A brief introduction to transition-related surgeries in Ontario, Canada

OHIP-Coverage

OHIP covers select pre-approved surgeries: genital and chest.

To qualify, 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

If you pay out of pocket before approval, the Ministry will not reimburse you.

Before 2016, the process for transition-related surgeries must be assessed only at CAMH in Toronto. This is no longer the case. After March 2016, qualified healthcare providers can assess patients for surgery. A qualified healthcare provider can be:

  • Physician (family doctor or specialist)
  • Nurse Practitioner (NP)
  • Registered Nurse (RP)
  • Psychologist
  • Registered Social Worker (with a Masters degree)

Note that one of the assessments for genital surgery approval must come from a physician or nurse practitioner.

OHIP-Funded Surgeries

  • Vaginoplasty
    • Includes penectomy, orchidectomy, clitoroplasty, and labiaplasty
  • Phalloplasty
    • Includes vaginectomy, urethroplasty, glansplasty, and penile & testicular implants
  • Metoidioplasty
    • Includes vaginectomy and urethroplasty
  • Clitoral release with vaginectomy
  • Testicular implants with scrotoplasty
  • Hysterectomy (removal of the uterus)
  • Salpingo-oophorectomy (removal of the tubes and ovaries)
  • Orchidectomy
  • Mastectomy (includes removal of breast tissue, excess skin, and proper positioning of nipple and areola)
    • OHIP will only cover the mastectomy part of chest surgery. Any masculinisation must be paid by the patient and will vary from surgeon to surgeon.
  • Breast Augmentation (has strict criteria: must have completed 12 months of hormone therapy with no breast enlargement and remain at Tanner Stage 1)

What doesn’t OHIP cover?

  • Chest contouring/masculinisation
    • OHIP will only cover the mastectomy part of chest surgery. Any masculinisation must be paid by the patient and will vary from surgeon to surgeon.
  • Breast augmentation for people with breast growth past Tanner Stage I after 12 months of hormone therapy
  • Facial masculinisation
  • Facial feminisation
  • Electrolysis
  • Laser hair removal
  • Hair transplants
  • Tracheal shave
  • Voice modification surgery
  • Liposuction
  • Chin, nose, cheek, or buttock implants
  • Travel and accommodation costs related to obtaining surgery
  • Supplies related to post-surgery care

Surgery Approval

The approval process for genital and chest surgery differs.

Genital Surgery

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

  • two assessments recommending surgery (from a qualified doctor, nurse practitioner, registered nurse, psychologist or registered social worker)
    • one of the assessments must be from a doctor or nurse practitioner
  • both assessments must confirm:
    • 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)

Chest Surgery

To be approved for chest surgery you’ll need:

  • one assessment recommending surgery from a qualified doctor or nurse practitioner
    • the assessment must confirm that you:
      • 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

The Process

TRS Process (Source: Rainbow Health Ontario)
TRS Process (Source: Rainbow Health Ontario)

TRS Information Sheets

Source Information
Rainbow Health Ontario TRS Summary Sheets
Rainbow Health Ontario Referrals, Letters, Surgery
Women’s College Hospital TRS Information
CAMH Transition-Related Surgery (TRS) FAQ

Gender-Affirming Surgeons in Canada

TransHealthcare List of Gender-Affirming Surgeons in Canada

TransHealthcare compiled a list of gender-affirming surgeons practicing in Canada. The list can be filtered by procedures such as breast augmentation, FFS, FMS, hysterectomy, top surgery, etc.

Sources

  1. CAMH - Transition-Related Surgery (TRS) FAQ
  2. Province of Ontario - Gender Confirming Surgery
Tags: medical_care guidelines