Referral for surgery

1. Get a referral from 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 
• Assist with medical needs identified by the surgeon before and after surgery (helping you with smoking cessation, ordering blood tests)
• Provide or refer you for surgical readiness assessments, if needed (see below) 
• Refer you to a obstetrician and gynecologist (OBGYN)

If your primary care provider does not know of a specialist to refer to, they can call the RACE line or Trans Care BC.

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 (if needed)

The surgeon you are referred to may require a 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. before seeing you for your consult.

What is a surgical readiness assessment?

The surgical readiness assessment 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?

Clinicians who meet the qualifications and competencies outlined in WPATH Standards of Care are considered qualified surgical assessors. This can include family doctors, nurse practitioners (primary care providers) and counsellors.

If your primary care provider is new to working with trans clients, they may not feel confident completing a surgical readiness assessment. If this is the case, ask them to refer you to a qualified surgical assessor For genital surgeries, a qualified surgical assessor is a medical provider (MD, NP, and RN) with the ability to support care before and after surgery and are trained to provide surgical care planning and recommendations for genital surgeries. For upper surgeries and gonadectomies, a qualified surgical assessor is a BC clinician who meets WPATH competencies to provide surgical care planning for upper surgeries and gonadectomies. . 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, most people are able to complete their readiness assessment within six 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 — 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 — What are 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 uterus and ovary removal. (This doesn’t apply if ovaries are not being removed). 

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. Be prepared for wait times

Like many other types of procedures, there is a wait prior to gender-affirming surgeries 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.