Surgical Readiness Assessment

The process for MSP (publicly funded) surgeries recently changed. Please see below for updated information. Additional updated information is also available about Surgery Funding and for Service Providers.

What is a surgical readiness assessment?

This is an assessment done by a Qualified Assessor to confirm that you meet the WPATH Standards of Care criteria for surgery.

Why is a surgical readiness assessment conducted?

This process is intended to ensure that you are prepared for the surgery and will have the best possible post-surgical outcomes. Surgical readiness assessments are part of the current WPATH Standards of Care (Version 7) to be eligible for gender-affirming surgery. The World Professional Association for Transgender Health (WPATH) sets the criteria for gender-affirming surgeries in a document called Standards of Care for the Health of Transsexual, Transgender, and Gender Non-Conforming People, Version 7 (SOC 7).

How do I get an assessment?

This process is in effect as of December 2016. Here is the updated information:
1. Your Primary Care Physician (PCP) will send a referral for a surgical readiness assessment to PHSA Trans Care BC or to a provider they know who already provides surgical readiness assessments. If your PCP is already a Qualified AssessorsHealthcare practitioners qualified to conduct surgical readiness assessments in the Province of British Columbia. Assessors were previously designated by the Chief Assessor or they have obtained the necessary training via Trans Care BC. then a referral to PHSA Trans Care BC is not required.
2. Your assessment(s) will take place with one or two  Qualified Assessors:

  • one Qualified Assessor for breast or chest construction
  • one or two Qualified Assessors for hysterectomy/bilateral salpingo-oophorectomy or orchiectomy
  • two Qualified Assessors for vaginoplasty, simple vulvoplasty (no vaginal opening), clitoral release, metoidioplasty or phalloplasty

Additional assessments may be required at the discretion of the surgeon.

3. The Qualified Assessor(s) will make one of these recommendations:
1. surgery is recommended
2. surgery not recommended at this time, or
3. return for further assessment
4. The Qualified Assessor(s) will send their recommendation(s) to the provider who requested the assessment.

Take a look at our Surgical Referral infographic:

trans-care-bc_surgical-assessment-infographic_final_page_1trans-care-bc_surgical-assessment-infographic_final_page_2

How do I get referred to a surgeon?

Once your PCP receives a copy of your surgical recommendation(s), they can refer you for surgery. The steps are different depending on which surgery you are having. For example, some surgeries take place in BC while others are done in Montreal.

Breast Construction

Your PCP will refer you to a plastic surgeon in BC.

Applications for provincial coverage for breast construction surgery are reviewed on a case-by-case basis.

The application for provincial coverage must be completed by the attending surgeon: http://www2.gov.bc.ca/assets/gov/health/forms/2769fil.pdf

Some general guidelines for breast construction surgery:
1. Client has been on hormones for at least 18 months; and
2. Has had little to no breast growth (smaller than a AA cup); and/or
3. Significant asymmetric growth (1 and ½ cup size difference)

Chest surgery

Your PCP can refer you to Dr Cameron Bowman. His office maintains the central waitlist for chest surgery.

Hysterectomy and bilateral salpingo-oophorectomy

Your PCP will refer you to a gynecologist for surgery in BC.

Orchiectomy

Your PCP will refer you to a plastic surgeon or urologist for surgery in BC.

Vaginoplasty, clitoral release, metoidioplasty or phalloplasty

1. Your PCP will send a referral letter, with a copy of your surgical assessments, to the GRS clinic in Montreal.
2. The GRS Clinic will send a form to HIBC to confirm MSP will fund out-of-province surgery.

3. GRS Clinic will contact you to complete some forms, and then book a surgical date. You can request a phone consultation if desired.
4. You will contact the GRS Clinic to confirm a date for your surgery in Montreal
5. Your PCP may send pre-op lab work results to the GRS Clinic, prior to your surgical date.

Can my primary care provider assess me for surgery?

In most cases, no. In BC, there are Qualified Assessors who are trained and approved to do surgical readiness assessments.

How long is the wait for a surgical readiness assessment?

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

How long does a surgical readiness assessment take?

Each assessment typically last for 1-2 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 other reasons such as complexities in current health or social situation.

What will the assessor ask about during my surgical assessment?

• Your gender identity and feelings about your body
• Your expectations of the surgery and how it will impact you socially, emotionally and financially
• 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

Do I need to do counselling to get surgery?

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

If I am not trans, am I eligible for gender-affirming surgery?

Yes. Gender-affirming surgery can be medically necessary for a range of people, including those who are genderqueer, gender variant, or gender non-conforming.

What are the criteria for gender-affirming surgeries?

All gender-affirming surgeries have 4 criteria in common:
1. Persistent gender dysphoria (distress or discomfort caused by a difference between your gender identity and the sex you were assigned at birth)
2. Age of majority (18 years old in British Columbia)
3. Capacity to consent (you understand procedure, understand associated risks, and have an aftercare plan)
4. Medical and mental health conditions are reasonably well-controlled
Masculinizing chest surgery is usually the only surgery that is done before 18 years of age. Two assessments are required for youth applying for chest surgery.

Additional criteria for feminizing surgeries

Surgery Additional Criteria & Notes Assessment

Breast Construction

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.

You need 1 letter from a qualified assessor recommending surgery.

Additional assessments may be required at the discretion of the surgeon.

Orchiectomy

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.

You may need 1-2 letters from qualified assessors recommending surgery, depending on the surgeon.

Additional assessments may be required at the discretion of the surgeon.

Vaginoplasty

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.

You need letters from 2 qualified assessors recommending surgery.

Additional assessments may be required at the discretion of the surgeon.

Additional criteria for masculinizing surgeries

Surgery Additional Criteria & Notes Assessment

Chest surgery

No additional criteria.Living in a gender role congruent with your gender identity is not required.

Hormone therapy is not required.

You need 1 letter from a qualified assessor recommending surgery.

Additional assessments may be required at the discretion of the surgeon.

Hysterectomy and bilateral salpingo oophorectomyRemoval of both ovaries and both Fallopian tubes

Living in a gender role congruent with your gender identity is not required. 12 continuous months of hormone therapy as appropriate to the your gender goals (unless hormones are not clinically indicated for you).

You may need 1-2 letters from qualified assessors, depending on the surgeon.

Additional assessments may be required at the discretion of the surgeon.

Metoidioplasty, Clitoral Release and Phalloplasty

12 continuous months of hormone therapy as appropriate to your gender goals (unless hormones are not clinically indicated for you). 12 continuous months of hormone therapy as appropriate to the your gender goals (unless hormones are not clinically indicated for you).

You need letters from 2 qualified assessors recommending surgery.

Additional assessments may be required at the discretion of the surgeon.

Changes to the WPATH Standards of Care

British Columbia has adopted Version 7 of the current WPATH Standards of Care (Version 7), which includes many positive changes. First, the current standards of care recognize trans and gender non-conforming identities to be a matter of diversity, not pathology. Second, the current standards of care no longer use the term “Real Life Experience” and only genital surgeries have the requirement of a period of time living congruently with gender identity. Third, you no longer have to identify as a woman or a man to meet the criteria – people who have non-binary identities (such as genderqueer) are also eligible for gender-affirming surgeries.

What changed about the MSP funding process?

There are two major changes:
1. As of December 2014, British Columbia residents no longer need to apply for MSP coverage for surgeries. Patients recommended for surgery by Qualified Assessor(s) are automatically covered by MSP.
2. As of December 2016, all patients will receive results of their assessments at their assessment visit or via their Primary Care Provider. Approval letters will no longer be sent out by MSP or the Chief Assessor’s office. There is no longer a centralized sign-off by the Chief Assessor.

Helpful tip!

Remember to keep your personal information updated with all of your health care providers, including change of names and contact information. This will ensure that they can reach you to schedule assessment and surgery appointments.