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For some trans and gender diverse people, these surgeries are needed for their well-being. Surgeries can give relief from gender dysphoria (distress experienced when a person’s gender identity does not match their sex assigned at birth), increase safety and comfort, and lessen or eliminate the need to take hormone therapies.
Overview of surgeries
Gender-affirming surgeries are often categorized as trans masculine or trans feminine. However, gender non-conforming people who do not identify with a binary gender of male or female may also need these surgeries.
There are a number of gender-affirming surgeries available. These include surgeries for the genitals, chest, face, and other areas of the body. People may choose to get one or more surgeries, depending on their needs and situation.
Types of surgeries
Chest contouring: Top surgery that removes breast tissue and shapes the chest in way that is seen as more masculine.
Breast augmentation: Top surgery that enlarges the breasts.
Orchiectomy: Lower surgery that removes the testicles.
Vaginoplasty: Lower surgery that removes the penis, scrotum and testes, and creates a vulva and vagina.
Hysterectomy with bilateral salpingo-oophorectomy: Lower surgery that removes the uterus, ovaries and fallopian tubes.
Clitoral release: Lower surgery to create a penis from the clitoris by cutting ligaments to release the clitoris and add length to the shaft.
Metoidioplasty: Lower surgery to create a penis from the clitoris through clitoral release and grafting skin around the shaft to add girth. Sometimes, the urethra is also lengthened to allow urination from the shaft, and a scrotum is created.
Phalloplasty: Surgery to create a penis, scrotum and testes using graft tissue from elsewhere on the body (like a forearm or thigh). Phalloplasty usually involves one surgery to create the penis and scrotal shaft, and follow-up surgeries to add scrotal implants and implants to cause penile erection (if desired).
Coverage for surgeries
In British Columbia, certain types of gender-affirming surgeries are covered through the British Columbia Medical Services Plan (BC MSP).
- For trans masculine or other gender diverse people who were assigned female at birth, these include: chest contouring, hysterectomy with bilateral salpingo-oophorectomy, metoidioplasty, clitoral release, and phalloplasty.
- For trans feminine and other gender diverse people who were assigned male at birth, these include: vaginoplasty, orchiectomy, and breast augmentation in cases where there is not sufficient breast growth after hormone therapy.
To get coverage and referral for gender-affirming surgery through BC MSP, a person will need:
- one clinical assessment for breast augmentation or chest surgery (if over age 18)
- two clinical assessments for chest surgery (if under age 18)
- two clinical assessments for orchiectomy, vaginoplasty, hysterectomy/ovary removal, clitoral release, metoidioplasty, or phalloplasty
To start this process, a person first needs a referral from their primary care doctor. This is a referral for a surgical readiness assessment, sent to the Chief Assessor’s Office in Victoria, British Columbia. The assessment is done by one or two qualified assessors, who will either approve the surgery, not approve the surgery, or recommend that the person come back for another assessment. These recommendations are sent to the Chief Assessor’s office, who will then send to the primary care doctor and their patient. Once approved, the primary care doctor can refer their patient for surgery.
There are a number of gender-affirming surgeries that are not covered by BC MSP, including vocal cord tightening, facial feminization surgery, tracheal shaving and body contouring. These surgeries need a doctor’s referral or a patient’s self-referral to a qualified surgeon.