Surgical Assessment

The surgical readiness assessment process is intended to ensure that you are prepared for the surgery and will have the best possible post-surgical outcomes.

Getting an assessment

Here is a brief outline of the process for getting a surgical readiness assessment. 

First, your primary care provider will send a referral for a surgical readiness assessment to Trans Care BC or to a provider that Trans Care BC knows who does surgical readiness assessments. If your primary care provider is already a qualified assessor then a referral to Trans Care BC will not be needed; the assessment will likely be done by your primary care provider.

Depending on the type of gender-affirming surgeries you are interested in pursuing, two assessments may be required. These may take place with one or two qualified assessors. Additional assessments may be required at the discretion of the surgeon:

  • an assessment for breast augmentation (or breast construction), or chest construction surgery - requires only one qualified assessor
  • an assessment for a hysterectomy, a bilateral salpingo-oophorectomy or an orchiectomy - requires one or two qualified assessors
  • an assessment for vaginoplasty, vulvoplasty, clitoral release, metoidioplasty or phalloplasty - requires two qualified assessors

The qualified assessor will make one of these recommendations:

  • surgery is recommended
  • surgery not recommended at this time, or
  • return for further assessment

Next, the aualified assessor will send the recommendation to the provider who requested the assessment.

Finally, once your primary care provider receives a copy of your surgical recommendation, which is sent to them from the provider, they can refer you for surgery. The next steps vary depending on the kind of surgery you are having. Visit the specific surgery procedure page for more information about surgery referral.

Remember: during this process you might want to keep your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule assessment and surgery appointments.

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Assessment period

Wait times for surgical readiness assessment fluctuate, but most people complete their assessments within 6 months.

An assessment appointment typically lasts 1 to 2 hours. You may need to return for a second visit if you don’t have a plan in place to be cared for after your surgery or for other reasons such as complexities in your current health or social situation.

Questions you’ll be asked

During the assessment, you will be asked about:

  • your gender identity and feelings about your body
  • your expectations of the surgery and how it will impact you socially, emotionally and financially
  • your health history (current and past medical and mental health conditions, surgical history, medications, allergies, smoking status, exercise, nutrition, family history, etc.)
  • your understanding of the surgical procedure, risks and post-operative healing process.
  • your support network and strategies for thriving in your changing gender expression with family and friends, at work and at school
  • your surgical aftercare plan

Counselling

Counselling is not typically required to get approval for an MSP-funded surgery. Counselling may be helpful or recommended if:

  • you require ongoing support beyond your current care team or network
  • you are uncertain about whether surgery is the right decision
  • you are not out to significant others and do not have a plan in place to come out
  • you have significant mental health concerns or addiction concerns which surgery may intensify

Eligibility & criteria for surgery

You do not have be trans to be eligible for gender-affirming surgery.  Gender-affirming surgery can be medically necessary for a range of people, including those who are genderqueer, gender variant, or gender non-conforming.

Eligibility for all surgeries

The four criteria for all gender-affirming surgeries are:

  • persistent gender dysphoria 
  • capacity to consent to the procedure (you understand the procedure and associated risks and have an aftercare plan)
  • medical and mental health conditions are reasonably well-controlled
  • being of the age of majority (in BC, the age of majority is 18). Note: masculinizing chest surgery is usually the only surgery that is done before 18 years of age. Two assessments may be required for youth seeking chest surgery
  • Additional criteria and requirements for gender-affirming surgeries are listed below:
  • additional criteria and notes: you must have taken hormones for at least 18 months, unless contraindicated; only funded if there is inadequate or asymmetric breast development after that 18 months (less than AA cup or greater than a 1.5 cup size asymmetry) as determined by a plastic surgeon. Living in a gender role congruent with your gender identity is not required.
  • assessment: you need one letter from a qualified assessor recommending surgery. Additional assessments may be required at the discretion of the surgeon
  • additional criteria and notes: 12 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you). Living in a gender role congruent with your gender identity is not required
  • assessment: you may need 1 to 2 letters from qualified assessors recommending surgery, depending on the surgeon. Additional assessment: assessments may be required at the discretion of the surgeon
  • additional criteria and notes: 12 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you); 12 continuous months of living in a gender role that is congruent with your gender identity

  • assessment: you need letters from two qualified assessors recommending surgery. Additional assessments may be required at the discretion of the surgeon

  • additional criteria and notes:  No additional criteria. Living in a gender role congruent with your gender identity is not required; hormone therapy is not required
  • assessment: you need one letter from a qualified assessor recommending surgery. Additional assessments may be required at the discretion of the surgeon
  • additional criteria and notes:  12 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you). Living in a gender role congruent with your gender identity is not required
  • assessment: you may need 1 to 2 letters from qualified assessors, depending on the surgeon. Additional assessments may be required at the discretion of the surgeon
  • additional criteria and notes:  12 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you)
  • assessment: you need letters from two qualified assessors recommending surgery. Additional assessments may be required at the discretion of the surgeon

SOURCE: Surgical Assessment ( )
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