Gender Identity Clinic: Criteria for Those Seeking Hormones and/or Surgery

The Gender Identity Clinic subscribes to many of the core criteria for Hormone Replacement Therapy (HRT) and Sex Reassignment Surgery (SRS) outlined in the World Professional Association for Transgender Health (WPATH), Standards of Care, 2011. The International Standards of Care specify that these represent minimum standards.

There are a number of relevant factors, all of which are necessary components in an approval, and none of which are alone sufficient for an approval. Some of the factors are related to eligibility, and other factors are related to readiness criteria.

Below is not an exhaustive list, but gives you some idea of both aspects of the criteria:

• You are 18.
• You have  received a diagnosis of Gender Identity Disorder.
• You have given this due thought and made appropriate disclosures and arrangements. This can include things like having considered implications for fertility, and having “come out” to important people in your life.
• You have completed a continuous Gender Role Experience (or GRE). The GRE is multidimensional and for us includes a gender-appropriate legal name change and documented activity of your community living in a role congruent with your identity. This activity should be commensurate with your abilities, and also demonstrate a social experience of good breadth and quality. A good GRE provides a reasonable set of social experiences necessary as part of informed consent, as well as time to adjust and adapt to the challenges within it in order to function successfully. For most people, this will continue to be found in employment, school studies and voluntarism, or any combination of these. For others we may take the approach of an individually-tailored plan as to the nature and quality of the GRE. The general expectation is that people will complete a GRE prior to approval for hormone therapy or chest surgery. Clients become eligible for genital sex reassignment surgery after one year of documented GRE, recently completed.
• Any mental health or substance abuse issues are well-controlled.
• You are knowledgeable about the intervention(s) and their risks.

If there are issues of concern, we’ll let you know and may offer guidance or community resources in order to help increase your readiness. The clinic recognizes that the decision to adopt the felt-gender role may have serious consequences affecting every sphere of a person’s life, from family relationships to employment, which must be considered. A clinic staff member is available to discuss the potential consequences of transition to the felt-gender role, and can also offer practical advice.

Existing and prospective clients should be aware that effective June 3, 2008 the Government of Ontario reinstated funding for sex reassignment surgery. The Government currently requires individuals seeking sex reassignment surgery to be approved by the CAMH Gender Identity Clinic.  Further information from the Ministry of Health can be found here. 

Please note that we do not make determinations of medical eligibility, only psychiatric eligibility and readiness. Medical eligibility determination is made by the endocrinologist and/or surgeon. It is possible that you are eligible from a psychiatric perspective, but not a medical perspective.

For example, smoking significantly increases medical risk of serious surgical complications--most surgeons will not operate on you unless you are smoke-free. If you would like support to quit smoking, please visit the CAMH Nicotine Dependence Clinic.  

 

Gender Identity Clinic Patient Referral

The Gender Identity Clinic requires a physician referral (by fax or regular mail.) Please note that at this time we cannot accept referrals submitted by e-mail.

• Print
  Follow us on
  
  Share