How To Access
Step 1
Decision-makingStep 2
Connect with a practitionerStep 3
Get A Surgical Readiness AssessmentsStep 4
Be Referred to the Surgical CenterStep 5
Have a Surgical ConsultStep 6
Get Hair Removal from your Donor Site
Step 1
Decision-making
Should I get surgery? Which procedures are right for me? These are big decisions. Below is a list of strategies that can help you make a decision you feel confident about.
Trans Care BC’s Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC contains reflection activities that can help you in this process. Choose any strategies you like.
Step 2
Connect with a practitioner
The first step to accessing phalloplasty, metoidioplasty or erectile tissue release surgery is to connect with a doctor (GP) or nurse practitioner (NP). The role of the GP or NP is to support you in accessing the care you need. This includes:
Ask your GP or NP to refer you to a qualified surgical assessor. If they don’t know of any, they can refer you to Trans Care BC’s Health Navigation Team. This team will coordinate an assessment appointment for you.
If your GP or NP happens to be a qualified surgical assessor, they can do the Surgical Readiness Assessment with you.
If you are having surgery in GRS Montreal, it is recommended that your healthcare provider also refer you to an urologist prior to your surgery so you can see them as part of your post-operative care.
Frequently Asked Questions
I don’t have a doctor or nurse practitioner. What can I do?
Contact Trans Care BC’s Health Navigation team for help connecting with a doctor or nurse practitioner.
How long is the wait for an assessment?
The waitlist to have a publicly-funded Surgical Readiness Assessment varies widely, depending on the availability of qualified surgical assessors near you.
Are there private pay options for Surgical Readiness Assessments?
Yes. Some people choose to pay for an assessment if they are having difficulty getting an appointment with an assessor. If you are interested in this option, you can contact us for help.
How many assessments do I need?
One readiness assessment is usually needed as part of the referral process. There are times when additional assessments may be recommended by your doctor, nurse practitioner, qualified surgical assessor, or surgeon.
There are no assessors in my area. What are my options?
You can contact Trans Care BC to confirm whether there are any assessors near you. If there aren’t, we can help you arrange a Telehealth or Virtual Health appointment with an assessor.
Step 3
Get A Surgical Readiness Assessments
You will meet with a qualified surgical assessor for a Surgical Readiness Assessment. The Surgical Readiness Assessment confirms that you meet the criteria for publicly funded phalloplasty, metoidioplasty or erectile tissue release surgery. It also helps ensure you are prepared and supported before, during, and after your surgery.
Many 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 well-being. It may ease your fears to know that these assessments have changed as understandings of gender and human rights have evolved. The focus is on supporting you.
Together, you and the assessor will discuss your gender, your health, your support people, and details about the surgical procedure.
After the appointment, the assessor will write a recommendation for surgery based on the criteria for approval and the information you’ve shared with them.
The assessor will send their recommendation to your doctor or nurse practitioner, who will send your completed referral package to the surgical clinic of your choice: the Gender Surgery Program BC. You will be added to the waitlist for a consult appointment.
Frequently Asked Questions
What are the criteria for publicly funded phalloplasty, metoidioplasty, or erectile tissue release surgery?
The criteria for phalloplasty, metoidioplasty or erectile tissue release surgery are guided by the World Professional Association for Transgender Health’s (WPATH) most current Standards of Care. In British Columbia, the criteria are:
One year of living in a way that is aligned with your gender. This means that you are actively expressing your gender in yourdaily life – it does not mean that your gender expression has to conform to a stereotype.
What kind of questions will the assessor ask?
The assessor may ask questions…
… about your gender:
- What pronouns do you use?
- How would you describe your gender?
- When did you start living outwardly as yourself?
- How long have you been thinking about gender-affirming treatment?
…about your physical and mental health:
- Have you ever been diagnosed with a physical health condition?
- Have you ever been diagnosed with a mental health condition?
- What is your height and weight?
- What medications are you on?
- Have you had any surgeries before? Did you receive anesthesia? Did you have any problems with it?
…about your support people:
- Who are your main support people? Will they be able to help you after surgery?
- Do you have a GP or NP, and are they supportive?
- Is there anything you think would be important for me to know to help with your care planning?
Here is a downloadable list of common question that you may be asked, during a readiness assessment for gender-affirming surgeries.
What do I need to know to make an informed decision about getting surgery?
It’s important to understand the following information:
Your assessor and your surgical team will help you understand these details. You should ask them any questions you have. To learn more about the procedure, see Rainbow Health Ontario’s resources
I don’t identify as masculine or male. Can I still be approved for phalloplasty, metoidioplasty or erectile tissue release surgery?
Yes. The most current WPATH Standards of Care support access to phalloplasty, metoidioplasty, or erectile tissue release surgery for people who have a non-binary gender and/or people who do not identify as masculine or male.
I have a non-binary gender. Can I still get phalloplasty, metoidioplasty, or erectile tissue release surgery?
Yes. The most current WPATH Standards of Care support access to phalloplasty, metoidioplasty and erectile tissue release surgeries for people who have a non-binary gender and/or people who do not dress or identify as masculine or male.
How long will the assessment take?
Surgical Readiness Assessments are usually completed in one session. An assessment lasts for 1-2 hours and there is no physical exam. Extra visits may be booked for individuals that need extra support.
What happens if the assessor decides I’m not ready for surgery?
If there are areas of your health or well-being that need attention to make sure you recover safely after surgery, the qualified surgical assessor will recommend that you make a plan with your doctor or nurse practitioner to address them. This can include managing acute or chronic health conditions, getting help with housing, or finding mental health supports that you may not already have. This does not mean you will be denied surgery. Instead, you will be presented with ways you can work towards a safer surgery and recovery. By addressing these areas, you start your healing process before your surgery and reduce the chances of having complications.
Step 4
Be Referred to the Surgical Center
In BC, publicly funded gender-affirming phalloplasty, metoidioplasty or erectile tissue release surgery can be done at the Gender Surgery Program BC.
For help with making decisions about lower surgeries, including location and procedures, refer to the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.
GSP BC (Vancouver)
The referral form for the Gender Surgery Program BC can be found on their website.
Once your assessments are complete and your referral has been sent, the Gender Surgery Program BC will contact your GP or NP to confirm they received it. You can also call the GSP BC directly and confirm that they received your referral package.
- Tel: 604-875-5060
GSP BC will contact you to book a surgical consult.
Erectile Tissue Release and Metoidioplasty
Once you have had your surgical consult appointment, the GSP BC will contact you to book your surgery date. The wait time for this can vary and your surgical team will give you up-to-date information during your consult appointment.
Phalloplasty
Once you have had your surgical consult appointment, the GSP BC may recommend you for medically necessary hair removal at your donor site (this may not be required for everyone).
If the GSP BC surgeons provide a written recommendation for medically-necessary hair removal, you will also receive detailed instructions on how to move forward with getting publicly-funded hair removal.
The GSP BC will meet with you to assess how the hair removal is coming along. Once the hair removal process is complete, they will contact you to book your surgery.
Frequently Asked Questions
Where can I learn more about the Gender Surgery Program of BC (GSP BC)?
The GSP BC website has a “resource” section with the following:
- a recording of their Information Session from September 18, 2019
- a Frequently Asked Questions document
Are the costs for travelling for this surgery covered?
No, but you can apply for financial support. Please see the Make Travel Arrangements section for details.
Are the costs of staying in Vancouver (before or after my hospital stay) funded?
Some people may prefer to stay in Vancouver for a couple days before and/or after their surgery. These accommodation costs are not funded, though GSP BC surgical team will give you a list of hotels with reduced medical rates.
Where can I learn more about the surgeons at the GSP BC?
The GSP BC website has a “Meet the Surgeons” section that introduces the surgeons. If you have questions about requirements or would like up-to-date estimates of wait times, you can call the GSP BC.
Step 5
Have a Surgical Consult
A surgical consult is an appointment with your surgeons to talk about your goals for surgery and your options in terms of procedures. It’s also an opportunity for you to ask questions.
GSP BC (Vancouver)
Tips for preparing for this consult:
What should I bring?
Click this support tool to review both lists.
These lists are included in the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.
What to expect from this visit
Before the appointment for your surgical consult, you will receive information about what to expect during this appointment. Sometimes you might have more than one appointment as part of this process. Each visit is a bit different, but generally you will:
Meet the nurse and have a detailed health history. The nurse might:
Meet the surgeons and have a focused health history. The surgeons might:
The surgical team will review the process of informed consent by helping you understand the:
You will also be shown a slide show about your surgery- this will include pictures of the surgery happening, and examples of post-operative results at different points of the healing process.
Next Steps
The next step is for the surgical team to initiate the process of filling out the OR Booking Package. This is done when someone is medically ready to proceed with surgery. Some people will fill out the OR Booking Package at their initial consult and others may need to complete a few additional assessments and have medically-necessary hair removal first.
Closer to the time of your surgery, you will be booked for an in-person appointment or phone call with the Pre-Admission Clinic (PAC), which is a clinic that provides support for patients having surgery at Vancouver General Hospital and UBC Hospital.
During this appointment, the nurse will review your health history, your current medications and your planned surgical procedure. You will be given information about any pre-op tests that are needed. You will also be reminded about instructions about diet and medications to take the day of surgery. You will spend time with the GSP BC nurse and health navigator to review the Enhanced Recovery After Surgery guide. This booklet will guide you through each step of the process and provide answers to common questions you may have.
Frequently Asked Questions
What if the surgeons recommend a type of surgery that is different from the one I want?
The surgeons will recommend the type of surgery that they think will provide you with the best surgical outcomes. Their recommendation is based on their extensive training, research, and experience.
If this is different from the surgery you want, let them know. This will lead to a conversation about the pros and cons of the different techniques as they apply to your goals.
I have been referred for an anesthesia consult. What does this mean?
Before surgery, you will be given anesthesia. Some health conditions can put you at higher risk for complications from anesthesia. In this case, your surgeon may refer you to an anesthesiologist for further assessment.
Having a consult with an anesthesiologist is a normal part of the surgical process for many people. We are all complex beings and some of us need more support than others. The purpose for anesthesia referrals is to make sure all measures are taken to keep you safe both during and after surgery. Because there are a number of different of anesthesia options, meeting with the anesthesiologist will help determine which one will best suit you and your health needs.
The anesthesia consult can be different based on the provider, but the doctor generally looks at a number of factors, including blood pressure, Body Mass Index and the presence of other medical conditions such as asthma or diabetes.
Depending on these factors, some patients with higher anesthetic risks may need to have surgery in a hospital operating room (rather than a private surgical centre) for safety reasons. In this case, having surgery in the US may be possible by applying to the Out-of-Country program. If appropriate, a qualified surgical specialist can complete an application for Out-of-Country Surgery. Clients can call Trans Care BC for more information.
Waiting and having challenges accessing surgery can be stressful. Many people find it helpful to connect with others who have gone through similar experiences. You might meet people who have had gender-affirming surgery through friends, support groups, or online networks.You may also find it helpful to talk to a counsellor during this time.
If you are experiencing challenges accessing surgery, or if you have questions about this process, call Trans Care BC.
What if GSP BC is not able to do my surgery?
If you are not medically eligible for surgery in BC, your surgical team will work with you to determine if other surgical centres may be an option. Clients can call Trans Care BC for more information.
How can I care for my mental health during the waiting process?
Waiting and having challenges accessing surgery can be stressful. Many people find it helpful to connect with others who have gone through similar experiences. You might meet people who have had gender-affirming surgery through friends, support groups, or online networks. You may also find it helpful to talk to a counsellor during this time.
If you are experiencing challenges accessing surgery, or if you have questions about this process, call Trans Care BC.
Step 6
Get Hair Removal from your Donor Site (for urethral lengthening only)
For patients having phalloplasty or metoidioplasty with urethral lengthening, medically-necessary hair removal may be required. Hair is removed from the part of the donor tissue that will become the new urethra.
GSP BC:
At the time of your surgical consult, the GSP BC surgeons will assess your donor site to determine if you need medically-necessary hair removal for this area (this may not be required for everyone).
If the GSP BC surgeons provide a written recommendation for medically-necessary hair removal, you will also receive detailed instructions on how to move forward with accessing publicly-funded hair removal.