Surgery Assessment

A surgical assessment ensures that you are prepared for the surgery and will have the best possible post-surgical outcome. Before learning about how to access a surgical assessment, first review the eligibility and criteria.
Eligibility 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.

The 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: Upper surgery are sometimes possible before the age of 18. In some cases, surgeons may recommend an additional readiness assessment for those under 18.

Below you will find outlines of the specific requirements for each type surgery.

Feminizing Surgeries

Additional criteria: 

  • Have been on hormones for at least 18 months; and
  • Have had little to no breast growth (smaller than a AA cup); and/or
  • Significant asymmetric growth (1 and ½ cup size difference) as determined by a plastic surgeon
  • Living in a gender role congruent with your gender identity is not required. Your plastic surgeon will use the above criteria to determine to proceed with funding application.

Assessment: You need one letter from a qualified assessor recommending surgery. Additional assessments may be required at the discretion of the surgeon.


Please note: for individuals recommeded for breast augmentation, they must be seen by a plastic surgeon who when appropriate will apply to MSP for funding. See surgery referral and surgery funding for more information.

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 one or two 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.


Masculinizing Surgeries 

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 one or two 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.




Surgery Assessment

Getting an assessment

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

1Get referred to an assessor

*Note: depending on the type of gender-affirming surgeries you are interested in, one or two assessments may be required. If you require two assessments, they must be carried out by different assessors. Additional assessments may be required at the discretion of the surgeon.

  • Your primary care provider will send a referral for a surgical readiness assessment directly to a qualified assessor, OR;
  • Your primary care provider will send a request to Trans Care BC who can refer you to a qualified assessor available in your community, OR;
  • Your primary care provider may be a qualified assessor and they can carry out the assessment themselves.
Surgical readiness assessments are funded if done with qualified assessors working in the publicly funded healthcare system.  There are also private qualified assessors such as psychologists or clinical counsellors who will charge you or your extended benefits plan for the assessment. 

Contact Us if you (or your primary care provider) need support in finding a qualified assessor in your community.

2Get assessed


  • Once you are referred, wait times for surgical readiness assessment fluctuate, but most people complete their assessments within 6 months.
  • An assessment appointment typically lasts between one and two 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.

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.

3Get your recommendation

  • After your assessment appointment, The qualified assessor will make one of these recommendations:
    • Surgery is recommended
    • Surgery not recommended at this time, or
    • Return for further assessment
  • The qualified assessor will send the recommendation to the provider who requested the assessment.
  • Once your primary care provider receives a copy of your surgical recommendation, which is sent to them from the qualified assessor(s), they can refer you for surgery. The next steps vary depending on the kind of surgery you are having. Visit the surgery referral page for more information,

Counselling

While counselling can play an important role for some trans people seeking surgery it is not typically required to get approval for an MSP-funded surgery. Counselling may be especially 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

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SOURCE: Surgery Assessment ( )
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