward the provision and access of this health care for the last two and a half years, and this is about the best news that I have received."

Clinic taking referrals 

Officially launched in September, the clinic is now accepting patient referrals.

According to the hospital, previously patients could only access top surgery in Ottawa, but not facial or bottom surgeries.

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

No one from The Ottawa Hospital was available for an interview on Thursday, but Brown said many in the region would travel to Montreal or Toronto for certain procedures. 

Brown said she's pleased the services will be offered closer to home, and said these supports can offer an array of improvements to the lives of trans and non-binary people. 

Travelling could be a struggle

Brown said previously, getting to Montreal or Toronto could also be a struggle for some patients.

"Many folks in this population are experiencing challenges that would make it difficult for them to travel, such as living by themselves, such as lower income," Brown said.

"These are social demographics of health that are really common for this subset of the population."

What's covered varies between provinces, with  OHIP funding chest and genital surgeries  in Ontario.

• CBC Investigates U.S. conservatives are using Canadian research to justify anti-trans laws

Brown said any extraneous costs associated with transitional surgeries usually fall to the patient.

Fae Johnstone, a local trans activist, said this will change, save and improve lives in the Ottawa region. 

While she knew such a clinic was in the works, she said it would have been difficult to describe her expression when she learned about the launch.

"It is so hard to access this care. Traditionally, it takes years and it takes personal effort from individuals," Johnstone said.

"And to have it made easier and to have not just a new clinic, but one that is working in partnership with our existing services — that is just incredible."

ABOUT THE AUTHOR

Joseph Tunney is a reporter for CBC News in Ottawa. He can be reached at [email protected]

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New Ottawa gender-affirming care clinic open; patients now welcome

By Mike Lacasse

Posted Jan 10, 2024 01:00:26 PM.

Last Updated Jan 10, 2024 01:01:16 PM.

The Ottawa Hospital’s new gender-affirming clinic is the first in province to offer a full range of sex reassignment surgeries to trans and non-binary patients.

First launched in September, 2023 by co-founder Dr. Nicholas Cormier, it is the only clinic in Ontario to offer facial, top and bottom gender-affirming surgeries in the same place.

“There’s just a massive gap in our health-care system for the treatment of the transgender population and people seeking gender-affirming care,” Cormier said.

“What’s so groundbreaking about this new clinic is that everyone is coming together to address this shortcoming in our system.”

Prior to opening its doors, only top surgery was available locally and patients needed to travel to GrS Montreal for others.

In addition to being partnered with with different surgical divisions at the Ottawa hospital, including plastic surgery, urology, obstetrics and gynecology, the clinic also works with trans health programs in the community.

Places like Centretown Community Health Centre’s  Trans Health Program , which refers patients to the clinic, and CHEO’s  Gender Diversity Clinic , are important to the process as accessing gender-affirming surgery is just one small component of gender-affirming care, Cormier added.

“In my residency, I was always interested in gender-affirming care,” Cormier said. “That led me to seek out a fellowship in San Francisco, where I was able to train with world-renowned experts in gender-affirming care and I’m really excited about bringing that to my hometown of Ottawa.”

The Ottawa Hospital previously launched the Gender and Diversity Specialty Clinic in January 2022 and it is one of Canada’s only hospital-based clinics dedicated to caring for medically complex trans and non-binary patients.

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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.

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How to access gender-affirming care: Options

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• Definitions

On this page

Types of care, treatment coverage and costs.

Gender-affirming care helps to support gender expression. This care can look different for everyone, and may be:

• a combination of some or all options

The information provided on this page isn't exhaustive. Talk to a health care provider to get advice about what specific care is available to you.

Find out which types of care are covered by your province or territory

Social transition

Socially transitioning involves publicly affirming your gender identity to others through social changes. Examples include:

• 'coming out' to others
• using pronouns that align with your gender identity
• choosing a different name that better aligns with your gender identity
• changing your appearance, such as the way you dress or style your hair
• voice therapy to help your voice better align with your gender identity

Provinces and territories have different policies for socially transitioning in schools. Some need parents or guardians to consent to or be informed of their child's request to socially transition at school. This could include being addressed by their chosen name or pronouns. Other provinces and territories need the child's consent to inform parents or guardians of their desire to socially transition at school.

Legal transition

Legal transition usually involves updating legal documents to reflect your chosen name and gender marker.

In Canada, anyone can request a gender marker change on federal documents, such as a passport or citizenship certificate. You can also request changes to provincial and territorial documents, such as your:

• driver's license
• birth certificate
• health insurance card

Most provinces and territories will require:

• a minor to have a parent or guardian's consent
• a parent or guardian to complete paperwork on a minor's behalf

Most provinces and territories will ask for supporting documents from a health care professional, such as a:

• psychologist
• social worker

These documents must confirm that changes to your gender designation are related to gender-affirming care.

There is often a fee to make these changes, which can vary depending on your province or territory.

Find out about your province or territory's processes, age stipulations and fees

Medical transition

Medical transition involves medical treatments that change your physical features to better align with your gender identity.

Always talk to a qualified health professional before beginning any type of medical care.

Non-surgical options: Hormone blockers

Hormone blockers, also known as puberty blockers, are medications that suppress the signs of puberty once it begins. In people assigned male at birth, they can:

• slow the growth of facial hair
• prevent the voice from deepening
• limit the growth of typically masculine muscles
• limit the growth of muscle tissue, as well as the penis, scrotum and testicles

In people assigned female at birth, they can:

• limit or stop breast development
• stop ovulation, menstruation, and maturation of the vagina

Young people may also use puberty blockers for other reasons, including:

• menstrual pain
• acne treatment
• precocious (early) puberty
• elite female athletics

Puberty suppression is reversible , as puberty restarts when a person stops taking puberty-blocking medications. Without them, they may develop secondary sex characteristics (body features of an adult male or adult female) that aren't consistent with their gender identity.

Access to puberty blockers at the right time can help avoid irreversible changes associated with puberty. They can allow a young person to develop secondary sex characteristics that align with their gender identity if they also choose to have gender-affirming hormone therapy.

Non-surgical options: Gender-affirming hormone therapy

Gender- affirming hormone therapy helps you develop physical features that align with your gender identity.

Feminizing hormone therapy, such as estrogen, will help induce secondary female sex characteristics, such as:

• rounder hips
• breast development
• slower body hair growth

Masculinizing hormone therapy, such as testosterone, will help induce secondary male sex characteristics, such as:

• a deeper voice
• muscle growth
• facial hair growth

Surgical options

Gender-affirming care can also involve surgical options. Having surgery is a personal decision, and whether you choose to have some, none or all is entirely up to you.

All lower or bottom surgeries are only available for people 18 years of age or older, regardless of gender. This aligns with the World Professional Association for Transgender Health's Standards of care. According to these, a person must be the age of majority to undergo gender reassignment surgery.

Options for transgender men and some non-binary people can include:

• voice surgery, which deepens the voice
• mastectomy, which removes the breasts (top surgery)
• fertility preservation by saving eggs to conceive with in the future
• vulvectomy, which removes the vulva
• vaginectomy, which removes the vagina
• nullification surgery, which hides or removes all external genitals
• phalloplasty, which uses skin from other parts of your body to create a penis
• scrotoplasty, which uses skin from other parts of your body to create a scrotum
• hysterectomy, which removes internal reproductive organs like the ovaries and uterus

Options for transgender women and some non-binary people can include:

• voice surgery, which changes the voice
• vulvoplasty, which creates a vulva
• vaginoplasty, which creates a vagina
• orchiectomy, which removes the testes

Additional treatments

These could include:

• fertility preservation by saving sperm or eggs to try to conceive with in the future
• removing hair from the face, neck, or other parts of the body
• voice training

In some jurisdictions, hormone therapy is covered under provincial and territorial drug insurance plans. Some others only cover hormones if you meet certain criteria.

Most Canadian provinces and territories cover the cost of some gender reassignment surgeries. However, not all provincial and territorial health insurance plans cover feminizing surgeries such as:

• voice surgery
• facial feminization
• breast augmentation
• Adam's apple reduction

They also don't all cover masculinizing surgeries such as chest or body contouring.

Some jurisdictions can't provide bottom surgeries due to lack of speciality physicians. However, they may cover some of the costs to receive these surgeries in another province or territory.

Find out what coverage is available in your province or territory

Criteria for coverage

The process and criteria for health insurance coverage varies across provinces and territories. All jurisdictions require a surgical readiness assessment, which evaluates your:

• health history
• social, emotional and financial readiness for gender reassignment surgery

Most provinces and territories also require you to have documented 'gender dysphoria' for gender-affirming surgical treatment.

Page details

New Ottawa gender-affirming surgery clinic a first in Ontario

A new clinic at The Ottawa Hospital aims to be a game changer for those seeking gender-affirming care in the nation's capital.

The hospital says it will offer facial, top and bottom surgeries, becoming the first in Ontario to do all three.

Previously, a Montreal-based clinic was the only facility in the country to offer that trifecta, according to the hospital's news release .

"It was about one of the best headlines I've read in some time," said Holly Brown, who leads the trans health team at Ottawa's Centretown Community Health Centre.

"I have been doing advocacy dedicated toward the provision and access of this health care for the last two and a half years, and this is about the best news that I have received."

Clinic taking referrals 

Officially launched in September, the clinic is now accepting patient referrals.

According to the hospital, previously patients could only access top surgery in Ottawa, but not facial or bottom surgeries.

No one from The Ottawa Hospital was available for an interview on Thursday, but Brown said many in the region would travel to Montreal or Toronto for certain procedures.

Brown said she's pleased the services will be offered closer to home, and said these supports can offer an array of improvements to the lives of trans and non-binary people.

Travelling could be a struggle

Brown said previously, getting to Montreal or Toronto could also be a struggle for some patients.

"Many folks in this population are experiencing challenges that would make it difficult for them to travel, such as living by themselves, such as lower income," Brown said.

"These are social demographics of health that are really common for this subset of the population."

What's covered varies between provinces, with  OHIP funding chest and genital surgeries  in Ontario.

Brown said any extraneous costs associated with transitional surgeries usually fall to the patient.

Fae Johnstone, a local trans activist, called the new clinic 'just incredible.' (Celeste Decaire/CBC)

Fae Johnstone, a local trans activist, said this will change, save and improve lives in the Ottawa region.

While she knew such a clinic was in the works, she said it would have been difficult to describe her expression when she learned about the launch.

"It is so hard to access this care. Traditionally, it takes years and it takes personal effort from individuals," Johnstone said.

"And to have it made easier and to have not just a new clinic, but one that is working in partnership with our existing services — that is just incredible."

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“Stewards of hormones”: Our Gender Diversity Specialty Clinic guides medically complex patients on their affirmation journey

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Growing up in the ‘70s and ‘80s, Spencer Hayward never met anyone who felt the same way he did.

Today, Spencer, a trans man, is a mentor to others who are socially or medically transitioning to the gender that aligns with their gender identity. “I consider myself an elder, so I help the younger crowd with their questions,” he says. “I want to help other people get to their end goal.”

He wants to help because he knows that this journey isn’t straightforward, especially for patients with complex medical needs. Just two years ago, his own journey looked uncertain. Thankfully, he managed to find the care he needed from a specialty clinic at The Ottawa Hospital.

A roadblock on his journey

In 2021, Spencer was told he had an aggressive form of breast cancer. After surgery and completing his course of treatment, he was deemed cancer free.

But there was one problem.

As part of his gender-affirming care, Spencer was on testosterone therapy, which doctors said could lead to a recurrence of his cancer. “They said I might have to stop testosterone entirely,” he recalls. “That’s when Dr. Druce came into the picture.”

Caring for patients who may have nowhere else to go

Dr. Irena Druce is an endocrinologist at The Ottawa Hospital. Endocrinologists are experts in hormones and the glands that produce them. Transgender patients may see an endocrinologist for hormone therapy as part of their gender transition.

Dr. Druce worked with Spencer to find a way for him to continue his gender-affirming hormone therapy while also mitigating the risks of his cancer returning.

Spencer was one of the first patients at The Ottawa Hospital’s Gender Diversity Specialty Clinic, launched in January 2022 by Dr. Druce and fellow endocrinologist Dr. Heidi Dutton, with the support of Dr. Heather Lochnan, Head of the Division of Endocrinology and Metabolism. The clinic helps trans and non-binary patients like Spencer who have had or are currently living with medically complex conditions.

“A lot of primary care providers are not comfortable with transgender health and may deem medically complex patients too high a risk to transition. These patients really have nowhere else to go for advice,” explains Dr. Druce. “And it’s well established that providing this therapy decreases the mental health burden, including suicidality rates.”

The Ottawa Hospital’s Gender Diversity Specialty Clinic is one of Canada’s only hospital-based clinics dedicated to caring for medically complex trans and non-binary patients.

Treating patients as partners

Medically complex patients may require the assistance of an endocrinologist to help determine which path their hormone therapy should take.

These include patients who have had a hormone-dependent cancer (such as breast or prostate cancer) or an embolic disease (such as a stroke, heart attack or pulmonary embolism) or who are taking immunosuppressants or HIV treatment.

Our clinic finds a hormonal regiment tailored to each patient and refers them to their primary care provider, who can perform the therapy and follow up with them throughout their gender affirmation journey. For patients who do not have a primary care provider, our clinic will refer them to a trans health program in the community, like the one at the Centretown Community Health Centre.

“I call myself a ‘steward of hormones,’” says Dr. Druce. “I work with each patient to establish their individual goals. I want to hear what they would like, and then I will let them know whether we can achieve that.”

Dr. Druce’s empathy has meant a lot to Spencer. “Every time I see her, it’s like sitting down having coffee with an old friend,” he says with growing emotion. “She just exudes this positivity. I was going through a really crappy time, and she was like, ‘Let’s figure this out together.’ She really cares about the people in her care. That’s what everybody hopes for with a doctor, but you don’t always get it.”

Helping both patients and health-care providers

Dr. Druce wants to connect more patients like Spencer to the kind of doctors that they’ve long hoped for. That’s why the Gender Diversity Specialty Clinic also serves as a training centre for our endocrinologists.  

“Research has demonstrated that one of the main reasons why health-care providers are not providing transgender medicine is that they don’t feel comfortable because of a lack of training,” explains Dr. Druce. “The main reason I helped establish this clinic was to provide a space for our endocrine trainees to get more exposure to this field of medicine so that when they graduate, they feel comfortable seeing this patient population. We need more health-care providers to do this work.”

Training more health-care providers is critical to fulfilling a growing demand for gender-affirming therapy and cutting down on growing wait times.

“Members of the trans and non-binary community are becoming more visible these days, which is fantastic. There’s now so much openness that patients feel empowered to finally live freely. This has increased the need to provide gender-affirming therapy,” explains Dr. Druce.

Hoping to inspire other clinics

The Ottawa Hospital’s Gender Diversity Specialty Clinic is open on the third Friday of every month, but Dr. Druce hopes to grow the clinic and inspire other health-care providers to open clinics of their own.

“Our clinic is still slowly taking off, but even the fact that it exists is really important,” she says. “The hope is that eventually we’ll be able to show how successful we’ve been and inspire other health-care providers to take our lead.”

For Spencer, the clinic is already a success story. “Everybody there that I’ve ever dealt with has been absolutely stellar as far as their care and their attitude,” he says. “These people have been very empathetic, and they’ve seen things from my point of view. I’m in awe of our hospital. For anybody who’s transitioning or questioning their gender, I would definitely recommend this clinic to them.”

Helpful resources for the 2SLGBTQ+ community and allies

The Ottawa Hospital is committed to providing compassionate, relevant care to the 2SLGBTQ+ community. 2SLGBTQ+ is an initialism that stands for two-spirited, lesbian, gay, bisexual, transgender and queer, with the plus representing other sexual identities. Here are a few ways we’re addressing the unique care needs of this often overlooked population:

• New Research Chair in Gay Men’s Health is setting out to break down barriers to care : Physician-scientist Dr. Paul MacPherson shares his plans to make quality health care more accessible to gay men.
• How patients and family members are helping to infuse pride into The Ottawa Hospital’s DNA : Learn about four initiatives spearheaded by our Rainbow Patient and Family Advisory Committee (PFAC) that are helping to create safer spaces for the 2SLGBTQ+ community.
• The Trans Health Program at the Centretown Community Health Centre : Our clinic refers many patients to this program, which offers surgery referrals, adult counselling, hormone starts and more.

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