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Surgical Referrals in Alberta
How does someone get transition-related surgery? Learn about the assessment and approval process in Alberta.
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Surgeries are an option for anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.
This might include hormone therapy and transition-related surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person has surgery – it’s a decision that’s yours to make.
Before getting surgery, you need to go through some assessments and paperwork. Navigating this process can be quite overwhelming – but we’re here to help! This article will explain the assessment process and how to get surgeries covered by Alberta Health, the province's public health plan.
What are surgical assessments?
To get surgery, you’ll need to have an assessment. Sometimes you’ll need two. This can feel like a frustrating step, but it’s an important one! Your assessments let you and your clinician talk through the risks, recovery and outcomes of surgery. They also make sure you’re able to consent, which is important because some TRSs are irreversible.
During your assessment, you’ll be asked about your gender history, your health history and your medication history. For most TRS, 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 province (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, bottom surgeries funded by Alberta Health are out of province so you’d need to make some travel plans. These surgeries are done at GRS Montreal.
The assessment process
There are two steps to getting TRS in Alberta. The first is one or two assessments, depending on the surgery you choose. These confirm you’re ready for the procedure. If you’re paying out of pocket or have private insurance, your clinician can write a referral to your surgeon when this is complete. Accepting this referral is at your surgeon’s discretion.
If you’d like your surgery to be covered by Alberta Health, there’s a second step. This is where you apply for a funding approval from the province, which means your costs are covered. The person who applies for funding on your behalf will vary depending on the surgery, which we’ll explain below. Unfortunately, Alberta Health doesn’t cover all TRS – we’ve also got a full list further down.
For minor surgeries that aren’t covered, 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.
Top surgery (mastectomy/chest reconstruction and breast augmentation)
To get mastectomy/chest reconstruction or breast augmentation in Alberta, first you’ll need one assessment. This can be done by a family doctor or a nurse practitioner who is knowledgeable about gender-affirming care. Once they have assessed you, they can refer you to a surgeon. Accepting this referral is at the surgeon’s discretion.
If you’d like this surgery to be covered by Alberta Health, your surgeon will then submit a funding application on your behalf. The outcome of your funding application will be sent directly to the surgeon.
Note that breast augmentation is only covered if you have had little to no breast growth after 12 months of continuous hormone therapy.
Hysterectomy and orchiectomy
To get hysterectomy or orchiectomy in Alberta, first you’ll need one assessment. This can be done by a family doctor or a nurse practitioner who is knowledgeable about gender-affirming care. Once you have completed the assessment, your assessor can then refer you to a surgeon. Accepting this referral is at the surgeon’s discretion.
Orchiectomy and hysterectomy are automatically covered by provincial health insurance. This means there is no separate funding application, and your surgeon can bill the province directly.
Bottom surgery (vaginoplasty, metoidioplasty and phalloplasty)
To get bottom surgery you’ll need two assessments. The first of these can be done by a family doctor, nurse practitioner or endocrinologist who is knowledgeable about gender-affirming care, or a psychiatrist at one of the specialized clinics in the province. The second must be done by a psychiatrist at one of these clinics.
If you’d like your surgery to be covered by Alberta Health, your psychiatrist will then submit a funding application on your behalf. They can also send the paperwork back to your first assessor who will then submit. The outcome of your funding application will be sent directly to the assessor who submitted this paperwork.
Once your funding application has been approved, your assessor can refer you to a surgeon. There are currently no surgeons in Alberta performing bottom surgery – all funded bottom surgeries take place at GRS in Montreal.
Getting surgery covered
If you’re applying for Alberta Health funding for 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) are treated and/or under good control.
You do not have a mental health condition that is symptomatic or likely to become so.*
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 bottom surgeries and breast augmentation).
You have had one year of “real-life experience” of your gender.*
You have a good support network and a stable lifestyle.
Your gender identity has remained stable over time.*
You’re over the age of 18.
* These are outdated requirements that do not reflect the lived experience of trans, non-binary and gender-diverse people. However, they are unfortunately still part of the approval process in Alberta. If you have any questions about specific approval criteria, we suggest reaching out to your assessor ahead of time.
What’s covered by Alberta Health?
Alberta Health will cover some but not all TRS. The procedures that can be funded are:
Vaginoplasty (includes orchiectomy, clitoroplasty, and labiaplasty)
Phalloplasty (includes vaginectomy, urethroplasty, glansplasty, and penile and testicular implants)
Metoidioplasty (includes vaginectomy, urethroplasty and testicular implants)
Hysterectomy (removal of the uterus)
Salpingo-oophorectomy (removal of the tubes and ovaries)
Orchiectomy (removal of the testicles)
Mastectomy/chest reconstruction (includes removal of breast tissue, excess skin, proper positioning of nipple and areola, and chest contouring)
Breast augmentation (after 12 months of continuous hormone therapy with little to no breast growth)
What isn’t covered by Alberta Health?
There are some TRS that Alberta Health doesn’t cover. There are also some costs related to surgery that you’ll have to pay yourself. These are:
Breast augmentation (for people who don't meet criteria above)
Laser hair removal
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
* If you are getting surgery at GRS Montreal, the clinic will cover your hotel and food costs for three days.
How can Foria help?
Foria will soon be able to offer surgery assessments in Alberta by our nurse practitioners.
If you have any questions, email email@example.com.
This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Rainbow Health Ontario’s Transition-Related Surgery FAQ.