Forms, referrals & assessments

Provincial benefit coverage

Gender-affirming breast construction A gender-affirming upper surgery (also called breast augmentation) that creates, enlarges or shapes one’s breasts by placing implants underneath natural breast tissue or muscle. surgery is covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgeons will recommend surgery for people who have breasts that have not developed in proportion to their body following an appropriate trial of hormone therapy (unless hormones are not clinically indicated). 

Surgery assessment and referral process

Step 1: Complete a surgical readiness assessment 

To complete 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. , use the Recommendation for Upper Surgery or Gonadectomy Template.

The surgical readiness assessment for breast surgery can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete this assessment if they meet the qualifications.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

• Refer the patient to a provider in community who can complete an assessment (if known).
• Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay options for surgical readiness assessment through mental health providers in community. There are some limited free options. 
• Download and use the Referral for Surgical Assessment Form to refer the patient to Trans Care BC.

Step 2: Refer the patient

Once an assessment is complete and received by the referring provider, there are two options for referring the patient.

Option 1: The referral goes to a network of surgeons trained to provide gender-affirming surgeries, working from a centralized waitlist.

1. Fax the following to Trans Care BC (604-297-9900):
   • Surgical Recommendation
   • Referral Form for Upper Surgery
   • The patient’s current medication list
   • Any other relevant medical history and recent consult reports
2. Trans Care BC manages a Central Waitlist, and will add the patient to the list once they receive the package outlined above.
3. Trans Care BC will contact the patient to discuss surgeons who the patient is eligible to see and associated surgeon wait times. The patient will provide Trans Care BC with their choice of surgeon.
4. Trans Care BC will forward the referral package to the surgeon's office.
5. The surgeon will assess the patient and complete the funding application if indicated.

Option 2: The referral goes to a plastic surgeon of the patient's choice (they are not affiliated with the network in Option 1).

1. Contact the plastic surgeon directly to determine what documentation they require to accept a referral.
2. The surgeon will assess the patient and complete the funding application if indicated.
3. You may contact the RACE line or eCASE and select the ‘Transgender Health’ option for information on surgeons who are experienced in gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. .

Revisions

• Patients can follow up directly with their original surgeon.
• If the patient cannot follow up with their original surgeon you can refer them to the Trans Care BC Upper Surgery Central Waitlist for revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. . To do this, fax a new Upper Surgery Referral Form and use the 'Revision' checkbox. 
• Alternatively, a referral for revision may be sent to a different plastic surgeon of the patient's choice (you will have to return to the first step of the Option 2 section in the Breast Construction referral process)
• A new surgical recommendation is not required unless requested by the surgeon. 

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

‎Step 1: Complete a surgical readiness assessment 

To complete 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. , use the Recommendation for Upper Surgery or Gonadectomy Template.

The surgical readiness assessments for chest construction A gender-affirming, upper surgery that removes breast tissue and sculpts remaining tissue into a shape that is typically considered to be more masculine. surgery can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete an assessment for them if they meet the qualifications.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

• Refer the patient to a provider in community who can complete an assessment (if known).
• Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay options for surgical readiness assessment through mental health providers in community. There are some limited free options. 
• Download and use the Referral for Surgical Assessment Form to refer the patient to Trans Care BC.

Step 2: Refer the patient

Once an assessment is complete and received by the referring provider the patient can be referred.

Follow these instructions to make the referral.

1. Fax the following to Trans Care BC: 604-297-9900:
   • Surgical Recommendation 
   • Referral Form for Upper Surgery
   • The patient’s current medication list
   • Any other relevant medical history and recent consult reports
2. Trans Care BC manages the Central Waitlist, and will add the patient to the list once they receive the package outlined above.
3. Trans Care BC will contact the patient to discuss surgeons who the patient is eligible to see and associated surgeon wait-times. The patient will provide Trans Care BC with their choice of surgeon.
4. Trans Care BC will forward the referral package to the surgeon's office.
5. The surgeon will see the patient for a consult.

Revisions

• Patients can follow up directly with their original surgeon.
• If the patient cannot follow up with their original surgeon they can be referred to the Trans Care BC Upper Surgery Central Waitlist for revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. . To do this, fax a new Upper Surgery Referral Form and use the 'Revision' checkbox. 
• A new surgical recommendation is not required unless requested by the surgeon.  

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

Step 1: Refer the patient to the obstetrician or gynecologist they choose.

For information on surgeons experienced in providing gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. , you may contact the RACE line, eCASE (select the transgender option), or our health navigation team.

Step 2: Complete a surgical readiness assessment (if required)

To complete 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. , complete the Recommendation for Upper Surgery or Gonadectomy Template. 

If the obstetrician or gynecologist requests a surgical recommendation, a surgical readiness assessment can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete an assessment for them if they meet the qualifications.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

• Refer the patient to a provider in community who can complete an assessment (if known).
• Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay options for surgical readiness assessment through mental health providers in community. There are some limited free options. 
• Download and use the Referral for Surgical Assessment Form to refer the patient to Trans Care BC.

Revisions

• Patients can follow up directly with their original surgeon.
• If the patient cannot follow up with their original surgeon they can be referred to a gynecologist or obstetrician of the patient's choice (see the section about the Hysterectomy A gender-affirming lower surgery to remove all or part of the uterus and sometimes the ovaries and/or fallopian tubes. referral process above).

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

There are two pathways for orchiectomy A gender-affirming lower surgery to remove the testicles. patients.

Option 1: Orchiectomy only

Step 1: Refer the patient to the urologist they choose.

You may contact the RACE line or eCASE and select the Transgender Health option for information on surgeons who are experienced in gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. .

Step 2: Complete a surgical readiness assessment (if required)

To complete 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. , use the Recommendation for Upper Surgery or Gonadectomy Template.

If the urologist requests a surgical recommendation, surgical readiness assessment can be provided by clinicians who meet the qualifications and competencies outlined in WPATH SOC 8. This includes non-medical mental health providers. A patient’s referring provider can complete an assessment for them if they meet the qualifications.

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

• Refer the patient to a provider in community who can complete an assessment (if known).
• Advise the patient to follow up with Trans Care BC’s health navigation team for information about private-pay options for surgical readiness assessment through mental health providers in community. There are some limited free options. 
• Download and use the Referral for Surgical Assessment Form to refer the patient to Trans Care BC.

Option 2: Orchiectomy done concurrently with vaginoplasty/vulvoplasty:

See our section on Vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. & Vulvoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and remove the penis, scrotum and testes. Vulvoplasty creates the external aspects of a vulva without creation of a vaginal canal. (below).

Revisions

• Patients can follow up directly with their original surgeon.
• If the patient cannot follow up with their original surgeon they can be referred to a urologist of the patient's choice (see Orchiectomy referral process Option 1 above)

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

Step 1: Conduct a surgical readiness assessment

To complete 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. , use the Recommendation for Genital Surgery Template.

Please note

Only individuals on Trans Care BC’s list of clinicians who are qualified to provide care planning Process that a person, their health care providers, family and other supporters undertake in planning to reach their gender-affirming care goals. for genital surgery may make recommendations for genital surgery. If you are interested in being added to this list, please Contact Us.

The surgical readiness assessment for genital surgery is limited to medical providers who have the training outlined in the WPATH SOC 8, such asNPs, MDs, and RNs in a multidisciplinary care setting with MD or NP signoff) who also have the ability to support care throughout the surgical journey (in conjunction with the surgeon and other relevant providers). 

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

• Refer the patient to a provider in community who can complete an assessment (if known).
• Advise the patient to follow up with Trans Care BC’s health navigation team for information about limited private-pay options for genital surgical readiness assessment.
• Download and use the Referral for Surgical Assessment Form to refer the patient to Trans Care BC.

Step 2: Refer the patient

Once an assessment is complete and received by the referring provider, you can refer the patient to Gender Surgery Program BC (GSPBC).

Follow these instructions to make the referral:

1. Fax the following to the Gender Surgery Program BC (GSP BC) at 604-875-5075:
   • VCH Lower Surgery Referral Form
   • Surgical recommendation
   • Any other relevant medical history and recent consult reports 
2. GSP BC will add the patient to their waitlist. 
3. GSP BC will contact the patient to book a consult (this can take up to a year).

Revisions

Patients can follow up directly with their original surgeon or surgical program.

Provincial benefit coverage

This surgery is a benefit covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. .

Surgery assessment and referral process

Step 1: Conduct a surgical readiness assessment 

To complete 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. , use the Recommendation for Genital Surgery Template.

Please note

Only individuals on Trans Care BC’s list of clinicians who are qualified to provide care planning Process that a person, their health care providers, family and other supporters undertake in planning to reach their gender-affirming care goals. for genital surgery may make recommendations for genital surgery. If you are interested in being added to this list, please Contact Us. 

The surgical readiness assessment for genital surgery is limited to medical providers who have the training outlined in the WPATH SOC 8, such as NPs, MDs, and RNs in a multidisciplinary care setting with MD or NP signoff. These providers must also have the ability to support care throughout the surgical journey (in conjunction with the surgeon and other relevant providers).

If the referring provider is not qualified or unable to complete an assessment for the patient, they can:

• Refer the patient to a provider in community who can complete an assessment (if known).
• Advise the patient to follow up with Trans Care BC’s health navigation team for information about limited private-pay options for genital surgical readiness assessment.
• Download and use the Referral for Surgical Assessment Form to refer the patient to Trans Care BC.

Step 2: Refer the patient

Once an assessment is complete and received by the referring provider the patient can be referred to Gender Surgery Program BC (GSPBC) or GRS Montreal.

Option 1: Gender Surgery Program B.C.

Follow these instructions to make the referral to GSPBC:

1. Fax the following to the Gender Surgery Program BC (GSPBC) at 604-875-5075:
   • VCH Lower Surgery Referral Form
   • Surgical recommendation
   • Any other relevant medical history and recent consult reports 
2. GSPBC will add your patient to their waitlist.
3. GSPBC will contact the patient to book a consult (this can take up to a year).

Option 2: GRS Montreal

Follow these instructions to make the referral to GRS Montreal:

1. Fax the following to GRS Montreal at 1-514-288-3547:
   • A brief referral letter, including relevant clinical details not covered in the surgical recommendation form (such as BMI, medical history and recent consult reports)
   • Surgical recommendation
   • If it has been more than six months since the recommendation was completed, include an update on mental and physical health, readiness for surgery and any significant changes.
   • Forms you completed with your patient:
     • Consent to disclose information between GRS Montreal & TCBC
     • Consent to disclose information between GRS Montreal & GP
     • GRS Montreal Identification Questionnaire
   • The following provider forms:
     • Health Status Information Form
     • Questionnaire to assess sleep apnea
     • Preoperative Questionnaire
2. Once faxed, advise your patient to contact GRS Montreal by phone: 1-514-288-2097 or email info@grsmontreal.com to initiate their surgical booking. 

Revisions

Patients can follow up directly with their original surgeon or surgical program.