Surgery Navigation

There are many things to consider when planning any gender-affirming or transition-related surgery. Some of these considerations are listed in the table below:

---

---

---

---

---

---

---

---

Breast Augmentation

Breast augmentation includes implants inserted beneath existing breast tissue to enlarge one’s breasts.

Patients must be referred using the “Request for Breast Surgery” form which lays out the criteria for having this surgery funded and can be found here (under Gender Surgeries).

This criteria includes:

• Being on feminizing hormone therapy for at least 1 year.
• “No or negligible breast growth”
  Note: most people will not qualify for breast augmentation to be funded as they do develop breast tissue after one year on Estrogen, even though they may be an “A-cup” size or smaller. The surgeon present in the consultation can help determine if you meet the necessary criteria.
• A referral to a surgeon in Alberta. Alberta Health Services (AHS) will not cover surgery performed out of province.
• Diagnosis of Gender Dysphoria from any Alberta psychiatrist;
  • If you have a diagnosis of Gender Dysphoria from a psychiatrist already, a Family doctor or Nurse Practitioner can fill out this form and refer to a surgeon themselves.

If you have not been diagnosed with Gender Dysphoria by a Psychiatrist then you will need a referral to a psychiatrist. Technically any psychiatrist in Alberta can give you the diagnosis of gender dysphoria and any family doctor can refer you to the surgeon, but many of them won’t be familiar with the process or willing to offer a referral

If your healthcare provider is not familiar with the surgery referral process they should contact a clinic that specializes in gender health for advice, such as the Calgary Gender Clinic, the Gender Program at the University of Alberta or the LGBTQ+ Wellness Centre.

Note that Psychology and Psychiatry are different professions. Psychologists can diagnose gender dysphoria but it does not count for this specific form, and you will still need to see a psychiatrist for the diagnosis.

Coverage: if an individual does not meet the criteria, Alberta Health will not fund the surgery and the individual will need to pay for the surgery out of pocket. Most surgeons in Alberta accept self-referrals if paying privately and can be contacted through their websites.

A surgical summary sheet for this surgery can be found here on page 1.

Orchiectomy 

An orchiectomy is the removal of the testes (testicles) and spermatic cord.

This criteria includes: (from WPATH – Standards of Care)

• Being on feminizing hormone therapy for at least 1 year.
• A letter from any one Alberta Psychiatrist diagnosing Gender Dysphoria.
• That the surgery is performed in Alberta.

The referral to the surgeon can come from either the psychiatrist, a family doctor or Nurse Practitioner. There is no specific referral form for this surgery.

This surgery will affect your fertility and ability to have biological children. It may be beneficial to obtain a referral to the fertility clinic to discuss your options prior to having surgery.

• The fertility clinic in Edmonton can be found here.
• The fertility clinic in Calgary can be found here.
• A resource on different fertility options can be found here.

A surgical summary sheet for this surgery can be found here on page 19.

Vaginoplasty and Vulvoplasty

Vaginoplasty is a surgery to create a vagina and vulva (including mons, labia, clitoris, internal vaginal cavity, and urethral opening) and remove the penis, scrotal sac and testes.

Vulvoplasty is the same as vaginoplasty but without creating the vaginal cavity (internal canal). In vulvoplasty only the external genitalia or vulva is created, including the mons, labia, clitoris and urethral opening.

• The application process for vaginoplasty and vulvoplasty are the same. The decision to have either is a personal choice based on your needs and goals.

Coverage: covered only if performed at GRS Montreal as current funding criteria does not include the option to cover this surgery in any other facility.

Criteria can be found in detail here. A summary for the criteria is listed below:

• Being on feminizing hormone therapy for at least 1 year.
• Physical exam from a family doctor identifying any chronic health conditions, and ongoing family doctor support.
• Social transition at least 1 year ago (unless unsafe to do so – for example at work – talk to your psychiatrist if this is the case).
• Two Alberta psychiatrist letters specifically recommending surgery.
• No active addictions (no physical dependence on drugs or alcohol, as withdrawal could make surgery and healing unsafe).

What is paid for:

• Return flight
• Surgery
• Stay in Montreal facility for medically recommended amount of time

What is not paid for:

• Dilators (needed if having vaginoplasty with internal vaginal canal, these are approximately $300 and should be bought at the surgical facility in Montreal)
• Flight and accommodation for a support person (if you are bringing one)
• Medications for flight home ($40)
• Medical supplies needed for aftercare routine

If you are planning for this surgery you can start by reading the Montreal surgery website to learn about the surgery they perform here.

For more information about planning for surgery, what to expect and how to prepare, check out this resource from British Columbia here.

• Remember the tab on “how to access” is specific to BC but the pages on what to expect, how to care for yourself, and self care are relevant.

A surgical summary sheet for this surgery can be found here on page 26.

Surgeries not covered by Alberta Health Care

The following surgeries are not covered by Alberta Health Care:

• Facial Feminization Surgery
• Tracheal Shave Surgery
• Voice Surgery
• Body Feminization Surgery

Most surgeons in Alberta accept self-referrals if paying privately and can be contacted through their websites.

Want to learn more?

Here are some resources from British Columbia and Ontario which have great information about surgeries and considerations that are also relevant to surgery in Alberta. Just keep in mind that the process to get a referral and forms may be different.

• Trans Care BC – Feminizing Surgery
• Rainbow Health Ontario – Surgical Summary Sheets

Top Surgery / Chest Surgery

Masculinizing chest surgery removes breast tissue and sculpts remaining tissue into a shape typically considered more masculine.

Breast reduction can also be an option, talk to your surgeon about your goals!

• Referral process is the same for breast reduction.

Referral must be made using the “Request for Breast Surgery” form which lays out the criteria for having this surgery funded and can be found here (under Gender Surgeries).

This criteria includes:

• A referral to a surgeon in Alberta. AHS will not cover surgery performed out of province.
• Diagnosis of Gender Dysphoria from any Alberta psychiatrist.
  If you have a diagnosis of Gender Dysphoria from a psychiatrist already, a Family doctor or Nurse Practitioner can fill out this form and refer to a surgeon themselves.

If you have not been diagnosed with Gender Dysphoria by a Psychiatrist then you will need a referral to a psychiatrist. Technically any psychiatrist in Alberta can give you the diagnosis of gender dysphoria and any family doctor can refer you to the surgeon, but many of them won’t be familiar with the process or willing to offer a referral.

If your healthcare provider is not familiar with the surgery referral process they should contact a clinic that specializes in gender health for advice such as the Calgary Gender Clinic, the Gender Program at the University of Alberta or the LGBTQ+ Wellness Centre.

Note that Psychology and Psychiatry are different professions. Psychologists can diagnose gender dysphoria but it does not count for this specific form, and you will still need to see a psychiatrist for the diagnosis.

Note: it is not required for you to take testosterone to get top surgery, especially if you do not want some of the other changes that testosterone causes.

A surgical summary sheet for this surgery can be found here on page 5.

Another helpful guide from British Columbia for planning top surgery can be found here.

• Remember that the “how to access care” tab on this page is specific to British Columbia.
• The other tabs about how to prepare for surgery, what to expect the day of surgery, and post surgical care are relevant everywhere.

Hysterectomy

The removal of the uterus, cervix and fallopian tubes with an option to leave ovaries in or remove them.

This criteria includes:

• Must be on masculinizing hormone replacement therapy for at least 1 year (if having ovaries removed).
• Masculinizing hormone replacement therapy is not required if you are not having your ovaries removed.
• Letter from one Alberta Psychiatrist required for referral.
• If you are getting a hysterectomy for a medically necessary reason other than gender dysphoria you can have a referral from a Family doctor or Nurse Practitioner without needing a psychiatrist diagnosis.
• The referral to the surgeon can come from either the psychiatrist, a family doctor or Nurse Practitioner. There is no specific referral form for this surgery.

A surgical summary sheet for this surgery can be found here on page 12.

Phalloplasty and Metoidioplasty

Phalloplasty (aka Phallo): is a gender-affirming, masculinizing, lower body surgery that creates a penis and scrotal sac (phase 1), then testicular implants in the scrotum and implants for erection (phases 2 and 3).

• The penis is created using tissues from your genitals and forearm.
• The scrotum can be created from the external genitals (labia or outer labia).
• Testicular implants can be inserted in the scrotum in a separate surgery months later.
• An implant to get erections can also be inserted.

The goal is to create a penis that preserves sexual sensation that can get erections with the assistance of an implant (if desired) and with enough length and bulk to be used for penetrative sexual intercourse, and to enable the ability to pee while standing. Hysterectomy is required before phalloplasty.

More information about this surgery can be found here.

Metoidioplasty (aka Meta): is a gender-affirming, masculinizing, lower body surgery that creates a penis by cutting ligaments around the erectile tissue (clitoris) to release it from the pubis and give the shaft more length (4 to 6 cm).

• It is optional to have the urethra lengthened to the tip of the penis and/or to have testicular implants.
• It is also optional to have a vaginectomy (closure of the vagina). If you choose to have a vaginectomy you must have a hysterectomy first.

More information about this surgery can be found here.

Covered only if performed at GRS Montreal as current funding criteria does not include the option to cover this surgery in any other facility or to cover techniques that are not offered at GRS Montreal.

Criteria can be found in detail here. A summary for the criteria is listed below:

• Being on masculinizing hormone therapy for at least 1 year.
• Physical exam from a family doctor identifying any chronic health conditions, and ongoing family doctor support.
• Social transition at least 1 year ago (unless unsafe to do so, for example at work – talk to your psychiatrist if this is the case).
• Two Alberta psychiatrist letters specifically recommending surgery
• No active addictions (no physical dependence on drugs or alcohol, as withdrawal could make surgery and healing unsafe).

What is paid for:

• Return fight
• Surgery
• Stay in Montreal facility for medically recommended amount of time

What is not paid for:

• Pre-surgical consultation ($50)
• Cost of flight for initial consultation appointment before phalloplasty surgery (Alberta health pays for your flights to multiple surgery steps but not for flights to the consult)
• Flight and accommodation for a support person (if you are bringing one)
• Hair removal (required for phalloplasty)
• Medications for flight home ($40)
• Dermal matrix for forearm donor graft site (optional) ($8,000-15,000)
• Compression sleeve for forearm

A surgical summary sheet for these surgeries can be found here on page 16 and 22.

Want to learn more?

Here are some resources from British Columbia and Ontario which have great information about surgeries and considerations that are also relevant to surgery in Alberta. Just keep in mind that the process to get a referral and forms may be different.

• Trans Care BC – Masculinizing Surgery
• Rainbow Health Ontario – Surgical Summary Sheets