How to access gender-affirming care: Options

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• Types of care
• Treatment coverage and costs

Types of care

Gender-affirming care helps to support gender expression. This care can look different for everyone, and may be:

• social
• legal
• medical
• a combination of some or all options

The information provided on this page isn't exhaustive. Talk to a health care provider to get advice about what specific care is available to you.

Find out which types of care are covered by your province or territory

Social transition

Socially transitioning involves publicly affirming your gender identity to others through social changes. Examples include:

• 'coming out' to others
• using pronouns that align with your gender identity
• choosing a different name that better aligns with your gender identity
• changing your appearance, such as the way you dress or style your hair
• voice therapy to help your voice better align with your gender identity

Provinces and territories have different policies for socially transitioning in schools. Some need parents or guardians to consent to or be informed of their child's request to socially transition at school. This could include being addressed by their chosen name or pronouns. Other provinces and territories need the child's consent to inform parents or guardians of their desire to socially transition at school.

Legal transition

Legal transition usually involves updating legal documents to reflect your chosen name and gender marker.

In Canada, anyone can request a gender marker change on federal documents, such as a passport or citizenship certificate. You can also request changes to provincial and territorial documents, such as your:

• driver's license
• birth certificate
• health insurance card

Most provinces and territories will require:

• a minor to have a parent or guardian's consent
• a parent or guardian to complete paperwork on a minor's behalf

Most provinces and territories will ask for supporting documents from a health care professional, such as a:

• psychologist
• nurse
• physician
• social worker

These documents must confirm that changes to your gender designation are related to gender-affirming care.

There is often a fee to make these changes, which can vary depending on your province or territory.

Find out about your province or territory's processes, age stipulations and fees

Medical transition

Medical transition involves medical treatments that change your physical features to better align with your gender identity.

Always talk to a qualified health professional before beginning any type of medical care.

Non-surgical options: Hormone blockers

Hormone blockers, also known as puberty blockers, are medications that suppress the signs of puberty once it begins. In people assigned male at birth, they can:

• slow the growth of facial hair
• prevent the voice from deepening
• limit the growth of typically masculine muscles
• limit the growth of muscle tissue, as well as the penis, scrotum and testicles

In people assigned female at birth, they can:

• limit or stop breast development
• stop ovulation, menstruation, and maturation of the vagina

Young people may also use puberty blockers for other reasons, including:

• menstrual pain
• acne treatment
• precocious (early) puberty
• elite female athletics

Puberty suppression is reversible, as puberty restarts when a person stops taking puberty-blocking medications. Without them, they may develop secondary sex characteristics (body features of an adult male or adult female) that aren't consistent with their gender identity.

Access to puberty blockers at the right time can help avoid irreversible changes associated with puberty. They can allow a young person to develop secondary sex characteristics that align with their gender identity if they also choose to have gender-affirming hormone therapy.

Non-surgical options: Gender-affirming hormone therapy

Gender-affirming hormone therapy helps you develop physical features that align with your gender identity.

Feminizing hormone therapy, such as estrogen, will help induce secondary female sex characteristics, such as:

• rounder hips
• breast development
• slower body hair growth

Masculinizing hormone therapy, such as testosterone, will help induce secondary male sex characteristics, such as:

• a deeper voice
• muscle growth
• facial hair growth

Surgical options

Gender-affirming care can also involve surgical options. Having surgery is a personal decision, and whether you choose to have some, none or all is entirely up to you.

All lower or bottom surgeries are only available for people 18 years of age or older, regardless of gender. This aligns with the World Professional Association for Transgender Health's Standards of care. According to these, a person must be the age of majority to undergo gender reassignment surgery.

Options for transgender men and some non-binary people can include:

• voice surgery, which deepens the voice
• mastectomy, which removes the breasts (top surgery)
• fertility preservation by saving eggs to conceive with in the future
• lower or bottom surgeries, such as:
  • vulvectomy, which removes the vulva
  • vaginectomy, which removes the vagina
  • nullification surgery, which hides or removes all external genitals
  • phalloplasty, which uses skin from other parts of your body to create a penis
  • scrotoplasty, which uses skin from other parts of your body to create a scrotum
  • hysterectomy, which removes internal reproductive organs like the ovaries and uterus

Options for transgender women and some non-binary people can include:

• voice surgery, which changes the voice
• lower or bottom surgeries, such as:
  • vulvoplasty, which creates a vulva
  • vaginoplasty, which creates a vagina
  • orchiectomy, which removes the testes
  • nullification surgery, which hides or removes all external genitals

Additional treatments

These could include:

• fertility preservation by saving sperm or eggs to try to conceive with in the future
• removing hair from the face, neck, or other parts of the body
• voice training

Treatment coverage and costs

In some jurisdictions, hormone therapy is covered under provincial and territorial drug insurance plans. Some others only cover hormones if you meet certain criteria.

Most Canadian provinces and territories cover the cost of some gender reassignment surgeries. However, not all provincial and territorial health insurance plans cover feminizing surgeries such as:

• voice surgery
• facial feminization
• breast augmentation
• Adam's apple reduction

They also don't all cover masculinizing surgeries such as chest or body contouring.

Some jurisdictions can't provide bottom surgeries due to lack of speciality physicians. However, they may cover some of the costs to receive these surgeries in another province or territory.

Find out what coverage is available in your province or territory

Criteria for coverage

The process and criteria for health insurance coverage varies across provinces and territories. All jurisdictions require a surgical readiness assessment, which evaluates your:

• health history
• social, emotional and financial readiness for gender reassignment surgery

Most provinces and territories also require you to have documented 'gender dysphoria' for gender-affirming surgical treatment.