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Gender-Affirming Care in Canada

Gender-Affirming Care in Canada
If you seek gender-affirming care, you may wonder if your country's insurance covers these expenses. This series of articles will explore gender-affirming care in different countries and how to access them.

If you seek gender-affirming care, you may wonder if your country’s insurance covers these expenses. This series of articles will explore gender-affirming care in different countries and how to access them. First, we will cover gender-affirming care in Canada.  

What is Gender Affirming Care and Surgery?

Gender-affirming surgery or care are surgeries, procedures, mental health care, and more that affirm a person’s gender identity. They can help a person change their primary or secondary sex characteristics to match one’s gender identity better.

Canadians who want to access gender-affirming healthcare will have different coverage, requirements, and wait times depending on the province/territory where they live. In addition, whether or not they live in urban or rural areas will impact the accessibility of care.  

What is Covered and Not Covered in Each Province and Territory?

Here is a list of what gender-affirming care is available in each province and territory:

British Columbia

COVERED:

  • Chest construction and reduction
  • Orchiectomy
  • Hysterectomy (with bilateral salpingo-oophorectomy)
  • Vaginoplasty
  • Vulvoplasty
  • Clitoral release
  • Metoidioplasty
  • Phalloplasty
  • Travel Assistance Program 
  • Expenses for out-of-province surgical aftercare if this is needed medically
  • Psychiatric services
  • Vocal feminization program 

PARTIALLY or CONDITIONALLY COVERED:

  • Breast construction and/or augmentation (on a case-by-case basis and can be funded in some situations)
  • Hormone therapy
  • If you have PWD coverage, you can get access to binders, packers, and breast forms (prescription/letter from MD or NP required)
  • Facial procedures (reduction of Adam’s apple, nose feminization, facial bone reduction, face lifts, eyelid rejuvenation)
  • Pectoral implants
  • Hair removal, reconstruction, or restoration
  • Liposuction or lipofilling
  • Voice surgery
  • Psychologists, social workers, and registered clinical counselors (made available through work benefits and private insurance. Also, some community organizations offer free counseling, but it is limited)
  • Travel and accommodation costs for travel to surgical centers (BC or MTL)
  • Supportive garments and supplies for wound care 
  • Travel-related costs which can include insurance or accommodation

Alberta

COVERED:

  • Phalloplasty
  • Metoidioplasty
  • Vaginoplasty
  • Hysterectomy and removal of ovaries
  • Breast augmentation and mastectomy (however, the patient must get pre-approval from Alberta Health)
  • Voice therapy

CONDITIONALLY/PARTIALLY COVERED:

  • The patient must have little to no breast growth as determined by the surgeon to be approved for breast augmentation surgery.
  • Hormone replacement therapy products from the Alberta Drug Benefit List (ADBL) for patients who are on government-sponsored drug plans 
  • Alternatives to GnRH therapy are listed as an available benefit on the ADBL. However, some testosterone products and GnRH medications need a particular authorization form to be completed by a prescriber, and special authorization criteria need to be met.

NOT COVERED:

  • Facial feminization
  • Tracheal shave
  • Voice pitch surgery
  • Non-medical interventions (for example, laser hair removal or electrolysis)
  • Take-home medications and equipment
  • Personal expenses, meals, and accommodation

Yukon

COVERED:

  • Hormone therapy (however, the medical practitioner needs to apply to the benefits program on behalf of the patient)
  • Vaginoplasty
  • Phalloplasty
  • Metoidioplasty
  • Penectomy
  • Hysterectomy
  • Salpingo-oophorectomy
  • Orchiectomy
  • Mastectomy
  • Chest contouring
  • Body contouring
  • Hair removal
  • Travel and medical costs
  • Facial feminization surgery 
  • Voice therapy and vocal surgery
  • Mental wellness services and resources (through the All Genders Yukon Society)
  • Training for healthcare professionals so that they can provide compassionate and culturally sensitive WPATH gender-inclusive care

PARTIALLY/CONDITIONALLY COVERED:

  • Counseling and mental health services

Northwest Territories

COVERED:

  • Mastectomy
  • Genital surgery (requires two assessments, referral, and prior approval from the government)
    • Vaginoplasty
    • Metoidioplasty
    • Phalloplasty
    • Clitoral release

PARTIALLY/CONDITIONALLY COVERED:

  • Breast augmentation is only covered when medically necessary

NOT COVERED:

  • Outpatient medications, equipment, and supplies
  • Meals, accommodations, and any personal expenses
  • Chest contouring
  • Facial feminization
  • Tracheal shave
  • Voice pitch surgery
  • Psychotherapy
  • Fertility preservation 
  • Liposuction and/or lipofilling
  • Electrolysis and/or laser hair removal
  • Cosmetic procedures from the previous surgery to enhance a person’s appearance

Nunavut

COVERED:

  • Mental health counseling and services
  • Chest surgery
  • Breast augmentation 
  • Genital surgery including:
    • hysterectomy
    • vaginoplasty
    • phalloplasty
  • Genital reconstruction 

PARTIALLY/CONDITIONALLY COVERED:

  • Hormone therapy 

NOT COVERED:

  • Facial feminization
  • Liposuction/body contouring
  • Tracheal shave
  • Hair transplantation
  • Voice training
  • Voice pitch surgery
  • Surgical revisions that are cosmetic 

Saskatchewan

COVERED:

  • Hysterectomy
  • Mastectomy
  • Oophorectomy
  • Metoidioplasty
  • Orchiectomy
  • Vaginoplasty 
  • Phalloplasty
  • Voice therapy

PARTIALLY/CONDITIONALLY COVERED:

  • Some hormones (listed on Saskatchewan Formulary)

NOT COVERED:

  • Breast augmentation
  • Chest contouring
  • Body sculpting surgeries 
  • Facial hair removal procedures
  • Hair transplantation
  • Laryngeal Chondroplasty
  • Tracheal shave
  • Accommodation or travel costs
  • Certain hormone therapy drugs
  • Voice training and/or Voice pitch surgery
  • Surgical revisions that are cosmetic

Manitoba

COVERED:

  • Chest masculinization
  • Hysterectomy and oophorectomy
  • Metoidioplasty
  • Orchiectomy
  • Penectomy
  • Vaginoplasty
  • Feminizing voice therapy
  • Laser hair removal procedures

PARTIALLY/CONDITIONALLY COVERED:

  • Breast augmentation 
  • Hormone therapy

NOT COVERED:

  • Facial feminization surgery
  • Tracheal shave
  • Electrolysis
  • Hair transplantation
  • Voice pitch surgery

Ontario

COVERED:

  • Assessment for hormone therapy treatment
  • Counseling and mental health services
  • Augmentation mammoplasty or mastectomy
  • Private clinic stay and/or ministry-approved services that are outside of Canada
  • Orchiectomy
  • Hysterectomy
  • Salpingo-oophorectomy
  • Vaginoplasty
  • Clitoroplasty
  • Clitoral release
  • Labiaplasty
  • Vaginectomy
  • Metoidioplasty
  • Phalloplasty
  • Testicular implants with scrotoplasty
  • Penile implant

PARTIALLY/CONDITIONALLY COVERED:

  • Hormones (patients covered by Ontario Drug Benefit program)
  • Anti-androgen and estradiol are covered without EAP approval

NOT COVERED:

  • Chest contouring/masculinization
  • Liposuction
  • Electrolysis
  • Laser hair removal
  • Hair transplants
  • Tracheal shave
  • Voice modification surgery
  • Implants (Chin, nose, cheek, or buttock)
  • Facial feminization or masculinization
  • Travel for surgery

Quebec

COVERED:

  • Phalloplasty
  • Metoidioplasty
  • Vaginoplasty
  • Double mastectomy with reconstruction
  • Hysterectomy

PARTIALLY/CONDITIONALLY COVERED:

  • Hormone therapy options

NOT COVERED:

  • Breast augmentation
  • Facial feminization
  • Liposuction and/or body contouring
  • Tracheal shave
  • Hair transplantation
  • Voice training
  • Voice pitch surgery
  • Surgical revisions that are cosmetic

New Brunswick

COVERED:

  • Hormone therapy
  • Chest masculinization 
  • Vaginoplasty 
  • Vaginectomy, hysterectomy, salpingo-oophorectomy
  • Mastectomy 
  • Metoidioplasty
  • Phalloplasty, erectile and testicular implants.

NOT COVERED:

  • Breast augmentation 
  • Facial feminization
  • Tracheal shaving
  • Hair removal
  • Hair transplantation
  • Travel, accommodation, or medications that are outside of what is provided by the hospital
  • Voice training
  • Voice pitch surgery
  • Cosmetic surgical revisions
  • Body contouring
  • Pectoral implants

Nova Scotia

COVERED:

  • Hysterectomy
  • Oophorectomy 
  • Orchiectomy
  • Penectomy
  • Breast augmentation
  • Breast reduction
  • Chest masculinization/mastectomy 
  • Phalloplasty
  • Metoidioplasty
  • Vaginoplasty (only available at Montreal’s Centre Metropolitain de Chirurgie)

PARTIALLY/CONDITIONALLY COVERED:

  • Mental health services can be funded when they are provided in public institutions
  • Hormone therapy from public institutions

NOT COVERED:

  • Facial feminization
  • Liposuction and/or body contouring
  • Tracheal shave
  • Hair transplantation
  • Voice training
  • Voice pitch surgery
  • Surgical revisions that are cosmetic 

Prince Edward Island

COVERED:

  • Hysterectomy
  • Mastectomy (with chest masculinization)
  • Breast augmentation
  • Metoidioplasty
  • Clitoral release
  • Erectile/testicular implant
  • Oophorectomy
  • Phalloplasty
  • Scrotoplasty
  • Vaginectomy
  • Clitoroplasty
  • Labiaplasty
  • Orchiectomy
  • Penectomy
  • Vaginoplasty

PARTIAL/CONDITIONALLY COVERED:

  • Hormone therapy (depending on the provincial drug formulary or a patient’s private insurance policy)

NOT COVERED:

  • Facial feminization
  • Liposuction and/or body contouring
  • Tracheal shave
  • Hair transplantation
  • Voice training
  • Voice pitch surgery
  • Surgical revisions that are cosmetic

Newfoundland and Labrador

COVERED:

  • Breast augmentation (when there is no breast development for 18 months of hormone therapy)
  • Mastectomy with chest masculinization (excluding implants and liposuction)
  • Hysterectomy
  • Orchiectomy
  • Salpingo-oophorectomy
  • Vaginoplasty (includes orchiectomy, penectomy, labiaplasty, clitoroplasty; with or without the construction of vaginal cavity)
  • Metoidioplasty
  • Phalloplasty (includes urethroplasty, scrotoplasty, vaginectomy, and insertion of testicular and approved penile implants)
  • Voice therapy

PARTIALLY/CONDITIONALLY COVERED:

  • Insured out-of-province procedures 
  • Travel for out-of-province procedures 
  • Hormone therapy 

NOT COVERED:

  • Facial feminization
  • Liposuction
  • Tracheal shave
  • Hair transplantation
  • Voice pitch surgery
  • Surgical revisions that are cosmetic
  • Liposuction and/or body contouring

Are you curious about gender-affirming care? Check out our article What is Gender-Affirming Care and Why Do Some People Seek it Out?

For more details on how to get approved for gender-affirming services, you can research your individual province’s requirements. You may also look further into if there are more requirements for specific procedures. 

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