gender reassignment surgery ontario cost

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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.

New gender-affirming surgery clinic now accepting patients

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Plastic Surgeon Dr. Nicholas Cormier has dedicated nearly his entire career to caring for trans and non-binary patients.

The Ottawa Hospital understands that trans and non-binary people often face barriers accessing gender-affirming care. Faced with long wait times or even lack of access in the communities where they live, they may struggle to achieve their gender-affirming goals.

We are very pleased to announce that The Ottawa Hospital’s new gender-affirming surgery clinic is here to help. Launched in September 2023, it is the only clinic in Ontario and the second in Canada to offer all three of the following gender-affirming procedures:

• Facial surgery to make facial features more masculine or feminine
• Top surgery to remove breast tissue for a more masculine appearance or enhance breast size for a more feminine appearance
• Bottom surgery to transform the genitalia

The clinic’s lead and co-founder, Plastic Surgeon Dr. Nicholas Cormier, has some more wonderful news to share: “We’re currently accepting patient referrals from physicians,” he announces with a smile. “We’re ready to service Ottawa and the surrounding communities.” 

A truly collaborative effort

Before our clinic, patients seeking gender-affirming surgery in Ottawa could only access top surgery but not bottom or facial. Previously, a clinic in Montreal was the only location in Canada offering all three procedures.

“There’s just a massive gap in our health-care system for the treatment of the transgender population and people seeking gender-affirming care,” says Dr. Cormier. “What’s so groundbreaking about this new clinic is that everyone is coming together to address this shortcoming in our system.”

These partners include different surgical divisions at the hospital—plastic surgery, urology, obstetrics and gynecology—as well as trans health programs out in the community, such as the Centretown Community Health Centre’s Trans Health Program , which provides patients with a referral to our clinic, and CHEO’s Gender Diversity Clinic , which provided Dr. Cormier and his team with advice on setting up the clinic and also refers patients who have reached the age of 18.

These community programs are also important for the overall health and wellbeing of Ottawa’s trans and non-binary population. “Accessing gender-affirming surgery is just one small component of gender-affirming care,” says Dr. Cormier. “That’s where these community partners really come into play.”

Years in the making

For Dr. Cormier, the clinic is the culmination of many years of caring for the gender-diverse community.

“In my residency, I was always interested in gender-affirming care, and 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,” he recalls. “And I’m really excited about bringing that to my hometown of Ottawa.”

And Ottawa’s gender-diverse community is (literally) in good hands, says Dr. Daniel Peters, Division Head of Plastic Surgery at The Ottawa Hospital. “Dr. Cormier has dedicated nearly his entire career to caring for this often underserved patient population. He has learned from the best of the best in this field and has the compassion to match his expertise. He joined The Ottawa Hospital’s Division of Plastic Surgery not long ago, and yet he has already shown tremendous leadership by getting this clinic up and running. That’s really a testament to his passion for helping people on their gender-affirmation journeys.”

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Everything you need to know about getting top surgery in Canada

It can cost thousands of dollars more out of pocket to get top surgery in Ontario compared to B.C.

Credit: Getty Images, Brian Wong/Xtra

Top surgery. Chest construction. The tit eviction. The ol’ nip-nop chip-chop. The teet yeet. Whatever you call it, it can be a life-changing and affirming procedure for trans folks of all stripes. 

While it’s not necessarily important for everyone’s gender journey, the gender-affirming procedure colloquially known as “top surgery” is a big part of some trans folks’ medical transition . The COVID-19 pandemic gave many trans people the space to explore their identities and come out , and now they may be considering surgeries. 

But a number of first-person accounts and guides for getting top surgery in English-speaking countries focus on the United States, which has a vastly different medical system from Canada. South of the border, the procedure can run up huge medical bills—well into the tens of thousands of dollars. And doctors like Florida’s Charles Garramone can garner thousands of online followers and celebrity-level name recognition amongst trans social media users. 

@drgarramone The official TikTok channel for Dr. Charles Garramone #ftmtopsurgery #mansculpture #mansculpting #transgender #nonbinary #lgbtq #gendersurgery ♬ original sound – Dr. Charles Garramone

But here in Canada, it’s (mostly) free if you need it. Gender-affirming top surgery is covered in most provinces under our public health care system. And while that’s great news for trans folks, it doesn’t mean the process is totally easy. Not every province and territory currently has surgeons who perform the procedure, and the exact process of getting referred and paying for it ranges from jurisdiction to jurisdiction. Some provinces like British Columbia have centralized trans health care networks, while it’s the wild west in others. 

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Here’s everything you need to know if you’re considering top surgery in Canada.

What is top surgery? 

Top surgery is a procedure some trans and non-binary folks assigned female at birth choose to undergo in order to achieve a flatter and more traditionally “masculine” chest. It is technically different from a straight-up mastectomy, in that it usually involves some level contouring or intentional scar placement to create that “masculine” chest. 

There are several techniques used to achieve this, and they vary based on patient preference and chest size. Smaller chested individuals may be able to have tissue removed without damaging or moving the nipple and areola, while larger chested folks usually require the nipple to be removed and reattached (or they may choose to go nipple-less). 

A subcutaneous or periareolar mastectomy involves small incisions at the base of the nipples from which the tissue, fat and extra skin is removed. A double-incision mastectomy involves multiple incisions made on the chest in order for excess tissue and skin to be removed. The incisions are then closed together and the nipples can be reattached. 

You can talk about which technique is best for you with your surgeon. 

How do I get a referral for top surgery in Canada?

In most provinces, it starts with speaking with your family doctor or nurse practitioner. If you don’t have access to either, you can reach out to a local LGBTQ2S+ health group to discuss options for finding affirming medical professionals, or even to be directly connected to someone who can refer you. Rainbow Health Ontario or T hree Bridges Community Health Centre can connect you to top surgery referrals in Toronto and Vancouver, respectively. 

Gil Goletski, who lives in Metro Vancouver, didn’t have a family doctor when they started their top surgery process, so they went through Three Bridges. They say it was helpful to have all of their transition-related medical care filtered through the same place—and it be an affirming place at that. 

“Originally when I wanted to start hormones and they set me up with a doctor, I went to a couple of appointments with her and she started me on that process, doing the referral for surgery,” Goletski says.

During your referral appointment, you can expect to be asked questions around your feelings about your body, gender identity, dysphoria and goals for surgery or other aspects of medical transition. You’ll also talk about whether you’re able to take time off of work for the surgery and what sort of support networks you have in your life—it’s important to have a close friend, partner or family member who can pick you up from the hospital and help you out with tasks like bathing in the weeks post-op. 

You’ll also be asked about your health habits, particularly smoking. Some research has shown that smoking cigarettes can increase your risk of surgical complications, including nipple necrosis (the horror situation of your nipple falling off). 

While the process varies from province to province, your assessor will usually provide a determination either for or against surgery after your referral appointment, and then you move on to a surgeon.

What requirements must I meet to get top surgery in Canada?  

Barriers to accessing top surgery mostly come at the level of individual surgeons. You do not have to be on HRT (hormone replacement therapy) to get top surgery, though some surgeons recommend it in order to achieve a certain look. Similarly, weight or BMI (body mass index) should not technically prevent you from getting the surgery, but internalized fatphobia in the medical system can lead to certain surgeons rejecting you.

Many surgeons will perform top surgery on anyone, regardless of size, though they may warn you about some risks and possible complications. 

Some surgeons also recommend chest-related strength-building in the months ahead of surgery in order to give some muscle definition to guide the incisions. 

It’s important to remember that if a certain surgeon isn’t a fit for you, there is usually an option to see another. Goletski was initially matched with one Vancouver-area surgeon, who said they couldn’t do the procedure due to their history with marijuana smoking.

“My referral was rejected because I said that I smoked cannabis, and they rejected me outright not because I wouldn’t stop before surgery but just because I smoked cannabis at all,” they say. 

However, when matched with another surgeon, Goletski was told that wouldn’t be an issue as they stopped around the surgery date.

“When I eventually got surgery, it wasn’t a problem,” they say. “I was just told to stop smoking when I was healing and to do edibles or vaping instead of smoking. And that was all fine.”

Goletski also recommends that folks not be afraid to switch surgeons if a particular waitlist seems to be taking a long time, particularly in a province like B.C. where everything is centralized through an authority like TransCare B.C. They were matched to a second surgeon and languished on their waitlist for months, before getting on a third waitlist and getting in right away.

Nico Mara-McKay got top surgery in Ontario during the pandemic, and they say that the variance between medical professions means that you should be prepared to advocate for yourself. 

“Do your research beforehand to know what you want because they won’t tell you what you need,” they say. “Even if you think they might, do your research.” 

They said they ended up in a situation where they had to essentially dictate their referral to their doctor because the practitioner wasn’t well-versed in trans issues. They also point out that even knowledgeable doctors may not be up-to-date on the latest requirements. 

“I’m not on hormones, that’s not part of my journey,” they say. “But doctors might have that old information. Make sure that you know what the rules and regulations are, or whatever health care options you have within your specific sphere, because they do change.”

How much does top surgery in Canada cost?

Ostensibly, it’s free across Canada, just like other medically necessary surgeries. But there can be unexpected fees in certain regions. 

Mara-McKay got top surgery from a popular Ontario surgeon earlier this year, but say they were hit with a “contouring fee” part way through the consultation process that caught them by surprise. 

“For the removal of breast tissue, there’s no fee,” they say. “But if you want contouring to get rid of ‘dog tags’ that are on the side of the chest or, you know, shape the chest, then you have to pay for it. For me, it was about $3,000.”

It turns out that’s very common in Ontario. When reached by Xtra , Rainbow Health Ontario confirmed that, unlike in other provinces, the entire top surgery procedure is not covered by the provincial health plan; most Ontario surgeons will charge the contouring fee to the patient, in addition to the top surgery cost they bill to the province. 

Provincial funding from the government of Ontario only covers the basic mastectomy. However, it is usually not an option for a patient to get “just the free part,” which means Ontario patients like Mara-MacKay end up footing some couple thousands of dollars worth of surprise bills. According to Rainbow Health Ontario, this “contouring” fee is a result of public health policy in the province, and a decision to only fund part of the procedure at the provincial level. 

It’s good to ask your referrer or surgeon about any fees early in the process, so you can understand your options. For example, some Ontario patients actually choose to see surgeons elsewhere, such as in Montreal, in order to get publicly-funded surgery while avoiding the contouring fee. 

You should also be prepared to budget for the time off of work, which will vary depending on your job, as well as for any bandages, pain medications or other healing process needs recommended by your surgeon. 

Where can you get top surgery in Canada?

In most Canadian provinces, the procedure is covered, at least partially, by public health care, since it is a medically necessary procedure for some people to alleviate gender dysphoria. Most provinces also have surgeons who will do top surgeries, though their availability can vary. 

The process of accessing the surgery can vary based on provincial public health policy, funding and the number of forms you need to fill out. Here’s where you can learn more about getting top surgery in each province and territory. 

British Columbia: TransCare BC 

Ontario: Rainbow Health Ontario

Quebec: GRS Montreal  

Alberta: Alberta’s Gender Reaffirming Program

Saskatchewan: Saskatchewan Trans Health Coalition 

Manitoba: Sexuality Education Resource Centre MB

Nova Scotia: Nova Scotia Health

New Brunswick: New Brunswick Health

Prince Edward Island: PEI Health

Newfoundland and Labrador: Trans Support NL

Yukon: TransCare BC

Northwest Territories and Nunavut: NWT Health

Senior editor Mel Woods is an English-speaking Vancouver-based writer and audio producer and a former associate editor with HuffPost Canada . A proud prairie queer and ranch dressing expert, their work has also appeared in Vice , Slate , the Tyee , the CBC , the Globe and Mail and the Walrus .

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Transition Related Surgery

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

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

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

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

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

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

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

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

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

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

Surgeries Available

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

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

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

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

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

Plastic Surgery

John semple md, msc, frcs(c), facs .

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

Mitchell Brown MD, MEd, FRCS(C) 

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

Dr. Kathleen Armstrong

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

Urologic surgery

Ethan grober md, med, frcs(c) .

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

Yonah Krakowsky, MD FRCS(C)

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

Lisa Allen, MD, FRCS(C)

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

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

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

Making a Referral

To make a referral please submit.

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

Before making your referral ensure

The patient meets OHIP eligibility for surgery (unless contraindicated)

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

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

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

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

For OHIP Funding

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

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

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

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

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

Criteria for Surgery

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

Surgery Planned Visits

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

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

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

Gender History

Discuss the patients current gender identity and process of transition.

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

Goals for surgery

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

Detailed surgery discussion/capacity for informed consent

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

Readiness (medical and psychosocial)

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

Criteria for Transition Related Surgery

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

Surgery	1st Letter (MD/NP)	2nd Letter (NP/MD/ RN/MSW/ Psychologist)	Hormones	Medical and Mental Health Coniditons	Gender Role Experience
Mastectomy	x		Not a pre-requisite	“controlled”
Augmentation Mammoplasty	x		12 continuous months with no breast development	“controlled”
Gonad: Hysterotomy or Orchiectomy	x	x	12 continuous months	“well controlled”
Vaginoplasty	x	x	12 continuous months	“well controlled”	12 continuous months of living in a gender role congruent with gender identity
Phalloplasty/Medtoidioplasty	x	x	12 continuous months	“well controlled”	12 continuous months of living in a gender role congruent with gender identity

Provider Resources

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

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

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

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

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

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

Referral Process for Patients

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

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

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

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

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

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

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

Post Surgical Resources – Vaginoplasty

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

Post-Surgical Resources – Chest Surgery

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

Find a Surgeon

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

Home » Surgeon News

Canada Finally Has Nation-Wide Funding For Gender-Affirming Surgeries

With last week’s announcement from the Government of Nunavut confirming that the territory will pay for mental health services and transition treatments for transgender and non-binary residents, Canada will now have nation-wide funding available for gender-affirming surgeries. Nunavut’s Health Department is partnering with GrS Montréal to provide the surgeries.

Health care in Canada is delivered by the provinces and territories and funding for gender-affirming surgeries varies depending on where a person lives. This patchwork of coverage has resulted in barriers to accessing care that have disproportionately affected people living in Canada’s territories in the North, which includes Yukon, Northwest Territories and Nunavut. While expansion of surgery funding in Canadian provinces has continually progressed over the last decade, comprehensive coverage has only been established in the territories over the past three years.

Nation-wide coverage is obviously a very positive development but advocacy is still needed to continue the work of dismantling barriers for Canadians to access surgical care. Current challenges include:

Getting coverage across the country for Facial Feminization , Breast Augmentation and Male Chest Contouring , procedures that are excluded from funding policies in some jurisdictions.

Surgeons who practice gender-affirming genital surgery are only located in Montreal, Toronto and Vancouver. This means that many transgender and non-binary Canadians need to travel great distances to access surgeons for primary surgeries, follow-ups and specialized care for complications, incurring significant expenses that aren’t universally covered or subsidized.

Wait times are a problem that is not unique to gender-affirming surgical care in Canada but with few experts performing these surgeries patients can wait up to three years just for a consultation with a surgeon.

With the Government of Nunavut’s funding commitment, the goal of nation-wide coverage for gender-affirming surgery in Canada has been achieved. Improvements to provincial and territorial funding policies are still needed but this is a milestone to be celebrated.

Review Funding Policies by Province and Territory:

• British Columbia
• New Brunswick
• Newfoundland and Labrador
• Nova Scotia
• Ontario – PDF
• Prince Edward Island
• Saskatchewan – PDF
• Northwest Territories – PDF
• Nunavut – News article: GN transgender, non-binary health services a positive step
• Yukon – News article: Yukon’s new gender-affirming care policy is most comprehensive in Canada

First-of-its-kind Ottawa Hospital gender-affirming clinic now accepting patients

The Ottawa Hospital is now accepting referrals to its new state of the art gender affirming care clinic.

The clinic is the first of its kind in Ontario and second in Canada to offer trans and non-binary patients facial, top and bottom procedures.

The clinic will have life-changing implications for trans and non-binary individuals, who often face barriers to seek care with long wait times or lack of access in the communities where they live.

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"There’s just a massive gap in our health-care system for the treatment of the transgender population and people seeking gender-affirming care," said the clinic’s lead and co-founder, Dr. Nicholas Cormier in a news release .

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

Before the clinic was opened, patients seeking gender-affirming surgery in Ottawa could only access top surgery but not bottom or facial operations. Previously, a clinic in Montreal was the only location in Canada offering all three procedures.

The clinic will be partnering with other surgical divisions at the hospital—plastic surgery, urology, obstetrics and gynecology.

The hospital will also be working with trans health programs out in the community, such as the Centretown Community Health Centre’s Trans Health Program , which provides patients with a referral to the clinic and CHEO’s Gender Diversity Clinic .

For Dr. Cormier, the clinic is the culmination of many years of caring for the gender-diverse community.

"Accessing gender-affirming surgery is just one small component of gender-affirming care," Cormier said. "That’s where these community partners really come into play."

The Ottawa Hospital also launched the Gender and Diversity Specialty Clinic in January 2022, providing care for medically complex trans and non-binary patients.

some gender-affirming surgeries are available at other Canadian hospitals.

Women’s College Hospital has been increasing its capacity and growing its team in order to provide this life-saving care for its patients requiring gender-affirming surgeries. Its transition related team started out in 2019 with nurse practitioner Emery Potter and medical director. The team has since grown.

Vancouver General Hospital also offers top and bottom surgery.

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Stay Connected

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:

If you are in an emergency, in crisis or need someone to talk to, there is help.

Gender Identity Clinic

The Gender Identity Clinic offers services to individuals and their primary care practitioners in regard to gender identity and expression.

Individuals over 17 who wish to explore issues related to their gender identity, which may include any degree of transgender expression.

Community professionals looking for support and consultation to help their clients reach their goals related to gender identity and expression.

Ask your health care provider to fill out the CAMH adult referral form. Here is a link to the online referral form . Forms should be faxed to Access CAMH at 416 979-6815. If you have any questions about the referral process, call Access CAMH at 416 535-8501 and press 2.

Types of Treatment and Services Offered

For individuals, consultation and support may include:

• diagnostic assessments in support of affirming a diagnosis of Gender Dysphoria in support of transition related surgeries. 
• individual support and treatment *Please note that our clinic does not offer long-term therapy
• surgical and hormone eligibility assessments *Please note that our clinic does not prescribe hormones
• group-based services

If you are interested in accessing LGBTQ2S affirmative psychotherapy, please check the service provider listing at Rainbow Health Ontario to find out options for psychotherapy in your region. 

For community professionals, consultations may include:

• completing a mental health assessment
• consultation with regard to completing a surgery referral assessment
• being a second assessor for surgery referrals

Program Overview

The Gender Identity Clinic at CAMH offers specialty services to both individuals and their primary care practitioners in Ontario with regard to issues related to gender identity and expression, including gender expansive, trans and non-binary identities. The program offers a comprehensive response to the variety of clinical issues experienced by clients. The clinical team is interdisciplinary and includes social work, psychiatry and psychology staff with specialized expertise in trauma-informed mental health and addiction care.

Our Services

For community professionals.

Primary care providers can diagnose for gender dysphoria, prescribe transition-related hormones, and refer for transition-related surgeries. If you are new to the field of trans care, Rainbow Health Ontario provides education, clinical support, and mentorship to primary care providers across Ontario. All courses provided by Rainbow Health Ontario are Mainpro+ certified. Please visit learn.rainbowhealthontario.ca for more information on courses offered at this time.

Rainbow Health Ontario also hosts a free bi-monthly Trans Health Mentorship Call to support clinicians in their practices. To register for this call, please visit learn.rainbowhealthontario.ca

IMPORTANT: Rainbow Health Ontario does not accept referrals or provide direct services of any kind.

Hormone Therapy

We would encourage referring physicians and/or nurse practitioners to consider prescribing hormone therapy (HT) for their trans clients.

If you are unsure about prescribing HRT:

• We recommend that you review the published Guidelines and Protocols for Comprehensive Primary Health Care for Trans Clients available through Sherbourne Health Centre , and review the WPATH Standards of Care
• If, after reading this document, you feel confident in your knowledge of HT, then you can prescribe in advance of the client’s initial assessment. If HT is your client’s sole gender goal, then there is no need to access the clinic once hormones have been prescribed. 
• If you are aware of complicating medical concerns and these medical concerns have prevented the initiation of hormone therapy, please consider making a referral to endocrinology on the client’s behalf.
• If you are interested in training to develop further competency in health care for trans clients, please contact Rainbow Health Ontario, which will take you to various training opportunities offered by that organization throughout the province of Ontario.

*If hormone replacement therapy is the primary reason for referral, we would ask that you consider these above-mentioned recommendations, as it will help to reduce unnecessary waiting for your client in terms of further medical transition.*

The clinic plays a significant role in training health professionals in culturally competent delivery of mental health assessment and treatment services to trans and gender expansive communities. We train and provide practicum and residency opportunities for social work students, psychologists and people from other health disciplines, including more than 10 PhD-level clinical psychologists over the past five years.

Consultation

Additionally, we provide support and consultations to primary care practitioners and other health care providers to help their clients reach their goals related to gender identity and expression. This may include consultations in regard to completing a mental health assessment, consultation in regard to completing a surgery readiness assessment, or being a second assessor for surgery readiness. The clinic will work collaboratively with you and your organization/practice to help you meet your client’s goals. Clinicians and organizations wanting consultation by the clinic for clients currently on our waitlist can contact our clinic at 416 535-8501 ext. 30985.

We have also launched an ECHO (Extension for Community Healthcare Outcomes) for trans and gender diverse health care . Please consider joining us for free CME-accredited training and consultation.

For Individuals

The clinic offers consultations and support to individuals over 17 years of age who wish to explore issues related to their gender identity, which may include any degree of transgender expression. Clients are seen for an assessment with one of our team members to determine the client’s transition goals, as well as to provide any diagnostic impressions regarding mental health and substance use. Recommendations about how to assist clients in meeting their transition goals are then made. This may include individual support and treatment, group-based support and treatment, as well as recommendations for surgery funding and referrals for clients seeking transition-related surgeries. The clinic follows the World Professional Association for Transgender Health Standards of Care (WPATH),V7 for transition-related surgery (TRS) .

Rainbow Health Ontario has an Ontario Service Provider Directory where you can search for a provider by region. Please go here to find a provider in your area.

If you cannot find anyone in your area after searching the provider directory, you can contact [email protected] . Please note that Rainbow Health Ontario cannot guarantee there will be a provider in your area to prescribe hormones or refer for surgeries.

Additionally, Rainbow Health Ontario’s Trans Health Knowledge Base can provide you with answers to general questions related to navigating the Ontario health care system. Go here for more information . 

For clients living outside the GTA

Given the context of the Covid-19 pandemic, our clinic provides virtual appointments via the Webex platform.

Given our referrals come from across the province, our clinic is equipped to see clients via telemedicine when possible. Typically, the first assessment in our clinic is in person in Toronto, and subsequent appointments for clients who live outside of the GTA may be made using telemedicine.

If you live in the north, you may be eligible for a Northern Travel Grant to cover basic travel costs to and from your appointments with CAMH. If you are an ODSP recipient, you may similarly be eligible to have basic travel costs reimbursed. Please ask your local provider for further details.

Transition-Related Surgery (TRS) - Frequently Asked Questions

T hese FAQ's are designed to provide a brief overview of the assessment and referral process in Ontario for persons considering gender-affirming surgeries funded by the Ministry of Health and Long-Term Care (MOHLTC). For more information on types of surgery, see the TRS Surgical Summary Sheets update .

For specific questions or more detailed information pertaining to gender-affirming surgeries, please don't hesitate to contact our office at 416 535-8501 ext. 30985.

Significant improvement in wait times for assessment

From 2008–2016 the Ministry of Health and Long Term Care (MOHLTC) regulation stipulated that CAMH was the sole assessment site for OHIP-funded transition-related surgery (TRS) (from 1998-2008 TRS was not funded by OHIP). In March 2016, the MOHLTC introduced a regulation change that improves and expands access to assessment for TRS for Ontarians, empowering primary care providers to provide surgery referrals and assessments. CAMH and its community partners championed this expansion of access to assessments for gender-affirming surgery. In anticipation of this important system change, CAMH partnered with Sherbourne Health Centre (including Rainbow Health Ontario) and Women’s College Hospital on a proposal to expand access to surgery-related care. Thanks to funding from the MOHLTC, the Trans Health Expansion (THEx) partnership is working on several key priorities including improving access to assessment, building capacity of primary care providers, and enhancing access to surgery and post-surgical recovery and support.

The funding helped our clinic to hire new staff members and in doing so, we were able to significantly decrease wait times for assessment. Prior to March 2016 the wait for assessment was over 30 months, and to date it is less than one-third of that. We continue to work to see more clients and reduce the current wait times.

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Gender Reassignment / Gender Reassignment: Male-to-Female (MTF)

Facial feminization surgery and MTF breast augmentation are some of the most exciting components of your transition - an opportunity for you to begin visualizing the face and body of the real you. Dr. Marc DuPéré offers a number of options that can be customized to your own journey, from subtle nonsurgical improvements to full-body transformations.

MTF chest surgery is often quite straightforward, but some people will require tissue expansion prior to having breast implants inserted. Dr. DuPéré will discuss this with you in detail at your consultation.

Dr. DuPéré performs breast augmentation, and you have many choices regarding your final look. For example, the decision between silicone and saline breast implants can be daunting, as they both have their advantages. For example, while many people feel silicone implants yield results that look and feel more natural, others are drawn to the saltwater filling and lower cost of saline. Only you can decide which option is right for you, although Dr. DuPéré guides you through the decision-making process to ensure you make the best choice for your body and lifestyle.

Breast augmentation is performed while you are completely asleep under general anesthesia. Dr. DuPéré makes an incision around the lower edge of your areola, in your armpit, or in the area where your breast crease will be. He creates a pocket in the tissue and inserts the implant. Dr. DuPéré uses a device called the Keller Funnel, which eliminates direct contact with the implant. This minimizes the risk of infection and later complications.

Recovery & Results

MTF breast augmentation patients should expect to be comfortably back to work within about 1 week. If you work at a more physically demanding job, you may need to take longer or work a modified schedule. It’s also important to refrain from strenuous physical activities, especially those that involve your upper body, for about 6 weeks after surgery.

Immediately after your breast surgery, you may notice that your breasts look high or tight on your chest. This is normal. Because this surgery is typically performed on patients with very little existing breast tissue, it takes some time for the skin and surrounding tissues to acclimate to the presence of the implant. Over time, the tissues will soften and the implants will sink to more natural-looking positions on the chest. This process is gradual and can take several months.

Other Options

Frontal Bossing Reduction | Frontal bossing reduction, also known as forehead contouring or brow ridge reduction, is a surgical technique designed to soften the masculine feature on the forehead and create a more feminine and harmonious facial structure.  

Hip Augmentation  | Hip implants can create the soft, sexy contours that form the base of an hourglass figure.

Buttock Augmentation | Whether through Brazilian butt lift or buttock implants, buttock augmentation can improve the shape and size of your buttocks for beautiful softness.

Fat Grafting | Your own fat, taken from another area of your body, can be used to enhance your breasts, face, and more.

Liposuction | Selectively remove unwanted fat deposits and improve your curves with liposuction. Dr. DuPéré uses a special technique that minimizes contour irregularities.

Brow Lift | This facial procedure can be used to lower the hairline and reduce the visual weight of a heavy brow.

Nose Refinement | Better known as rhinoplasty, this surgery is appropriate for MTF patients because it can feminize the nose.

Dermal Fillers | These injectable products can be used to subtly augment the cheeks or lips for attractive, soft facial curvature or a beautiful pout.

Dr. DuPéré also performs the tracheal shave procedure to reduce the look of a prominent Adam’s apple. He will cover all of your options for you during your personal, candid consultation.

No matter where you are in your transition, Dr. DuPéré has the tools and the sensitivity to meet you where you are. Request your consultation right here on our website, or call Visage Clinic at (416) 929-9800 to schedule your visit.

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What Is Facial Feminization Surgery, aka FFS?

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Breast Implants: The Consult, Decision, and Recovery

Ontario expands referrals for gender reassignment surgery

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The Ontario government will move to allow more health-care providers to provide patient referrals for sex-reassignment surgeries, a move Health Minister Eric Hoskins said will reduce long wait times currently faced by transgender people.

Hoskins made the announcement at a Friday news conference at the Sherbourne Health Centre in Toronto.

​Patients can currently only receive a referral for surgeries paid for by the province's health-care plan through the Gender Identity Clinic program at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Hoskins said the province wants to allow all qualified health-care providers throughout the province to be able to refer patients for this surgery starting in 2016.

"Every Ontarian has the right to be who they are," said Hoskins. "Our health care system should reflect this vision, which is why we are improving access to sex-reassignment surgery."

He said more and more Ontarians are experiencing gender dysphoria, defined as the distress caused by a discrepancy between a person's gender identity and that person's sex assigned at birth. Patients who need surgery often face long wait times. 

2-year waitlist

"One of the most vulnerable times for trans people is when they are ready for surgery, but face a prolonged wait," said Hoskins. "This change would reduce wait times by allowing many trans clients to get surgical approvals from their own local primary care teams."

The wait list for gender reassignment surgery currently stands at more than 1,000 people. The referral wait time in Ontario is typically now more than two years, a wait that will be "dramatically" reduced as a result of the changes, said Hoskins.

Hoskins said the new referral process for gender reassignment surgery will still be based on existing criteria and internationally recognized standards of care. He also said the number of people in Ontario asking for gender identity services has been on the increase in recent years.

"We are moving from a single site [for referrals] to what could potentially be hundreds of sites," he said. 

The changes to allow local referrals will come in the form of amendments to the Health Insurance Act. Hoskins said the government will provide additional funds to CAMH while the transition to local referrals takes place. 

Patients will still head out of province for surgeries

Dr. Amy Bourns, whose practice includes a special interest in transgender health, said the announcement is "an amazing step forward." 

Hoskins was asked about the fact that gender-reassignment surgeries are currently not available in Ontario, even for patients who complete the long referral process. Many Ontario patients go to Quebec or other jurisdictions to have the surgery. 

"We need to look at the provision of the surgical services and we're looking at that," he said, pointing out the expanding referrals to health-care providers across Ontario as a "first step."

Dr. Amy Bourns at the announcement to expand referrals for gender reassignment surgery

Related stories.

• Thunder Bay transgender teen wants others to know they're not alone

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How Much Does Gender-Affirming Surgery Cost?

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Gender-affirming care encompasses a broad range of psychological, behavioral and medical treatments for transgender, nonbinary and gender-nonconforming people.

The care is designed to “support and affirm an individual’s gender identity” when it is at odds with the sex they were assigned at birth, as defined by the World Health Organization.

What is gender-affirming surgery?

Gender-affirming surgery refers to the surgical and cosmetic procedures that give transgender and nonbinary people “the physical appearance and functional abilities of the gender they know themselves to be,” according to the American Society of Plastic Surgeons. It is sometimes called gender reassignment surgery.

There are three main types of gender-affirming surgeries, per the Cleveland Clinic:

Top surgery , in which a surgeon either removes a person’s breast tissue for a more traditionally masculine appearance or shapes a person’s breast tissue for a more traditionally feminine appearance. 

Bottom surgery , or the reconstruction of the genitals to better align with a person’s gender identity.

Facial feminization or masculinization surgery , in which the bones and soft tissue of a person’s face are transformed for either a more traditionally masculine or feminine appearance.   

Some people who undergo gender-affirming surgeries also use specific hormone therapies. A trans woman or nonbinary person on feminizing hormone therapy, for example, takes estrogen that’s paired with a substance that blocks testosterone. And a trans man or nonbinary person on masculinizing hormone therapy takes testosterone.

Gender-affirming surgeries and treatments are the recommended course of treatment for gender dysphoria by the American Medical Association. Gender dysphoria is defined as “clinically significant distress or impairment related to gender incongruence, which may include desire to change primary and/or secondary sex characteristics,” according to the American Psychiatric Association.

Some LGBTQ+ advocates and medical professionals feel that gender dysphoria shouldn't be treated as a mental disorder, and worry that gender dysphoria’s inclusion in the DSM-5 — the authoritative source on recognized mental health disorders for the psychiatric industry — stigmatizes trans and nonbinary people.

How much does gender-affirming surgery cost?

Gender-affirming surgery can cost between $6,900 and $63,400 depending on the precise procedure, according to a 2022 study published in The Journal of Law, Medicine and Ethics.

Out-of-pocket costs can vary dramatically, though, depending on whether you have insurance and whether your insurance company covers gender-affirming surgeries.

There are also costs associated with the surgery that may not be represented in these estimates. Additional costs may include:

Surgeons fees

Hospital fees

Consultation fees

Insurance copays

The cost of psychiatric care or therapy, as most insurance companies and surgeons require at least one referral letter prior to the surgery. An hour of therapy can cost between $65 and $250, according to Good Therapy, an online platform for therapists and counselors. 

Time off work. After bottom surgery, you can expect to miss six weeks of work while recovering. Most people miss around two weeks of work after top surgery. 

Miscellaneous goods that’ll help you recover. For example, after bottom surgery, you might need to invest in a shower stool, waterproof bed sheets, cheap underwear and sanitary towels. Top surgery patients may need, depending on the procedure, a mastectomy pillow, chest binder and baggy clothes.

Is gender-affirming surgery covered by insurance?

It’s illegal for any federally funded health insurance program to deny coverage on the basis of gender identity, sexual orientation or sexual characteristics, per Section 1557, a section of the Affordable Care Act. Section 1557 doesn’t apply to private insurance companies, though, and several U.S. states have passed laws banning gender-affirming care.

The following states have banned gender-affirming surgery for people under 18 years old, according to the Human Rights Campaign: Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, West Virginia. In four of these states — Alabama, Arkansas, Florida and Indiana — court injunctions are currently ensuring access to care.

And these states have either passed laws — or have governors who issued executive orders — protecting access to gender-affirming surgery, according to the Movement Advancement Project, a public policy nonprofit: California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, Vermont and Washington, D.C.

But even if your state has enshrined protections for gender-affirming care, some private insurance companies may consider surgeries “cosmetic” and therefore “not medically necessary,” according to the Transgender Legal Defense and Education Fund. If you have private insurance or are insured through your employer, contact your insurance company and see if they cover gender-affirming care. Also, ask about any documentation the insurance company requires for coverage.

The Williams Institute estimates that 14% of trans Americans currently enrolled in Medicaid live in states where such coverage is banned, while another 27% of trans Americans live in states where coverage is “uncertain,” because their state laws are “silent or unclear on coverage for gender-affirming care.”

Because of Section 1557, Medicaid is federally banned from denying coverage on the basis of sex or gender; among the roughly 1.3 million transgender Americans, around 276,000 have Medicaid coverage, according to a 2022 report from the Williams Institute.

How to pay for gender-affirming surgery

If your private insurance company won’t cover gender-affirming care, and you’re unable to obtain coverage through the federal marketplace, consider these sources:

Online personal loan.

Credit union personal loan.

Credit card.

CareCredit.

Home equity line of credit.

Family loan.

There are also several nonprofits that offer financial assistance for gender-affirmation surgeries. Those organizations include:

Point of Pride , which offers grants and scholarships to trans and nonbinary people seeking gender-affirming surgery and care.

The Jim Collins Foundation , which raises money to fund gender-affirming surgeries. 

Genderbands , which offers grants for gender-affirming surgeries and care. 

Black Transmen Inc. , which funds gender-affirming surgeries for Black trans men. 

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How to afford transgender surgery expenses.

Updated: Nov 11, 2022, 2:00pm

Transgender surgeries—also called gender affirmation or gender confirmation surgeries—are medical procedures you can undergo to affirm your gender identity.

The cost of these kinds of surgeries are often steep, and health insurance coverage for them can vary by policy. “Even if a procedure is covered by insurance, there are still deductibles and out-of-pocket maximums,” said Wynne Nowland, CEO of Bradley & Parker, who transitioned at 56. Surgeries that are solely cosmetic might not be covered by insurance at all.

The good news is that several financing options are available to help you pay for procedures. Some organizations even offer grants and scholarships that can help you afford surgery costs.

How Much Does Transgender Surgery Cost?

The cost of transgender surgery can vary by provider and the type of surgery you choose to get. For a female-to-male transition, masculinization chest surgery (also known as top surgery) might cost $3,000 to $10,000 while chest surgery for a male-to-female transition could cost $5,000 to $10,000, according to Longwood Plastic Surgery.

Bottom surgeries, such as vaginoplasty or phalloplasty, can cost $25,600 and $24,900, respectively, according to estimates from The Philadelphia Center for Transgender Surgery. Additional procedures can increase the transition expenses from there. Aside from the actual surgery cost, other hidden expenses can arise as well.

For example, you could need help at home while in recovery if you don’t have a good support system, according to Nowland. There may also be travel and hotel expenses, which are typically not covered by insurance. Nowland says the best way to prepare for surgery is to reach out to insurance to discuss coverage and plan on saving the funds you’ll need to proceed.

If you’re considering borrowing money to pay for surgery and recovery costs, here are four options to consider.

Related: Does Being Transgender Affect Life Insurance?

4 Ways to Finance Transgender Surgery Costs

Personal loans, credit cards, medical credit cards and home equity loans are products you could use to pay for transgender surgery costs over time. Here’s what you need to know about each:

Personal loans are typically unsecured installment loans that provide a lump sum you can use for almost any legal personal expense, including medical bills. Lenders may offer loans of $1,000 to $100,000. However, your credit and income can affect how much you can borrow and your interest rate.

The average annual percentage rate (APR) for a five-year personal loan is 15.93% as of Sept. 19, 2022, but rates can go up to 36% APR. The good news is that many lenders let you prequalify for personal loans online without a hard credit check , allowing you to shop around for rates and compare costs before borrowing.

Credit Cards

Credit cards give you access to a credit line you can use to cover medical bills. You’ll then pay off the balance over time. While certain credit cards have annual fees, many don’t. Some credit cards even offer an introductory 0% APR for a number of months when you open a new account.

Standard interest applies after the interest-free period, but charging and paying off procedures during the interest-free period could be an affordable way to finance bills. That said, credit cards are usually best for expenses you can repay relatively quickly since interest rates can be higher than personal loans, so maintaining a high balance over several years can get costly.

Medical Credit Cards

Medical credit cards are designed specifically for medical bills and could be a financing option recommended by your doctor’s office.

CareCredit is a popular medical credit card that offers no-interest financing plans of six, 12, 18 or 24 months on transactions over $200. There’s a catch, though: If you don’t pay off the balance during the financing period, interest is charged retroactively from the time of your purchase.

For purchases of at least $1,000, CareCredit offers extended financing terms of 24, 36, 48 or 60 months. The APR for payment plans is fixed and ranges from 14.90% to 17.90%, depending on how much you borrow and the loan term you choose.

Home Equity Loans or Lines of Credit

If you own a house, home equity loans and home equity lines of credit (HELOCs) are ways to borrow from the equity you’ve built up. Here’s how both of these options work:

• Home equity loans: A home equity loan is an installment loan that lets you borrow money in a lump sum, which you could use to cover transgender surgery costs. Homeowners are typically able to borrow up to 85% of home equity, and loan terms can range from five to 30 years.
• HELOCs: These are lines of credit you can draw from and pay down with a variable interest rate. A HELOC could be a better alternative to a home equity loan if you have ongoing costs as it will give you the flexibility to borrow only what you need and pay it back as you go.

The advantage of home equity products for medical expenses is that interest rates may be lower than unsecured personal loans since the collateral (your home) backing minimizes risk for the lender.

However, since your home secures the transaction, you could lose your house if you can’t keep up with loan payments. If the value of your home decreases, there’s also a chance you could go underwater on the house if you end up owing more on your mortgage and loan than the home is worth.

Can You Get Transgender Surgery Grants?

Several organizations offer grants to help cover transition costs, including gender-affirming surgery, which is money you don’t have to pay back. Requirements for grant funding can vary, but in some cases, you need to show that you’ve saved up some money on your own for the surgery to be awarded money. Here are a few examples of organizations offering grants:

• Jim Collins Foundation : The Jim Collins Foundation offers two grants. General Fund grants can cover all gender-affirming surgery costs while Krysallis Anne Hembrough Legacy Fund grants can cover 50% of surgery costs for recipients who match the grant funds awarded.
• Point of Pride : Point of Pride offers an annual scholarship-like program that provides financial assistance for gender-affirming surgery.
• The Loft LGBTQ+ Community Center : TransMission grant funds through the Loft LGBTQ+ Community Center aren’t enough to cover the full cost of surgery. However, grants may be used to help pay for therapy, hormones and other transition expenses.

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Tips to Pay For Transgender Surgery Expenses

As you come up with a plan and explore ways to pay for surgeries, here are a few tips to consider:

• Double-check your insurance policy. Read policy terms carefully and reach out to your insurer to ask about what surgeries are covered. “Like all covered insurance procedures, expect to deal with some red tape, but your patience in doing so will be worth it,” said Nowland.
• Use a health savings account (HSA) or flexible spending account (FSA). HSAs and FSAs are both tax-advantaged accounts designed to help you stash money for medical expenses, which could include gender-affirming surgeries. You can make pre-tax contributions to both accounts from your salary if you set them up with your employer. If you set up an HSA on your own, you can deduct contributions from your tax return.
• Consider crowdfunding. Crowdfunding is when you set up a campaign to raise funds. If you prefer to keep medical procedures private, creating a campaign and asking for donations may not be the right route to take. But if you feel comfortable sharing your story, setting up a GoFundMe or Fundly fundraising page could be a way to cover the cost of your surgeries. Bonfire is another site you can use to fundraise by selling customized t-shirts.
• Get support from family and peers. If you have friends or family able to gift or loan you money, it can be more affordable than taking out a loan from a bank, online lender or credit union.

How to Save Up for Gender Affirming Surgery

Using a combination of funding sources is a strategy that could help you rely less heavily on loans.

Different surgeons charge different fees, so compare prices to project costs. From there, you can determine how much you’ll need to save and by when. If you don’t use an FSA or HSA to save, consider stashing your savings for surgery in a high-yield savings account so your savings earn more interest than it would in a traditional savings account.

Certain savings tools can make setting aside money easier. For example, banks often have recurring transfer features you can set up to automatically move money from a checking account to your savings on a schedule. Plus, savings apps like Digit exist, which can connect to your bank account, use an algorithm to review your cash flow and put spare money away for you automatically. Your savings can grow over time, so you can pay for treatment and surgery as you go.

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Gender Confirmation Surgery (GCS)

What is Gender Confirmation Surgery?

• Transfeminine Tr

Transmasculine Transition

• Traveling Abroad

Choosing a Surgeon

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

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

Ellen Lindner / Verywell

Transfeminine Transition

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

Gender confirmation procedures that a transfeminine person may undergo include:

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

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

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

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

Gender confirmation procedures that a transmasculine person may undergo include:

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

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

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

Paying For Gender Confirmation Surgery

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

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

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

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

Traveling Abroad for GCS

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

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

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

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

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

A Word From Verywell

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

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

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

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

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

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

American Society of Plastic Surgeons. Rhinoplasty nose surgery .

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

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

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

Ontarian takes OHIP to court for gender-affirming surgery funding

An Ontario resident is fighting the government to secure public funding for a specialized gender-affirming surgery argued to be "experimental" by the provincial health insurer.

The prospective patient, identified only as K.S. in documents filed with the provincial Health Services Appeal and Review Board (HSARB), is seeking coverage under the Ontario Health Insurance Plan (OHIP) for a penile-preserving vaginoplasty, a procedure in which a vaginal cavity is surgically created while keeping the penis intact. 

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“There have been so many times that I have had to justify myself to just be,” K.S. told CTV News Toronto in a statement submitted through her counsel. “People who aren’t trans or nonbinary don’t have to get that permission to exist.”

K.S., whose identity is protected under a publication ban, identifies as nonbinary. She presents as predominantly female and uses she/her pronouns, but does not align with the gender binary.

The procedure she seeks is not widely practiced. In what most consider a traditional vaginoplasty, the erectile tissue is inverted to create a vaginal cavity. In a penile-preserving vaginoplasty, the vaginal cavity is created using a skin graft instead. There is currently no peer-reviewed research on the outcomes of the technique, only offered by a small number of private clinics, none of which are in Canada.

Since 2023, K.S. has been engaged in a series of appeals put forth to the review board following an initial denial by OHIP to cover the surgery.

Having experienced gender dysphoria since her teenage years, K.S. first applied for funding in 2022, seeking to have the surgery performed at the Crane Center for Transgender Surgery in Austin, TX. OHIP denied her request, claiming it wasn't included in the list of insured services under OHIP. 

Without coverage, K.S. said undergoing the procedure would be nearly impossible – it costs tens of thousands of dollars that she doesn’t have.

READ MORE : What gender-affirming care is and how it can be life-saving

The legal battle that has played out in front of the review board has seen K.S. repeatedly make her case for why such a specialized procedure is medically necessary, measuring years of suffering through gender dysphoria against the assumed risk of a procedure not yet in the mainstream.

“The absurdity of managing to get through all the unjustly imposed barriers only to still be told that my surgical request is not valid has been heartbreaking,” she said.

When reached for comment, the Ministry of Health, which oversees health insurance in Ontario, said it could not comment on cases that are before the review board.

The case unfolds a critical juncture for transgender care in Canada  — just weeks ago, Alberta unveiled sweeping policy changes including a ban for all gender-affirming surgeries for minors aged 17 and under  — and, according to experts, could stand to inform national conversations of access to healthcare faced by non-binary population across the country.

Legal lens on gender identity

With no options to secure the surgery outside of insurance, K.S. appealed the government’s initial denial of funding in April 2023 .

“I felt I had no choice," she said. “There quite literally is no ‘do or don’t’ when it comes to treating gender dysphoria.”

Throughout the two-day hearing, lawyers representing the province argued that for a vaginoplasty to be considered an insurable service, a patient also needed to undergo a penectomy, as is considered the standard of practice in Ontario.

It called upon Dr. Yonah Krakowski, a sexual medicine surgeon at Women’s College Hospital, to provide expert testimony. Krakowski said that, while he supports patient autonomy, he believed wider expert opinion would deem the procedure sought by K.S. as “experimental” at this time.

Self-represented, K.S. argued, in part, that the denial singled her out based on gender identity and that nowhere in the provincial legislation or regulations was it a requirement that someone transition from one binary gender to another in order to be eligible for funding.

During the hearing, K.S. put forth “impressive legal challenges,” lawyer John McIntyre told CTV News. McIntyre, now representing K.S. in OHIP’s recent appeal.

“The process was incredibly challenging for her, as she was not only up against lawyers and the government, but she was having to fight against the view that her identity was not valid,” McIntyre said.

The challenge proved worth it – five months later, the three-person review panel ruled in K.S.’ favour . Her procedure, now deemed an insured service, would be paid for.

The victory didn’t come easily, K.S. said. “More than once during the legal process, the impacts of statements and opinions expressed by OHIP and its lawyers drove me to tears, messed with my sleep, and caused significant anxiety, unintended weight loss, and chest pains,” she said.

But it wasn’t long before OHIP filed its own appeal. Now, despite the unanimous ruling last year in her favour, K.S. must make her case for the panel for a second time — the thought of which brings her “despair.”

“The very idea that one should have to endure the significant legal process after already having to fight every single aspect of the medical system to just meet the criteria is unfair,” she said.

McIntyre called his client one of the “bravest people” he’s ever met.

“The only reason why she keeps pushing is the hope she can protect other trans and nonbinary folks from having to endure the same problems,” he said.

The case reflects wider issues: experts

This time, K.S. isn’t alone in her fight for funding. McIntyre and Egale, a non-profit organization advancing equality and justice for LGBTQ2S+ Canadians, are helping her navigate OHIP’s appeal.

In early January, Egale signed on as an intervenor in the case .

"The concern I have is this a tendency to treat these requests [...] as experimental," counsel for Egale, Daniel Girlando, told CTV News Toronto.

Girlando said the organization decided to step in, in part, because it feels that the ability to express one’s self in a way that doesn’t “necessarily reflect a binary gender” is important. “That means that some [OHIP applicants] will have customized requests,” he said.

The lawyer pointed to the World Professional Association of Transgender Health (WPATH), a leading authority on gender-affirming medical and surgical care, for guidance in this case. The WPATH’s Standard of Care guidelines note that “gender diverse presentations may lead to individually customized surgical requests some may consider ‘non-standard.’”

“In this evolving world, where standards are fast-changing and when we’re dealing with a small number of population, are we supposed to wait, what, years before there is enough data to deem these procedures experimental?” Girlando questioned.

Some experts say that’s exactly what Ontario should do.

Kinnon MacKinnon, an assistant professor at York University who studies the intersection of healthcare and gender, said in this case, the province will have difficulty establishing a risk-to-benefit ratio, as it has no data to draw from.

“In terms of medical ethics, clinical decision making, and funding, the risk-to-benefit ratio has to be favourable and with there being no studies, it would be hard to make the argument that the procedure is medically necessary,” he told CTV News in an interview last week.

“I think the priority right now should be to collect higher quality and long-term outcomes data to inform better care because I think we need a better sense of long-term outcome following certain surgeries,” he continued.

K.S. agrees more data collection is needed, but claims the province is failing to invest in the effort.

"They never get to collect the data because people like me are generally firewalled before we can get there," she said.

While K.S. said the harm done to her over the last two years has been “irreparable," she hopes to pave the way for others to express themselves freely. 

“Our fundamental existence is not optional," she said. "There’s a reason we see higher suicide rates for trans and non-binary people, and a positive ruling will save lives."

OHIP’s appeal will be heard virtually on Feb. 27.

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