Surgical Assessments

During your assessment, you’ll be asked about your gender history, your health history and your medication history. For most transition-related surgeries, you’ll need a diagnosis of gender dysphoria. Even though some people don’t identify with this label, it’s still required by surgeons and the Ontario Ministry of Health (if you’re applying for coverage).

You’ll also be asked how the surgery will impact your life, where you’d get surgery and what your recovery plan is. Because of this, it’s a good idea to do some research in advance. For example, some OHIP-covered surgeons are out of province so you’d need to make some travel plans. Most out of province OHIP surgeries are at GRS Montreal.

For bottom (genital) surgery, you’ll need two assessments.* For top (breast or chest) surgery, you’ll only need one.

Your first assessment can be done by a doctor or nurse practitioner. Your second can be done by a doctor, nurse practitioner, registered nurse, psychologist or registered social worker (MSW). Your assessor must be experienced in and/or knowledgeable about gender-affirming care. They must also be registered with their regulatory college in Ontario.

For minor surgeries that aren’t covered by OHIP, like hair transplants, your surgeon may do the assessment themselves. For these procedures, you can reach out to your surgeon and ask what their protocol is.

* The World Professional Association for Transgender Health (WPATH) released guidelines in September 2022 that recommend only one assessment for all gender-affirming surgeries. At the time of writing, Ontario’s Ministry of Health hasn’t updated their requirements to reflect this.

To get surgeries covered by OHIP, you’ll need to have your assessments first. Your clinician then puts in a request for funding to the Ministry of Health. Based on our recent processing times, decisions for surgeries can take anywhere from a week to a few months.

If you’re approved, the clinician who assessed you will receive a letter (if you had two assessments this will be sent to the first clinician who assessed you). This letter won’t be sent to you, but we will let you know when we receive it. After this, your assessor can then write a referral to your surgeon, which will let you book a surgery under the public system. Approvals are valid for 3 years.

OHIP will cover some but not all transition-related surgeries. Based on information from the Rainbow Health Guide, these are:

• Vaginoplasty (includes penectomy, orchidectomy, clitoroplasty and labiaplasty)

• Phalloplasty (includes vaginectomy, urethroplasty, glansplasty and penile and 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 (removal of the testicles)

• Mastectomy* (includes removal of breast tissue, excess skin, and proper positioning of nipple and areola)

• Breast augmentation (after 12 months of hormone therapy with no breast growth)
  
  * OHIP will only cover the mastectomy part of chest surgery. Any masculinization must be paid separately, and varies depending on surgeon and province. If you are getting surgery at GRS Montreal this cost is covered by the clinic.

There are some transition-related surgeries that OHIP doesn’t cover. There are also some costs related to surgery that you’ll have to pay yourself. Based on information from the Rainbow Health Guide, these are:

• Chest contouring/masculinization*

• Breast augmentation for people with breast growth after 12 months of hormone therapy

• Facial masculinization

• Facial feminization

• Electrolysis

• Laser hair removal

• Hair transplants

• Tracheal shave

• Voice modification surgery

• Body contouring (e.g. liposuction, BBL)

• Chin, nose, cheek, or buttock implants

• Travel and accommodation costs related to surgery**

• Supplies related to post-surgery care

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* OHIP will only cover the mastectomy part of chest surgery. You’ll have to pay for any masculinization, which varies depending on surgeon and province. If you are getting surgery at GRS Montreal this cost is covered by the clinic.

** If you live in Northern Ontario, you can apply for a Northern Travel Grant to get to your surgery. If you are getting surgery at GRS Montreal, the clinic will cover your hotel and food costs for three days.

If you’re applying for OHIP approval for your surgery, you’ll need to meet these criteria:

• You have a diagnosis of gender dysphoria. This can be a previous diagnosis or the clinician can make the diagnosis in your appointment, based on your history.

• Other health conditions (like diabetes or depression) are treated and/or under good control.

• You’ve considered the alternatives to surgery, like binding for chest surgery.

• Surgery could help you achieve the goals you have.

• You understand the risks and benefits of surgery and can give consent.

• You’ve been on hormones for at least a year (for everything except chest surgery).

• You’re over the age of 18.

If your clinician can verify all of these, they fill out the Ministry of Health form (called Prior Approval Form) to request funding. For all TRS except chest or breast surgery, two different clinicians must verify this information and fill out the form. These are separate parts of the same form.