Gender Identity Clinic: Criteria for Those Seeking Surgery

Please note these criteria only apply to those seeking full surgical reassignment. The Gender Identity Clinic subscribes to the criteria of the Harry Benjamin International Gender Dysphoria Association, Standards of Care, 1998. The International Standards of Care represent minimum standards. The Gender Identity Clinic at the Centre for Addiction and Mental Health uses these standards as guidelines, however, in terms of the real-life experience our clinic uses a two year period of cross-living in the felt-gender role prior to consideration of a recommendation for sex reassignment surgery.

During this period individuals seeking such surgery are expected to fulfil the real-life experience criteria as outlined below and in the Standards of Care. These criteria include being able to demonstrate successful adaptation in the felt-gender role by sustaining either full-time employment, full-time student status or the equivalent of full-time voluntarism, or any combination of these three criteria.

Our clients become "eligible" for hormone therapy after one-year of completion of living full-time in the felt-gender role. In term of "readiness" clients must demonstrate psychosocial stability as defined by the Standards of Care. These standards state that clients must be able to show that "the patient has made some progress in mastering other identified problems leading to improved or continuing stable mental health (this implies an absence of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance)." The clinic also uses objective criteria to assess each individual’s adaptation in the felt-gender role. These include altering identifying documentation such as legal name change, name on your social insurance card, drivers license and health card.

The clinic recognizes that the decision to adopt the felt-gender role should never be taken lightly. There may be 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 consequences of transition to the felt-gender role. For those who proceed with transitioning to the felt-gender, the clinic offers advice in altering their documentation in order to facilitate the real-life experience as far as possible.

Finally as of October 1, 1998 the Government of Ontario has delisted coverage for sex reassignment surgery as a benefit of the Ontario Health Insurance Plan. Other Canadian provinces that cover the costs of surgery include Manitoba, Saskatchewan, Alberta and Newfoundland. Traditionally this has been conditional on their residents obtaining approval from the Gender Clinic at the Centre for Addiction and Mental Health. In addition, most surgeons require approval or recommendation from a recognized psychiatric or psychological professional. British Columbia residents should contact the Gender Dysphoria Program located at Vancouver General Hospital.

Gender Identity Clinic Patient Referral Letter
Please note that the Gender Identity Clinic sees patients who are experiencing any degree of gender confusion or dysphoria. Patients who are confused about their sexual orientation should be referred to the Sexual Behaviours Clinic at the Centre for Addiction and Mental Health, Clarke Site.

Please note that we cannot accept referrals submitted by e-mail.

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