Referral for Surgery

1. Connect with a primary care provider

The first step is to meet with a primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. . Their role is to support you in your surgery journey. They will:

• Help you understand and meet requirements for surgery 
• Provide or refer you for surgical readiness assessments (see step below) 
• Refer you to a surgeon (see step below)
• Assist with medical needs identified by the surgeon before and after surgery (helping you with smoking cessation, ordering blood tests)

If your primary care provider is unsure how to support you through your gender-affirming surgery, they can consult an experienced physician through RACE or eCASE. 

If you don't have a primary care provider and need support finding one, visit our Finding a Primary Care Provider page.

2. Get a surgical readiness assessment

What is a surgical readiness assessment?

The surgical readiness assessment An evaluation conducted by a health care professional to determine if a patient is ready to begin hormone therapy or have gender-affirming surgery. helps ensure you are prepared and supported before, during, and after your surgery. It also confirms that you meet the criteria for gender-affirming surgery. A readiness assessment appointment lasts between 1–2 hours. Some people complete the process in one appointment, while others may need multiple appointments.

Who conducts the surgical readiness assessment?

Surgical assessments for genital surgery may only be conducted by medical providers (physicians, nurse practitioners and registered nurses) who have received the training outlined in the WPATH Standards of Care and are on the list of qualified assessors maintained by Trans Care BC.

If your primary care provider is not a qualified assessor, ask them to refer you to a provider who is. If they don’t know of any, ask them to contact Trans Care BC. 

How long does it take to have an assessment done?

While wait times can vary, many people are able to complete their readiness assessment within 10 months.

What to expect from your surgical readiness assessment

Some people feel anxious about the surgical readiness assessment. They worry about saying the wrong thing and being denied a surgery that is very important to their health and wellbeing. 

It may ease your fears to know that the focus of the assessment is on supporting you. During a readiness assessment appointment, the assessor will ask about your:

• Gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) — Including how you feel about your body.
• Health history — Including current and past medical and mental health conditions, surgical history, medications, allergies, smoking status, exercise, nutrition and family history.
• Expectations — Your hopes for the surgery and how it will impact you socially, emotionally and financially.
• Understanding of the surgery — The assessor will ensure you understand the surgical procedure, risks and postoperative healing process.
• Surgical aftercare plan — Where will you access support and what strategies will help you thrive with family and friends, at work and at school?

WPATH criteria for surgery

The assessor will also ensure that you meet the WPATH World Professional Association for Transgender Health (WPATH) is a professional organization devoted to transgender health, whose mission as an international multidisciplinary professional association is to promote evidence-based care, education, research, advocacy, public policy and respect in transgender health. criteria to have a gender-affirming surgery. The criteria for all gender-affirming surgeries are:

• Diagnosis of gender incongruence A mismatch between a person's gender and the sex they were assigned at birth. (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)

Other criteria

Additionally, you must also have six continuous months of hormone therapy (unless hormones are not clinically recommended for you) prior to erectile tissue release This procedure creates a penis by cutting the ligaments around the erectile tissue (clitoris), so the shaft falls away from the body, giving it a more pronounced appearance. , metoidioplasty A gender-affirming lower surgery to create a penis. Metoidioplasty involves cutting ligaments around the clitoris to add length to the shaft and grafting skin around the shaft to create more girth. Optional additional procedures include scrotoplasty and urethral lengthening. or phalloplasty A gender-affirming lower surgery to create a penis and scrotal sac (phase 1) followed by testicular implants and implants to obtain rigidity/erection (phases 2 and 3). surgery. 

Why do I need six months of hormone therapy?

Sex hormones Hormones, such as estrogen and testosterone, that affect sexual and reproductive development or function. (estrogen and testosterone) play a vital role in bone and cardiovascular health, and contribute to one's overall sense of well-being. After a gonadectomy The surgical removal of either the testes or the ovaries. , the body is no longer able to produce its own sex hormones, 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 A doctor specially trained in the study of hormones and their actions and disorders in the body. about your goals and concerns.

3. Request a referral from your primary care provider

After the readiness assessment appointment, the assessor will write a letter of recommendation for surgery. If your assessor is not your primary care provider, they will send the letter of recommendation to them. The next step is for your primary care provider to send a referral and your letter of recommendation to the Gender Surgery Program B.C. (GSPBC) at Vancouver General Hospital (VGH). You will need to make an appointment with your primary care provider to request this referral following your readiness assessment.

After the GSPBC receives a fully completed referral, you are placed on a first come first served waitlist dependent on their surgical type.

4. Be prepared for wait times

Like many other types of procedures, gender-affirming surgeries have wait times in B.C. Unfortunately it's not possible to provide an estimate for wait times. This is because wait times change frequently and depend on many factors. You can, however, talk to your primary care provider or surgeon to find out what your anticipated wait time for surgery will be. 

We recognize that waiting long periods for medically necessary Treatments, procedures or services that health care professionals determine are essential for diagnosing or treating a medical condition based on established medical guidelines and individual patient needs. surgery can be stressful, however, there are a number of ways in which you can advocate for yourself. We’ve prepared tips for ensuring that your referral moves through the system as seamlessly as possible. 

Another way of coping with stress is to connect with others who have gone through similar experiences. You may want to talk to a counsellor or join a support group.