Surgical Care Planning

Surgical care planning is a process that helps ensure you are prepared and supported before, during, and after your surgery.

Part of this process includes assessing whether you meet the WPATH criteria required for the surgery and whether you are ready for surgery. The clinician who works with you on surgical care planning will write the surgical recommendation. Before learning about how to access surgical care planning, 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 Two-Spirit or gender diverse.

The criteria for all gender-affirming surgeries are:

Diagnosis of gender incongruence (ICD-10)
Gender incongruence is well-documented and persistent
Other possible causes of gender incongruence have been identified and excluded
Mental and physical health conditions that could negatively impact outcome have been assessed, and risks and benefits have been discussed
Capacity to consent to the specific treatment
Capacity to understand the impact on fertility or infant feeding (where relevant)

All of the criteria should be fulfilled.

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

Upper body surgeries

Breast construction (breast augmentation)

Additional criteria:

Have been on hormones for at least 18 months (unless hormones are not clinically indicated for you); and
Have had little to no breast growth; and/or
Significant asymmetric growth as determined by a plastic surgeon

Surgical care planning: You will need one surgical recommendation. This can be done by a clinician who meets the qualifications and competencies that have been outlined in the WPATH Standards of Care 8- this can include your primary care provider or a counsellor.

Please note: After consultation, the plastic surgeon will use the above criteria to determine whether to proceed with applying to MSP for funding. See surgery referral and surgery funding for more information.

Chest construction or reduction

‎Additional criteria and notes: No additional criteria. Hormone therapy is not required.

Surgical care planning: You will need one surgical recommendation. This can be done by a clinician who meets the qualifications and competencies outlined in the WPATH Standards of Care 8- this can include your primary care provider or a counsellor.

Lower body surgeries

Orchiectomy

Additional criteria and notes:

6 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you)

Sex hormones (estrogen and testosterone) play a vital role in bone and cardiovascular health, and contribute to one's overall sense of well-being. The body is no longer able to produce its own sex hormones after gonadectomy, so hormone therapy is needed to maintain the health of bones, heart and blood vessels. If hormone therapy doesn't feel like the right fit for you, speak with your primary care provider or an endocrinologist about your goals and concerns.

Living in a gender role congruent with your gender identity is not required.

Surgical care planning: You may need one surgical recommendation. This can be done by a clinician who meets the qualifications and competencies outlined in the WPATH Standards of Care 8- this can include your primary care provider or a counsellor.

Hysterectomy/Salpingo-oopherectomy

Additional criteria and notes:

6 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you)

Sex hormones (estrogen and testosterone) play a vital role in bone and cardiovascular health, and contribute to one's overall sense of well-being. The body is no longer able to produce its own sex hormones after gonadectomy, so hormone therapy is needed to maintain the health of bones, heart and blood vessels. If hormone therapy doesn't feel like the right fit for you, speak with your primary care provider or an endocrinologist about your goals and concerns.

Living in a gender role congruent with your gender identity is not required.

Vaginoplasty & vulvoplasty

‎Additional criteria and notes:

6 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you)

Sex hormones (estrogen and testosterone) play a vital role in bone and cardiovascular health, and contribute to one's overall sense of well-being. The body is no longer able to produce its own sex hormones after gonadectomy, so hormone therapy is needed to maintain the health of bones, heart and blood vessels. If hormone therapy doesn't feel like the right fit for you, speak with your primary care provider or an endocrinologist about your goals and concerns.

Living in a gender role congruent with your gender identity is not required.

Surgical care planning: You will need one surgical recommendation. This recommendation must be completed by a provider on Trans Care BC’s list of clinicians who are qualified to do surgical care planning for genital surgeries. Contact Us for help finding a clinician qualified to do surgical care planning for genital surgery.

Erectile tissue release, metoidioplasty & phalloplasty

‎Additional criteria and notes:

6 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you)

Sex hormones (estrogen and testosterone) play a vital role in bone and cardiovascular health, and contribute to one's overall sense of well-being. The body is no longer able to produce its own sex hormones after gonadectomy, so hormone therapy is needed to maintain the health of bones, heart and blood vessels. If hormone therapy doesn't feel like the right fit for you, speak with your primary care provider or an endocrinologist about your goals and concerns.

Living in a gender role congruent with your gender identity is not required.

Surgical care planning: You will need one surgical recommendation. This recommendation must be completed by a provider on Trans Care BC’s list of clinicians who are qualified to do surgical care planning for genital surgeries. Contact Us for help finding a clinician qualified to do surgical care planning for genital surgery.

Surgical care planning

How to get a surgical recommendation

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

1Arrange surgical care planning

Upper surgery: You will need one surgical recommendation. This can be done by a clinician who meets the qualifications and competencies outlined in the WPATH Standards of Care 8- this can include your primary care provider or a counsellor.

Gonadectomy: You may need one surgical recommendation. This can be done by a clinician who meets the qualifications and competencies outlined in the WPATH Standards of Care 8- this can include your primary care provider or a counsellor.

Genital surgery: You will need one surgical recommendation. This recommendation must be completed by a provider on Trans Care BC’s list of clinicians who are qualified to do surgical care planning for genital surgeries. Contact Us for help finding a clinician qualified to do surgical care planning for genital surgery.

There are different ways to arrange surgical care planning:

Your primary care provider may be able to do surgical care planning and provide the surgical recommendation
Your primary care provider will send a referral for directly to a surgical care planner, OR;
Your primary care provider will send a request to Trans Care BC who can refer you to a surgical care planner in your community,
Your primary care provider will send a request to Trans Care BC, who can arrange an appointment for surgical care planning
You can contact a surgical care planner directly in some circumstances (i.e. a psychologist or a clinical counsellor in private practice)

Funding for surgical care planning:

There is no cost for the surgical care planning when a clinician working in the publicly funded healthcare system completes it.
Surgical care planners (such as psychologists or clinical counsellors) who work in private practice charge you or your extended benefits plan for the recommendation (this can only be done for upper surgery and gonadectomy).

2Surgical care planning

Wait times for surgical care planning fluctuate, but most people complete their care planning within 6 months.
A care planning appointment typically lasts between one and two hours. The number of appointments depends on your unique situation, the clinician and the setting. Sometimes the surgical care planner may need to consult other members of your health care team or specialists to complete your surgical care plan.

During your care planning appointment, 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.

3Receive a surgical recommendation

After your care planning appointment, the care planner will make one of these recommendations:

Surgery is recommended
Surgery not recommended at this time, or
Return for further care planning

The care planner will send the recommendation your primary care provider.

Be referred for surgery

Once your primary care provider receives a copy of your surgical recommendation, 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

Counselling is often very helpful for trans people seeking surgery but 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

Tab Heading