Gender affirming care

Gender affirming care includes a range of social, psychological, behavioral and medical interventions (like hormone treatment and gender affirming surgeries) that support and affirm an individual's gender identity.

Several healthcare services and expenses that support gender affirming care (like psychological services, counselling and hormone treatment) are insured benefits if you receive care in publicly funded healthcare facilities in Nova Scotia.

Nova Scotia Pharmacare Programs provide coverage for hormonal therapies. Some therapies are covered by regular benefits. Some therapies require a request from a doctor. Patients can access their usual drug insurance for any required hormone therapies, according to the rules of their specific plan.

Trans care (including readiness assessment or psychosocial assessment, hormone treatment and follow-up visits after hormone treatment or surgical procedures) is offered by physicians and nurse practitioners.

Social and legal transitioning supports are available through prideHealth and publicly funded sexual health centres.

Gender affirming surgery

Gender affirming surgery (sometimes called sex reassignment or gender confirming surgery) is surgery to affirm a person's gender identity. Gender affirming surgery is a publicly funded service in Nova Scotia.

Gender affirming surgeries include procedures to enhance and more closely match the desired internal and external primary or secondary sex characteristics.

What's publicly funded

The following gender affirming procedures are publicly funded when a Gender Affirming Surgery Application is approved by Medical Services Insurance (MSI) before the surgery takes place.

Some surgeries are available in Nova Scotia and at Centre Métropolitain de Chirurgie-GrS Montreal, Quebec (a pre-approved out-of-province partner facility). Some surgeries are only available at Centre Métropolitain de Chirurgie-GrS Montreal. The location of the procedure is determined on a case-by-case basis. It depends on the nature and extent of the surgery and the availability of infrastructure and clinical expertise.

Available in Nova Scotia and Montreal Only available in Montreal
Orchiectomy Phalloplasty
Penectomy Metoidioplasty
Breast augmentation Vaginoplasty
Breast reduction  
Chest masculinization/mastectomy  

Out-of-province coverage

When gender affirming procedures can't be performed in Nova Scotia, out-of-province surgeries will only be publicly funded if performed at GrS Montreal. You need to get approval from MSI before the surgery.

For eligible individuals who travel to Montreal for gender affirming surgery, many costs directly associated with the procedure are covered. These include transportation and accommodation costs as per the Nova Scotia Out-of-Province Travel and Accommodation Assistance Policy.

What’s not publicly funded

Not all procedures and expenses related to gender affirming surgeries are covered. There's no public funding available for:

  • gender affirming surgical services outside of Canada
  • procedures sometimes performed with gender affirming surgery, including facial feminization, liposuction, tracheal shave and voice pitch surgery
  • gender affirming surgical services received outside Nova Scotia without prior approval from MSI
  • any services not insured by MSI
  • any take-home medications, equipment, meals and other personal expenses


Clinical eligibility for gender affirming surgery is outlined in the Gender Affirming Care Policy (PDF). The policy is based on the World Professional Association for Transgender Health's (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (PDF).

The Department of Health and Wellness regularly reviews the Gender Affirming Surgery Application and eligibility criteria to make sure they meet applicable policies and standards, including the World Professional Association for Transgender Health's Standards of Care.

How to apply

If you're interested in accessing gender affirming care or gender affirming surgery, you can start the readiness or psychosocial assessment and referral process by contacting:

  • a healthcare professional (including family doctor, nurse practitioner or specialist) who has the required World Professional Association for Transgender Health's Standards of Care credentials and training in culturally competent trans care
  • prideHealth
  • a sexual health centre
  • community mental health services

A psychosocial assessment is required for:

  • adolescents if hormone treatment is a transition goal or a prerequisite for gender affirming surgery
  • adults who want to receive gender affirming surgery

If you don't have a healthcare professional who can conduct the assessment, contact prideHealth.

Any required letters must be completed and signed by a doctor, nurse practitioner or specialist and sent to MSI for pre-approval. More details on the assessment, referral and approval process are outlined in the Gender Affirming Care Policy (PDF).

Application form: Gender Affirming Surgery Application (PDF)

Contact us

For questions about the approval process for these surgeries, contact MSI (in Nova Scotia).
Toll-free: 1-800-563-8880

For questions about out-of-province travel and accommodation, contact the Department of Health and Wellness - Benefit Eligibility.
Toll-free: 1-877-449-5476
Phone: 902-424-7538