Medical Forms

This section contains forms related to gender-affirming hormone therapy and surgery.

Hormone therapy

These forms and additional information can be found in Trans Care BC's Primary Care Toolkit.

Surgical care planning

The forms below are for surgical recommendations for gender-affirming surgeries.

  • Upper surgery: Care planning and surgical recommendations can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers.
  • Gonadectomy: Not all gynecologists or urologists require a surgical recommendation. If needed, care planning and surgical recommendations can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers.
  • Genital surgery: Care planning and surgical recommendations are limited to medical providers who have the training outlined in the WPATH SOC 8 (NPs, MDs, and RNs in a multidisciplinary care setting with MD or NP signoff) who also have the ability to support care throughout the surgical journey (in conjunction with the surgeon and other relevant providers). Only individuals on Trans Care BC’s list of clinicians that are qualified to provide care planning for genital surgery may make recommendations for genital surgery. If you are interested in being added to this list, please Contact Us.

Recommendation templates: 

Surgery referral

Trans Care BC will return completed surgical recommendations to the primary care provider who will then refer the patient as follows:

  1. Fax the following to Trans Care BC: 604-297-9900:
  1. Patient will be placed on the Central Waitlist (managed by Trans Care BC).
  2. Trans Care BC will contact patient to discuss their choice of surgeon.
  3. Trans Care BC will forward the referral package to the surgeon's office.
 

MSP-funded benefit only under special circumstances (less than AA cup breast development or > 1.5 cup size asymmetry after at least 18 months on hormone therapy)


Option 1:

Network of surgeons trained to provide gender-affirming surgeries, working from a centralized waitlist.


  1. Fax the following to Trans Care BC: 604-297-9900:
  2. Patient will be placed on the Central Waitlist (managed by Trans Care BC).
  3. Trans Care BC will contact patient to discuss their choice of surgeon.
  4. Trans Care BC will forward the referral package to the surgeon's office.
  5. Surgeon will assess the patient and complete the funding application if indicated.

Option 2:

Plastic surgeon of patient's choice (not affiliated with network).


  1. Contact plastic surgeon to determine what documentation they require to accept referral.
  2. Surgeon will assess the patient and complete the funding application if indicated.
  3. You may contact the RACE Line or e-CASE and select "Transgender Health" option for information on surgeons that are experienced in gender-affirming care.
  1. Refer to gynecologist of patient's choice.
  2. You may contact the RACE Line or e-CASE and select "Transgender Health" option for information on surgeons that are experienced in gender-affirming care.
  3. If the gynecologist requests a surgical recommendation, the Recommendation for Upper Surgery or Gonadectomy form can be used by clinicians who meet the qualifications and competencies to provide surgical care planning, outlined in WPATH SOC 8.

Option 1:

Orchiectomy only:


  1. Refer to urologist of patient's choice.
  2. You may contact the RACE Line or e-CASE and select "Transgender Health" option for information on surgeons that are experienced in gender-affirming care.
  3. If the urologist requests a surgical recommendation, the Recommendation for Upper Surgery or Gonadectomy form can be used by clinicians who meet the qualifications and competencies to provide surgical care planning, outlined in WPATH SOC 8.

Option 2:

Done concurrently with Vaginoplasty/Vulvoplasty:


  1. See “Vaginoplasty/Vulvoplasty” section.

Gender Surgery Program BC (GSP BC):


  1. Fax to the Gender Surgery Program BC (GSP BC): 604-875-5075
  1. GSP BC will add patient to their waitlist. 
  1. GSP BC will contact patient to book consult (this can take up to a year).
 

Option 1:

Gender Surgery Program BC (GSP BC):


  1. Fax the following to the Gender Surgery Program BC (GSPBC): 604-875-5075
  1. GSP BC will add your patient to their waitlist
  1. GSP BC will contact patient to book consult (this can take up to a year) 

Option 2:

GRS Montreal:


  1. Fax the following to GRS Montreal: 1-514-288-3547   
  1. Once faxed, advise your patient to contact GRS Montreal by phone: 1-514-288-2097 or email: info@grsmontreal.com to initiate their surgical booking.
 

For chest construction surgery:

  • Patients can follow up directly with their original surgeon or;
  • If the patient cannot follow up with their original surgeon they can be referred to the Trans Care BC Upper Surgery Central Waitlist for revision. To do this, fax a new Upper Surgery Referral Form and use the 'revision' checkbox. 
  • A new surgical recommendation is not required unless requested by the surgeon.

For breast construction surgery:

  • Patients can follow up directly with their original surgeon or;
  • If the patient cannot follow up with their original surgeon they can be referred to the Trans Care BC Upper Surgery Central Waitlist for revision. To do this, fax a new Upper Surgery Referral Form and use the 'revision' checkbox. 
  • Alternatively, a referral for revision may be sent to a plastic surgeon of the patient's choice  (see "Breast construction" referral process Option 2)
  • A new surgical recommendation is not required unless requested by the surgeon.

For orchiectomy:

  • Patients can follow up directly with their original surgeon or;
  • If the patient cannot follow up with their original surgeon they can be referred to a urologist of the patient's choice (see "Orchiectomy" referral process Option 1)

For hysterectomy:

  • Patients can follow up directly with their original surgeon or;
  • If the patient cannot follow up with their original surgeon they can be referred to a gynecologist of the patient's choice (see "Hysterectomy" referral process Option 1)

For vaginoplasty/vulvoplasty:

  • Patients can follow up directly with their original surgeon/surgical program.

For phalloplasty/metoidioplasty/erectile tissue release:

  • Patients can follow up directly with their original surgeon/surgical program.



If you require assistance in supporting your patient post-operatively, please contact the Trans Care BC health navigation team at: 1-866-999-1514 or Transcareteam@phsa.ca. This team can also be accessed on an ongoing basis to support any clinical questions you may have. 

You may also contact the RACE Line or e-CASE and select "Transgender Health" option to speak with an clinician experienced in providing gender-affirming pre- and post- operative care.





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