Sex Reassignment Surgery

Beginning April 1, the government will now cover eight sex types reassignment surgeries for Nova Scotians who intend to begin that process. The funding will help those for whom the surgery is an important part of their transition.

Questions and Answers

What is the process for someone who wants sex reassignment surgery in Nova Scotia?
There are several steps before a patient can access sex reassignment surgery. The first step is for the patient to approach a family physician or community mental health.

The patient would be assessed for clinical eligibility using criteria established by the World Professional Association for Transgender Health (WPATH). This assessment is required by other Canadian jurisdictions that insure these surgeries.

The WPATH assessment involves a comprehensive psychiatric assessment and prolonged medical management before considering surgery as an option.

When the patient has received a positive recommendation from their physician, they will work with a medical team to develop a surgical plan.

What is medical management?
Medical management depends on the particular needs of the patient and may include access to endocrinology (hormone therapy).

What if a patient doesn’t have a family physician?
Those who wish to begin the process of sex reassignment surgery and who are without a family physician can go to the Department of Health and Wellness website Community Mental Health in their area.

What is PrideHealth?
PrideHealth provides safe and accessible primary health care services for people who are gay, lesbian, bisexual, transgender, intersex and queer.

Will patients have to travel for surgery?
Patients may have to travel out of province for some surgeries. This will depend on the surgery required and the surgical plan. Any out-of-province medical services that are part of the patient’s surgical plan for sex reassignment surgery, will now be publicly funded.

Three insured surgeries are currently not performed in Nova Scotia and will require travel outside the province. These are phalloplasty, metoidoplasty and vaginoplasty. Patients seeking these surgeries must be pre-approved by MSI prior to travelling for surgery.

Sex reassignment surgery is funded as of April 1, 2014. Does that mean that if someone wanted to schedule surgery, or has already taken steps toward surgery, will they be able to have a surgical procedure on April 1?
Sex reassignment surgery would not happen immediately. There are several steps before a patient can access sex reassignment surgery, starting with consulting their family physician or community mental health. An assessment must take place and meetings with a medical team to put a surgical plan in place.

If a comprehensive assessment is required, can someone be refused sex reassignment surgery?
An assessment is required to ensure the health, wellness and safety of the patient. A positive recommendation for sex reassignment surgery or refusal would be determined after the assessment by a healthcare professional.

The assessment was developed by the World Professional Association for Transgender Health (WPATH) and is used by other Canadian jurisdictions that insure these surgeries.

What will specifically be covered under sex reassignment surgery?
Sex reassignment surgery can be categorized into three areas:

  • Removal of the internal and external organs associated with the current sex
  • Reconstruction of the external characteristics of the desired sex
  • Procedures to enhance the appearance and more closely match the desired sex

In Nova Scotia, we will publicly fund the removal and/or reconstruction of the external organs and/or characteristics, including:

  • Mastectomy
  • Oophorectomy
  • Hysterectomy
  • Penectomy
  • Orchiectomy
  • Phalloplasty
  • Metoidioplasty
  • Vaginoplasty

Does Nova Scotia have the expertise to perform these types of surgeries?
Several surgeries that can be part of sex reassignment surgery are currently performed in the province, but not necessarily as part of sex reassignment. These include:

  • Hysterectomy
  • Oophorectomy
  • Mastectomy
  • Penectomy
  • Orchiectomy

Is chest masculinization and/or chest contouring now publically funded?
The province is now funding mastectomies, including nipple-sparring mastectomies which can be part of a transition from Female to Male. The outcome of mastectomies for a FtM transition would be to create a chest that more closely resembles a male chest. The province is not covering chest masculinization and/or chest contouring, which typically involve liposuction and implants.

What will the cost be per patient? How many patients annually are expected to apply for sex reassignment surgery?
We have estimated that about four to eight patients annually will request funding for sex reassignment surgery. This is based on our analysis of other provinces.

It is difficult to determine the cost per patient. It depends on the type and amount of surgeries required. The costs for transitioning from male to female and from female to male differ.

Are there enough doctors in Nova Scotia trained to help patients with these transitions?
We will be monitoring the demand for these health services and the distribution of public funding, to determine whether action is needed to improve access to treatment.