Guide to Gender Affirming Surgery in Ontario

What is Gender Affirming Surgery? 

Gender affirming surgery refers to different types of surgical procedures used to affirm a person’s gender identity. Some surgeries include:

• Top surgery, which is used to reshape a person’s chest. 
  • Masculinizing top surgery varies depending on the size of your chest and what you are looking for.
    • Types include: Double Incision, Periareolar, Keyhole, and Inverted-T.
  • Breast augmentation refers to a procedure that increases the size or changes the shape of the breasts.  
• Bottom surgery, which is used to reshape a person’s genitals.
  • Transfeminine bottom surgery is known as vaginal construction or vaginoplasty.
    • It refers to a procedure that reconstructs tissue from the penis and scrotum into a vaginal canal, clitoris, and labia. 
  • Transmasculine bottom surgery is known as penile construction surgeries.
    • These involve removal of the vagina and reconstruction of a penis and urethra. 
    • Some people may also have surgeries to remove the uterus, fallopian tubes, and ovaries.  
• Other gender affirming surgeries can include:
  • Facial feminizing surgeries. 
  • Facial masculinizing surgeries. 
  • Body contouring. 
  • Vocal surgery.
  • Among many others (see: sherbourne.wpenginepowered.com/wp-content/uploads/2022/10/TRS-FAQ_Accessibility_Updated-October-2021.pdf) 

Qualifying for Gender Affirming Surgery Through OHIP

Ontario only funds genital and chest surgery.

To qualify you must: 

• Be assessed and recommended for surgery by either one OR two healthcare providers (two for genital surgery, one for chest).
• Have a referral for surgery completed and submitted to the Ministry of Health and Long-Term Care by a physician or nurse practitioner.
• Have the surgery approved by the Ministry of Health and Long-Term Care BEFORE the surgery takes place.

FOR CHEST SURGERY:

You must have:

• ONE assessment recommending surgery from a qualified doctor or nurse practitioner.
  • This assessment must confirm that you:
    • Have a diagnosis of persistent gender dysphoria
    • Have completed 12 months of continuous hormone therapy (unless hormones are not recommended) with no breast enlargement if you’re seeking breast augmentation. 

After being approved for chest surgery, your family doctor or nurse practitioner can refer you to a specialist to perform the surgery.

IMPORTANT NOTE: OHIP will only cover the mastectomy part of masculinizing top surgery. They will not cover any masculinization. The cost of masculinization will vary.   

FOR GENITAL SURGERY:

You must have:

• TWO assessments recommending surgery from a qualified doctor OR nurse practitioner OR registered nurse OR psychologist OR registered social worker.
  • ONE of these assessments MUST be from a doctor or nurse practitioner. 
  • BOTH assessments MUST confirm:
    • You have a diagnosis of persistent gender dysphoria. 
    • You 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 SURGERY WILL NOT BE COVERED. 

Your doctor or nurse practitioner must fill out this form, PLUS the assessments and recommendations for surgery. They must submit all of this to the Ministry of Health and Long-Term Care. 

• Your doctor or nurse practitioner should let you know if your application is approved. 

HOW LONG IS THE WAIT? 

• Once you’re approved for funding, the wait depends on individual surgeon’s waitlists and the availability of hospital operating rooms. 

Finding Service Providers

Rainbow Health Ontario

•  Has a directory “designed to help you find health and social service providers who have expressed a commitment to providing competent and welcoming care to 2SLGBTQ+ people in Ontario.”
• Has TONS of resources on the different types of gender affirming surgeries. 
• They have a Trans Health Knowledge Base that has TONS of answers to common questions about trans health care in Ontario! 

Check out CAMH’s Gender Identity Clinic

• They provide diagnostic assessments in support of affirming a diagnosis of Gender Dysphoria in support of transition related surgeries. 
• Surgical and hormone eligibility assessments *The clinic does not prescribe hormones.

Guelph Queer Health Hub

• Provides queer and trans affirming therapy, and gender affirming medical care (including surgical referrals)!

HIVE Health Services

• Provides surgical funding applications/referrals. 
• Provides post-operative care.
• Provides system navigation and support with exploring identity and expression. 
• Provides hormonal treatment options. 
• Provides mental health counseling. 

Paying Out of Pocket

Some people might choose to pay out of pocket due to the extensive OHIP process and long wait times.

Out of pocket prices vary greatly depending on the procedure(s) (from around $5,000 to over $20,000). You can get a quote at a clinic and/or inquire about their average costs.  

• Use Rainbow Health Ontario’s Service Provider Directory to find clinics.  

Some clinics include: 

• Catalyst Surgical in Toronto, ON 
• GraceMed x McClean Clinic in Mississauga, ON 
• The Ottawa Hospital’s Gender Affirming Surgery Clinic in Ottawa, ON