Transition-Related Surgical (TRS) Assessments

Overview

In order to receive OHIP prior approval for funding a transition-related surgery (TRS), the Ministry of Health (MOH) has specific requirements that need to be met on your application.

An assessment conducted by a qualified health care provider is one of the MOH’s funding requirements for both upper and lower surgeries. For upper surgeries (i.e., chest/top surgery, breast augmentation) you require one assessment from a primary assessor (i.e., physician or nurse practitioner). For lower surgeries (i.e., vaginoplasty, hysterectomy, phalloplasty, orchiectomy, metoidioplasty, etc.) you require two assessments, one from your primary assessor and one from a secondary assessor (i.e., physician, nurse practitioner, psychologist, or registered social worker).

Additionally, the MOH requires that both primary and secondary assessors confirm the following: 

  1. A diagnosis of persistent gender dysphoria

  2. Have completed 12 continuous months of hormone therapy (unless hormones are not recommended)

  3. Have lived 12 continuous months in the gender role you identify with (for lower surgery only)

This process is not intended to assess the validity of your gender identity or experience, rather, it provides you with a space to create a pre/post-surgical plan that considers the social, emotional, and logistical elements of your surgical recovery. Additionally, this process ensures that you are making an informed decision regarding surgery.

As a Registered Social Worker that has obtained a Master’s degree and received training from Rainbow Health Ontario, I am qualified to provide secondary assessments for transition-related lower surgeries.

Appointment Structure

​This 60-minute session will be spent assessing the resources in your life (i.e., financial, social and community support in place, housing, mental health status, etc.) and planning for how to be best prepared before and after your surgery. Our conversation may include discussion about your gender history, post-surgical depression (post-op blues), how to stop smoking before surgery, realistic expectations regarding recovery time, where to stay after surgery, time off of work, etc. Additionally, throughout the session, I will provide education about surgery, what you might expect during your surgical recovery, and additional resources as requested.   

Following our session together, I will write a letter that meets the standards of the World Professional Association of Transgender Health (WPATH) as well as the requirements set by the Ministry of Health. Once finished, I will forward my letter to you for review before it is finalized and forwarded to your primary assessor. This process will require consent to communicate with your primary assessor in order for me to sign off on the required documentation for your application. 

Duration: 60-minutes

Cost: Sliding scale between $75.00 - $150.00 (includes 60-minute session and one letter) 

A note on cost and access: I believe that these assessments should be free and accessible to anyone who wishes to undergo transition-related lower surgery. However, to sustain my practice and this service, I offer a reduced rate for secondary assessments. This service, as it is therapeutic in nature, may be covered by some extended health benefit plans that provide reimbursement for services offered by registered social workers. For individuals who do not have extended health benefits and cannot afford the lower end of my sliding scale, please reach out to me directly to discuss the possibility of accessing a more reduced rate or pro-bono assessment.

Everyone deserves access to gender-affirming care and surgeries. 

Transition-Related Resources

  • These summaries offer in-depth information regarding different transition-related surgeries which includes the description of the surgery, what to expect throughout the process (pre/post-op), intended results, surgical risks, etc.
     

  • Sherbourne Health provides a short-term health care unit offering 24/7 care for individuals ages 16 and older who are experiencing homelessness, under-housed and/or socially isolated who need a safe place to recuperate from an acute medical condition, illness, injury or surgery. Specifically, ARC opened a space devoted to transition-related care offering four beds to support individuals recovering from transition-related surgery.

    More information here.

  • The list of hospitals and clinics below are located in Canada and provide different transition-related surgeries. Each of them have distinct requirements, wait times and funding coverage. Please connect with them directly for up-to-date information.

  • CAMH Gender Identity Clinic: intended for individuals over 17 who wish to explore issues related to their gender identity, which may include any degree of transgender expression.

    Sick Kids Gender Care Clinic: this clinic supports trans and gender diverse youth and their families in exploring gender identity and what that means for them (intended for individuals under 17).

    • Explore and Transition: a resource to find information for yourself or a loved one to help understand the transition journey and available options by Trans Care BC. 

    • Foria Clinic, virtual gender-affirming care

    • I.D. Guide, a free resource designed to help people navigate legal name, gender marker, and identity document changes in Canada

    • Trans Health Knowledge Base, answers common questions from trans and non-binary people in Ontario (designed for residents 18 and older).

    • Transition-Related Surgery Frequently Asked Questions, a resource for Ontarians considering transition-related surgery and the people supporting them by Rainbow Health Ontario.

    • Trans Supply Library, a free-to-use system of borrowing and returning supplies for trans healthcare needs. Serving the Hamilton, Ontario area