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Other CAMH Services Centre for Addiction
and Mental Health

Gender Identity Clinic: Criteria for Those Seeking Hormones and/or Surgery

The Gender Identity Clinic subscribes to the core criteria for Hormone Therapy (HT) and Sex Reassignment Surgery (SRS) outlined in the World Professional Association for Transgender Health (WPATH), Standards of Care, 2011. The International Standards of Care specify that these represent minimum standards and how they are applied can vary by professionals and by setting. Other aspects of our criteria, for example, reflect requirements to access OHIP funding.

Given our lengthy waitlist, we are encouraging family doctors, as much as possible, to take up the work of hormone therapy evaluations. Please see our Open Letter to Family Doctors link which offers related resources.

There are a number of relevant factors in any approval, all of which are necessary components in an approval, and none of which are alone sufficient for an approval. Some of the factors are related to eligibility, and other factors are related to readiness criteria.

Core aspects of the criteria for hormone therapy approvals include:

  • You have received a diagnosis of Gender Dysphoria
  • You have given this due thought and made appropriate disclosures and arrangements. This can include things like having considered implications for fertility, and having “come out” to important people in your life.
  • Any mental health or substance use issues are well-controlled.
  • You are knowledgeable about the intervention(s) and their risks.

Core aspects of the criteria for surgery are:

  • You are 18.
  • You have received a diagnosis of Gender Dysphoria.
  • You have given this due thought and made appropriate disclosures and arrangements. This can include things like having considered implications for fertility (where relevant), and having “come out” to important people in your life.
  • Except in the case of chest surgery, you have been on hormones continuously for one year.
  • Except in the case of chest surgery or hysterectomy where there is no set expectation, you have completed a continuous Gender Role Experience (or GRE). The GRE is multidimensional and includes documented activity of your community living in a role congruent with your identity. This activity should be commensurate with your abilities, and also demonstrate a social experience of good breadth and quality. A good GRE provides a reasonable set of social experiences necessary as part of informed consent, as well as time to adjust and adapt to the challenges within it in order to function successfully. For most people, this will continue to be found in employment, school studies and voluntarism, or any combination of these. For others we may take the approach of an individually-tailored plan as to the nature and quality of the GRE. Clients become eligible for genital sex reassignment surgery after one year of documented GRE, recently completed. An identity-congruent legal name change is strongly recommended. 
  • Any mental health or substance use issues are well-controlled.
  • You are knowledgeable about the intervention(s) and their risks, and have a good aftercare plan in place.

If there are issues of concern, we’ll let you know and may offer guidance or community resources in order to help increase your readiness. The clinic recognizes that the decision to adopt the felt-gender role may have serious consequences affecting every sphere of a person’s life, from family relationships to employment, which must be considered. A clinic staff member is available to discuss the potential consequences of transition to the felt-gender role, and can also offer practical advice.

Existing and prospective clients should be aware that effective June 3, 2008 the Government of Ontario reinstated funding for sex reassignment surgery. The Government currently requires individuals seeking sex reassignment surgery to be approved by the CAMH Adult Gender Identity Clinic.  Further information from the Ministry of Health can be found here.

Please note that we do not make determinations of medical eligibility, only psychiatric eligibility and readiness. Medical eligibility determination is made by the endocrinologist and/or surgeon. It is possible that you are eligible from a psychiatric perspective, but not a medical perspective.

For example, smoking significantly increases medical risk of serious surgical complications-- most surgeons will not operate on you unless you are smoke-free. If you would like support to quit smoking, please visit the CAMH Nicotine Dependence Clinic

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