Transition Related Surgery

The Transition Related Surgery (TRS) Program began in 2018 with the goal of providing high quality, accessible gender affirming surgery for transgender and gender diverse individuals to maximize their overall health and well-being. While not all individuals seek surgical interventions as part of their journey, many find surgery to be an important and/or essential part of their transition.  

The TRS program at Women’s College Hospital is composed of multidisciplinary team members including urologists, plastic surgeons, gynecologists, nurses, physiotherapists and psychiatrists. Our specialized, multidisciplinary team is devoted to providing high-quality care with a focus on optimizing the patient experience and surgical outcomes.

At Women’s College Hospital, we are committed to offering the best care possible to all patients no matter their gender identity, and this extends beyond just the Transition Related Surgery program. All staff, physicians and volunteers across all programs receive training to serve transgender and gender diverse individuals.

Questions? Visit our FAQ page or email us at transitionrelatedsurgery@wchospital.ca.

Contact

Women’s College Hospital
76 Grenville Street
Floor 5
Toronto, ON M5S 1B2

Phone: 416-323-6148
Email
transitionrelatedsurgery@wchospital.ca

There are multiple structural, societal and financial barriers to accessing optimal healthcare for transgender and gender diverse communities. There continues to be significant gaps in accessing skilled healthcare providers that can provide evidence-informed, culturally appropriate care to these individuals and their unique, important health needs. For some individuals, these health needs may include access to medically necessary surgical services.

In response to a significant wait list for surgical referrals and lack of access to surgical services in publicly funded hospitals, Women’s College Hospital (WCH) partnered with Sherbourne Health Centre including Rainbow Health Ontario (RHO), the Centre for Addiction and Mental Health (CAMH), along with a group of committed individuals from the community, to form the Trans Health Expansion Partnership (THEx). Through the work of the THEx, the WCH TRS Program was born with the goal of creating an accessible, and quality surgical program. The program name “Transition Related Surgery Program” also came after a broad community consultation at this time.

WCH is dedicated to supporting the health and wellness of transgender and gender diverse clients. The surgical team of the Transition-Related Surgery (TRS) Program includes specialists in plastic surgery, urology, gynecology, psychiatry and anesthesiology as well as nursing, physiotherapy and other health care disciplines. This program represents the first public hospital-based surgical program in Canada focused on providing safe and timely access to gender affirming surgical care.

At WCH, we are dedicated to offering safe and evidence informed surgical options for TRS. Working in partnership with our patients, we bring expertise, experience and a commitment to the highest quality of care and patient experience.

If you have questions about the TRS Program, the team can be reached at 416-323-6148 or transitionrelatedsurgery@wchospital.ca.

Through training and recruitment of clinical staff with specialized expertise, we are building a comprehensive trans surgical program. At this time, the following surgeries are available at Women’s College Hospital.

  • Mastectomy with Chest contouring* (waitlist currently on hold)
  • Breast Augmentation** (waitlist currently on hold)
  • Hysterectomy
  • Bilateral salpingo-oopherectomy
  • Orchiectomy
  • Scrotectomy
  • Vaginoplasty
  • Vulvaplasty
  • Metoidioplasty (coming soon)

*currently not covered by OHIP, there is a $1500 +HST cost for this procedure

**currently covered by OHIP following 12 months continuous hormone therapy with no breast growth defined as Tanner Stage 1

Please note: The waitlist for top surgeries (mastectomy with chest contouring and breast augmentation) are currently on hold. We are not currently accepting new referrals for surgery. Please check back here for updates on our waitlist.

Harikrishnan (Hari) Gopalakrishnan Nair, PT, TRS Program Manager

Hari is the Clinical Manager for TRS and Pain Clinic at Women’s College Hospital. Hari has post-graduate degrees in management and applied psychology and holds positions as Assistant Professor, Teaching, with the Ontario Internationally Educated Physical Therapy Bridging Program and Adjunct Lecturer with the Department of Physical Therapy at UofT as part of the pain team.

Hari is passionate about equity, diversity, inclusivity, accountability and social justice work and volunteers with the Corporate Equity Committee at Women’s College Hospital and was the first Co-Chair of the Committee.

 

Nursing

Emery Potter, NP-PHC, BSsN, MN, Nurse Practitioner

Emery Potter is a nurse practitioner and an adjunct lecturer at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto. With a deep passion for improving access to quality healthcare for transgender and gender diverse communities, Emery has contributed to both medical and surgical transition supports. They have also played a key role in developing and delivering curriculum, education, and training to enhance trans healthcare capacity across Ontario. In their current role, Emery provides care to individuals undergoing gender-affirming surgery and is involved in several research projects focused on patient-reported outcomes.

Emily MacLeod, BScN, MN, Advanced Practice Nurse

Emily MacLeod is an Advanced Practice Nurse in the Transition Related Surgery program at Women’s College Hospital. Emily obtained her Bachelor of Science in Nursing from the University of Ottawa and Master of Nursing in Clinical Education with a collaborative specialization in gender and health studies from the University of Toronto. Emily has clinical experience within various surgical environments/programs, with an avid interest in addressing health inequities and barriers to healthcare experienced by transgender and gender diverse communities. Emily is passionate about education and knowledge translation, with a particular interest in advancing clinical and cultural competence for healthcare and social service providers for their 2SLGBTQIA+ service users.

 

Plastic Surgery

John Semple MD, MSc, FRCS(C), FACS 

Dr. John Semple is Head, Division of Plastic Surgery at Women’s College Hospital and Professor in the Department of Surgery, Faculty of Medicine at the University of Toronto.  Areas of specialty and interest include Breast Surgery, Breast reconstruction, Tissue engineering, Lymphedema, Mobile health technology and high-altitude meteorology and global waning in the Himalaya.

Kathleen Armstrong, MD, MSc, FRCSC

Dr. Kathleen Armstrong is an award winning teacher and expert in gender affirming top surgeries. She completed fellowship training with Dr. Hugh McLean at the McLean Clinic and is the highest volume top surgeon in Ontario. She has extensive experience as an educator having participated in medical student and resident education for the last 10 years in various roles. In her role within the Division of Plastic, Reconstructive & Aesthetic Surgery at the University of Toronto, she trains medical students, residents and fellows in top surgery providing core lectures, office based and technical experience. She has a MSc in Health Services Research specializing in Health Economics. Her presentations have garnered various awards and she has published in multiple prestigious journals including CMAJ, JAMA and JAMA Surgery. As an Early Career Researcher at Women’s College Research Institute, she aligns her surgical and research interests to focus on gender affirming surgeries.

 

Urologic surgery

Ethan Grober MD, MEd, FRCS(C) 

Dr. Ethan Grober is the Division Head Urology and Assistant Professor at the University of Toronto, Department of Surgery.  Dr. Grober’s clinical activities focus on vasectomy reversal microsurgery, male reproductive and sexual medicine and testosterone deficiency.  His research interests include the assessment of technical competence and operative judgement, the integration and evaluation of new technologies in surgery and the validation of surgical simulation and laboratory-based surgical skills training.

Yonah Krakowsky, MD FRCS(C)

Dr. Yonah Krakowsky is the Division Head of Trans Surgery and a Surgeon-Educator at the University of Toronto.  His clinical and research interests are in peyronies disease, erectile dysfunction, female sexual medicine and increasing access for Trans Surgery in Canada.

Alexi Millman, MD, FRCS©

Dr. Millman MD MPH FRCSC is a reconstructive urologist on staff at Women’s College Hospital and Mount Sinai Hospital. Dr. Millman is a surgeon-investigator at the University of Toronto with the rank of assistant professor.

Originally from the West Coast, Dr. Millman completed her medical training and urologic surgery residency at the University of Toronto. She then completed a fellowship in Genital Reconstructive Surgery with Dr. Kocjancic at the University of Illinois at Chicago. She also holds a Masters in Public Health from the London School of Hygeine and Tropical Medicine. Dr. Millman’s clinical and research interests are in gender affirming surgery, reconstructive urology, and patient reported outcomes.

 

Gynecology

Lisa Allen, MD, FRCS(C)

Dr. Allen obtained her MD from the University of Western Ontario, London. She completed a fellowship at the Women’s College Hospital, which was directed to developing surgical skills in pelvic floor surgery, laparoscopic urogynaecologic surgery, and laser endometriosis surgery.  On completing her fellowship, she joined the Section of Paediatric and Adolescent Gynaecology at the Hospital for Sick Children in Toronto.

Dr. Allen is currently the Head of the Section of Paediatric & Gynaecology at the Hospital for Sick Children and Head of Gynaecology at Mt. Sinai Hospital and Site Chief of the Department of Obstetrics and Gynaecology at Women’s College Hospital

She is President of the North American Society of Paediatric and Adolescent Gynaecology as well as the Co-Chair of CANPAGO, the paediatric gynaecology subspecialty committee of the Society of Obstetricians and Gynaecologists.

 

Physiotherapy

Olivia Drodge, PT

Reg. PT. (Ont.), MScPT, B.Kin.(Hons) Co-op

Olivia is a Registered Pelvic Health Physiotherapist who graduated with a Bachelor of Kinesiology Degree (Honours) from Memorial University of Newfoundland. Following this, Olivia moved to Toronto, Ontario, where she obtained her Master of Science in Physical Therapy from the University of Toronto. Specializing in pelvic health, Olivia’s expertise encompasses a diverse range of areas, which has brought a wealth of knowledge and hands-on experience to her practice at Women’s College Hospital.

During her academic pursuits, Olivia actively engaged in research, serving as a Research Assistant and contributing as a co-author to various research articles, abstracts, and conference proceedings in Neurorehabilitation. Her commitment to advancing knowledge in her field is evident through her ongoing involvement in research at Women’s College Hospital and the University of Toronto.

Beyond her clinical practice, Olivia serves as a lab assistant with Pelvic Health Solutions and co-facilitates the Pelvic Health Selective in the Physical Therapy Program at the University of Toronto on an annual basis. Furthermore, she holds the role of Professional Practice Advisor for Physiotherapy and Kinesiology at Women’s College Hospital, demonstrating her commitment to elevating professional standards within her field.

 

Psychiatry

Dr. Evan Klajncar (he/him)

Dr. Klajncar is a staff psychiatrist at Women’s College Hospital (WCH) and a lecturer in the Department of Psychiatry at the University of Toronto. He completed medical school at the University of Manitoba (2017) and residency training in Psychiatry at the University of Toronto (2022). He provides clinical care within the General Psychiatry Program, with focused interests including ADHD and the provision of gender-affirming psychiatric care.

Qualified health care professionals can apply for OHIP funded Transition Related Surgery (TRS) for their patients. Providers must be trained in assessing, diagnosis and treating gender incongruence/gender dysphoria according to the  World Professional Association for Transgender Health (WPATH) Standards of Care. 

Eligible professionals include physicians or nurse practitioners, while supporting assessments recommending surgery can also be completed by registered nurses, psychologists or registered social workers with a master’s degree.

If you are a provider interested in becoming a qualified provider for surgery recommendation and referral, see our provider resources below.

Required Documents

To refer a patient for surgery, please fax the following documents to (416)32306310

  1. Transition Related Surgery Referral COVER SHEET
  2. Prior Approval Funding Confirmation Letter.
  3. Comprehensive referral
    • Should include medical, gender, surgical and social history
    • Must document clear surgical goals
    • A Referral template (.docx) is available for guidance

Before submitting a referral, please ensure…

After submitting the referral…

  • Once received, referrals are assessed by the TRS team
  • If incomplete, it will be returned via fax requesting the missing information
  • If complete, the referral will be processed and a consultation will be scheduled when available

OHIP Funding Process

For details on OHIP funding for gender affirming surgery, see:

How to apply for OHIP Funding

Once your patient…

  • Meets eligibility criteria for surgery
  • Completes TRS planning visits discussing surgery, risks and benefits
  • Decides to proceed with surgery

You must…

  1. Complete the Prior Approval Funding Form
  2. Fax the form to the Ministry of Health at (613) 536-3188 (DO NOT send it to WCH’s TRS Program).
  3. Wait for approval (typically one to four weeks) where the Ministry will fax a Prior Approval Funding Confirmation Letter to the referring provider.
  4. The form is to be completed and faxed to the MOHLTC at (613) 536-3188

Additional Funding Options

  • UHIP (for international students)
  • Federal funding (for individuals who are incarcerated or military personnel).

For upper body surgeries including mastectomy with chest contouring and augmentation mammoplasty, only one provider (physician or nurse practitioner) is required to complete surgery planning visit(s) and complete the Request for Prior Approval for Funding of Sex-Reassignment Surgery Form.

For lower body surgeries, including but not limited to orchiectomy, hysterectomy,  phalloplasty, metoidioplasty and vaginoplasty, two providers are required to complete separate surgery planning visits and complete the Request for Prior Approval for Funding of Sex-Reassignment Surgery Form. One of the providers must be a physician or nurse practitioner and the other may be any of the listed qualified providers.

TRS planning visits are to be completed as you wish, however, to assist you we have created a template to guide you through the key topics. The documentation should confirm that these topics have been reviewed.

Providers should document that these topics were reviewed:

1. Gender History

  • Current gender identity and transition process
  • Confirmation of persistent gender dysphoria
  • Steps taken or considered (e.g., medical, social transition)
  • WPATH and OHIP eligibility (e.g., hormone therapy, gender role experience)

2. Surgical Goals

  • Why does the patient want surgery?
  • How will surgery help achieve gender goals/reduce dysphoria/incongruence?
  • Are expectations realistic?
  • Awareness of alternative surgical/non-surgical options
  • Fertility considerations (if applicable)

3. Surgery Details & Consent

  • Description of desired surgery, risks, and alternatives
  • Discussion of irreversible effects
  • The surgeon will provide further detailed discussion during consultation

4. Readiness for Surgery (Medical & Psychosocial)

  • Medical & mental health conditions (stability and management)
  • Smoking, alcohol, and substance use history
  • Post-surgery support system and financial resource

Criteria for surgery must be met prior to referral to a surgeon/program. The criteria for surgery are outlined in the box below. Please ensure your client has met these criteria, unless contraindicated, and please make comments on your referral letter. Criteria for all surgeries, including what is listed in the table, must include persistent and well documented gender dysphoria, capacity to make a fully informed decision and consent to treatment.

Criteria for surgery are set by the World Professional Association of Transgender Health’s (WPATH) Standards of care (SOC). The SOC ‘s criteria for surgery include:

  • Gender incongruence is marked and sustained.
  • Meets diagnostic criteria for gender incongruence & other possible causes have been identified and excluded.
  • Mental and physical health conditions that could negatively impact outcome have been assessed with risk-benefit discussion.
  • Demonstrates the capacity to consent to the specific treatment.

For genital surgeries:

  • Understands the effect of gender-affirming surgical intervention on fertility & options have been discussed.

Minimum 6 months of hormone therapy, unless not desired or medically contraindicated.

  1. If you would like more information on how to become a provider qualified to make referrals for Trans Related Surgery please see the RHO website for trainings and information.
  2. For information on the referral process for surgery in Ontario see Rainbow Health Ontario’s Frequently Asked Questions.
  3. For information about specific transition related surgeries, please see these surgical info summary sheets.
  4. RHO provides a weekly mentorship call on Wednesdays from 12-1. Providers are encouraged to call in to ask any trans related health care questions. Register at the bottom of the page on their website.
  5. If you are looking for a primary or secondary provider to support trans pre-surgical planning visits you can make a referral to CAMH.
  6. Visit the RHO Newsroomto be kept up-to-date as our program and website expands to include helpful resources and ensure access to care.
  7. The WCH TRS Program has numerous resources regarding surgery including patient handouts and recorded videos. Please see “Patient Resources” for more information.

Contact Information

For questions about referrals or the TRS Program:
📞 Phone: 416-323-6148
📠 Fax: 416-323-6310
📧 Email: transitionrelatedsurgery@wchospital.ca

At Women’s College Hospital, we are committed to providing compassionate and comprehensive care for individuals seeking gender affirming surgeries. Our expert team of surgeons, clinicians, and staff are dedicated to helping you achieve your personal health goals in a safe, respectful and supportive environment. We understand the unique needs of each patient and offer a range of pre and post operative care options to support you as you make decisions about surgery.

Surgeries & Referral Process

If you wish to access Ontario Health Insurance Plan (OHIP) funded TRS, please make an appointment with your physician or nurse practitioner. TRS planning visits can occur in a primary care setting, with a specialist or at the CAMH Gender Identity Clinic (or in combination depending on your needs and local resources). TRS planning visits will take place with your health care team. You may be asked to see one or two providers depending on the surgery you are requesting. In addition to a physician or nurse practitioner, this might include a social worker, a registered nurse or a psychologist

Your health care provider will arrange or provide the necessary surgery planning visits prior to referral for surgery. In these appointments the provider will ensure that you have met all the OHIP funded surgery criteria in addition to having an in depth conversation with you about your goals, different surgical and non-surgical options, risks and benefits of surgery and other relevant medical and mental health issues.

Once you have completed your TRS planning visit(s), your health care providers will complete a special medical form seeking OHIP funding for transition- related surgeries. Once this is approved, a referral will be made to your chosen surgeon. If the referral is complete and accepted, you will receive a call to set up an initial appointment with the surgeon. The TRS Frequently Asked Questions (.pdf) is a guide to the assessment and referral process for Ministry of Health and Long-Term Care Approval for OHIP funding. The resource is intended for persons considering transition-related surgery in Ontario, and the people supporting them.

For your first appointment, depending on the type of surgery, you will either meet with your surgeon, or with nursing. During this visit, we will take a comprehensive history and there will be a detailed discussion about surgery. If the appointment is with the surgeon, a physical exam will take place or previously sent photos will be reviewed. If the initial appointment is with the nursing team, no physical exam will take place at this visit.  An in person follow up appointment with the surgeon will be made and an exam will take place at this time. A social support person is welcome to join during this part of the visit if that may be helpful to you

After the initial consultations, the next steps may look as follows:

  1. Option 1: No issues identified. Surgery planning continues, including booking a surgery date once one becomes available.
  2. Option 2: An issue(s) has been identified that may increase the risk of putting you to sleep for surgery. A preoperative anesthesia consult (PAC) will be required to determine if you can safely proceed to surgery at WCH. If anesthesia gives approval, and no other issues identified, surgery planning continues, including booking a surgery date once one becomes available.
  3. Option 3: An issue(s) has been identified that may not allow for surgery to safely proceed at WCH. We will follow up with you and your referring health care provider to determine if this issue can be addressed sufficiently to proceed forward with surgery planning. If we are not able to safely address the issue- surgery will not be possible at WCH and this will be communicated to you and your referring provider.

Once surgery is booked, you will get another appointment for pre-admission clinic. This visit typically occurs in the week or two before surgery. At the pre-admission visit you will be given more details about your surgery, pre-operative instructions, review an after-care plan and you may be given information to take home. You may also meet with anesthesia and possibly pharmacy or internal medicine at this visit.

You are expected to have someone to pick you up from surgery and Stay with you for a minimum of 24 hours, and up to 96 hours depending on the surgery. If you do not have such a person, we will discuss options available to you including the Acute Respite Care (ARC) program at Sherbourne Health Center (SHC). If you require ARC, your surgery date will need to be coordinated with the availability of this service.

Through training and recruitment of clinical staff with specialized expertise, we are building a comprehensive trans surgical program. At this time, the following surgeries are available at Women’s College Hospital.

  • Mastectomy with Chest contouring* (waitlist currently on hold)
  • Breast Augmentation** (waitlist currently on hold)
  • Hysterectomy
  • Bilateral salpingo-oopherectomy
  • Orchiectomy
  • Scrotectomy
  • Vaginoplasty
  • Vulvaplasty
  • Metoidioplasty (coming soon)

*currently not covered by OHIP, there is a $1500 +HST cost for this procedure

**currently covered by OHIP following 12 months continuous hormone therapy with no breast growth defined as Tanner Stage 1

Please note: The waitlist for top surgeries (mastectomy with chest contouring and breast augmentation) are currently on hold. We are not currently accepting new referrals for surgery. Please check back here for updates on our waitlist.

Support Programs and Resources

Join us for an anonymous virtual seminar to learn about and discuss gender affirming surgeries with our team of medical experts. This event is open to trans and gender diverse people, their loved ones and providers living in Ontario.

The series is an informational event for those who are making decisions regarding gender affirming surgery and provides an accessible pathway for education on the surgery, surgical techniques, surgical outcomes and the patient experience. These events hope to provide prospective patients an anonymous opportunity to engage with medical experts to discuss this important milestone in their lives and will include an anonymous Q&A period at the end of each seminar.

Individuals considering or receiving surgery at other surgical centers are welcome.

To see the most up to date schedule and to register, click here.

 

Don’t see an answer to your question below? Email us at transitionrelatedsurgery@wchospital.ca. Please note, due to a high volume of emails it may take some time to get back to you. We appreciate your patience.

For more FAQs, read Rainbow Health Ontario’s FAQ document.

 What TRS does OHIP cover?

OHIP only covers pre-approved surgeries. The Ministry will not reimburse you if you pay out of pocket. Multiple procedures can be applied for on the same form if they are performed in the same location. This does not mean that both surgeries can occur at the same time.

OHIP-Funded Procedures (note, some of these procedures are not offered at WCH)

  • Vaginoplasty (includes penile desconstruction, orchidectomy, clitoroplasty, labiaplasty, with and without the creation of a vaginal canal)
    • Phalloplasty (includes vaginectomy, urethroplasty, glansplasty, and penile and
    testicular implants)
    • Metoidioplasty (includes vaginectomy and urethroplasty)
    • Clitoral release with vaginectomy
    • Testicular implants with scrotoplasty
    • Hysterectomy (removal of the uterus)
    • Salpingo-oophorectomy (removal of the tubes and ovaries)
    • Orchidectomy
    • Mastectomy* (includes removal of breast tissue, excess skin, and proper positioning of
    nipple and areola)
    • Breast Augmentation**

*Mastectomy with Chest contouring is currently not covered by OHIP. There is a $1500 +HST cost for this procedure.

**Breast Augmentation is currently covered by OHIP following 12 months continuous hormone therapy with no breast growth defined as Tanner Stage 1.o

Please note, some of these procedures are not offered at WCH

  • Chest contouring/masculinization**
    • Breast augmentation for people with breast growth past Tanner Stage I after 12 months
    of hormone therapy
    • Facial masculinization
    • Facial feminization
    • Electrolysis
    • Laser hair removal
    • Hair transplants
    • Tracheal shave
    • Voice modification surgery
    • Liposuction
    • Chin, nose, cheek, or buttock implants
    • Travel and accommodation costs related to obtaining surgery
    • Supplies related to post-surgery care

** OHIP will only cover the Mastectomy part of chest surgery. Any masculinization must be paid by the patient and will vary from surgeon to surgeon.

As a surgical program, we are not involved in all aspects of gender affirming medical care provision. We do not provide consultations for hormone provision or deliver primary care. Initial surgery discussions are required with a qualified health care provider and funding approval must be in place prior to referral to our program.

Wait times for surgery can be highly variable. Once you have completed your consultation and begin surgical planning, please ask someone from the TRS Program for the estimated wait times.

To inquire about the status of your referral, please first reach out to your referring health care provider. Upon receipt of any referral, a member of our team will send a response to your referring provider indicating that the referral has either been accepted, declined or is incomplete (requires further information). If your referring provider has not received such a response letter, please have them re-send the referral.

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