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 an insured, publicly funded service in Nova Scotia.

Eligibility for gender affirming surgery is based on the World Professional Association for Transgender Health’s Standards of Care guidelines (version 7) (PDF).

Counselling, psychotherapy and hormone therapy are also funded when provided in public institutions in Nova Scotia.

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

Insured procedures

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

Some surgeries are available in Nova Scotia. Others are available at GrS Montreal in Montreal, Quebec. The location where the procedure is performed will be determined on a case-by-case basis. It depends on the nature and extent of the surgery and the availability of staff with surgical expertise.

Only available in Nova Scotia Available in Nova Scotia and Montreal Available only in Montreal








Breast augmentation



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, Quebec. 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 costs include transportation and accommodation costs as per the Nova Scotia Out-of-Province Travel and Accommodation Assistance Policy.

What’s not covered

Not all procedures and expenses related to gender affirming surgeries are insured. 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 will be determined through the criteria of the World Professional Association for Transgender Health (WPATH) Standards of Care (version 7).

You need an initial psychosocial assessment from a health care provider with the clinical competencies outlined in the Standards of Care. The psychosocial assessment is required to confirm your readiness including eligibility, ensuring informed consent, and troubleshooting barriers to medical and surgical care.

The Department of Health and Wellness regularly reviews our applications 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 surgery, you can contact a doctor, nurse practitioner, specialist or any other health care provider with clinical competencies as outlined in the WPATH Standards of Care, for a psychosocial assessment. If your primary care provider does not have these competencies, a free mainpro+ accredited course is available at Care providers can also contact for support and resources.

If you don’t have a healthcare provider who can conduct the assessment, contact prideHealth for help. prideHealth also has other resources to help you understand the process.

Once you’ve been assessed for surgery, you and your physician, nurse practitioner or specialist need to complete the Gender Affirming Surgery Application before you schedule or plan surgery. Your primary care provider will submit the application to MSI for pre-approval of coverage. In addition to the application, you will need a psychosocial assessment letter and a post-operative care letter from your physician or nurse practitioner for out-of-province surgeries.

Gender Affirming Surgery Application (PDF)

MSI will inform you, your referring provider and the Department of Health and Wellness’s Insured Services (for out-of-province surgeries) when your application is approved. Your health care provider will coordinate a surgical plan with your surgeon.

For gender affirming surgical procedures performed in Montreal, your health care provider will send the required documentation to the clinic, who will assess your application and notify you and your primary provider if they need any further documents.

They’ll provide your surgery date and other information about your procedure by mail.
Wait times for surgery vary by procedure.

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 - Insured Services.
Toll-free: 1-877-449-5476
Phone: 902-424-7538