Gender-affirming care in Alberta is accessible through primary care providers, as well as several specialty clinics available below. For additional information and support, check out the Trans Wellness Initiative.
The Calgary Gender Clinic provides assessment and support for people throughout their transition, including connecting people to hormone providers and psychiatric referrals for gender-affirming surgeries. This clinic also offers mental health treatment (e.g. related to anxiety around gender), and support regarding social transition (including support with family, work, and legal document changes).
The Gender Program at the University of Alberta in Edmonton also provides comprehensive assessments, as well as gender-affirming interventions in the areas of psychiatry, endocrinology, pediatric and adolescent medicine, and nursing support.
As for financial coverage, Alberta Health Services covers many options for medical transition such as gender-affirming hormone therapy, and surgeries through their Gender Reaffirming Program. But, some Alberta-funded surgeries must be conducted at Montreal GRS. The waitlist for the Montreal clinic is several years long which leads many patients to seek out-of-pocket options elsewhere.
For those pursuing government-funded medical transition, Alberta Health provides once per lifetime funding for Alberta residents diagnosed with gender dysphoria who meet the established program criteria to receive lower body surgery (phalloplasty, metoidioplasty or vaginoplasty). Application forms for the funding program can be found here.
Alberta also offers coverage for breast augmentation and mastectomy, but you must be pre-approved through a Request for Breast Surgery application. You also have to be assessed by a psychiatrist or other physician and be diagnosed with gender dysphoria, and have little to no breast growth according to the surgeon.
Launched in late 2023, the Foria Clinic provides virtual consultations for health and wellness support, gender-affirming hormone therapy, surgical referrals, letters for gender marker change and more to trans, non-binary and gender-diverse people in Alberta. There is limited availability in Alberta right now as they have moved to a physician-based model, allowing for appointments to be free with a valid health card. They are working to add more physicians and up-to-date availability can be found on their booking site at this time. (Last updated February 2024)
The Alex Youth Centre provides peer support groups and transition-related care, including sexual health and ID document support, to youth ages 12-24 in Calgary.
All aspects of gender affirming medical care in BC are integrated into the provincial health system through Trans Care BC. Trans Care BC supports the delivery of equitable and accessible care, surgical planning, and peer support for trans people across the province. They have developed one of Canada’s leading guidance documents on gender-affirming healthcare, Gender-Affirming Care for Trans, Two-Spirit, and Gender Diverse Patients in BC: A Primary Care Toolkit.They also provide healthcare navigation services through their Health Navigation Team.
In BC, trans and gender diverse people can access gender-affirming hormone therapy through a primary care provider, an endocrinologist (provided they are given a hormone readiness assessment by another health care provider), or in some places, transgender specific clinics.
For patients seeking gender-affirming surgeries, the first step is to arrange surgical care planning with a primary care provider. Trans Care BC has a comprehensive guide on How to Get Surgery explaining surgical care planning, eligibility, specific requirements by procedure, funding information, and all the necessary forms. Since 2019, both upper and lower body surgeries have been accessible in-province, minimizing the need to travel out–of-province or out-of-country for care. The Gender Surgery Program BC is the largest program on the West Coast that ensures that patients have access to lower body surgeries. It also serves patients from Yukon. In addition to public coverage for many surgeries and procedures, other financial assistance programs include:
- The Gender Surgery Program BC covers medically-necessary hair removal in preparation for surgery.
- Hope Air provides funding for flights to and from surgery locations.
- The Travel Assistance Program (TAP) can help to cover surgery travel costs.
- The First Nations Health Authority may cover meals, accommodation, travel for those who qualify.
For public coverage of gender-affirming care in Manitoba, a diagnosis of gender dysphoria is required. This can be given by a primary care provider or clinic specializing in gender-affirming care. You can find a primary care provider using the province’s Family Doctor Finder.
Gender-affirming hormone therapy can be accessed through a qualified primary care provider or gender-inclusive clinic (listed below). Hormone therapy prescriptions are partially or conditionally covered, and are also accessible through the Manitoba Pharmacare Program, if eligible.
To qualify for gender-affirming surgeries, Manitoba Health requires a referral letter by an approved psychologist as well as a recognized health care provider. Most surgeries also require a patient to be on hormone replacement therapy for at least one year, and many procedures are conducted out of province, at the Centre de Chirurgie in Montreal. Wait times for surgeries can take up to 30 months. For a full list of what procedures are covered, see this resource for Gender Affirming Services in Manitoba, developed by the Canadian Queer Medical Students Association, or reach out to Manitoba Health.
Manitoba has two main trans health clinics providing gender affirming care, (a youth clinic, and an adult clinic) both located in Winnipeg. However, they both have long wait times. Gender Diversity Assessment and Action for Youth (GDAAY) is a program at HSC Winnipeg Children’s Hospital that offers integrated care and support services for youth through their gender affirming journey. This includes both assessment and treatment for young people up to the age of 14. The Trans Health Klinic serves people 16 and older seeking transitioning care (hormone start, procedures, and surgery). They require clients to have a primary care provider as they aim to transfer some aspects of care (such as hormone prescription renewals) to their regular health care provider eventually.
New Brunswick has made significant progress in gender-affirming care since first offering coverage for surgeries in 2016.
To access gender-affirming hormone therapy, a hormone readiness assessment must be completed. A primary health care provider can complete this assessment but, as many folks in New Brunswick do not have a primary care provider, the readiness assessment can also be completed by an endocrinologist, nurse practitioner (NP) or a Doctor at a community clinic or sexual health centre. Providers completing the assessment may require a referral letter from a WPATH trained therapist. For gender-affirming surgeries however, 1-2 letters of support from WPATH trained providers are necessary. Once the surgical readiness assessment is complete, your healthcare provider needs to submit a Prior Approval Request Form to gain funding approval from New Brunswick Medicare. Many gender-affirming surgeries are now done within the province, but most bottom surgeries are still referred out of province to the Centre de Chirurgie in Montreal, Quebec. Voice surgery is also referred out of province but is not covered by New Brunswick medicare. It should also be noted that travel expenses out of province are not covered by Medicare.
See this resource by TransCare+ for all details regarding accessing care, including a contact list for gender-inclusive care providers, detailed coverage information, and required government forms.
Access to gender-affirming care in Newfoundland and Labrador (NL) is improving, with Newfoundland and Labrador having expanded their coverage for gender affirming surgeries in 2019 to include services such as chest and genital surgeries, gender-affirming hormone therapy, and mental health services; coverage is limited for certain procedures such as facial feminization, voice surgery, and hair removal. Transgender surgery assessments were also made available in the province; transgender and non-binary individuals no longer need to be evaluated by the Centre for Addiction and Mental Health in Toronto, Ontario, to be approved for gender affirming surgeries.
There are primary care physicians, both in Newfoundland and Labrador, who are offering and supporting the provision of gender affirming care services. A specialized clinic offering trans healthcare in Newfoundland is the Gender Wellness Clinic (for youth) at the Janeway Children's Health and Rehabilitation Centre in St. John's. A noted challenge in the provision of gender affirming care in the province is the concentration of services in urban areas, like St. John's, which makes it difficult for individuals in rural areas to access care.
Gender-affirming hormone therapy can be accessed through primary care without requiring gender dysphoria diagnosis with hormone prescriptions being partially, if not fully, covered by the Newfoundland and Labrador Medical Care Plan (MCP), depending on which part of the program an individual is covered under. It should be noted that not everyone in the province has access to the provincial drug program. Details on transition-related coverage under MCP can be found here.
Eligibility and coverage for surgeries is outlined in the Department of Health and Community Service’s Trans-Related Surgeries Policy (2019). Before scheduling a surgery, your doctor will need to submit a Request for Prior Approval Form to the NL Department of Health and Community Services. Doctors that are qualified to conduct surgical readiness assessments can be found here. Currently, all gender affirming surgeries are performed out of province.
The Northwest Territories gender-affirming care guidelines are outlined in this document: Healthcare for Transgender, Non-binary, and Gender-Non Conforming People: Guidelines for the NWT (2020). The intended audience of this document is healthcare providers, and it aims to establish a clear referral process for gender-affirming healthcare services. However, the guidelines do not provide comprehensive clinical directions for providers. Instead they direct to resources from Trans Care BC, Rainbow Health Ontario, and the Alberta Medical Association for specific guidelines and protocols for assessments.
In the NWT, gender affirming care is accessed through your primary care practitioner and a diagnosis of gender dysphoria is often required. Generally, gender-affirming hormone therapy can be prescribed in the NWT by a clinical expert, however youth may be referred to paediatric specialists out of territory. The NWT does not have the capacity to perform gender-affirming surgeries, so people are assessed by a clinical expert and then referred to out of territory surgical providers, mostly in Quebec, Alberta, and Ontario. Wait times for surgeries can often be several years.
Clinical experts, as defined in the guidelines, may be doctors, NPs, RNs, psychologists, or RSWs. However, the reality is that there are very few designated clinical experts in the NWT. This can be a barrier to accessing gender affirming care, because an assessment by a clinical expert is often required to access care. The NWT Health Care Plan covers vaginoplasty, metoidioplasty, phalloplasty, mastectomy, and, in some cases, breast augmentation. Most other procedures are not covered.
If you would like help navigating gender affirming care in the NWT, you can reach out to Northern Mosaic Network’s Peer Support Program: https://www.northernmosaic.net/peer-support
Gender Affirming Care is governed by the province’s Gender Affirming Care Policy (2023) which provides details on readiness assessments, referrals and approvals. The Nova Scotia Health Authority also has a specific advocacy and navigation program, prideHealth, that supports 2SLGBTQIA+ people in understanding the gender affirming care policy in practice as well as navigating the healthcare system, including referrals to trained mental health providers, STBBI testing, and gender affirming primary care providers for hormones and/or surgery assessments.
Youth in Nova Scotia (aged 19 and under inside or outside of the HRM) can seek out gender affirming care by contacting their primary care provider or the IWK Trans Health Team. Youth outside of Halifax (province wide) can also call Nova Scotia Health's Mental Health and Addictions Intake Service toll-free at 1-855-922-1122 and ask to be connected to the child and youth community health clinic nearest them. Adults aged 18+ can contact their primary care provider, or connect with prideHealth to be put in touch with a Gender Affirming Hormone Prescriber. prideHealth also refers to primary care providers for surgical readiness assessments as most primary care providers can take people on for the majority of their primary care needs.
It is important to note that in Nova Scotia, accessing gender-affirming care involves navigating significant wait times, particularly for surgeries and specialist consultations. For example, wait time to see a specialist for gender-affirming care can range from six to 18 months which is a significant part of the overall timeline for accessing surgery and other gender-affirming treatments.
Gender affirming surgeries are a publicly funded service through Medical Services Insurance (MSI). Some surgeries (listed here) are available in Nova Scotia, while others will be referred to the Centre de Chirurgie in Montreal. For those who travel to Montreal for gender affirming surgery, some costs directly associated with the procedure can be covered. These include transportation and accommodation costs as per the Nova Scotia Out-of-Province Travel and Accommodation Assistance Policy. Some community support resources to consider are the Nova Scotia Youth Project (for those up to age 24), the Cape Breton Transgender Network (volunteer support and advocacy for all ages/families) and pflag Canada are additional community resources.
Individuals seeking gender-affirming care in Nunavut, as with other provinces, start with readiness and mental health assessments which can be conducted by a primary care provider.
Gender-affirming hormone therapy, including the initiation and monitoring of treatment, is available in Nunavut. This includes prescriptions and necessary blood work, which can be managed by local healthcare providers.
Coverage for gender-affirming surgeries in Nunavut is limited. Most patients need to travel outside the territory for these procedures. The territorial healthcare plan does not comprehensively cover all gender-affirming surgeries.
In March, 2022, Nunavut Health Minister John Main announced that the Government of Nunavut will pay for mental health and transitioning services for transgender and non-binary Nunavummiut. The Health Department will be partnering with the Centre de Chirurgie in Montreal to deliver these services. However, eligibility criteria have not been made public. TransCare+ has created a Surgery Access Info and Coverage by Province/Territory resource that includes details for Nunavut.
Gender affirming healthcare in Ontario is largely supported by Sherbourne Health in Toronto. Sherbourne runs Rainbow Health Ontario (RHO), a program with a mandate to improve queer and trans health outcomes. Trans and gender diverse patients can use their 2SLGBTQ+ Health Service Provider Directory to find qualified care providers in their community.
Gender-affirming hormone replacement therapy (HRT) for trans and non-binary people in Ontario is no longer a specialty area. This means that, in most cases, your current primary care provider (doctor or nurse practitioner) can provide HRT for you. RHO’s Trans Health Guide, can advise providers and patients on HRT, as well as all other aspects of gender-affirming care. For patients covered by the Ontario Drug Benefit, injectable testosterone is covered with the submission of an Exceptional Access form (EAP), while anti-androgens and oral estradiol are covered without the need for EAP approval. People younger than 17 can get transition-related support at SickKids Transgender Youth Clinic.
Ontario covers gender-affirming surgeries with the submission of a Prior Approval Form from a primary care provider. See RHO’s Transition-Related Surgery FAQ for a full list of surgery coverages. Ontario also offers financial assistance towards travel costs for Northern Ontario residents seeking out-of-town medical specialist services through the Northern Travel Grant. Further details on each OHIP covered surgery can also be found in these Transition-Related Surgery Summary Sheets developed by RHO.
Prince Edward Island publicly funds various gender affirming procedures and surgeries, as outlined in their Health PEI Gender Confirming Surgery Policy/Health PEI Gender-Affirming Procedure Approval Policy (2023). The Policy was updated in July 2023, adding voice surgery (for example., glottoplasty), facial feminization surgeries, tracheal shave, chest feminization, and non-surgical hair removal.
Doctors and Nurse Practitioners can offer gender-affirming hormone therapy treatments with informed consent. If a patient does not have access to a qualified doctor or nurse, they can seek out a readiness assessment through the Patient Navigator or a Trans Health Systems Navigator at Gender Affirming Care PEI. It should be noted that readiness assessments are generally not required under informed consent for gender-affirming hormone therapy—but in practice, they are still used for minors. Those who don’t have a family physician or nurse practitioner (or don’t feel comfortable discussing this with them), can self-refer to the Gender Affirming Clinic that is held twice a month at the Sherwood Medical Centre, 2nd floor, 15 Brackley Point Rd., Charlottetown. You can call 902-569-7772 or email [email protected].
Some gender-affirming surgeries are performed in PEI, however the majority are referred out-of-province. Most non-surgical procedures can be completed in PEI. All procedures must be pre-approved to be covered by Health PEI. Approval for out-of-province surgical procedures can be obtained by having a primary care provider complete and submit the Gender Confirming Surgery Prior Approval Request Form to Health PEI’s Out of Province Coordinator. Approval for non-surgical procedures can be obtained by having a primary care provider complete and submit the Gender Confirming Procedure Prior Approval Request Form to the Health PEI Gender-Affirming Clinic.
Financial Assistance for Out-of-Province Medical Travel is also available.
Quebec follows the WPATH standards of care when determining eligibility for access to medical transition. Transitionner.info is an online resource website which explains various aspects of Quebec gender-affirming care in more detail.
There is no standardized route for hormone therapy in Quebec. Some doctors will require a referral from a mental health professional, while others will act independently, using principles of informed consent to prescribe hormone therapy. In some cases, people are referred to endocrinologists. If you don’t have a primary care provider, see this list of gender-affirming healthcare providers.
Gender-affirming surgeries are funded via a special program from the Ministry of Health and Social Services managed by the CHUM (Central Hospital at the University of Montreal) and must be done at the private GRS Montreal clinic to be covered. Details on eligibility and access requirements can be found here.
In Saskatchewan, gender-affirming care can be accessed through primary care providers. Individuals without a primary care doctor can seek one out through the Trans Health Navigators - TransSask. The Saskatchewan Trans Health Coalition also created a Medical Transition Guide that provides an overview of options for gender affirming care in Saskatchewan.
Residents who have an active Saskatchewan health card are eligible for coverage of certain hormone replacement therapies. Inquiries about hormone therapy coverage can be directed to the Ministry of Health's Drug Plan and Extended Benefits Branch at 1-800-667-7581 or 306-787-3317.
Some gender-affirming surgeries, such as hysterectomy and mastectomy, are provided in Saskatchewan. More complex procedures will be referred out-of-province. Prior approval is required from the Ministry for coverage of out-of-province procedures. Full details on seeking access to surgeries and approvals are found here: Gender Identity, Gender Diversity, and Transgender Support.
Yukon has the most comprehensive gender-affirming health system in Canada since unveiling new gender affirming healthcare policies in 2021. Policies B.13 (Non-medical procedures) and B.14 (surgical procedures) outline the gender-affirming health service Yukoners have access to through public insurance. This includes procedures such as upper and lower body surgeries, facial surgeries, body contouring, voice feminization surgeries, hair removal, and voice and communication training.
While coverage for certain procedures was initially paused due to required regulatory changes, regulation has now been updated. As such, many gender-affirming procedures are now directly covered under the Yukon Health Care Insurance Plan.
It is important to note that access to healthcare in the Yukon has been described as “limited at best” which can be challenging for those needing gender-affirming services to navigate the systems in place. Community access points, such as the Queer Yukon Society, for resources, support and connection are extremely important in navigating those systems.
In addition to coverage offered by provinces or territories, the cost of medications related to gender-affirming care, equipment, as well as transportation required for surgeries are covered under the Non-Insured Health Benefit program.
Most medications related to gender-affirming care, such as hormones, are available without prior approval. Equipment such as binders and packers is also covered under the Non-Insured Health Benefits program according to the medical supplies and equipment benefit. More information is available under the Self-care equipment and supplies benefit list. The Non-Insured Health Benefits program doesn’t cover the cost of surgeries, however the program does cover transportation costs for surgeries not available locally. This includes travel out of province for gender-affirming surgeries, as long as they are covered by a provincial or territorial insurance plan. More information is available in a government scenario note on Non-Insured Health Benefits.