Surgery Readiness Assessment
What is a Surgery Readiness Assessment?
In British Columbia, Canada, it’s one of the first steps that need to be taken in order to access any gender-affirming surgeries in the province.
It shouldn't be a form of gatekeeping
It's more so care providers can understand how you feel about yourself, how you identify, what your goals are, what your expectations are, and to make sure you're aware of what procedures are available and what all the risk are
Am I Eligible for a Surgery Readiness Assessment?
You don't have to be a binary trans person to access gender-affirming surgery. Genderqueer, gender-variant, nonbinary and gender nonconforming people can be eligible for a surgery readiness assessment as long as you...
Have persistent gender dysphoria over your chest
Have the capacity to consent to the procedure (ie understand what it entails, what the risks are and are able to establish an aftercare plan)
Have mental and medical conditions that are reasonably well-controlled
Are the age of majority (aka 19 years old) BUT it is possible in some cases to get surgery under 19, you just need additional assessments
Living or presenting as any particular gender identity is not required. Hormone therapy is not required.
How do you get a Surgery Readiness Assessment?
STEP ONE - Get referred to a qualified assessor
Your primary care provider (aka GP or NP) can send a referral for you to a qualified assessor
Or they can send a request to Trans Care BC for them to refer you to an assessor
Or they may be a qualified assessor themselves! If that’s the case, they would be able to do it for you.
You can opt to pay for a qualified assessor. This would entail paying out of pocket and/or using your extended health benefits if you have any. There are several care providers who can do it for you for a fee. You can find them by asking around at the AFAB facebook group or by searching for registered counselors who list Surgery Readiness Assessments as part of the services they provide
If you don't have a primary care provider (or can’t rely on your primary care provider to help you) you can contact Trans Care BC for help finding one who can take you on. You can find information about this on their section about accessing gender-affirming care.
If you live in Vancouver, another option is to reach out to Three Bridges. They’re a medical clinic in Downtown Vancouver that provides a variety of services, including, but not limited to Trans Specialty Care. You can refer yourself as a new client by filling out their online intake form.
STEP TWO - Get Assessed!
Wait times with assessors fluctuate but it doesn't typically take as long as referrals for surgery itself, and opting to privately pay an assessor could potentially mean an even shorter wait time.
The assessment lasts between 1-2 hours for 1-2 appointments. It may take more time or visits if you have any other health issues or a more complex living/social situation, or if the assessor otherwise feels they need more information.
That said, it shouldn't feel like a gatekeeping situation. They're not there to judge if you DESERVE it. It should just cover
Your gender identity and feelings about your body
Your expectations
Your health history
Your understanding of the surgery and risks
Your support network and any plan you have in place with how the change in your appearance or gender expression may be noticed by family, friends, work, school, etc
Your surgery aftercare plan
STEP THREE - Get your recommendation
After the assessment, the assessor will say whether or not surgery is recommended at this time or if you need to come back for further assessment
TYPICALLY, they shouldn't turn you away without a very good reason.
The assessor (if they're not your primary care provider) will send the recommendation to the provider who requested it.
What happens after the assessment?
Once the assessment is done, your provider will be able to put together a referral package for you and send it to Trans Care BC, where your info will be placed on the central waitlist that they maintain. You may indicate who your preferred surgeon is as part of the referral package.
Be ready to advocate for yourself if necessary
Confirm with your primary care provider's office if the referral had been sent and if there was confirmation that the referral was received
Contact Trans Care to find out what your place is on the central waitlist or if they can give you an estimated time frame of how long until they call you.
Once it's your turn on the central waitlist, Trans Care will ask you which surgeon you want to have a consultation with. We can walk through what to expect at your top surgery consultation in my next post.
Resources
http://www.phsa.ca/transcarebc/surgery/how-to-get-surgery
http://www.vch.ca/Locations-Services/result?res_id=686
My own experience accessing gender-affirming care