Referral for surgery

1. Connect with 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 care (such as necessary tests) you need before and after surgery
• Provide or refer you for surgical readiness assessments (see step below)
• Refer you to a surgeon (see step below) 

If your primary care provider is unsure how to support you through your gender-affirming surgery, they can consult an experienced physician through RACE or eCASE. 

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

What is a surgical readiness assessment?

The 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. 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 qualified to complete surgical readiness assessment. 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 qualified to complete 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 a year when completed through Trans Care BC.

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 identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) — 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 — 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)

What happens next?

After the readiness assessment appointment, the assessor will write a letter of recommendation for surgery and should send this to your primary care provider. To ensure your referral is then complete you must make a follow-up appointment with your primary care provider.  

3. Choose a referral pathway

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, you will need to ask your primary care provider to send your letter of recommendation and referral form to the Trans Care BC Central Waitlist. Trans Care BC will then match you with a gender-affirming surgeon. 

You can consider the following to help make your decision:

• Wait times — Would you like the first available surgeon to do your surgery? Is there a specific surgeon you would like to do your surgery? If you would like a specific surgeon, what is the current wait time for them to do chest construction surgery?
• Location and costs — Does it matter how far you have to travel for your surgery? Can you afford the travel costs not covered by the Medical Services Plan ( 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. ). You can find information on financial assistance here. 
• Surgeon’s requirements — Each surgeon sets requirements related to age, Body Mass Index (BMI) and smoking status. Ensure you meet those criteria if you want to select a specific surgeon.
• Techniques — Some surgeons may only offer specific techniques.

Trans Care BC will contact your primary care provider to confirm receiving your referral. A health navigator at Trans Care BC will then contact you within 2–3 months to discuss your surgeon options. Once you have chosen a surgeon, your referral will be forwarded to the surgeon’s office and they will contact you to schedule your consult appointment. 

4. Be prepared for wait times

Like many other types of procedures, gender-affirming surgeries have wait times 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. The Trans Care BC Central Waitlist health navigator will provide estimated wait-times for surgeons you are eligible to see when they contact you. 

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.