Trans Care BC has worked, over a number of months, engaging with peer and clinical advisors to review the new standards of care and their implications for access to gender-affirming surgery in BC. This review has led to some changes that are intended to decrease barriers to care and increase the safety and quality of the care experience for those seeking gender-affirming surgeries.
We are pleased to share that as of February 16, 2023, some pathway and practice changes, in line with the WPATH SOC8 are being implemented in B.C. related to gender-affirming surgical care.
A summary of these changes, along with commonly asked questions, are shared below.
- Only 6 months of hormone therapy are required to access genital surgery or gonadectomy. (Previously, 12 months were required).
- Congruent living is no longer a requirement to access genital surgery. (Previously, 12 months were required)
- As part of the surgical referral process for gender-affirming surgeries, care planning is an important step that begins before the referral for surgery.
- As part of this process clients meet with a care planner to document or confirm their gender incongruence/dysphoria diagnosis, review their surgical goals, discuss the risks and benefits of gender-affirming surgery and determine readiness and the care plan for surgery and recovery.
- The care planner documents the important parts of the care planning conversations in a letter of recommendation that gets sent to the surgeon’s office along with the referral form.
- As part of the new standards, only one surgical care planning letter of recommendation, is needed for all genital surgeries (previously, two letters of recommendation were required). This should improve access and wait times for surgical care planning (also called surgical readiness assessment).
- As of February 16, 2023, only one letter of recommendation is needed for genital surgery. Formerly, two letters of recommendation were required.
- There are important changes to who can provide surgical care planning and recommendations for genital surgeries (phalloplasty, metoidioplasty, erectile tissue (clitoral) release, vaginoplasty, and vulvoplasty).
- Due to the complex nature of these procedures, only medical providers (MDs, NPs, and certain RNs) with the ability to support your care before and after surgery will be able to provide surgical care planning and recommendations for these surgeries. This change is intended to ensure that patients are well prepared and supported throughout their surgical journey.
- Until April 1, 2023: Surgical programs will continue to accept recommendations from the old pathway (2 surgical recommendations completed by previously approved clinicians) until April 1, 2023.
- This grace period means you can be referred for genital surgery with two surgical recommendations completed by previously approved clinicians, as long as the recommendations were done before April 1, 2023.
- After April 1, 2023: All referrals must be made through the new pathway: 1 surgical recommendation by a medical provider on Trans Care BC's list of clinicians able to provide care planning for genital surgeries (MDs, NPs and certain RNs with the ability to support care before and after surgery.)
- Trans Care BC will continue to maintain a list of clinicians who are qualified to provide surgical care planning for genital surgeries.
- To find a qualified provider, or if you are concerned about what these changes mean for you, please contact the Trans Care BC health navigators.
- As before, only one letter of recommendation is required for chest and breast construction surgeries
- Moving forward, BC clinicians can confirm that they meet WPATH competencies to provide surgical care planning for upper surgeries. Trans Care BC has created a form to help with this confirmation.
- Previously, providers needed to apply to Trans Care BC to be on a list of clinicians qualified to provide surgical care planning. This was a historical practice that pre-dated the program and was handed over when Trans Care BC began its work. A review of this step related to upper surgery has resulted in this change in practice.
- This change is anticipated to reduce the wait times for surgical care planning.
- The process for gonadectomy is the same as for upper surgeries, as above.
- Moving forward, BC clinicians can confirm that they meet WPATH competencies to provide surgical care planning for gonadectomy surgeries. Trans Care BC has created a form to help clinicians with this step.
- Previously, providers needed to apply to Trans Care BC to be on a list of clinicians qualified to provide surgical care planning. This was a historical practice that pre-dated the program and was handed over when Trans Care BC began its work. A review of this step related to breast and chest surgery has resulted in this change in practice.
- This change is anticipated to reduce the wait times for surgical care planning.
- Until April 1, 2023: Surgical programs will continue to accept recommendations from the old pathway (2 surgical recommendations completed by previously approved clinicians) until April 1, 2023.
- This grace period allows patients to be referred for genital surgery with two surgical recommendations completed by previously approved clinicians that were done before April 1, 2023.
- After April 1, 2023: As of February 15, 2023, the surgical programs will accept surgical recommendations through the new pathway (1 surgical recommendation by a medical provider on Trans Care BC's list of clinicians able to provide care planning for genital surgeries). After April 1, all referrals must be made through this new pathway.
