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Refined beauty through aesthetic medicine.

Through the science and artistry of aesthetic medicine, Dr. Marc DuPéré and the experienced medical staff of Visage Clinic will help you refine your appearance and reveal your true beauty.

gender reassignment surgery toronto

Visage Clinic: Dr. Marc DuPéré 101-133 Hazelton Avenue Toronto, ON M5R 0A6 Phone: (416) 929-9800 Fax: (416) 368-3113 Toll Free: 1 (855) 8 VISAGE Monday-Friday: 8:00 a.m.–5:00 p.m.

Requests for gender reassignment or gender confirmation surgery in Toronto have increased dramatically over the past 15 years. Attitudes have evolved, and the transgender community has become much more visible and vocal, especially here in Canada’s largest metropolis. We’re fortunate to live in a time and place that celebrates diversity.

About Gender Confirmation Surgery

Like language itself, the vocabulary referring to gender identity changes over time. Terms currently used for this purpose include transgender, trans, trans-male, trans-female, female-to-male (FTM), and male-to-female (MTF). The names of relevant surgical procedures also incorporate these words. Many patients in Toronto reference “top surgery” when describing any procedure that involves the breasts — whether adding them or taking them away.

Why Choose Dr. DuPéré?

Dr. Marc DuPéré is one of Toronto's standout plastic surgeons, and he's especially adept at enhancing and improving the breasts for many reasons — including the following:

Your Options

Gender reassignment: female-to-male (ftm).

Dr. DuPéré uses a variety of customized techniques for chest reconstruction and contouring. He also offers pectoral augmentation, calf augmentation, and nonsurgical options for facial masculinization.

Gender Reassignment: Male-to-Female (MTF)

In addition to breast augmentation, Dr. DuPéré offers options for reducing the appearance of an Adam’s apple, adding feminine contours to the body, and feminizing the face with both surgical and nonsurgical options.

Our Latest Gender Reassignment Blog Posts

“Top surgery” is a common term for our Toronto transgender community, more specifically my female-to-male (FTM) patients. It refers to the removal of breast tissue and to the masculinization of their chest, a strong component of gender reassignment surgery. I have been performing top plastic surgery here in Toronto since 2001. I offer 6 different techniques of top surgery […]

Many people are somewhat familiar with the breast augmentation procedure, an important component of gender reassignment surgery, required for our Toronto trans-female patients. But many are unaware that techniques and considerations are truly different as compared to our cis-females contemplating the same breast augmentation procedure. That being said, little is mentioned about the other crucial components of their surgical […]

Tracheal shave. Adam’s apple reduction. Smooth neck. Longer neck. These are common names for a procedure I perform often for both males with very prominent Adam’s apple and also for trans-female patients. Toronto and its surrounding communities have a strong transgender community, so the tracheal shave is a common request at my practice. When MTF […]

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The safety of our patients and employees has always been a core part of VISAGE and we continue to keep our values during this time focusing primarily on illness prevention. The global COVID-19 pandemic is an evolving situation and we are taking every precaution to avoid the spread of the virus.

Care for our patients is also very important which is why VISAGE remains open and continues to adapt and alter our normal operating procedures as the COVID-19 outbreak continues.

Please note we are offering FACETIME, SKYPE and PHONE consultation and follow-up with Dr. DuPéré, our nurses Genevieve and Jay (HAIR thinning and Hair restoration, DiVa laser vaginal rejuvenation, post-op questions, etc.) and our aesthetician Gabriela for all things related to skin care.

As a step to ensuring the health and safety of our patients and employees, these are the precautions we are taking:

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Transition Related Surgery

As you all know, these are unprecedented times. Currently our Transition-Related Surgery (TRS) Program at Women’s College Hospital is focusing our efforts on catching up on the backlog of cancelled surgeries and consultations after our program was on hold for several months. We recognize that this is an incredibly difficult time and that there will be significant negative impacts on our trans, non-binary and gender diverse communities as a result of this situation.

We believe that TRS is an essential and life-saving service. We are also part of the health care system that must respond to our current situation by doing what we can to keep you, your family, and your loved ones safe. We will be in touch with you when we are able to schedule an appointment. Please refer to the wait times below as to when you can expect to receive a call. We appreciate your patience with delayed response times.

If you are currently on our waitlist for a Transition-Related Surgery, please note our current estimated wait times below:

If you have questions about the referral process, please first review the “For Providers” tab below for detailed explanation of the elements required in a surgical referral.

If you are inquiring about the status of your referral, please first reach out to your referring physician. Upon receipt of any referral, we always send a response to your referring physician indicating that the referral has either been: accepted, declined or incomplete (requires further information). If your referring provider has not received such a response letter, please have them re-send the referral.

Transgender healthcare access issues are prominent in Canada and worldwide, with significant health gaps in access to skilled primary, emergency and specialty care services, which may include, for some individuals, 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) has partnered with Sherbourne Health Centre including Rainbow Health Ontario (RHO), and 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).

THEx supports the expansion of health services for trans individuals and communities across Ontario. Under the umbrella of THEx, the Transition Related Surgery Sub-committee led by WCH, is charged with the goal of creating an accessible, and quality surgical program.

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

At WCH, we are dedicated to offering the safest proven 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 [email protected] .

Surgeries Available

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.

*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

Yonah Krakowsky, MD FRCS(C), TRS Medical Director Emery Potter, NP-PHC, BSCN, MN, TRS Program Nurse Practitioner Nahir Anashara, Nurse Practitioner Olivia Drodge, TRS Physiotherapist

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.

Mitchell Brown MD, MEd, FRCS(C) 

Dr. Mitchell Brown is a Professor of Surgery in the Department of Surgery at the University of Toronto.  Founder and co-course director of the Toronto Annual Breast Surgery Symposium and Breast Reconstruction Awareness (BRA)Day.  Dr. Brown specializes in aesthetic and reconstructive breast surgery, body contouring and facial aesthetic surgery.

Dr. Kathleen Armstrong

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 performs over 250 top surgeries per year. 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.

Lisa Allen, MD, FRCS(C)

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

Phone : 416-323-6148 Email : [email protected]

OHIP funded Transition Related Surgery (TRS) is applied for by qualified health care professionals. This includes providers who are trained in the assessment, diagnosis, and treatment of gender dysphoria in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care. This may include a Physician or Nurse Practitioner (NP) as well as a Registered Nurse, Psychologist or Registered Social Worker with a Master’s degree. If you are one of the aforementioned professionals interested in becoming a qualified provider, please see our Community Resource page for more information. 

Making a Referral

To make a referral please submit.

Before making your referral ensure

The patient meets OHIP eligibility for surgery (unless contraindicated)

You have provided the patient with comprehensive TRS planning visit(s)

Once you receive the OHIP approval form, have completed the referral and have attached a completed cover page, please fax the referral to: 416 323-6310. If you have any questions about the referral or referral process please call: 416 323-6400 x 4339 or x5333.

Once the referral is received, it will be assessed by someone from the TRS team. If incomplete, it will be returned by fax requesting the missing information.

If the referral is complete, it will then be sent to the appropriate surgeon’s secretary and they will be in contact once they have an appointment available.

For OHIP Funding

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.

The Ministry of Health and Long-Term Care’s  website  outlines the Ontario Health Insurance Plan (OHIP) funding criteria for transition- related surgeries. There is a specific form, the  Request for Prior Approval for Funding of Sex-Reassignment Surgery Form (.pdf) , you must complete in the current referral system to gain access to OHIP coverage. This form can be found  here.

The form is completed and faxed to the MOHLTC at (613)536-3188 once

Once the form is faxed to the MOHLTC, they will fax back a letter with the decision (typically within 1-4 weeks). This Prior Approval Funding Confirmation Letter will be sent to the patient and the referring provider. The form will not be sent to the surgical team as of November 1st, 2019.

Criteria for Surgery

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. 

Surgery Planned Visits

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 (.pdf).

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 (.pdf). 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 list of key topics to discuss and include during these appointments. Documentation should confirm that these topics have been reviewed.

Gender History

Discuss the patients current gender identity and process of transition.

Confirm persistent Gender Dysphoria, the patients experience with transition so far, medical and social steps taken or considered Include Eligibility as per the Ministry of Health and Long Term Care and the World Professional Association of Transgender Health (i.e. duration of hormones, gender role experience)

Goals for surgery

Why does the patient want surgery? How will surgery help the patient achieve their gender goals/reduce dysphoria? Are their expectations for surgery realistic? Aware of alternative non-surgical and surgical options If relevant, discussion around fertility and options for preservation reviewed

Detailed surgery discussion/capacity for informed consent

Description of desired surgery, realistic outcomes, risks, side effects (irreversibility), alternate options. (A more detailed and focused discussion about surgical details will take place between the surgeon and client)

Readiness (medical and psychosocial)

How well controlled are medical and mental health conditions Smoking, alcohol, substance use Supports in place (including financial), and aftercare planning

Criteria for Transition Related Surgery

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. 

Provider Resources

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

For information on the referral process for surgery in Ontario see  Rainbow Health Ontario’s Frequently Asked Questions.

For information about specific transition related surgeries, please see these surgical info summary sheets.

RHO provides a weekly mentorship call from Wednesday 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.

If you are looking for a primary or secondary provider to support trans pre-surgical planning visits you can make a referral to CAMH .

Visit the  RHO Newsroom  to be kept up-to-date as our program and website expands to include helpful resources and ensure access to care.

Referral Process for Patients

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.

The first appointment is a surgical consultation. At this visit you will meet with your surgeon and possibly the Nurse Practitioner or Social Worker. During this visit, we will take a comprehensive history, there will be a detailed discussion about surgery, a physical exam will take place, photos may or may not be taken and consent to communicate with your primary care team will be sought. A pre-op medical questionnaire will be completed.

After this consult visit, if surgery is the next step, the surgeons secretary will follow up with you in order to book surgery. 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 24 hours afterwards. If you do not have such a person, we will discuss options available to you including the ARC program at SHC.

Post Surgical Resources – Vaginoplasty

Post-Surgical Resources – Chest Surgery

If you are in an emergency, in crisis or need someone to talk to, there is help.

Gender Identity Clinic (Adult)

The Adult Gender Identity Clinic offers services to individuals and their primary care practitioners in regard to gender identity and expression.

Individuals over 18 who wish to explore issues related to their gender identity, which may include any degree of transgender expression.

Community professionals looking for support and consultation to help their clients reach their goals related to gender identity and expression.

Ask your health care provider to fill out the CAMH adult referral form. Here is a link to the online referral form . Forms should be faxed to Access CAMH at 416 979-6815. If you have any questions about the referral process, call Access CAMH at 416 535-8501 and press 2.

Types of Treatment and Services Offered

For individuals, consultation and support may include:

If you are interested in accessing LGBTQ2S affirmative psychotherapy, please check the service provider listing at Rainbow Health Ontario to find out options for psychotherapy in your region. 

For community professionals, consultations may include:

Program Overview

The Adult Gender Identity Clinic at CAMH offers specialty services to both individuals and their primary care practitioners in Ontario with regard to issues related to gender identity and expression, including gender expansive, trans and non-binary identities. The program offers a comprehensive response to the variety of clinical issues experienced by clients. The clinical team is interdisciplinary and includes social work, psychiatry and psychology staff with specialized expertise in trauma-informed mental health and addiction care.

Our Services

For community professionals.

Primary care providers can diagnose for gender dysphoria, prescribe transition-related hormones, and refer for transition-related surgeries. If you are new to the field of trans care, Rainbow Health Ontario provides education, clinical support, and mentorship to primary care providers across Ontario. All courses provided by Rainbow Health Ontario are Mainpro+ certified. Please visit learn.rainbowhealthontario.ca for more information on courses offered at this time.

Rainbow Health Ontario also hosts a free bi-monthly Trans Health Mentorship Call to support clinicians in their practices. To register for this call, please visit learn.rainbowhealthontario.ca

IMPORTANT: Rainbow Health Ontario does not accept referrals or provide direct services of any kind.

Hormone Therapy

We would encourage referring physicians and/or nurse practitioners to consider prescribing hormone therapy (HT) for their trans clients.

If you are unsure about prescribing HRT:

*If hormone replacement therapy is the primary reason for referral, we would ask that you consider these above-mentioned recommendations, as it will help to reduce unnecessary waiting for your client in terms of further medical transition.*

The clinic plays a significant role in training health professionals in culturally competent delivery of mental health assessment and treatment services to trans and gender expansive communities. We train and provide practicum and residency opportunities for social work students, psychologists and people from other health disciplines, including more than 10 PhD-level clinical psychologists over the past five years.


Additionally, we provide support and consultations to primary care practitioners and other health care providers to help their clients reach their goals related to gender identity and expression. This may include consultations in regard to completing a mental health assessment, consultation in regard to completing a surgery readiness assessment, or being a second assessor for surgery readiness. The clinic will work collaboratively with you and your organization/practice to help you meet your client’s goals. Clinicians and organizations wanting consultation by the clinic for clients currently on our waitlist can contact our clinic at 416 535-8501 ext. 30985.

We have also launched an ECHO (Extension for Community Healthcare Outcomes) for trans and gender diverse health care . Please consider joining us for free CME-accredited training and consultation.

For Individuals

The clinic offers consultations and support to individuals over 18 years of age who wish to explore issues related to their gender identity, which may include any degree of transgender expression. Clients are seen for an assessment with one of our team members to determine the client’s transition goals, as well as to provide any diagnostic impressions regarding mental health and substance use. Recommendations about how to assist clients in meeting their transition goals are then made. This may include individual support and treatment, group-based support and treatment, as well as recommendations for surgery funding and referrals for clients seeking transition-related surgeries. The clinic follows the World Professional Association for Transgender Health Standards of Care (WPATH),V7 for transition-related surgery (TRS) .

Rainbow Health Ontario has an Ontario Service Provider Directory where you can search for a provider by region. Please go here to find a provider in your area.

If you cannot find anyone in your area after searching the provider directory, you can contact [email protected] . Please note that Rainbow Health Ontario cannot guarantee there will be a provider in your area to prescribe hormones or refer for surgeries.

Additionally, Rainbow Health Ontario’s Trans Health Knowledge Base can provide you with answers to general questions related to navigating the Ontario health care system. Go here for more information . 

For clients living outside the GTA

Given the context of the Covid-19 pandemic, our clinic provides virtual appointments via the Webex platform.

Given our referrals come from across the province, our clinic is equipped to see clients via telemedicine when possible. Typically, the first assessment in our clinic is in person in Toronto, and subsequent appointments for clients who live outside of the GTA may be made using telemedicine.

If you live in the north, you may be eligible for a Northern Travel Grant to cover basic travel costs to and from your appointments with CAMH. If you are an ODSP recipient, you may similarly be eligible to have basic travel costs reimbursed. Please ask your local provider for further details.

Transition-Related Surgery (TRS) - Frequently Asked Questions

T hese FAQ's are designed to provide a brief overview of the assessment and referral process in Ontario for persons considering gender-affirming surgeries funded by the Ministry of Health and Long-Term Care (MOHLTC). For more information on types of surgery, see the TRS Surgical Summary Sheets update .

For specific questions or more detailed information pertaining to gender-affirming surgeries, please don't hesitate to contact our office at 416 535-8501 ext. 30985.

Significant improvement in wait times for assessment

From 2008–2016 the Ministry of Health and Long Term Care (MOHLTC) regulation stipulated that CAMH was the sole assessment site for OHIP-funded transition-related surgery (TRS) (from 1998-2008 TRS was not funded by OHIP). In March 2016, the MOHLTC introduced a regulation change that improves and expands access to assessment for TRS for Ontarians, empowering primary care providers to provide surgery referrals and assessments. CAMH and its community partners championed this expansion of access to assessments for gender-affirming surgery. In anticipation of this important system change, CAMH partnered with Sherbourne Health Centre (including Rainbow Health Ontario) and Women’s College Hospital on a proposal to expand access to surgery-related care. Thanks to funding from the MOHLTC, the Trans Health Expansion (THEx) partnership is working on several key priorities including improving access to assessment, building capacity of primary care providers, and enhancing access to surgery and post-surgical recovery and support.

The funding helped our clinic to hire new staff members and in doing so, we were able to significantly decrease wait times for assessment. Prior to March 2016 the wait for assessment was over 30 months, and to date it is less than one-third of that. We continue to work to see more clients and reduce the current wait times.

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Private Clinic vs Hospital for Gender Reassignment Surgery

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Stethoscope and sphygmomanometer|Patient talking to a primary care nurse in a private clinic|Doctor and nurse in operating room|Stethoscope and sphygmomanometer

For many, getting a gender reassignment surgery is a dream come true. It’s a decision that they went over their heads thousand times over, if not more. While preparing for it, one of the major aspects that you have to consider is whether to have your procedure done in a private clinic or a hospital. It’s a critical deciding factor that will dictate whether you’ll have the freedom to choose a plastic surgeon or not and what options you can take to settle the financial part.

Stethoscope and sphygmomanometer

In this article, we’ll discuss the pros and cons of private clinics and hospitals in Canada when it comes to gender reassignment procedures.Let’s delve right in!

Shorter Wait Time

Canadian healthcare has quite a reputation for its long waiting time, which can take up to several months. In a 2018 study by the Canadian Institute of Health, 84 percent of patients in Ontario had to wait for 182 weeks on average before they got a hip replacement surgery.Waiting for treatment can be an emotionally and physically challenging ordeal for anyone, and patients who are hoping to get their turn for gender reassignment surgery are no exception. Countless top surgery hopefuls in Canada wait for a long time if they are lucky to get approved for healthcare coverage.Although some provinces, such as Ontario and Alberta, have expanded access to medically necessary sex reassignment surgery, applicants go against stringent criteria and approval is decided on a case-by-case basis during a consultation with a government-assigned gender psychiatrist.Private practices offer a convenient alternative in this scenario because of the significantly quicker turnaround time. It is possible to get scheduled for an FTM top surgery merely days after consultation with a plastic surgeon in a private clinic.Admittedly, there is a huge price difference as to how sex reassignment surgeons in private practices are going to charge compared to those who will perform it in a public hospital setting. Nevertheless, some would rather pay out of pocket and move forward with their future than put their life on hold while queuing for what seems like an eternity.

Patient talking to a primary care nurse in a private clinic

Personalized Standard of Care

In hospitals, physicians and nursing staff attend to multiple patients with different conditions every day. Sometimes they are understaffed and therefore tend to get overwhelmed when push comes to shove. Naturally, they will prioritize patients in the emergency and intensive care units.On the other hand, private clinics are designed mainly to cater to niche cases and provide a more intimate treatment setting. They have a limit to the number of clients they take on board. They also have an excellent patient to surgeon and staff ratio to begin with, which allows them to deliver a personalized level of care and service that can go above and beyond for the benefit of their patients.Going through a gender reassignment surgery is a life-changing event for most individuals. It requires an extraordinary level of medical and emotional support and attention from surgeons and caregivers. These are a couple of things you can consistently count on in a private clinic.

Sense of Empowerment

Many people grow hopeless and desperate while waiting for their turn if they are ever approved for coverage for operation. Unfortunately, this can take a toll on their physical and emotional well being.Beyond changing body parts, a gender reassignment procedure affirms who and what they are, which means the world to them. Without it, they continue to suffer from body dysmorphia. They are trapped and sucked into a body and life they dislike and never chose to have in the first place.In the case of non-binary individuals seeking for FTM top surgery, they may resort to binding to conceal their female breasts and to achieve a masculine physique. When done daily for extended hours, it can cause devastating effects to their breast tissues or internal organs, and they may encounter breathing difficulties.Opting to get your sex reassignment procedure in a private clinic can make you feel empowered and in control of such a personal journey. You have the power to decide when and where it’s going to happen. You can select a plastic surgeon, the surgery date, and every little detail in your treatment to tailor your specific needs and preference.


In 2019, Toronto‘s Women’s College Hospital (WCH), based in Toronto, made headlines for being the first public hospital in Canada to offer transition-related surgeries. Although this is deemed fantastic news , the truth remains that it’s still not as widely available as everyone hoped it would be.Travelling to get your gender reassignment surgery can be inconvenient for a lot of people. You have to book for hotel accommodation for at least a week while you are recovering from your operation. Sadly, having it done in a public hospital away from home means having to go through everything alone, without the valuable support of your partner, family, and friends.The beauty of getting private clinics is that they are super accessible and can be found in many convenient locations within where you live. This means you can arrange for a friend or a ride-hailing service to take you straight to your home a few hours after you wake up from the procedure. You can rest and recuperate in your room without having to pay for an additional expense on accommodation. Your loved ones can check in on you anytime.

 Doctor and nurse in operating room

Lower Infection and Complication Risk

Private practices do not have overnight beds, similar to hospitals. When you get your gender reassignment surgery done in a private clinic, you will be sent home several hours after the anesthetics have worn off and when you can stand on your own already. Because of this, there’s a dramatically reduced chance of developing an infection, a common scenario in a hospital setting.Another disadvantage of getting a surgical procedure done in a hospital is the susceptibility of exposure to nosocomial infections, otherwise known as healthcare-associated infections (HAIs). Based on research, 1 in every 10 patients admitted to hospitals will contract some form of hospital-acquired infection, which can significantly impact morbidity, mortality, and hospital billing.For an infection to be classified as HAI, it should be contracted by the patient:

The most common examples of HAI are urinary tract infections (UTIs, surgical site infections, gastroenteritis, meningitis, and pneumonia. These conditions are triggered after being exposed to bacteria, viruses, and fungus. Ninety percent of HAI cases are caused by bacteria, with Staphylococcus aureus (S. aureus) or Staph infection in the blood and Escherichia coli (E. coli) being the two most infamous ones.You have to give this aspect a serious thought before deciding to get your gender reassignment surgery done in a hospital. Picture yourself crippled with anxiety about catching an infection while recovering from your hospital bed for eight days.

Upscale Equipment and Facilities

A winning quality among most private practices is that they are equipped with the latest state-of-the-art medical instruments and facilities to efficiently deliver the specialty treatment they offer, including gender reassignment surgery. As transition-related procedures are still rarely, if ever offered in hospitals in Canada, it can be expected that there will be little to no advancement or funding dedicated to procuring medical equipment for it.

Highly Qualified and Specialized Surgeons

One of the top reasons why people willingly go to private clinics for their gender reassignment surgery, even if it means paying out of their pocket, is that they get the assurance that they are in the hands of a seasoned specialist. Private clinics have one or a roster of highly trained and professionally experienced surgeons who specialize in plastic surgery in addition to transition-related operations.Our very own Dr. Hugh McLean is certified as a specialist in plastic surgery by the Royal College of Physicians & Surgeons of Canada and the American Board of Plastic Surgeons, Inc.He graduated from the Faculty of Medicine, University of Toronto and completed specialized training in plastic surgery in Toronto and cosmetic surgery in Miami.He has been on staff at the Trillium Health Centre since 1980 and is former Chief of Plastic Surgery at the Mississauga Hospital. He opened his private clinic in 1988, which means he has at least three decades under his belt. Dr. Mc Lean is best known as a “Top Surgeon” for “Top Surgery” because of his particular interest in FTM (female to male) and MTF (male to female) surgical transformation.

The Only Disadvantage

Perhaps the biggest and most obvious disadvantage of going to a private clinic to have a transition-related surgery is that it will not be covered by healthcare insurance. As it will be classified as an elective procedure, you have to settle the entire cost with your own money.How much does a gender reassignment surgery cost , you ask. A typical FTM top surgery can cost $8,500 plus applicable taxes. This amount covers almost everything, from consultation to recovery, including:

The cost can be settled in cash or through credit cards and certified cheques. McLean Clinic is one of the best-rated private clinics in Ontario that offers gender reassignment surgery. We can assist you in obtaining financing through the widely respected finance companies, Crelogix and Medicard.

Find Out More About Our Private Clinic

To schedule a consultation with Dr. Mclean, we encourage you to reach out to us immediately. A member of our team will get in touch with you shortly. Contact us now!

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Toronto home to first public hospital in Canada that offers transition-related surgery

gender reassignment surgery toronto

Kiera Howe is a patient advisor at Toronto ‘s Women’s College Hospital (WCH), helping transgender patients through a journey she herself has undergone.

gender reassignment surgery toronto

“I started my process four years ago with Women’s College because I’m a patient with the family health practice. I went in there and said I want to start hormones because I’m transgender,” she said.

Then in September 2018, she packed her bags and left the city for surgery.

“I had my surgery in September in Montreal and one of the reasons I had to go to Montreal was because there was no surgical program in Toronto,” she said.

READ MORE: ‘An experience like no other’: Finding love and intimacy as a trans person

“I thought it was inconvenient, it would have been much better to have the surgery in Toronto and be around my friends and family during recovery and for the eight days after the surgery,” said Howe, who has been able to have her follow-up appointments at WCH.

Last Monday marked the first time vaginoplasty, a surgery that constructs a vagina out of penile tissue for trans patients, had been performed in the province in more than two decades. It also made WCH the first public hospital in the country that offers this type of operation.

“The need for vaginoplasty in Ontario is great, in Toronto specifically great as well,” said Dr. Yonah Krakowsky, urologist and medical lead of the Transition-related Surgery Program at WCH. “We know there are hundreds of people waiting for this surgery.

“Vaginoplasty surgery, for the most part, over the past two decades, hasn’t been available in Ontario. Certainly not through a public academic program,” he added.

Krakowsky noted that Toronto is home to world-class institutions performing some of the most complicated surgeries in the world, but medically necessary vaginoplasty was not one of them.

“It really took an institution, Women’s College here, saying this is an important need in health care, there’s a large gap that needs to be bridged and we have the motivation to make the infrastructure possible,” said Krakowsky.

READ MORE: Gillette ad shows father teaching transgender son to shave for the first time

Transition-related surgery was excluded from Ontario Health Insurance Plan (OHIP) coverage in 1998 and it was not until 2008 that select procedures were made eligible under the plan.

Then, in March 2016, OHIP changed the funding criteria for transition-related surgery to align with internationally accepted standards of care for Gender Dysphoria. The change expanded the list of health-care providers who can provide surgical eligibility assessments.

Two years later, WCH established its Transition-Related Surgery (TRS) Program. And by June 2019, the WCH TRS Program began offering vaginoplasty.

Jack Woodman, Chief Strategy and Quality Officer at WCH, spearheaded the effort to have gender reassignment surgeries available at the hospital.

“I have been honestly beaming with pride that this happened at my organization,” said Woodman, who participated, along with the WCH team, in Toronto Pride’s Trans March.

WATCH: New Gillette ad shows father teaching his transgender son to shave

“This kind of surgery is really, medically necessary because it comes from a diagnosis of gender dysphoria,” explained Woodman. “Different individuals have different levels of gender dysphoria and, depending what it is, some folks may need surgery.. and some folks may not want surgery at all.”

Woodman said there are hundreds of trans patients who have received approvals for surgeries, but they were not able to have them in Ontario.

For Woodman, that “was a real gap in care.”

Howe has recovered physically from the surgery.

“This is huge. This is sort of really setting my body in the way I feel it should look and the way it should feel,” she said.

Howe now spends her time helping to advise and guide others through the process in a program that aims to become a model for other provinces in Canada.

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gender reassignment surgery toronto

gender reassignment surgery toronto

Transition-Related Procedures

Individuals who are undergoing the process of transition each have their own unique goals and expectations. The process of transitioning will be different for each patient and involves care provided from a variety of health care professionals. Surgery plays a role in that process. Plastic surgeons have the ability to assist in a wide array of gender confirming procedures to include surgical and non-surgical facial procedures, breast and chest surgery, as well as genital surgery. Surgery aims to produce a successful cosmetic and functional result, with minimal complications, that align with the individual’s unique goals and thus, helps to alleviate gender dysphoria.

At Toronto Plastic Surgery, we have been involved in the care of patients undergoing transition procedures for over twenty years. Our staff is sensitive to the needs of the transgender community including their unique hopes, dreams, concerns and worries. You will find everyone you speak to on the phone and in person to be dedicated to your personalized care and comfortable recovery.

Raw Talk Podcast: “Trans Health: True to Self” In April 2020, Dr. Brown spoke on Raw Talk Podcast about the Transition-Related Surgery Program, the first public hospital-based surgical program in Canada focused on providing safe and timely access to transition-related surgical care. His segment begins at the 28-minute mark. document.createElement('audio'); https://www.torontoplasticsurgery.com/wp-content/uploads/Raw%20Talk%20Podcast%20-%20Trans%20Health.mp3

Top Surgery – Feminine Chest Contouring

The creation of a female chest contour means different things to different people. Most commonly, this involves augmenting the size of the breast to create a breast shape that is in better proportion with the rest of the body. This is typically performed with the use of breast implants, although in some patients, the breasts can be augmented with the use of transferred fat.

Often transgender women begin the affirmation process through the use of feminizing hormone therapy, which can stimulate breast growth. This growth is often inadequate to meet the patient’s goals. It is important to recognize that breast augmentation performed for trans females has unique differences from a breast augmentation performed on a cisgender female. Not only is the underlying muscle anatomy different but there will be other aspects of feminization to address including appropriate size of the nipple and areola complex as well as the removal of unwanted hair and chest wall fat. There is a myth that transgender patients typically seek unnatural breasts; in reality their requests are as varied as those of cisgender women, ranging from a subtle and natural change to a look that is fuller and more obviously surgical.

There are several important anatomic differences between cisgender female and transgender female augmentations that often go unrecognized by patients and surgeons:

Transfemale Breast Augmentation with smooth round gel 450cc implants, Before and After 6 Months

Transfemale Breast Augmentation with smooth round gel 450cc implants, Before and After 6 Months

Transfemale Breast Augmentation with smooth round gel 450cc implants, Before and After 6 Months

Transfemale Breast Augmentation with 485cc implants, fold incision, Before and 10 months After

Transfemale Breast Augmentation with 485cc implants, fold incision, Before and 10 months After

Trans-female breast augmentation with 420 cc implants, fold incision, Before and 3 Years

Trans-female breast augmentation with 420 cc implants, fold incision, Before and 3 Years

Trans-female breast augmentation, 280cc implant, fold incision, Before and 4 Years

Trans-female breast augmentation, 280cc implant, fold incision, Before and 4 Years

Fat Injection for Transgender Breast Augmentation

Many transgender patients enquire about liposuction contour the waist and hips and help feminize the torso. Sometimes this fat is transferred into the buttocks or outer thigh. This fat can also be used for the breast. In most patients, fat alone does not produce a breast of adequate size, but it can help widen a breast that responded very well to hormones. It also can be used in conjunction with an implant to conceal the implant edges and make the breast look more natural than it might with an implant alone.

Click here for more information on breast augmentation.

Top Surgery – Chest Surgery

For many transgender and nonbinary individuals, chest surgery is essential and medically necessary to alleviate gender dysphoria. Thus, many patients request mastectomy with or without nipple areolar reconstruction. The goals of chest surgery are to create an aesthetically pleasing chest contour through the removal of breast tissue and excess skin. Chest surgery often includes reduction and repositioning of the nipple and areola. With many more patients identifying as gender fluid and nonbinary, chest surgery has evolved into a procedure that is tailored to meet a patient’s own goals. This will be discussed with you in detail at the time of your initial consultation.

The type of surgery offered will depend on the amount of tissue that is to be removed, the position of the nipple and the quality and amount of excess skin. Every effort is made to perform the surgery with as few visible scars as possible. The most common approaches include the “Keyhole” or “Periareola” procedure that involves a small incision made around the border of the pigmented areola skin, or the “Double Incision” procedure that involves the removal of the excess breast tissue and skin with or without the repositioning and resizing of the nipple and areola. This approach leaves a scar in the crease at the lower border of the pectoral muscle and a second scar around the border of the new areola if nipple areolar reconstruction is requested. Delete this line: In larger breasts a small vertical scar may also be recommended.

Adjunctive procedures, including lipocontouring of the chest wall and the use of internal shaping sutures, may also be indicated to optimize the appearance of the chest and meet your specific goals.

gender reassignment surgery toronto

Top surgery is performed under general anesthesia and you will be able to go home the same day. Drains are typically used and you will be asked to wear a thin compression garment for several weeks to assist with your recovery.

Following surgery, patients often state that they have an improved level of confidence and quality of life. Surgical satisfaction is reported to be very high and a significant improvement in gender dysphoria-related mental health conditions has been found.

Transmale, double incision free nipple graft. Before and After 6 months.

Transmale, double incision free nipple graft. Before and After 6 months.

Transmale, double incision free nipple graft. Before and After 6 months.

Transmale, Keyhole Mastectomy, Before and 4 months after

Transmale, Keyhole Mastectomy, Before and 4 months after

Transmale, Double Incision Free Nipple Graft, Before and 6 Months

Transmale, Double Incision-Free Nipple Graft, Before and 3 Months After

Transmale, Double Incision-Free Nipple Graft, Before and 3 Months After

Transmale, Double Incision-Free Nipple Graft, Before and 3 Months After

Transmale, Keyhole Mastectomy, Before and 6 Months After

Transmale, Keyhole Mastectomy, Before and 6 Months After

Facial Procedures

Patients will often consider a variety of facial procedures as part of the process of transition. These procedures may be either surgical or non-surgical. The specific treatment plan will be tailored to the individual’s goals and needs. Examples of common procedures include:

Bottom Surgery

Genital surgery (also referred to as “bottom surgery”) is an involved procedure requiring the participation of several health care professionals. It is important that this be performed in a center with experience managing patients undergoing transition. This option is now available in the Province of Ontario at Women’s College Hospital in Toronto.

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Canada Finally Has Nation-Wide Funding For Gender-Affirming Surgeries

Canada Finally Has Nation-Wide Funding For Gender-Affirming Surgeries

With last week’s announcement from the Government of Nunavut confirming that the territory will pay for mental health services and transition treatments for transgender and non-binary residents, Canada will now have nation-wide funding available for gender-affirming surgeries. Nunavut’s Health Department is partnering with GrS Montréal to provide the surgeries.

Health care in Canada is delivered by the provinces and territories and funding for gender-affirming surgeries varies depending on where a person lives. This patchwork of coverage has resulted in barriers to accessing care that have disproportionately affected people living in Canada’s territories in the North, which includes Yukon, Northwest Territories and Nunavut. While expansion of surgery funding in Canadian provinces has continually progressed over the last decade, comprehensive coverage has only been established in the territories over the past three years.

Nation-wide coverage is obviously a very positive development but advocacy is still needed to continue the work of dismantling barriers for Canadians to access surgical care. Current challenges include:

Getting coverage across the country for Facial Feminization , Breast Augmentation and Male Chest Contouring , procedures that are excluded from funding policies in some jurisdictions.

Surgeons who practice gender-affirming genital surgery are only located in Montreal, Toronto and Vancouver. This means that many transgender and non-binary Canadians need to travel great distances to access surgeons for primary surgeries, follow-ups and specialized care for complications, incurring significant expenses that aren’t universally covered or subsidized.

Wait times are a problem that is not unique to gender-affirming surgical care in Canada but with few experts performing these surgeries patients can wait up to three years just for a consultation with a surgeon.

With the Government of Nunavut’s funding commitment, the goal of nation-wide coverage for gender-affirming surgery in Canada has been achieved. Improvements to provincial and territorial funding policies are still needed but this is a milestone to be celebrated.

Review Funding Policies by Province and Territory:

gender reassignment surgery toronto

Toronto’s Women’s College Hospital launches new program for gender-reassignment surgery

This article was published more than 3 years ago. Some information may no longer be current.

gender reassignment surgery toronto

Janet Macbeth, seen here, was the first patient in Canada to receive a vaginoplasty at Toronto’s Women’s College Hospital. Womens College Hospital

When Janet Macbeth underwent surgery in Toronto on Monday, it was a milestone not just for her, but for Canada.

Ms. Macbeth, 40, was the first patient to receive a vaginoplasty – a four-hour operation that gave her the female genitalia she had always desired – at Toronto’s Women’s College Hospital (WCH), the only public hospital in the country to offer the complex surgery.

“This is such an amazing program and it has so much promise,” Ms. Macbeth said in an interview before her surgery. “It’s something I feel honoured to be a part of.”

As awareness and acceptance of transgender rights has grown, so, too, has the demand for gender-reassignment surgeries, also sometimes called gender-confirming surgeries.

But until now, transgender Canadians have had to travel to the United States or to a private clinic in Montreal to receive any kind of bottom surgery, as procedures replacing a penis with a vagina, or vice-versa, are known.

The formal launch of the vaginoplasty program at WCH should begin to alleviate the Montreal clinic’s waiting list, which has grown substantially since the Ontario government loosened its rules for approving public coverage of gender-reassignment procedures three years ago, according to one of the surgeons who operated on Ms. Macbeth on Monday.

“That was the impetus for this program,” said urologist Yonah Krakowsky, medical director of the new Transition-Related Surgery program at WCH. “How can you open up these assessments and have so many people now approved for surgery without providing any access to surgical care?”

gender reassignment surgery toronto

Toronto’s Women’s College Hospital (WCH) is the only public hospital in the country to offer the complex surgery. Michael Wong/Womens College Hospital

Before Ontario’s former Liberal government made a regulatory change in 2016, the Ontario Health Insurance Plan (OHIP) paid only for gender-reassignment surgeries for patients who had first received approval from one overburdened clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto.

After the Liberals expanded approval-granting powers to health-care providers across the province, the number of gender-reassignment surgeries that OHIP covered in Montreal and outside of Canada jumped from 158 in 2015-16 to 414 in 2018-19, according to the Ministry of Health and Long-Term Care.

At the same time, the province began tracking the number of transition-related surgeries that were already being offered inside Ontario, including chest surgeries and the removal of the uterus or testicles.

Such surgeries nearly tripled from 204 in 2016-17 to 548 in 2018-19, the ministry said.

Other provinces have also seen an increase in demand for genital surgeries, including British Columbia, which is planning to offer bottom surgeries soon at Vancouver General Hospital.

Dr. Krakowsky and his surgical colleagues operated on Ms. Macbeth on Monday under the experienced eye of Marci Bowers, a world-renowned California surgeon who flew in to guide the Toronto team through its first three vaginoplasties at WCH this week.

Dr. Bowers has a transgender history of her own, having grown up as Mark before transitioning more than two decades ago. She has since performed transition-related surgeries on nearly 2,000 patients.

“Many of them consider this life-saving,” Dr. Bowers said. “They’ve battled this for most of their lives. The concept of gender identity is just now coming to light as being a core element of your soul, if you will.”

For Ms. Macbeth, the dawning realization that she was a girl trapped in the wrong body was one of her earliest memories.

Growing up in a conservative family in California and Georgia, she had little choice but to bury her frustrations about her gender identity. The Jerry Springer Show, where transgender people were treated like freaks, shaped her view of the future that awaited her if she came out.

“There were no role models,” Ms. Macbeth said. “There wasn’t anyone saying, ‘Hey, look! Here’s somebody that’s transgender and they have a career and they have a family and they’re living a great life.’ That’s not the representation that I would see.”

Nonetheless, Ms. Macbeth said she partly came out of the closet as a student at the University of California, Santa Cruz, declaring herself queer and trans to some close friends, including the Canadian woman she would go on to marry in 2005.

When the couple moved to Walpole Island First Nation, near Windsor, Ont., Ms. Macbeth, afraid of being shunned in her new country, returned to the closet. She lived as a man until just before their second child, a girl, was born in 2017. Her son is now 5 and her daughter is 2.

“I wanted to be able to show my children that you can be yourself. How can I model that type of behaviour if I can’t even do it myself?” Ms. Macbeth said.

Ms. Macbeth was approved to travel to Montreal for a vaginoplasty, but she chose to wait until the Toronto program – which was already providing other transition-related surgeries – was ready to add vaginoplasties to its repertoire.

Dr. Krakowsky is hopeful that Women’s College Hospital will eventually recruit a surgeon capable of performing phalloplasties, the even-more-difficult feat of constructing a penis.

“Going through surgery – whatever the surgery is – is disruptive and difficult enough as it is,” he said. “We know medical outcomes are better if you don’t travel for health care.”

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Everything you need to know about getting top surgery in Canada

It can cost thousands of dollars more out of pocket to get top surgery in Ontario compared to B.C.

gender reassignment surgery toronto

Credit: Getty Images, Brian Wong/Xtra

Top surgery. Chest construction. The tit eviction. The ol’ nip-nop chip-chop. The teet yeet. Whatever you call it, it can be a life-changing and affirming procedure for trans folks of all stripes. 

While it’s not necessarily important for everyone’s gender journey, the gender-affirming procedure colloquially known as “top surgery” is a big part of some trans folks’ medical transition . The COVID-19 pandemic gave many trans people the space to explore their identities and come out , and now they may be considering surgeries. 

But a number of first-person accounts and guides for getting top surgery in English-speaking countries focus on the United States, which has a vastly different medical system from Canada. South of the border, the procedure can run up huge medical bills—well into the tens of thousands of dollars. And doctors like Florida’s Charles Garramone can garner thousands of online followers and celebrity-level name recognition amongst trans social media users. 

@drgarramone The official TikTok channel for Dr. Charles Garramone #ftmtopsurgery #mansculpture #mansculpting #transgender #nonbinary #lgbtq #gendersurgery ♬ original sound – Dr. Charles Garramone

But here in Canada, it’s (mostly) free if you need it. Gender-affirming top surgery is covered in most provinces under our public health care system. And while that’s great news for trans folks, it doesn’t mean the process is totally easy. Not every province and territory currently has surgeons who perform the procedure, and the exact process of getting referred and paying for it ranges from jurisdiction to jurisdiction. Some provinces like British Columbia have centralized trans health care networks, while it’s the wild west in others. 

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Here’s everything you need to know if you’re considering top surgery in Canada.

What is top surgery? 

Top surgery is a procedure some trans and non-binary folks assigned female at birth choose to undergo in order to achieve a flatter and more traditionally “masculine” chest. It is technically different from a straight-up mastectomy, in that it usually involves some level contouring or intentional scar placement to create that “masculine” chest. 

There are several techniques used to achieve this, and they vary based on patient preference and chest size. Smaller chested individuals may be able to have tissue removed without damaging or moving the nipple and areola, while larger chested folks usually require the nipple to be removed and reattached (or they may choose to go nipple-less). 

A subcutaneous or periareolar mastectomy involves small incisions at the base of the nipples from which the tissue, fat and extra skin is removed. A double-incision mastectomy involves multiple incisions made on the chest in order for excess tissue and skin to be removed. The incisions are then closed together and the nipples can be reattached. 

You can talk about which technique is best for you with your surgeon. 

How do I get a referral for top surgery in Canada?

In most provinces, it starts with speaking with your family doctor or nurse practitioner. If you don’t have access to either, you can reach out to a local LGBTQ2S+ health group to discuss options for finding affirming medical professionals, or even to be directly connected to someone who can refer you. Rainbow Health Ontario or T hree Bridges Community Health Centre can connect you to top surgery referrals in Toronto and Vancouver, respectively. 

Gil Goletski, who lives in Metro Vancouver, didn’t have a family doctor when they started their top surgery process, so they went through Three Bridges. They say it was helpful to have all of their transition-related medical care filtered through the same place—and it be an affirming place at that. 

“Originally when I wanted to start hormones and they set me up with a doctor, I went to a couple of appointments with her and she started me on that process, doing the referral for surgery,” Goletski says.

During your referral appointment, you can expect to be asked questions around your feelings about your body, gender identity, dysphoria and goals for surgery or other aspects of medical transition. You’ll also talk about whether you’re able to take time off of work for the surgery and what sort of support networks you have in your life—it’s important to have a close friend, partner or family member who can pick you up from the hospital and help you out with tasks like bathing in the weeks post-op. 

You’ll also be asked about your health habits, particularly smoking. Some research has shown that smoking cigarettes can increase your risk of surgical complications, including nipple necrosis (the horror situation of your nipple falling off). 

While the process varies from province to province, your assessor will usually provide a determination either for or against surgery after your referral appointment, and then you move on to a surgeon.

What requirements must I meet to get top surgery in Canada?  

Barriers to accessing top surgery mostly come at the level of individual surgeons. You do not have to be on HRT (hormone replacement therapy) to get top surgery, though some surgeons recommend it in order to achieve a certain look. Similarly, weight or BMI (body mass index) should not technically prevent you from getting the surgery, but internalized fatphobia in the medical system can lead to certain surgeons rejecting you.

Many surgeons will perform top surgery on anyone, regardless of size, though they may warn you about some risks and possible complications. 

Some surgeons also recommend chest-related strength-building in the months ahead of surgery in order to give some muscle definition to guide the incisions. 

It’s important to remember that if a certain surgeon isn’t a fit for you, there is usually an option to see another. Goletski was initially matched with one Vancouver-area surgeon, who said they couldn’t do the procedure due to their history with marijuana smoking.

“My referral was rejected because I said that I smoked cannabis, and they rejected me outright not because I wouldn’t stop before surgery but just because I smoked cannabis at all,” they say. 

However, when matched with another surgeon, Goletski was told that wouldn’t be an issue as they stopped around the surgery date.

“When I eventually got surgery, it wasn’t a problem,” they say. “I was just told to stop smoking when I was healing and to do edibles or vaping instead of smoking. And that was all fine.”

Goletski also recommends that folks not be afraid to switch surgeons if a particular waitlist seems to be taking a long time, particularly in a province like B.C. where everything is centralized through an authority like TransCare B.C. They were matched to a second surgeon and languished on their waitlist for months, before getting on a third waitlist and getting in right away.

Nico Mara-McKay got top surgery in Ontario during the pandemic, and they say that the variance between medical professions means that you should be prepared to advocate for yourself. 

“Do your research beforehand to know what you want because they won’t tell you what you need,” they say. “Even if you think they might, do your research.” 

They said they ended up in a situation where they had to essentially dictate their referral to their doctor because the practitioner wasn’t well-versed in trans issues. They also point out that even knowledgeable doctors may not be up-to-date on the latest requirements. 

“I’m not on hormones, that’s not part of my journey,” they say. “But doctors might have that old information. Make sure that you know what the rules and regulations are, or whatever health care options you have within your specific sphere, because they do change.”

How much does top surgery in Canada cost?

Ostensibly, it’s free across Canada, just like other medically necessary surgeries. But there can be unexpected fees in certain regions. 

Mara-McKay got top surgery from a popular Ontario surgeon earlier this year, but say they were hit with a “contouring fee” part way through the consultation process that caught them by surprise. 

“For the removal of breast tissue, there’s no fee,” they say. “But if you want contouring to get rid of ‘dog tags’ that are on the side of the chest or, you know, shape the chest, then you have to pay for it. For me, it was about $3,000.”

It turns out that’s very common in Ontario. When reached by Xtra , Rainbow Health Ontario confirmed that, unlike in other provinces, the entire top surgery procedure is not covered by the provincial health plan; most Ontario surgeons will charge the contouring fee to the patient, in addition to the top surgery cost they bill to the province. 

Provincial funding from the government of Ontario only covers the basic mastectomy. However, it is usually not an option for a patient to get “just the free part,” which means Ontario patients like Mara-MacKay end up footing some couple thousands of dollars worth of surprise bills. According to Rainbow Health Ontario, this “contouring” fee is a result of public health policy in the province, and a decision to only fund part of the procedure at the provincial level. 

It’s good to ask your referrer or surgeon about any fees early in the process, so you can understand your options. For example, some Ontario patients actually choose to see surgeons elsewhere, such as in Montreal, in order to get publicly-funded surgery while avoiding the contouring fee. 

You should also be prepared to budget for the time off of work, which will vary depending on your job, as well as for any bandages, pain medications or other healing process needs recommended by your surgeon. 

Where can you get top surgery in Canada?

In most Canadian provinces, the procedure is covered, at least partially, by public health care, since it is a medically necessary procedure for some people to alleviate gender dysphoria. Most provinces also have surgeons who will do top surgeries, though their availability can vary. 

The process of accessing the surgery can vary based on provincial public health policy, funding and the number of forms you need to fill out. Here’s where you can learn more about getting top surgery in each province and territory. 

British Columbia: TransCare BC 

Ontario: Rainbow Health Ontario

Quebec: GRS Montreal  

Alberta: Alberta’s Gender Reaffirming Program

Saskatchewan: Saskatchewan Trans Health Coalition 

Manitoba: Sexuality Education Resource Centre MB

Nova Scotia: Nova Scotia Health

New Brunswick: New Brunswick Health

Prince Edward Island: PEI Health

Newfoundland and Labrador: Trans Support NL

Yukon: TransCare BC

Northwest Territories and Nunavut: NWT Health

gender reassignment surgery toronto

Senior editor Mel Woods is an English-speaking Vancouver-based writer and audio producer and a former associate editor with HuffPost Canada . A proud prairie queer and ranch dressing expert, their work has also appeared in Vice , Slate , the Tyee , the CBC , the Globe and Mail and the Walrus .

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  1. HLN: Transgender in America

  2. When cisgender people also get gender affirming surgery

  3. Gender reassignment surgery no longer required for transgender recognition in Queensland


  1. Transgender / Gender Reassignment Surgery in Toronto

    “Top surgery” is a common term for our Toronto transgender community, more specifically my female-to-male (FTM) patients. It refers to the removal of breast

  2. Transition Related Surgery

    WCH is dedicated to supporting the health and wellness of our transgender and gender diverse clients. The surgical team of the Transition-Related Surgery (TRS)

  3. Gender confirming surgery

    How to apply for gender confirming surgery (also known as sex reassignment surgery) in Ontario. If you are eligible, this service is covered

  4. Gender Identity Clinic (Adult)

    Primary care providers can diagnose for gender dysphoria, prescribe transition-related hormones, and refer for transition-related surgeries.

  5. Private Clinic vs Hospital for Gender Reassignment Surgery

    In 2019, Toronto's Women's College Hospital (WCH), based in Toronto, made headlines for being the first public hospital in Canada to offer transition-related

  6. Toronto home to first public hospital in Canada that offers transition

    Last Monday marked the first time vaginoplasty, a surgery that constructs a vagina out of penile tissue for trans patients, had been performed

  7. Transition-Related Procedures

    For many transgender and nonbinary individuals, chest surgery is essential and medically necessary to alleviate gender dysphoria. Thus, many patients request

  8. Canada Has Nation-Wide Funding For Gender-Affirming Surgery

    Surgeons who practice gender-affirming genital surgery are only located in Montreal, Toronto and Vancouver. This means that many transgender

  9. Toronto's Women's College Hospital launches new program for

    As awareness and acceptance of transgender rights has grown, so, too, has the demand for gender-reassignment surgeries, also sometimes called

  10. Everything you need to know about getting top surgery in Canada

    But here in Canada, it's (mostly) free if you need it. Gender-affirming top surgery is covered in most provinces under our public health care